%0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e68665 %T Assessment of an App-Based Sleep Program to Improve Sleep Outcomes in a Clinical Insomnia Population: Randomized Controlled Trial %A Staiano,Walter %A Callahan,Christine %A Davis,Michelle %A Tanner,Leah %A Coe,Chelsea %A Kunkle,Sarah %A Kirk,Ulrich %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 65502695, ukirk@health.sdu.dk %K cognitive behavioral therapy for insomnia %K mindfulness %K randomized controlled trial %K RCT %K therapy %K insomnia %K behavioral %K app based %K app %D 2025 %7 23.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Insomnia is the most commonly reported sleep disturbance and significantly impacts mental health and quality of life. Traditional treatments for insomnia include pharmacological interventions or cognitive behavioral therapy for insomnia (CBT-I), but these options may not be accessible to everyone who needs treatment. Objective: This study aims to assess the effectiveness of the app-based Headspace Sleep Program in adults with clinical insomnia on sleep disturbance and mental health outcomes, compared with a waitlist control group. Methods: This randomized controlled trial included 132 adults with clinical insomnia who were assigned to either the Headspace Sleep Program (an 18-session self-guided, in-app program utilizing CBT-I techniques augmented by mindfulness) or a waitlist control group. Sleep disturbance outcomes were assessed by changes in insomnia symptoms (measured using the Insomnia Severity Index) and sleep efficiency (measured via sleep diary and actigraphy). Mental health outcomes included perceived stress (measured by the 10-item Perceived Stress Scale), depressive symptoms (measured by the 8-item Patient Health Questionnaire), sleep quality (measured by the Pittsburgh Sleep Quality Index), anxiety symptoms (measured by the 7-item Generalized Anxiety Disorder Scale), and mindfulness (measured by the Mindful Attention Awareness Scale). Changes from baseline to postintervention and follow-up were assessed for each outcome. Results: Participants had a mean (SD) age of 37.2 (10.6) years, with 69 out of 132 (52.3%) identifying as female. Those randomized to the Headspace Sleep Program group experienced significantly greater improvements in insomnia symptoms from baseline to postintervention and follow-up compared with participants in the waitlist control group (P<.001, η²p=0.107). Improvements from baseline to postintervention and follow-up were also observed in the Headspace Sleep Program group for sleep efficiency, as measured by both sleep diary (P=.01, η²p=.03) and actigraphy outcomes (P=.01, η²p=.03). Participants in the Headspace Sleep Program group showed greater improvements in insomnia remission rates (8/66, 12%, at postintervention and 9/66, 14%, at follow-up) and treatment response (11/66, 17%, at postintervention and 15/66, 23%, at follow-up) compared with the control group (remission rate 2/66, 3%, at postintervention and 0/66, 0%, at follow-up; treatment response 3/66, 5%, at postintervention and 1/66, 2%, at follow-up). The results suggest significant improvements in depressive symptoms (P=.01, η²p=.04), anxiety symptoms (P=.02, η²p=.02), and mindfulness (P=.01, η²p=.03) in the Headspace Sleep Program group. Conclusions: The Headspace Sleep Program is an effective intervention for improving sleep disturbances in adults with clinical insomnia. Trial Registration: ClinicalTrials.gov NCT05872672; https://clinicaltrials.gov/ct2/show/NCT05872672 %M 40267472 %R 10.2196/68665 %U https://mhealth.jmir.org/2025/1/e68665 %U https://doi.org/10.2196/68665 %U http://www.ncbi.nlm.nih.gov/pubmed/40267472 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65163 %T Developing Digital Mental Health Tools With Culturally Diverse Parents and Young People: Qualitative User-Centered Design Study %A Butorac,Isobel %A McNaney,Roisin %A Seguin,Joshua Paolo %A Olivier,Patrick %A Northam,Jaimie C %A Tully,Lucy A %A Carl,Talia %A Carter,Adrian %+ School of Psychological Sciences, Monash University, 770 Blackburn Road, Clayton, 3800, Australia, 61 9905 0100, isobel.butorac@monash.edu %K digital mental health %K young people %K cultural diversity %K web-based and mobile health interventions %K qualitative methods %K user-centered design %K human-computer interaction %D 2025 %7 22.4.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Approximately 39% of young people (aged 16-24 y) experience mental ill health, but only 23% seek professional help. Early intervention is essential for reducing the impacts of mental illness, but young people, particularly those from culturally diverse communities, report experiencing shame and stigma, which can deter them from engaging with face-to-face services. Digital mental health (DMH) tools promise to increase access, but there is a lack of literature exploring the suitability of DMH tools for culturally diverse populations. Objective: The project was conducted in partnership with a large-scale national DMH organization that promotes evidence-based early intervention, treatment, and support of mental health in young people and their families. The organization wanted to develop a self-directed web-based platform for parents and young people that integrates psychological assessments and intervention pathways via a web-based “check-in” tool. Our project explored the views of culturally diverse parents and young people on the opportunities and barriers to engagement with a web-based DMH screening tool. Methods: We conducted a 2-phase qualitative study aiming to identify potential issues faced by culturally diverse communities when engaging with DMH tools designed for the Australian public. We worked with 18 culturally diverse participants (parents: n=8, 44%; young people: n=10, 56%) in a series of design-led workshops drawing on methods from speculative design and user experience to understand the opportunities and barriers that organizations might face when implementing population-level DMH tools with culturally diverse communities. NVivo was used to conduct thematic analyses of the audio-recorded and transcribed workshop data. Results: Five themes were constructed from the workshops: (1) trust in the use and application of a DMH tool, (2) data management and sharing, (3) sociocultural influences on mental health, (4) generational differences in mental health and digital literacy, and (5) stigma and culturally based discrimination in mental health support. Conclusions: The emergent themes have important considerations for researchers wishing to develop more inclusive DMH tools. The study found that healthy parent-child relationships will increase engagement in mental health support for young persons from culturally diverse backgrounds. Barriers to engagement with DMH tools included culturally based discrimination, the influence of culture on mental health support, and the potential impact of a diagnostic label on help seeking. The study’s findings suggest a need for culturally safe psychoeducation for culturally diverse end users that fosters self-determination with tailored resources. They also highlight important key challenges when working with culturally diverse populations. %M 40262130 %R 10.2196/65163 %U https://pediatrics.jmir.org/2025/1/e65163 %U https://doi.org/10.2196/65163 %U http://www.ncbi.nlm.nih.gov/pubmed/40262130 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e68960 %T Trust, Anxious Attachment, and Conversational AI Adoption Intentions in Digital Counseling: A Preliminary Cross-Sectional Questionnaire Study %A Wu,Xiaoli %A Liew,Kongmeng %A Dorahy,Martin J %+ , School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand, 64 02059037078, xwu40@uclive.ac.nz %K attachment style %K conversational artificial intelligence %K CAI %K perceived trust %K adoption intentions %K CAI counseling %K mobile phone %D 2025 %7 22.4.2025 %9 Original Paper %J JMIR AI %G English %X Background: Conversational artificial intelligence (CAI) is increasingly used in various counseling settings to deliver psychotherapy, provide psychoeducational content, and offer support like companionship or emotional aid. Research has shown that CAI has the potential to effectively address mental health issues when its associated risks are handled with great caution. It can provide mental health support to a wider population than conventional face-to-face therapy, and at a faster response rate and more affordable cost. Despite CAI’s many advantages in mental health support, potential users may differ in their willingness to adopt and engage with CAI to support their own mental health. Objective: This study focused specifically on dispositional trust in AI and attachment styles, and examined how they are associated with individuals’ intentions to adopt CAI for mental health support. Methods: A cross-sectional survey of 239 American adults was conducted. Participants were first assessed on their attachment style, then presented with a vignette about CAI use, after which their dispositional trust and subsequent adoption intentions toward CAI counseling were surveyed. Participants had not previously used CAI for digital counseling for mental health support. Results: Dispositional trust in artificial intelligence emerged as a critical predictor of CAI adoption intentions (P<.001), while attachment anxiety (P=.04), rather than avoidance (P=.09), was found to be positively associated with the intention to adopt CAI counseling after controlling for age and gender. Conclusions: These findings indicated higher dispositional trust might lead to stronger adoption intention, and higher attachment anxiety might also be associated with greater CAI counseling adoption. Further research into users’ attachment styles and dispositional trust is needed to understand individual differences in CAI counseling adoption for enhancing the safety and effectiveness of CAI-driven counseling services and tailoring interventions. Trial Registration: Open Science Framework; https://osf.io/c2xqd %M 40262137 %R 10.2196/68960 %U https://ai.jmir.org/2025/1/e68960 %U https://doi.org/10.2196/68960 %U http://www.ncbi.nlm.nih.gov/pubmed/40262137 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e63500 %T Effects of Web-Based Single-Session Growth Mindset Interventions for Reducing Adolescent Anxiety: Four-Armed Randomized Controlled Trial %A Zhu,Shimin %A Hu,Yuxi %A Qi,Di %A Tse,Samson %A Chan,Ko Ling %A Sun,Jessica %A Lee,Paul %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, GH348, 11 Yuk Choi Rd, Hung Hom, Hong Kong, China (Hong Kong), 852 2766 5787, jasmine.zhu@polyu.edu.hk %K belief-in-change %K growth mindset %K mental health %K secondary school students %K brief intervention %K randomized controlled trial %D 2025 %7 18.4.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Anxiety disorders are the most common mental health conditions worldwide, yet 65% of those affected do not access services. The high prevalence of anxiety and the low rate of intervention uptake highlight the urgent need to develop timely, scalable, and effective interventions suitable for adolescents. This study adapted existing single-session interventions (SSIs) to further develop an SSI focused on a growth mindset regarding negative emotions for adolescent mental health. Objective: The study aims to compare the effectiveness of 4 SSIs, SSI of a growth mindset for anxiety (SIGMA), SIGMA with boosters (SIGMA-Booster), SSI of a growth mindset of personality (SSIGP), and an active control group (support therapy [ST]), in reducing adolescent anxiety. Methods: Classes from each secondary school were randomized to 1 of 4 intervention conditions: SIGMA, SIGMA-Booster, SSIGP, or ST. Each intervention took approximately 45 minutes online. Participants reported on anxiety symptoms (primary outcome), depressive symptoms, suicidal/self-harming thoughts, perceived control, hopelessness, attitude toward help-seeking, and psychological well-being (secondary outcomes) at preintervention, 2-week follow-up, and 8-week follow-up. Participants also completed a feedback scale postintervention. Generalized estimating equations were used to examine the effectiveness of the SSIs. Results: A total of 731 adolescents from 7 secondary schools were randomized. The intent-to-treat analysis found a significant decrease in anxiety symptoms. The mean and 95% CI at baseline were 6.8 (6.0-7.6) for SIGMA-Booster, 6.5 (5.8-7.3) for SIGMA, 7.0 (6.2-7.7) for SSIGP, and 6.9 (6.1-7.7) for ST. At the 2-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.7 (4.9-6.5) for SIGMA, 5.4 (4.6-6.2) for SSIGP, and 5.7 (4.9-6.4) for ST. At the 8-week follow-up, the mean and 95% CI were 5.9 (5.1-6.7) for SIGMA-Booster, 5.3 (4.5-6.0) for SIGMA, 5.6 (4.8-6.4) for SSIGP, and 5.8 (5.1-6.6) for ST. These reductions were observed across all 4 groups. Moderation analysis found that participants with higher motivation for change, higher baseline anxiety scores, and fixed mindsets showed greater improvements in anxiety symptoms. Most participants (459/731, 62.8%) viewed the feasibility and acceptability of the SSIs positively. Conclusions: The SSI for all 4 groups was effective in reducing anxiety and depression among adolescents over 8 weeks. Our data suggest the potential benefits of brief web-based interventions for adolescents, which could serve as scalable, destigmatized, and cost-effective alternatives to school-based programs. The intervention effects may have been underestimated, as this study did not exclude adolescents with minimal or no anxiety symptoms. Future studies should focus on the specific effects of interventions for adolescents with varying levels of anxiety symptoms. Trial Registration: ClinicalTrials.gov NCT05027880; https://clinicaltrials.gov/ct2/show/NCT05027880 %M 40249649 %R 10.2196/63500 %U https://pediatrics.jmir.org/2025/1/e63500 %U https://doi.org/10.2196/63500 %U http://www.ncbi.nlm.nih.gov/pubmed/40249649 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68204 %T Consumer-Grade Neurofeedback With Mindfulness Meditation: Meta-Analysis %A Treves,Isaac %A Bajwa,Zia %A Greene,Keara D %A Bloom,Paul A %A Kim,Nayoung %A Wool,Emma %A Goldberg,Simon B %A Whitfield-Gabrieli,Susan %A Auerbach,Randy P %+ McGovern Institute for Brain Research, Massachusetts Institute of Technology, Building 46-4037, 550 Memorial Dr, Cambridge, MA, 02139, United States, 1 (646) 774 5745, Isaac.Treves@nyspi.columbia.edu %K neurofeedback %K mindfulness %K device %K neurotechnology %K meditation %K stress %K cognition %K Muse %K consumer grade %K meta-analyses %K neuroscientific technology %K neurotechnologies %K randomized %D 2025 %7 17.4.2025 %9 Review %J J Med Internet Res %G English %X Background: There is burgeoning interest in the application of neuroscientific technology to facilitate meditation and lead to beneficial psychological outcomes. One popular approach is using consumer-grade neurofeedback devices to deliver feedback on brain targets during meditation (mindfulness-based neurofeedback). It is hypothesized that optimizing brain targets like alpha and theta band activity may allow meditators to experience deeper mindfulness and thus beneficial outcomes. Objective: This study aimed to systematically review and meta-analyze the impacts of consumer-grade mindfulness-based neurofeedback compared with control conditions. Included studies involved mindfulness practice operationalized as open monitoring or focused attention meditation. This study was preregistered. Methods: A total of 16 randomized controlled training trials, as well as 5 randomized within-participant designs were included, encompassing 763 and 167 unique participants, respectively. Effects were categorized outcomes (ie, psychological distress, cognitive function, and physiological health) and process variables (ie, state mindfulness and brain measures). Study risk of bias, reporting bias, and publication bias were assessed. Results: Samples were typically small (n=30-50), and the majority of studies used mindfulness apps as controls. To deliver neurofeedback, most studies used the Muse device (11/16 randomized controlled trials [RCTs]). There was a modest effect for decreases in psychological distress compared with controls (k=11, g=–0.16, P=.03), and heterogeneity was low (I2< 0.25). However, there was no evidence for improvements in cognition (k=7, g=0.07, P=.48), mindfulness (k=9, g=0.02, P=.83), and physiological health (k=7, g=0.11, P=.57) compared to controls. Mechanistic modulation of brain targets was not found in RCTs or within-participant designs. Sex (male or female), age, clinical status, study quality, active or passive controls, sample size, and neurofeedback duration did not moderate effects. There was some evidence for reporting bias, but no evidence of publication bias. Adverse effects were not assessed in 19 out of 21 studies and not found in the 2 studies that assessed them. Conclusions: Assertions that consumer-grade devices can allow participants to modulate their brains and deepen their meditations are not currently supported. It is possible that neurofeedback effects may rely on “neurosuggestion” (placebo effects of neurotechnology). Future research should examine more extensive calibration and individualization of devices, larger sample sizes, and gold-standard sham-controlled RCTs. %M 40246295 %R 10.2196/68204 %U https://www.jmir.org/2025/1/e68204 %U https://doi.org/10.2196/68204 %U http://www.ncbi.nlm.nih.gov/pubmed/40246295 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63192 %T The Application of AI to Ecological Momentary Assessment Data in Suicide Research: Systematic Review %A Melia,Ruth %A Musacchio Schafer,Katherine %A Rogers,Megan L %A Wilson-Lemoine,Emma %A Joiner,Thomas Ellis %+ Health Research Institute, University of Limerick, Castletroy, Limerick, V94T9PX, Ireland, 353 61202700, ruth.melia@ul.ie %K ecological momentary assessment %K artificial intelligence %K machine learning %K suicidal thoughts and behaviors %K mobile health %K mHealth %D 2025 %7 17.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) captures dynamic processes suitable to the study of suicidal ideation and behaviors. Artificial intelligence (AI) has increasingly been applied to EMA data in the study of suicidal processes. Objective: This review aims to (1) synthesize empirical research applying AI strategies to EMA data in the study of suicidal ideation and behaviors; (2) identify methodologies and data collection procedures used, suicide outcomes studied, AI applied, and results reported; and (3) develop a standardized reporting framework for researchers applying AI to EMA data in the future. Methods: PsycINFO, PubMed, Scopus, and Embase were searched for published articles applying AI to EMA data in the investigation of suicide outcomes. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to identify studies while minimizing bias. Quality appraisal was performed using CREMAS (adapted STROBE [Strengthening the Reporting of Observational Studies in Epidemiology] Checklist for Reporting Ecological Momentary Assessment Studies). Results: In total, 1201 records were identified across databases. After a full-text review, 12 (1%) articles, comprising 4398 participants, were included. In the application of AI to EMA data to predict suicidal ideation, studies reported mean area under the curve (0.74-0.86), sensitivity (0.64-0.81), specificity (0.73-0.86), and positive predictive values (0.72-0.77). Studies met between 4 and 13 of the 16 recommended CREMAS reporting standards, with an average of 7 items met across studies. Studies performed poorly in reporting EMA training procedures and treatment of missing data. Conclusions: Findings indicate the promise of AI applied to self-report EMA in the prediction of near-term suicidal ideation. The application of AI to EMA data within suicide research is a burgeoning area hampered by variations in data collection and reporting procedures. The development of an adapted reporting framework by the research team aims to address this. Trial Registration: Open Science Framework (OSF); https://doi.org/10.17605/OSF.IO/NZWUJ and PROSPERO CRD42023440218; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023440218 %M 40245396 %R 10.2196/63192 %U https://www.jmir.org/2025/1/e63192 %U https://doi.org/10.2196/63192 %U http://www.ncbi.nlm.nih.gov/pubmed/40245396 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65555 %T Acoustic and Natural Language Markers for Bipolar Disorder: A Pilot, mHealth Cross-Sectional Study %A Crocamo,Cristina %A Cioni,Riccardo Matteo %A Canestro,Aurelia %A Nasti,Christian %A Palpella,Dario %A Piacenti,Susanna %A Bartoccetti,Alessandra %A Re,Martina %A Simonetti,Valentina %A Barattieri di San Pietro,Chiara %A Bulgheroni,Maria %A Bartoli,Francesco %A Carrà,Giuseppe %K digital mental health %K remote assessment %K mHealth %K speech %K NLP %K natural language processing %K acoustic %K symptom severity %K machine learning %K markers %K mental health %K bipolar disorders %K app %K applications %K multimodal %K mobile health %K voice %K vocal %K bipolar %K verbal %K emotion %K emotional %K psychiatry %K psychiatric %K mental illness %D 2025 %7 16.4.2025 %9 %J JMIR Form Res %G English %X Background: Monitoring symptoms of bipolar disorder (BD) is a challenge faced by mental health services. Speech patterns are crucial in assessing the current experiences, emotions, and thought patterns of people with BD. Natural language processing (NLP) and acoustic signal processing may support ongoing BD assessment within a mobile health (mHealth) framework. Objective: Using both acoustic and NLP-based features from the speech of people with BD, we built an app-based tool and tested its feasibility and performance to remotely assess the individual clinical status. Methods: We carried out a pilot, observational study, sampling adults diagnosed with BD from the caseload of the Nord Milano Mental Health Trust (Italy) to explore the relationship between selected speech features and symptom severity and to test their potential to remotely assess mental health status. Symptom severity assessment was based on clinician ratings, using the Young Mania Rating Scale (YMRS) and Montgomery-Åsberg Depression Rating Scale (MADRS) for manic and depressive symptoms, respectively. Leveraging a digital health tool embedded in a mobile app, which records and processes speech, participants self-administered verbal performance tasks. Both NLP-based and acoustic features were extracted, testing associations with mood states and exploiting machine learning approaches based on random forest models. Results: We included 32 subjects (mean [SD] age 49.6 [14.3] years; 50% [16/32] females) with a MADRS median (IQR) score of 13 (21) and a YMRS median (IQR) score of 5 (16). Participants freely managed the digital environment of the app, without perceiving it as intrusive and reporting an acceptable system usability level (average score 73.5, SD 19.7). Small-to-moderate correlations between speech features and symptom severity were uncovered, with sex-based differences in predictive capability. Higher latency time (ρ=0.152), increased silences (ρ=0.416), and vocal perturbations correlated with depressive symptomatology. Pressure of speech based on the mean intraword time (ρ=–0.343) and lower voice instability based on jitter-related parameters (ρ ranging from –0.19 to –0.27) were detected for manic symptoms. However, a higher contribution of NLP-based and conversational features, rather than acoustic features, was uncovered, especially for predictive models for depressive symptom severity (NLP-based: R2=0.25, mean squared error [MSE]=110.07, mean absolute error [MAE]=8.17; acoustics: R2=0.11, MSE=133.75, MAE=8.86; combined: R2=0.16; MSE=118.53, MAE=8.68). Conclusions: Remotely collected speech patterns, including both linguistic and acoustic features, are associated with symptom severity levels and may help differentiate clinical conditions in individuals with BD during their mood state assessments. In the future, multimodal, smartphone-integrated digital ecological momentary assessments could serve as a powerful tool for clinical purposes, remotely complementing standard, in-person mental health evaluations. %R 10.2196/65555 %U https://formative.jmir.org/2025/1/e65555 %U https://doi.org/10.2196/65555 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e71071 %T Mental Health Apps Available in App Stores for Indian Users: Protocol for a Systematic Review %A Mehrotra,Seema %A Tripathi,Ravikesh %A Sengupta,Pramita %A Karishiddimath,Abhishek %A Francis,Angelina %A Sharma,Pratiksha %A Sudhir,Paulomi %A TK,Srikanth %A Rao,Girish N %A Sagar,Rajesh %+ Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Hosur Road, Bengaluru, 560029, India, 91 9448503853, drmehrotra_seema@yahoo.com %K mental health apps %K mHealth %K review of apps %K smartphone apps %K MHApps for Indian users %K India %K mobile phones %D 2025 %7 16.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: There has been a surge in mental health apps over the past few years. While these have great potential to address the unmet mental health needs of the population, the recent proliferation of mental health apps in the commercial marketplace has raised several concerns, such as privacy, evidence-based, and quality. Although there is mounting research on the effectiveness of mental health apps, the majority of these are not accessible to the public and most of those available have not been researched. Despite the rapid growth of the digital health market in India, there are no comprehensive reviews of publicly available mental health apps for Indian users. Hence it becomes important to review mental health apps freely available to potential end users in terms of their scope, functions, and quality. Objective: This study aims to systematically evaluate mental health apps available to Indian users in app stores. Methods: This systematic review of mental health apps will be performed following the Target user, Evaluation focus, Connectedness and Health domain approach and the PASSR (Protocol for App Store Systematic Reviews) checklist. Fifteen key search terms covering various mental health conditions and therapies will be used on the Android and iOS stores. The identified apps will be further screened and reviewed based on the inclusion and exclusion criteria. The pool of eligible apps will be downloaded for detailed review. The following steps will be adopted to streamline the review process and interrater consistency. Six apps will be randomly selected from the downloaded apps, for joint discussion and review by a team of 4 primary reviewers and 2 mentors. Following this, a new set of 6 randomly selected apps will be rated independently by the primary reviewers and the differences in ratings will be jointly discussed for generating consensus. Subsequently, the primary reviewers will individually review the remaining apps in the list. Data will be extracted based on predecided parameters such as privacy policy, basic purpose, type of developer, nature of intervention strategies, and guided versus unguided nature. Additionally, the apps will be reviewed for quality using the Mobile Application Rating Scale. The data analysis and synthesis strategy will incorporate descriptive statistics based on quality evaluation using the Mobile Application Rating Scale and examining the content of the apps for generating descriptive information. Results: The initial screening of mental health apps available for Indian users on the Google Play Store and Apple App Store was initiated in October 2024. We expect to complete the detailed systematic review by April 2025. Conclusions: This study will offer a comprehensive review of mental health apps available in digital marketplaces for Indian users and has implications for end users, policy makers, developers, and mental health professionals. Trial Registration: International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY2024100035; https://inplasy.com/inplasy-2024-10-0035/ International Registered Report Identifier (IRRID): DERR1-10.2196/71071 %M 40239205 %R 10.2196/71071 %U https://www.researchprotocols.org/2025/1/e71071 %U https://doi.org/10.2196/71071 %U http://www.ncbi.nlm.nih.gov/pubmed/40239205 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67764 %T Using Music to Promote Hong Kong Young People’s Emotion Regulation and Reduce Their Mood Symptoms and Loneliness: Protocol for a Pilot Randomized Controlled Trial %A Cao,Yuan %A Shi,Yuanxin %A Low,Debbie Chi Wing %A Shek,Daniel T L %A Shum,David H K %A Tanksale,Radhika %A Dingle,Genevieve %+ , Department of Social Work and Social Administration, The University of Hong Kong, CJT-534, 5/F, The Jockey Club Tower, The Centennial Campus, Pok Fu Lam, China (Hong Kong), 852 39172287, sallycao@hku.hk %K youth %K adolescents %K adolescence %K teens %K teenagers %K music %K moods %K mood symptoms %K loneliness %K emotion regulation %K emotions %K Hong Kong %K mental health %K mental illnesses %K mental disorders %K randomized controlled trial %K RCTs %K protocol %D 2025 %7 16.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health needs in the community surged during the pandemic, with concerning reports of increased negative mood symptoms among youth. At the same time, preventive psychoeducational interventions were insufficient within frontline youth mental health services in Hong Kong, and research specifically addressing youth loneliness remained limited on an international scale. Given the association between loneliness and other mental health symptoms, psychoeducational programs that empower adolescents to cope with emotions may help address both the research gap and local demand. As such, Tuned In, a previously validated intervention program originally developed in Australia, was introduced to the local context. Cultural adaptations and an added focus on loneliness were incorporated into the project to enhance its acceptability and test its effectiveness. Objective: This study aims to evaluate an adapted version of the Tuned In music-based psychoeducation program, designed to reduce loneliness, depression, and anxiety symptoms among young people in Hong Kong by enhancing their emotion regulation skills. Methods: Participants aged 16-19 years will be randomly assigned to either the experimental or control group. The experimental group will receive an online, group-based psychoeducation program focused on emotion recognition and management, delivered weekly over 4 consecutive weeks. The intervention is grounded in Russell’s emotion circumplex model and music psychology, and program content included: The 2D model and characteristics of emotions from different quadrants (session 1); happiness and loneliness (session 2); high-arousal and negative-valence emotions, for example, stress and anxiety (sessions 3); and anxiety, perfectionism, and a celebration of achievement (session 4). Both therapist- and participant-selected music will be used in the intervention to provide a rich repertoire for group discussion, psychoeducation, reflection, and the practice of social skills. The main outcome measures will be assessed using the Emotion Regulation Questionnaire, the Difficulties in Emotion Regulation Scale, the Depression Anxiety Stress Scale, and the De Jong Gierveld Loneliness Scale. Feedback on the project arrangement will be gathered through qualitative input. A mixed methods analysis will be conducted following data collection. Results: The project was successfully funded in February 2023 by the Health and Medical Research Fund in Hong Kong and commenced in August 2023. As of September 16, 2024, a total of 316 completed questionnaires had been received through Qualtrics for screening purposes, with 89 participants deemed eligible for the program. The project is scheduled to conclude in August 2025, with results to be published thereafter. Conclusions: Participants are expected to show improvements in emotion regulation, along with reductions in mood symptoms and loneliness, following the intervention. Trial Registration: ClinicalTrials.gov NCT06147297; https://clinicaltrials.gov/study/NCT06147297 International Registered Report Identifier (IRRID): DERR1-10.2196/67764 %M 40239199 %R 10.2196/67764 %U https://www.researchprotocols.org/2025/1/e67764 %U https://doi.org/10.2196/67764 %U http://www.ncbi.nlm.nih.gov/pubmed/40239199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e71030 %T Association Between Internet Use and Sleep Health Among Middle-Aged and Older Chinese Individuals: Nationwide Longitudinal Study %A Li,Xueqin %A Liu,Jin %A Huang,Ning %A Zhao,Wanyu %A He,Hongbo %+ Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital Ganzhou Hospital, Guangdong Academy of Medical Sciences, No. 106 Zhongshan 2nd Road, Yuexiu District, Guangdong Province, Guangzhou, 510000, China, 86 02083827812, hongbo_he@yeah.net %K internet use %K sleep %K Chinese middle-aged and older adults %K internet frequency %K cohort study %D 2025 %7 16.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep disorders are common among older adults and have a bidirectional impact on their emotional well-being. While some studies suggest that internet use may offer mental health benefits to this population, the relationship between internet use and sleep outcomes remains underexplored. Objective: This study investigates the association between internet use (including use frequency) and sleep quality and duration in middle-aged and older Chinese adults. Methods: A longitudinal analysis was conducted using the China Health and Retirement Longitudinal Study data from 2015 to 2018. Sleep quality was assessed using the sleep item from the Centre for Epidemiologic Studies Depression Scale, categorized as “good” (<1 day; reference), “fair” (1-4 days), or “poor” (5-7 days). Sleep duration was classified as short (<6 hours), medium (6-9 hours; reference), or long (>9 hours). Adjusted multinomial logistic regressions were used to examine the associations between internet use or frequency in 2015 and sleep quality or duration in 2018, controlling for age, sex, residence, diseases, smoking, drinking, and napping time and further exploring sex and age group variations. Results: The baseline analysis included 18,460 participants aged 45 years and older, with 1272 (6.9%) internet users, 8825 (48.1%) participants had fair or poor sleep, and 6750 (37.2%) participants had abnormal sleep duration. Internet users, particularly those who used it almost daily, were less likely to report poor sleep quality (relative risk [RR] 0.71, 95% CI 0.54-0.94) and longer sleep duration (RR 0.22, 95% CI 0.11-0.44) than nonusers. In the longitudinal analysis, baseline internet users had a significantly reduced risk of fair (RR 0.66, 95% CI 0.51-0.86) and poor sleep quality (RR 0.60, 95% CI 0.44-0.81), as well as short (RR 0.73, 95% CI 0.53-1.00) and long sleep duration (RR 0.39, 95% CI 0.21-0.72) during the follow-up period than nonusers. These associations remained significant for almost daily internet use (RR 0.32, 95% CI 0.15-0.69). Subgroup analyses by sex revealed a positive relationship between internet use and sleep quality, with a stronger effect in female (poor sleep: RR 0.57, 95% CI 0.36-0.89) than male (poor sleep: RR 0.61, 95% CI 0.40-0.92) participants. The effect on sleep duration was significant only in daily male users, showing a reduced risk of long sleep duration (RR 0.30, 95% CI 0.11-0.78). In the age subgroup analysis, most internet users were in the 45- to 59-year age group, with results consistent with the overall findings. Conclusions: This study suggests that internet use is associated with a reduced risk of sleep problems in middle-aged and older adults. The findings indicate that moderate, regular internet engagement—such as daily use—may promote better sleep health in this population. %M 40239202 %R 10.2196/71030 %U https://www.jmir.org/2025/1/e71030 %U https://doi.org/10.2196/71030 %U http://www.ncbi.nlm.nih.gov/pubmed/40239202 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 8 %N %P e70640 %T Limited Moderating Effect of Podcast Listening on Work Stress and Emotional Exhaustion Among Nurses During the COVID-19 Pandemic: Cross-Sectional Study %A Li Jung,Lu %A Chou,Pei Chin %A Wu,Yu-Hua %+ , Department of Respiratory Care, Chang Gung University of Science and Technology, 3F, No. 5, Aly 9, Ln 1, Sec 1, Neihu Rd, Taipei, 114, Taiwan, 886 915814999, harning999@gmail.com %K work stress %K emotional exhaustion %K podcasts %K nurses %K COVID-19 %K mental health %D 2025 %7 16.4.2025 %9 Original Paper %J JMIR Nursing %G English %X Background: The COVID-19 pandemic placed unprecedented pressure on health care systems worldwide, significantly impacting frontline health care workers, especially nurses. These professionals faced considerable psychological stress from caring for patients with COVID-19 and the fear of spreading the virus to their families. Studies report that more than 60% (132/220) of nurses experience anxiety, depression, and emotional exhaustion, which adversely affect their mental health and the quality of care they provide. Objective: This study aimed to investigate the relationship between work-related stress and emotional exhaustion among nurses and to assess whether listening to podcasts moderates this association. Methods: A cross-sectional online survey was conducted between March 1, 2023, and March 31, 2023. A total of 271 clinical nurses, aged 20 years to 65 years, were recruited for the study. Participants were divided into 2 groups: experimental group consisting of regular podcast listeners (n=173) and control group comprising nonlisteners (n=98). Ethical approval for this study was obtained from the local ethics committee (IRB number YGHIRB20230421B). Validated scales were used to measure work stress, emotional dissonance, and emotional exhaustion. Data analysis included descriptive statistics, independent t tests, and structural equation modeling to examine the relationships between variables. Results: No statistically significant differences were found between the experimental and control groups in terms of overall work stress (mean difference=–0.09, 95% CI –0.31 to 0.13; P=.42) or emotional exhaustion (mean difference=0.07, 95% CI –0.15 to 0.29; P=.53). Emotional dissonance emerged as a significant predictor of emotional exhaustion in both the experimental (β=0.476, P<.001) and control (β=0.321, P=.01) groups. Nurses reporting higher workloads had significantly higher emotional exhaustion levels (experimental group: β=0.302, P<.001; control group: β=0.327, P=.002). Podcast listening demonstrated only a slight, nonsignificant moderating effect. Conclusions: Although podcasts alone may not significantly reduce work stress or emotional exhaustion among nurses, there was a potential, albeit limited, moderating effect of podcasts on emotional well-being. They could serve as a supplementary tool for emotional support. However, broader and more comprehensive interventions are required to address the underlying causes of stress and emotional exhaustion in this population. More in-depth exploration and recommendations are possible by analyzing the content and patterns of listening. Further research is needed to examine the long-term benefits of integrating podcasts with other digital tools for holistic stress management in health care settings. %M 40159623 %R 10.2196/70640 %U https://nursing.jmir.org/2025/1/e70640 %U https://doi.org/10.2196/70640 %U http://www.ncbi.nlm.nih.gov/pubmed/40159623 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68132 %T Acceptability, Usability, and Insights Into Cybersickness Levels of a Novel Virtual Reality Environment for the Evaluation of Depressive Symptoms: Exploratory Observational Study %A Sutori,Sara %A Eliasson,Emma Therése %A Mura,Francesca %A Ortiz,Victor %A Catrambonephd,Vincenzo %A Hadlaczky,Gergö %A Todorov,Ivo %A Alfeo,Antonio Luca %A Cardi,Valentina %A Cimino,Mario G C A %A Mioni,Giovanna %A Raya,Mariano Alcañiz %A Valenza,Gaetano %A Carli,Vladimir %A Gentili,Claudio %+ National Centre for Suicide Research and Prevention, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Granits väg 4, Stockholm, 171 65, Sweden, 46 701407295, emma.eliasson@ki.se %K depression %K virtual reality %K assessment %K acceptability %K usability %K cybersickness %D 2025 %7 16.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a clear need for enhanced mental health assessment, depressive symptom (DS) evaluation being no exception. A promising approach to this aim is using virtual reality (VR), which entails the potential of adding a wider set of assessment domains with enhanced ecological validity. However, whilst several studies have used VR for both diagnostic and treatment purposes, its acceptance, in particular how exposure to virtual environments affects populations with psychiatric conditions remains unknown. Objective: This study aims to report on the acceptability, usability, and cybersickness levels of a pilot VR environment designed for the purpose of differentiating between individuals with DSs. Methods: The exploratory study, conducted in Italy, included 50 healthy controls and 50 young adults with mild-to-moderate DSs (without the need for a formal diagnosis). The study used an observational design with approximately 30 minutes of VR exposure followed by a self-report questionnaire battery. The battery included a questionnaire based on the Theoretical Framework of Acceptability, the System Usability Scale as well as the Simulator Sickness Questionnaire. Results: Results indicate that the majority found VR acceptable for the purposes of mental health screening and treatment. However, for diagnostics, there was a clear preference for VR to be used by mental health professionals as a supplementary tool, as opposed to a stand-alone solution. In practice, following exposure to the pilot VR environment, generally, good levels of acceptability and usability were reported, but areas in need of improvement were identified (such as self-efficacy). Self-reported cybersickness levels were comparable to literature averages but were considerably higher among those with DSs. Conclusions: These findings raise questions about the potential interplay between underlying somatic symptoms of depression and VR-induced cybersickness and call for more attention from the scientific community both in terms of methodology as well as potential clinical and theoretical implications. Conclusively, user support indicates a potential for VR to aid mental health assessment, but further research is needed to understand how exposure to virtual environments might affect populations with varying severity and other forms of psychiatric symptoms. International Registered Report Identifier (IRRID): RR2-10.1186/ISRCTN16396369 %M 40238239 %R 10.2196/68132 %U https://formative.jmir.org/2025/1/e68132 %U https://doi.org/10.2196/68132 %U http://www.ncbi.nlm.nih.gov/pubmed/40238239 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63269 %T iCogCA to Promote Cognitive Health Through Digital Group Interventions for Individuals Living With a Schizophrenia Spectrum Disorder: Protocol for a Nonrandomized Concurrent Controlled Trial %A Au-Yeung,Christy %A Thai,Helen %A Best,Michael %A Bowie,Christopher R %A Guimond,Synthia %A Lavigne,Katie M %A Menon,Mahesh %A Moritz,Steffen %A Piat,Myra %A Sauvé,Geneviève %A Sousa,Ana Elisa %A Thibaudeau,Elisabeth %A Woodward,Todd S %A Lepage,Martin %A Raucher-Chéné,Delphine %+ Douglas Mental Health University Institute, 6875 Boulevard LaSalle, Verdun, QC, H4H 1R3, Canada, 1 (514) 761 6131 ext 4393, martin.lepage@mcgill.ca %K schizophrenia spectrum disorders %K digital technology %K cognitive health %K cognitive remediation %K metacognitive training %K schizophrenia %K digital group interventions %D 2025 %7 15.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive impairments are a key aspect of schizophrenia spectrum disorders (SSDs), significantly affecting clinical and functional outcomes. The COVID-19 pandemic has heightened concerns about mental health services and cognitive stimulation opportunities. Despite evidence-based interventions like action-based cognitive remediation (ABCR) and metacognitive training (MCT), a research-to-practice gap exists in their application across mental health settings. Objective: The iCogCA study aims to address this gap by implementing digital ABCR and MCT through a national Canadian collaborative effort using digital psychological interventions to enhance cognitive health in SSDs. Methods: The study involves 5 Canadian sites, with mental health care practitioners trained digitally through the E-Cog platform, which was developed by our research group. Over 2.5 years, participants with SSDs will undergo pre- and postintervention assessments for clinical symptoms, cognition, and functioning. Each site will run groups annually for both ABCR and MCT, totaling ~390 participants. A nonrandomized concurrent controlled design will assess effectiveness design, in which one intervention (eg, ABCR) acts as the active control for the other (eg, MCT) and vice versa, comparing cognitive and clinical outcomes between the interventions using generalized linear mixed effect modeling. Implementation strategy evaluation will consider the digital platform’s efficacy for mental health care practitioners’ training, contextual factors influencing implementation, and sustainability, using descriptive statistics for quantitative data and thematic analysis for qualitative data. Results: A pilot pragmatic trial has been conducted previously at the Montreal site, evaluating 3 early implementation outcomes: acceptability, feasibility, and engagement. Patient and therapist acceptability was deemed as high and feasible (21/28, 75% of recruited service users completed therapy, rated feasible by therapists). Technology did not appear to significantly impede program participation. Therapist-rated levels of engagement were also satisfactory. In the ongoing study, recruitment is underway (114 participants recruited as of winter 2024), and intervention groups have been conducted at all sites, with therapists receiving training via the E-Cog learning platform (32 enrolled as of winter 2024). Conclusions: At least 3 significant innovations will stem from this project. First, this national effort represents a catalyst for the use of digital technologies to increase the adoption of evidence-based interventions and will provide important results on the effectiveness of digitally delivered ABCR and MCT. Second, the results of the implementation component of this study will generate the expertise needed to inform the implementation of similar initiatives. Third, the proposed study will introduce and validate our platform to train and supervise mental health care practitioners to deliver these interventions, which will then be made accessible to the broader mental health community. Trial Registration: ClinicalTrials.gov NCT05661448; https://clinicaltrials.gov/study/NCT05661448 International Registered Report Identifier (IRRID): DERR1-10.2196/63269 %M 40233365 %R 10.2196/63269 %U https://www.researchprotocols.org/2025/1/e63269 %U https://doi.org/10.2196/63269 %U http://www.ncbi.nlm.nih.gov/pubmed/40233365 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66301 %T Evaluating User Engagement With a Real-Time, Text-Based Digital Mental Health Support App: Cross-Sectional, Retrospective Study %A Coffield,Edward %A Kausar,Khadeja %+ , Department of Population Health, Hofstra University, 255 Hofstra University, 101 Oak Street Center, Room 100A, Hempstead, NY, 11549, United States, 1 516 463 7019, edward.coffield@hofstra.edu %K mental health support %K text %K app %K utilization %K mobile %K on demand %K scheduled %K mHealth %K mobile health %K app %K student %K university %K college %K mental health %K employee %K job %K work %K occupational health %K counselor %K counseling %K usage %K engagement %K self-reported %D 2025 %7 14.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 20% of US adults identify as having a mental illness. Structural and other barriers prevent many people from receiving mental health services. Digital mental health apps that provide 24-hour, real-time access to human support may improve access to mental health services. However, information is needed regarding how and why people engage with licensed counselors through a digital, real-time, text-based mental health support app in nonexperimental settings. Objective: This study aimed to evaluate how people engage with Counslr, a 24-hour, digital, mental health support app where users communicate in real time with human counselors through text messaging. Specifically, access patterns (eg, day of the week and time of session) and reasons for accessing the platform were examined. Furthermore, whether differences existed between session types (on-demand or scheduled) and membership types (education or noneducation) in regard to access patterns and why people accessed the platform were evaluated. Methods: The study population (users) consisted of students whose schools, universities, or colleges partnered with Counslr and employees whose organizations also partnered with Counslr. Users participated in text-based mental health support sessions. In these sessions, users engaged with licensed counselors through digital, text-based messaging in real time. Users could initiate an on-demand session or schedule a session 24 hours a day. User engagement patterns were evaluated through session length, session day, session time, and self-reported reasons for initiating the session. The data were stratified by membership type (education [students] or noneducation [employees]) and session type (on-demand or scheduled) to evaluate whether differences existed in usage patterns and self-reported reasons for initiating sessions by membership and session types. Results: Most students (178/283, 62.9%) and employees (28/44, 63.6%) accessed Counslr through on-demand sessions. The average and median session times were 40 (SD 15.3) and 45 minutes. On-demand sessions (37.9 minutes) were shorter (P=.001) than scheduled sessions (43.5 minutes). Most users (262/327, 80.1%) accessed Counslr between 7 PM and 5 AM. The hours that users accessed Counslr did not statistically differ by membership type (P=.19) or session type (P=.10). Primary self-reported reasons for accessing Counslr were relationship reasons, depression, and anxiety; however, users initiated sessions for a variety of reasons. Statistically significant differences existed between membership and session types (P<.05) for some of the reasons why people initiated sessions. Conclusions: The novel findings of this study illustrate that real-time, digital mental health support apps, which offer people the opportunity to engage with licensed counselors outside of standard office hours for a variety of mental health conditions, may help address structural barriers to accessing mental health support services. Additional research is needed to evaluate the effectiveness of human-based apps such as Counslr and whether such apps can also address disparities in access to mental health support services among different demographic groups. %M 40228290 %R 10.2196/66301 %U https://formative.jmir.org/2025/1/e66301 %U https://doi.org/10.2196/66301 %U http://www.ncbi.nlm.nih.gov/pubmed/40228290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65357 %T The EmpkinS-EKSpression Reappraisal Training Augmented With Kinesthesia in Depression: One-Armed Feasibility Study %A Keinert,Marie %A Schindler-Gmelch,Lena %A Rupp,Lydia Helene %A Sadeghi,Misha %A Richer,Robert %A Capito,Klara %A Eskofier,Bjoern M %A Berking,Matthias %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Nägelsbachstraße 25a, Erlangen, 91052, Germany, 49 9131 8567563, marie.keinert@fau.de %K depression %K cognitive reappraisal %K facial expression %K kinesthesia %K smartphone-based intervention %K mobile phone %D 2025 %7 14.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Harboring dysfunctional depressogenic cognitions contributes to the development and maintenance of depression. A central goal of cognitive behavioral therapy (CBT) for depression is to invalidate such cognitions via cognitive reappraisal (CR). However, relatively low remission rates and high dropout rates in CBT demonstrate the need for further improvement. Potentially, the effects of CBT could be enhanced by addressing not only dysfunctional depressogenic cognitions but also body states associated with depression. This may be done, for example, by systematically pairing the invalidation of depressogenic cognitions with the performance of antidepressive kinesthesia. Objective: This study aimed to examine the feasibility and clinical potential of a smartphone-based cognitive restructuring task that required users to deliberately perform antidepressive kinesthesia in conjunction with the rejection of depressogenic statements and the affirmation of antidepressive statements. This feasibility study was conducted as a precursor to a large-scale randomized controlled trial. Methods: In total, 10 healthy participants engaged in a single 90-120-minute session of smartphone-based CR training. During the training, they completed 2 phases in which they were required to reject 20 depressogenic and affirm 20 antidepressive statements, respectively. Diagnostic assessments were conducted 1 week (T1) before and directly prior (T2) to the training, and again directly posttraining (T3) and at a 2-week follow-up posttraining (T4). Feasibility outcomes assessed at T3 included intervention safety recorded by study therapists, compliance, technical feasibility, usability assessed using the Short Version of the User Experience Questionnaire (UEQ-S), and acceptability assessed using the UEQ-S and self-developed items. Preliminary clinical potential was evaluated via single-item ratings of current depressed and positive mood assessed continuously during the training. Feasibility outcomes were analyzed descriptively, and clinical potential was examined using paired-sample t tests of pre and post ratings of mood at each training phase. Results: Overall, the results indicated that the training was safe, feasible, and usable (UEQ-S pragmatic quality scale: mean 1.45, SD 0.71). However, acceptance was limited (UEQ-S hedonic quality scale: mean 1.05, SD 0.79). While 80% (8/10) of the participants were generally satisfied with the training, 80% (8/10) would recommend it to a friend, 90% (9/10) found it interesting, and 80% (8/10) rated it as “leading edge,” 40% (4/10) to 70% (7/10) did not consider it particularly helpful and 50% (5/10) found it repetitive. Preliminary results regarding clinical potential were promising, with significant increases in positive mood (rejection: Hedges g=0.63; affirmation: Hedges g=0.25), whereas changes in depressed mood were not significant. Conclusions: This study evaluated the feasibility and acceptability of a smartphone-based CR training augmented with validating and invalidating kinesthesia. This provided valuable insights for further optimizing the intervention for the subsequent randomized controlled trial, but also potential similar interventions. If future studies confirm their clinical potential, such interventions offer a promising approach to enhancing CBT for depression. Trial Registration: OSF Registries pw6ma; https://osf.io/pw6ma/ %M 40228242 %R 10.2196/65357 %U https://formative.jmir.org/2025/1/e65357 %U https://doi.org/10.2196/65357 %U http://www.ncbi.nlm.nih.gov/pubmed/40228242 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e55433 %T Exploring the Potential of a Digital Intervention to Enhance Couple Relationships (the Paired App): Mixed Methods Evaluation %A Aicken,Catherine %A Gabb,Jacqui %A Di Martino,Salvatore %A Witney,Tom %A Lucassen,Mathijs %+ Faculty of Arts & Social Sciences, The Open University, Walton Hall, Milton Keynes, MK7 6BJ, United Kingdom, jacqui.gabb@open.ac.uk %K digital intervention %K couple relationships %K romantic relationships %K relationship quality %K app %K digital technology %K couples %K internet-based intervention %K evaluation research %K mobile phone %D 2025 %7 14.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the effects of poor relationship quality on individuals’, couples’, and families’ well-being, help seeking often does not occur until problems arise. Digital interventions may lower barriers to engagement with preventive relationship care. The Paired app, launched in October 2020, aims to strengthen and enhance couple relationships. It provides daily questions, quizzes, tips, and detailed content and facilitates in-app sharing of question and quiz responses and tagged content between partners. Objective: To explore the potential of mobile health to benefit couple relationships and how it may do this, we examined (1) Paired’s impact on relationship quality and (2) its mechanisms of action. Methods: This mixed methods evaluation invited Paired subscribers to complete (1) brief longitudinal surveys over 3 months (n=440), (2) a 30-item web-based survey (n=745), and (3) in-depth interviews (n=20). For objective 1, survey results were triangulated to determine associations between relationship quality measures and the duration and frequency of Paired use, and qualitative data were integrated to provide explanatory depth. For objective 2, mechanisms of action were explored using a dominant qualitative approach. Results: Relationship quality improved with increasing duration and frequency of Paired use. Web-based survey data indicate that the Multidimensional Quality of Relationship Scale score (representing relationship quality on a 0-10 scale) was 35.5% higher (95% CI 31.1%-43.7%; P=.002), at 7.03, among people who had used Paired for >3 months compared to 5.19 among new users (≤1 wk use of Paired), a trend supported by the longitudinal data. Of those who had used Paired for >1 month, 64.3% (330/513) agreed that their relationship felt stronger since using the app (95% CI 60.2%-68.4%), with no or minimal demographic differences. Regarding the app’s mechanisms of action, interview accounts demonstrated how it prompted and habituated meaningful communication between partners, both within and outside the app. Couples made regular times in their day to discuss the topics Paired raised. Daily questions were sometimes lighthearted and sometimes concerned topics that couples might find challenging to discuss (eg, money management). Interviewees valued the combination of fun and seriousness. It was easier to discuss challenging topics when they were raised by the “neutral” app, rather than during stressful circumstances or when broached by 1 partner. Engagement seemed to be enhanced by users’ experience of relationship benefits and by the app’s design. Conclusions: This study demonstrates proof of concept, showing that Paired may have the potential to improve relationship quality over a relatively short time frame. Positive relationship practices became embedded within couples’ daily routines, suggesting that relationship quality improvements might be sustained. Digital interventions can play an important role in the relationship care ecosystem. The mixed methods design enabled triangulation and integration, strengthening our findings. However, app users were self-selecting, and methodological choices impact our findings’ generalizability. %R 10.2196/55433 %U https://mhealth.jmir.org/2025/1/e55433 %U https://doi.org/10.2196/55433 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67772 %T Acoustic Features for Identifying Suicide Risk in Crisis Hotline Callers: Machine Learning Approach %A Su,Zhengyuan %A Jiang,Huadong %A Yang,Ying %A Hou,Xiangqing %A Su,Yanli %A Yang,Li %+ , Laboratory of Suicidal Behavior Research, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin, 300354, China, 86 13752183496, yangli@tju.edu.cn %K suicide %K crisis hotline %K acoustic feature %K machine learning %K acoustics %K suicide risk %K artificial intelligence %K feasibility %K prediction models %K hotline callers %K voice %D 2025 %7 14.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Crisis hotlines serve as a crucial avenue for the early identification of suicide risk, which is of paramount importance for suicide prevention and intervention. However, assessing the risk of callers in the crisis hotline context is constrained by factors such as lack of nonverbal communication cues, anonymity, time limits, and single-occasion intervention. Therefore, it is necessary to develop approaches, including acoustic features, for identifying the suicide risk among hotline callers early and quickly. Given the complicated features of sound, adopting artificial intelligence models to analyze callers’ acoustic features is promising. Objective: In this study, we investigated the feasibility of using acoustic features to predict suicide risk in crisis hotline callers. We also adopted a machine learning approach to analyze the complex acoustic features of hotline callers, with the aim of developing suicide risk prediction models. Methods: We collected 525 suicide-related calls from the records of a psychological assistance hotline in a province in northwest China. Callers were categorized as low or high risk based on suicidal ideation, suicidal plans, and history of suicide attempts, with risk assessments verified by a team of 18 clinical psychology raters. A total of 164 clearly categorized risk recordings were analyzed, including 102 low-risk and 62 high-risk calls. We extracted 273 audio segments, each exceeding 2 seconds in duration, which were labeled by raters as containing suicide-related expressions for subsequent model training and evaluation. Basic acoustic features (eg, Mel Frequency Cepstral Coefficients, formant frequencies, jitter, shimmer) and high-level statistical function (HSF) features (using OpenSMILE [Open-Source Speech and Music Interpretation by Large-Space Extraction] with the ComParE 2016 configuration) were extracted. Four supervised machine learning algorithms (logistic regression, support vector machine, random forest, and extreme gradient boosting) were trained and evaluated using grouped 5-fold cross-validation and a test set, with performance metrics, including accuracy, F1-score, recall, and false negative rate. Results: The development of machine learning models utilizing HSF acoustic features has been demonstrated to enhance recognition performance compared to models based solely on basic acoustic features. The random forest classifier, developed with HSFs, achieved the best performance in detecting the suicide risk among the models evaluated (accuracy=0.75, F1-score=0.70, recall=0.76, false negative rate=0.24). Conclusions: The results of our study demonstrate the potential of developing artificial intelligence–based early warning systems using acoustic features for identifying the suicide risk among crisis hotline callers. Our work also has implications for employing acoustic features to identify suicide risk in salient voice contexts. %M 40228243 %R 10.2196/67772 %U https://www.jmir.org/2025/1/e67772 %U https://doi.org/10.2196/67772 %U http://www.ncbi.nlm.nih.gov/pubmed/40228243 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e67137 %T Adapting Cognitive Behavioral Therapy for Adolescents in Iraq via Mobile Apps: Qualitative Study of Usability and Outcomes %A Ibrahim,Radhwan Hussein %A Yaas,Marghoob Hussein %A Hamarash,Mariwan Qadir %A Al-Mukhtar,Salwa Hazim %A Abdulghani,Mohammed Faris %A Al Mushhadany,Osama %K cognitive behavioral therapy %K CBT %K psychotherapy %K mHealth %K app %K adolescents %K teenager %K mental health %K usability %K engagement %K anxiety %K depression %K user experience %K UX %K focus group %K interview %K digital health %D 2025 %7 11.4.2025 %9 %J JMIR Pediatr Parent %G English %X Background: Mental health challenges, including anxiety and depression, are increasingly common among adolescents. Mobile health (mHealth) apps offer a promising way to deliver accessible cognitive behavioral therapy (CBT) interventions. However, research on the usability and effectiveness of apps explicitly tailored for adolescents is limited. Objective: This study aimed to explore the usability, engagement, and perceived effectiveness of a mobile CBT app designed for adolescents, focusing on user experiences and mental health outcomes. Methods: A qualitative study was conducted with 40 adolescents aged 13‐19 years (mean age 15.8, SD 1.9 years; 18/40, 45% male; 22/40, 55% female) who engaged with a CBT app for 4 weeks. Mental health diagnoses included anxiety (20/40, 50%), depression (15/40, 38%), and both (5/40, 13%). Of these, 10 (25%) of the 40 participants had previous CBT experience. Feedback was gathered through focus groups and individual interviews, and thematic analysis identified key themes related to usability, engagement, and perceived effectiveness. Quantitative data on mood and anxiety scores were analyzed with paired t tests. Results: The mean usability score was 3.8 (SD 0.6), and the mean effectiveness score was 3.9 (SD 0.7). Older participants (aged 16‐19 years) reported significantly higher usability (mean 4.1, SD 0.4) and effectiveness scores (mean 4.3, SD 0.5) compared to younger participants (aged 13‐15 years) (P=.03). Females had higher usability (mean 4, SD 0.6) and effectiveness scores (mean 4.2, SD 0.7) than males (mean 3.6, SD 0.7, and mean 3.5, SD 0.8, respectively; P=.03). Participants with prior CBT experience had 2.8 times higher odds of reporting high usability scores (95% CI 1.6‐5; P=.002) and 3.1 times higher odds of reporting high effectiveness scores (95% CI 1.7‐5.6; P=.001). Usability challenges included complex navigation (20/40, 50%), interface design issues (12/40, 30%), and content overload (8/40, 20%). Factors positively influencing engagement were motivation driven by personal relevance (20/40, 50%) and gamification features (10/40, 25%), while lack of personalization (14/40, 35%) and external distractions (18/40, 45%) were significant barriers. Mood improvement (15/40, 38%) and learning new coping skills (12/40, 30%) were the most reported outcomes. Conclusions: The mobile CBT app shows potential for improving adolescent mental health, with initial improvements in mood and anxiety. Future app iterations should prioritize simplifying navigation, adding personalization features, and enhancing technical stability to support long-term engagement. %R 10.2196/67137 %U https://pediatrics.jmir.org/2025/1/e67137 %U https://doi.org/10.2196/67137 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65770 %T Examining a Telemedicine-Based Virtual Reality Clinic in Treating Adults With Specific Phobia: Protocol for a Feasibility Randomized Controlled Efficacy Trial %A Schuler,Kaitlyn R %A Ong,Triton %A Welch,Brandon M %A Craggs,Jason G %A Bunnell,Brian E %+ Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 E. Fletcher Ave, Tampa, FL, 33613, United States, 1 (813) 794 8607, bbunnell@usf.edu %K virtual reality %K exposure therapy %K phobias %K telemedicine %K telemental health %K tele-VR %K immersive simulations %D 2025 %7 10.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Virtual reality (VR) has strong potential to enhance the effectiveness of telemental health care (TMH) by providing accessible, personalized treatment from home. While there is ample research supporting VR for in-person treatment, there is only preliminary data on the efficacy of telemedicine-based VR. Furthermore, the majority of VR apps used in therapy are not designed for mental health care. VR has the potential to enhance TMH through innovative technology solutions designed specifically for the enhancement of remotely delivered evidence-based practices. This feasibility randomized controlled efficacy trial aims to fill both of these gaps by piloting a novel telemedicine-based VR app (Doxy.me VR) equipped with animal phobia exposure stimuli. Objective: This is a feasibility randomized controlled efficacy trial comparing exposure therapy via a telemedicine-based VR clinic versus standard TMH with adults with an intense fear of dogs, snakes, or spiders. The primary objective is to assess the feasibility of a fully powered trial. The secondary objective is to conduct a preliminary examination of clinical outcomes (eg, specific phobia symptoms). Methods: This single-site trial will enroll a minimum of 30 and a maximum of 60 adults with self-reported fear of dogs, snakes, or spiders. Potential participants will be recruited through clinical trial and research recruitment websites and posting flyers. All self-report assessments and homework will be partially automated using REDCap (Research Electronic Data Capture; Vanderbilt University) forms and surveys, but the baseline assessment of phobia symptoms and exposure intervention will be administered by the study therapist. Results: The feasibility of the proposed trial methodology will be assessed using enrollment, retention, assessment completion, and treatment protocol fidelity benchmarks. Between-group differences in specific phobia, anxiety, and depression symptoms while covarying for pretreatment scores, will be conducted using repeated measures ANOVA along with differences in therapeutic alliance and presence. Data obtained from these analyses will inform power analyses for a fully powered efficacy trial. In total, 54 participants were randomized between October 25, 2023, and July 26, 2024 (Doxy.me VR n=28 and TMH n=26). Data analysis will be completed and submitted by the end of the second quarter of 2025. Conclusions: This feasibility randomized controlled trial comparing Doxy.me VR versus TMH aims to enhance the delivery of evidence-based treatments via telemedicine and reduce barriers to remotely delivered exposure therapy. This feasibility trial will be followed by a fully powered efficacy trial on telemedicine-based VR for animal phobias. Trial Registration: ClinicalTrials.gov NCT06302868; https://clinicaltrials.gov/study/NCT06302868 International Registered Report Identifier (IRRID): DERR1-10.2196/65770 %M 40209221 %R 10.2196/65770 %U https://www.researchprotocols.org/2025/1/e65770 %U https://doi.org/10.2196/65770 %U http://www.ncbi.nlm.nih.gov/pubmed/40209221 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63491 %T Encouraging the Voluntary Mobilization of Mental Resources by Manipulating Task Design: Explorative Study %A Louis,Lina-Estelle %A Moussaoui,Saïd %A Ravoux,Sébastien %A Milleville-Pennel,Isabelle %K visual game-like elements %K gamification %K multiplicity of cognitive functions %K cognitive tasks %K perceived playfulness %K mental workload %K performance %K cognitive training %K aging %K mental effort %K cognitive function %K cognitive skills %K cognitive tests %D 2025 %7 10.4.2025 %9 %J JMIR Form Res %G English %X Background: Cognitive training is increasingly being considered and proposed as a solution for several pathologies, particularly those associated with aging. However, trainees need to be willing to invest enough mental effort to succeed and make progress. Objective: In this study, we explore how gamification in a narrative context (ie, the addition of visual game-like elements [GLEs] embedded in real-world contexts) could contribute increase in perceived playfulness (PP) and voluntary mental effort allocated to a cognitive task. In such context, narrative elements and GLEs can be designed to align with a commonly relatable scenario (like simulating fishing or gardening activity) to ground the task in familiar, real-world contexts. We also consider if the supposed effect of GLEs on PP and voluntary mental effort could endure while manipulating an intrinsic variable of the task (ie, by increasing cognitive solicitation). Methods: In total, 20 participants (average age 33.6, SD 8.6 y) took part in 3 cognitive tasks proposed in a numerical format: a classic version of the Corsi test (Classic Corsi, a spatial memory task), a playful version of the Classic Corsi test (Playful Corsi), with added visual GLEs in a narrative context, and a playful version of the Classic Corsi test with added cognitive solicitation, that is, mental motor inhibition (Playful Corsi Multi). We assessed the impact of visual GLEs and cognitive solicitation on PP (1 question) and mental workload (MWL) using NASA-Task Load Index (NASA-TLX) and workload profile (WP) questionnaires. Results: Results showed that PP was not influenced by interface’s playful characteristics (Classic Corsi [mean 62.4, SD 8.8] vs Playful Corsi [mean 66, SD 8.8]; W=77; P=.30) but decreased the time necessary to complete the task (Classic Corsi [mean 10.7, SD 2.1 s] vs Playful Corsi [mean 6.8, SD 1.6 s]; W=209; P<.001) as well as performance (Classic Corsi [mean 92.4, SD 9.1] vs Playful Corsi [mean 88.2, SD 11.3]; W=140.5; P=.02). So, possibly, visual GLEs could raise the stakes of the task slightly and implicitly encourage people to go a bit faster. Furthermore, visual GLEs increased MWL regarding attentional resources (assessed by WP: Classic Corsi [mean 52.4, SD 10.9] vs Playful Corsi [mean 65.8, SD 10.9]; W=27.5; P=.04), while manipulating cognitive solicitation impacted MWL when linked to task requirements (assessed by NASA-TLX: Playful Corsi [mean 54.2, SD 9.4] vs Playful Corsi Multi [mean 67.5, SD 9.4]; W=35.5; P=.01) without impacting the performance to the task (Playful Corsi [mean 83.8, SD 13.9] vs Playful Corsi Multi [mean 94, SD 5.5]; W=27; P=.007). Thus, working on the way cognitive functions are solicited would be wiser than adding visual GLEs to improve users’ voluntary mental effort while preserving performance. Conclusion: These results offer valuable insights to improve users’ experience during gamified cognitive tasks and serious games. %R 10.2196/63491 %U https://formative.jmir.org/2025/1/e63491 %U https://doi.org/10.2196/63491 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67624 %T Provider Perspectives on Implementing an Enhanced Digital Screening for Adolescent Depression and Suicidality: Qualitative Study %A Coren,Morgan A %A Lindhiem,Oliver %A Angus,Abby R %A Toevs,Emma K %A Radovic,Ana %K depression %K suicidality %K adolescent mental health screening %K primary care %K digital tools %D 2025 %7 10.4.2025 %9 %J JMIR Form Res %G English %X Background: With a growing adolescent mental health crisis, pediatric societies are increasingly recommending that primary care providers (PCPs) engage in mental health screening. While symptom-level screens identify symptoms, novel technology interventions can assist PCPs with providing additional point-of-care guidance to increase uptake for behavioral health services. Objective: In this study, we sought community PCP feedback on a web-based, digitally enhanced mental health screening tool for adolescents in primary care previously only evaluated in research studies to inform implementation in community settings. Methods: A total of 10 adolescent providers were recruited to trial the new screening tool and participate in structured interviews based on the Consolidated Framework for Implementation Research domains. Interviews were audio recorded, transcribed, and coded according to a prespecified codebook using a template analysis approach. Results: Providers identified improving mental health screening and treatment in pediatric primary care as a priority and agreed that a web-based digitally enhanced screening tool could help facilitate identification of and management of adolescent depression. Salient barriers identified were lack of electronic health record integration, time to administer screening, implications on clinic workflow, accessibility, and lack of transparency within health care organizations about the process of approving new technologies for clinical use. Providers made multiple suggestions to enhance implementation in community settings, such as incorporating customization options. Conclusions: Technology interventions can help address the need for improved behavioral health support in primary care settings. However, numerous barriers exist, complicating implementation of new technologies in real-world settings. %R 10.2196/67624 %U https://formative.jmir.org/2025/1/e67624 %U https://doi.org/10.2196/67624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64138 %T Safety and Efficacy of Modular Digital Psychotherapy for Social Anxiety: Randomized Controlled Trial %A Garvert,Mona M %A McFadyen,Jessica %A Linke,Stuart %A McCloud,Tayla %A Meyer,Sofie S %A Sobanska,Sandra %A Sharp,Paul B %A Long,Alex %A Huys,Quentin J M %A Ahmadi,Mandana %+ Alena, 25 Wilton Rd, Pimlico, London, SW1V 1LW, United Kingdom, 44 09313185834, mona.garvert@gmail.com %K social anxiety disorder %K randomized controlled trial %K digital mental health %K cognitive behavioral therapy %K internet-delivered CBT %D 2025 %7 10.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Social anxiety disorder is a common mental health condition characterized by an intense fear of social situations that can lead to significant impairment in daily life. Cognitive behavioral therapy (CBT) has been recognized as an effective treatment; however, access to therapists is limited, and the fear of interacting with therapists can delay treatment seeking. Furthermore, not all individuals respond. Tailoring modular treatments to individual cognitive profiles may improve efficacy. We developed a novel digital adaptation of CBT for social anxiety that is both modular and fully digital without a therapist in the loop and implemented it in the smartphone app Alena. Objective: This study aimed to evaluate the safety, acceptability, and efficacy of the new treatment in online participants with symptoms of social anxiety. Methods: In total, 2 web-based randomized controlled trials (RCTs) comparing individuals with access to the treatment through the app to a waitlist control group were conducted. Participants were recruited on the web and reported Social Phobia Inventory (SPIN) total scores of ≥30. Primary outcomes were safety and efficacy over 6 weeks in 102 women aged 18 to 35 years (RCT 1) and symptom reduction (SPIN scores) after 8 weeks in 248 men and women aged 18 to 75 years (RCT 2). Results: In RCT 1, active and control arm adverse event frequency and severity were not distinguishable (intervention: 7/52, 13%; waitlist control: 8/50, 16%; χ21=0.007; P=.93). App acceptability was high, with a median completion rate of 90.91% (IQR 54.55%-100%). Secondary outcomes suggested greater symptom reduction in the active arm (mean SPIN score reduction −9.83, SD 12.80) than in the control arm (mean SPIN score reduction −4.13, SD 11.59; t90=−2.23; false discovery rate P=.04; Cohen d=0.47). RCT 2 replicated these findings. Adverse event frequency was comparable across the 2 groups (intervention: 20/124, 16.1%; waitlist control: 21/124, 16.8%; χ21<0.001; P>.99). Despite a longer treatment program, median completion remained high (84.85%, IQR 51.52%-96.97%). SPIN score reduction was greater in the active arm (mean −12.89, SD 13.87) than in the control arm (mean −7.48, SD 12.24; t227=−3.13; false discovery rate P=.008; Cohen d=0.42). Conclusions: The web-only, modular social anxiety CBT program appeared safe, acceptable, and efficacious in 2 independent RCTs on online patient groups with self-reported symptoms of social anxiety. Trial Registration: ClinicalTrials.gov NCT05858294; https://clinicaltrials.gov/study/NCT05858294 (RCT 1) and ClinicalTrials.gov NCT05987969; https://clinicaltrials.gov/study/NCT05987969 (RCT 2) %M 40208666 %R 10.2196/64138 %U https://www.jmir.org/2025/1/e64138 %U https://doi.org/10.2196/64138 %U http://www.ncbi.nlm.nih.gov/pubmed/40208666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e42406 %T Factors Impacting Mobile Health Adoption for Depression Care and Support by Adolescent Mothers in Nigeria: Preliminary Focus Group Study %A Kola,Lola %A Fatodu,Tobi %A Kola,Manasseh %A Olayemi,Bisola A %A Adefolarin,Adeyinka O %A Dania,Simpa %A Kumar,Manasi %A Ben-Zeev,Dror %+ WHO Collaborating Centre for Research and Training in Mental Health, Neurosciences and Drug and Alcohol Abuse, Department of Psychiatry, College of Medicine, University of Ibadan, P.M.B 3017 G.P.O, Ibadan, 23401, Nigeria, 234 (2) 2411768, lola_kola2004@yahoo.com %K adolescent perinatal depression %K primary care %K mHealth app %K user centered design %K smartphone %K human-centered design %K HCD %K depression %K postpartum %K perinatal %K postnatal %K teenage %K adolescent %K youth %K low-middle-income countries %K LMIC %K middle income %K adoption %K acceptability %K mobile health %K mHealth %K mobile app %K women’s health %K mental health %K depressive %D 2025 %7 9.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth), the use of mobile technology in health care, is increasingly being used for mental health service delivery even in low- and middle-income countries to scale up treatment, and a variety of evidence supports their potential in different populations. Objective: This study aims to use the Social Cognitive Theory (SCT) as a lens to explain knowledge of mHealth use for mental health care, personal behavioral capabilities, and the external social contexts that can impact the adoption of an mHealth app for depression care among perinatal adolescents in Nigeria. Methods: At the preliminary stage of a user-centered design (UCD), 4 focus group discussions were conducted among 39 participants: 19 perinatal adolescents with a history of depression and 20 primary care providers. Guided by the SCT, a popular model used for predicting and explaining health behaviors, we documented participants’ knowledge of mHealth use for health purposes, advantages, and challenges to the adoption of an mHealth app by young mothers, and approaches to mitigate challenges. Data collection and analysis was an iterative process until saturation of all topic areas was reached. Results: The mean age for young mothers was 17.3 (SD 0.9) years and 48 (SD 5.8) years for care providers. Mistrust from relatives on mobile phone use for therapeutic purposes, avoidance of clinic appointments, and sharing of application contents with friends were some challenges to adoption identified in the study population. Supportive personal factors and expressions of self-efficacy on mobile app use were found to be insufficient for adoption. This is because there are social complications and disapprovals that come along with getting pregnant at a young age. Adequate engagement of parents, guardians, and partners on mHealth solutions by care providers was identified as necessary to the uptake of digital tools for mental health care in this population. Conclusions: The SCT guided the interpretations of the study findings. Young mothers expressed excitement at the use of mHealth technology to manage perinatal depression. Real-life challenges, however, need to be attended to for successful implementation of such interventions. Communications between care providers and patients’ relatives on the therapeutic use of mHealth are vital to the success of a mHealth mental health management plan for depression in young mothers in Nigeria. %M 40203299 %R 10.2196/42406 %U https://formative.jmir.org/2025/1/e42406 %U https://doi.org/10.2196/42406 %U http://www.ncbi.nlm.nih.gov/pubmed/40203299 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67744 %T Young Adult Perspectives on Artificial Intelligence–Based Medication Counseling in China: Discrete Choice Experiment %A Zhang,Jia %A Wang,Jing %A Zhang,JingBo %A Xia,XiaoQian %A Zhou,ZiYun %A Zhou,XiaoMing %A Wu,YiBo %+ Department of Research, Shandong Provincial Hospital Affiliated to Shandong First Medical University, No.324 Jingwu Road, Huaiyi District, Jinan, 250021, China, 86 15168887283, sdslyy@yeah.net %K artificial intelligence %K medication counseling services %K discrete choice experiment %K willingness to pay %D 2025 %7 9.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: As artificial intelligence (AI) permeates the current society, the young generation is becoming increasingly accustomed to using digital solutions. AI-based medication counseling services may help people take medications more accurately and reduce adverse events. However, it is not known which AI-based medication counseling service will be preferred by young people. Objective: This study aims to assess young people’s preferences for AI-based medication counseling services. Methods: A discrete choice experiment (DCE) approach was the main analysis method applied in this study, involving 6 attributes: granularity, linguistic comprehensibility, symptom-specific results, access platforms, content model, and costs. The participants in this study were screened and recruited through web-based registration and investigator visits, and the questionnaire was filled out online, with the questionnaire platform provided by Questionnaire Star. The sample population in this study consisted of young adults aged 18-44 years. A mixed logit model was used to estimate attribute preference coefficients and to estimate the willingness to pay (WTP) and relative importance (RI) scores. Subgroups were also analyzed to check for heterogeneity in preferences. Results: In this analysis, 340 participants were included, generating 8160 DCE observations. Participants exhibited a strong preference for receiving 100% symptom-specific results (β=3.18, 95% CI 2.54-3.81; P<.001), and the RI of the attributes (RI=36.99%) was consistent with this. Next, they showed preference for the content model of the video (β=0.86, 95% CI 0.51-1.22; P<.001), easy-to-understand language (β=0.81, 95% CI 0.46-1.16; P<.001), and when considering the granularity, refined content was preferred over general information (β=0.51, 95% CI 0.21-0.8; P<.001). Finally, participants exhibited a notable preference for accessing information through WeChat applets rather than websites (β=0.66, 95% CI 0.27-1.05; P<.001). The WTP for AI-based medication counseling services ranked from the highest to the lowest for symptom-specific results, easy-to-understand language, video content, WeChat applet platform, and refined medication counseling. Among these, the WTP for 100% symptom-specific results was the highest (¥24.01, 95% CI 20.16-28.77; US $1=¥7.09). High-income participants exhibited significantly higher WTP for highly accurate results (¥45.32) compared to low-income participants (¥20.65). Similarly, participants with higher education levels showed greater preferences for easy-to-understand language (¥5.93) and video content (¥12.53). Conclusions: We conducted an in-depth investigation of the preference of young people for AI-based medication counseling services. Service providers should pay attention to symptom-specific results, support more convenient access platforms, and optimize the language description, content models that add multiple digital media interactions, and more refined medication counseling to develop AI-based medication counseling services. %M 40203305 %R 10.2196/67744 %U https://www.jmir.org/2025/1/e67744 %U https://doi.org/10.2196/67744 %U http://www.ncbi.nlm.nih.gov/pubmed/40203305 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65889 %T Co-Designing a Web-Based and Tablet App to Evaluate Clinical Outcomes of Early Psychosis Service Users in a Learning Health Care Network: User-Centered Design Workshop and Pilot Study %A Burch,Kathleen E %A Tryon,Valerie L %A Pierce,Katherine M %A Tully,Laura M %A Ereshefsky,Sabrina %A Savill,Mark %A Smith,Leigh %A Wilcox,Adam B %A Hakusui,Christopher Komei %A Padilla,Viviana E %A McNamara,Amanda P %A Kado-Walton,Merissa %A Padovani,Andrew J %A Miller,Chelyah %A Miles,Madison J %A Sharma,Nitasha %A Nguyen,Khanh Linh H %A Zhang,Yi %A Niendam,Tara A %+ Department of Psychiatry & Behavioral Sciences, University of California-Davis, 4701 X St, Sacramento, CA, 95817, United States, 1 916 699 5193, knye@ucdavis.edu %K eHealth %K user-centered design %K learning health system %K psychosis %K early psychosis %K user-driven development %K web-based %K data visualization %K surveys and questionnaires %K measurement-based care %D 2025 %7 9.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The Early Psychosis Intervention Network of California project, a learning health care network of California early psychosis intervention (EPI) programs, prioritized incorporation of community partner feedback while designing its eHealth app, Beehive. Though eHealth apps can support learning health care network data collection aims, low user acceptance or adoption can pose barriers to successful implementation. Adopting user-centered design (UCD) approaches, such as incorporation of user feedback, prototyping, iterative design, and continuous evaluation, can mitigate these potential barriers. Objective: We aimed to use UCD during development of a data collection and data visualization web-based and tablet app, Beehive, to promote engagement with Beehive as part of standard EPI care across a diverse user-base. Methods: Our UCD approach included incorporation of user feedback, prototyping, iterative design, and continuous evaluation. This started with user journey mapping to create storyboards, which were then presented in UCD workshops with service users, their support persons, and EPI providers. We incorporated feedback from these workshops into the alpha version of Beehive, which was also presented in a UCD workshop. Feedback was again incorporated into the beta version of Beehive. We provided Beehive training to 4 EPI programs who then piloted Beehive’s beta version. During piloting, service users, their support persons, and EPI program providers completed Beehive surveys at enrollment and every 6 months after treatment initiation. To examine preliminary user acceptance and adoption during the piloting phase, we assessed rates of participant enrollment and survey completion, with a particular focus on completion of a prioritized survey: the Modified Colorado Symptom Index. Results: UCD workshop feedback resulted in the creation of new workflows and interface changes in Beehive to improve the user experience. During piloting, 48 service users, 42 support persons, and 72 EPI program providers enrolled in Beehive. Data were available for 88% (n=42) of service users, including self-reported data for 79% (n=38), collateral-reported data for 42% (n=20), and clinician-entered data for 17% (n=8). The Modified Colorado Symptom Index was completed by 54% (n=26) of service users (total score: mean 24.16, SD 16.81). In addition, 35 service users had a support person who could complete the Modified Colorado Symptom Index, and 56% (n=19) of support persons completed it (mean 26.71, SD 14.43). Conclusions: Implementing UCD principles while developing the Beehive app resulted in early workflow changes and produced an app that was acceptable and feasible for collection of self-reported clinical outcomes data from service users. Additional support is needed to increase collateral-reported and clinician-entered data. %M 40203298 %R 10.2196/65889 %U https://humanfactors.jmir.org/2025/1/e65889 %U https://doi.org/10.2196/65889 %U http://www.ncbi.nlm.nih.gov/pubmed/40203298 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66966 %T Developing an Internet-Based Cognitive Behavioral Therapy Intervention for Adolescents With Anxiety Disorders: Design, Usability, and Initial Evaluation of the CoolMinds Intervention %A Sørensen,Nikita Marie %A Skaarnes,Helene %A Mathiasen,Kim %A Thastum,Mikael %A Lomholt,Johanne Jeppesen %+ , Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 11, Aarhus C, 8000, Denmark, 45 87159439, nikita@psy.au.dk %K user-centered design %K digital treatment %K digital mental health %K internet-based %K cognitive behavioral therapy %K anxiety %K adolescents %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions may help increase access to psychological treatment for adolescents with anxiety disorders. However, many clinical evaluations of digital treatments report low adherence and engagement and high dropout rates, which remain challenges when the interventions are implemented in routine care. Involving intended end users in the development process through user-centered design methods may help maximize user engagement and establish the validity of interventions for implementation. Objective: This study aimed to describe the methods used to develop a new internet-based cognitive behavioral therapy intervention, CoolMinds, within a user-centered design framework. Methods: The development of intervention content progressed in three iterative design phases: (1) identifying needs and design specifications, (2) designing and testing prototypes, and (3) running feasibility tests with end users. In phase 1, a total of 24 adolescents participated in a user involvement workshop exploring their preferences on graphic identity and communication styles as well as their help-seeking behavior. In phase 2, a total of 4 adolescents attended individual usability tests in which they were presented with a prototype of a psychoeducational session and asked to think aloud about their actions on the platform. In phase 3, a total of 7 families from the feasibility trial participated in a semistructured interview about their satisfaction with and initial impressions of the platform and intervention content while in treatment. Activities in all 3 phases were audio recorded, transcribed, and coded using thematic analysis and qualitative description design. The intervention was continuously revised after each phase based on the feedback. Results: In phase 1, adolescent feedback guided the look and feel of the intervention content (ie, color scheme, animation style, and communication style). Participants generally liked content that was relatable and age appropriate and felt motivating. Animations that resembled “humans” received more votes as adolescents could better “identify” themselves with them. Communication should preferably be “supportive” and feel “like a friend” talking to them. Statements including praise—such as “You’re well on your way. How are you today?”—received the most votes (12 votes), whereas directive statements such as “Tell us how your day has been?” and “How is practicing your steps going?” received the least votes (2 and 0 votes, respectively). In phase 2, adolescents perceived the platform as intuitive and easy to navigate and the session content as easy to understand but lengthy. In phase 3, families were generally satisfied with the intervention content, emphasizing the helpfulness of graphic material to understand therapeutic content. Their feedback helped identify areas for further improvement, such as editing down the material and including more in-session breaks. Conclusions: Using user involvement practices in the development of interventions helps ensure continued alignment of the intervention with end-user needs and may help establish the validity of the intervention for implementation in routine care practice. %M 40198911 %R 10.2196/66966 %U https://formative.jmir.org/2025/1/e66966 %U https://doi.org/10.2196/66966 %U http://www.ncbi.nlm.nih.gov/pubmed/40198911 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65788 %T The Use of Mobile Apps in Adolescent Psychotherapy: Assessment of Psychotherapists’ Perspectives %A Wüllner,Sarah %A Hermenau,Katharin %A Hecker,Tobias %A Siniatchkin,Michael %+ University Clinic of Child and Adolescent Psychiatry and Psychotherapy, Medical School EWL, Protestant Hospital Bethel, Bielefeld University, Remterweg 13a, Bielefeld, 33617, Germany, 49 5211063166, sarah.wuellner@uni-bielefeld.de %K mental health app %K psychotherapy %K adolescent %K mHealth %K youth %K feasibility %K implementation %K app features %K barriers %K drivers %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Therapy-accompanying mental health apps can play an important role in the psychotherapeutic treatment of adolescents. They can enhance adolescents’ engagement and autonomy, provide immediate support in critical situations, and positively influence the therapeutic working alliance. Nevertheless, mental health apps are rarely used by psychotherapists. Furthermore, due to the limited or nonexistent use of apps in psychotherapy, little is known about the actual barriers and drivers affecting their integration into psychotherapists’ daily routines. To better understand how mental health apps should be designed for practical use, it is essential to explore psychotherapists’ perspectives on key app features and characteristics, as well as the factors influencing their integration into clinical practice. Objective: This study aims to analyze which app features and characteristics are essential for psychotherapists to use a mobile app in psychotherapy with adolescents and to identify the key drivers and barriers influencing the integration of a psychotherapeutic app from the psychotherapists’ perspectives. Methods: We conducted 3 feasibility studies using Steps, a transdiagnostic, therapy-accompanying app for adolescents, across 3 different psychotherapeutic treatment contexts: inpatient treatment, treatment in psychiatric outpatient clinics, and outpatient treatment with psychotherapists in private practice. All studies followed a qualitative quasi-experimental design. Participants provided information on their age, occupation, years of work experience, media affinity, attitudes toward psychotherapeutic apps, perceived app quality and feasibility, and the implementation process of the therapy-accompanying app. Qualitative data were analyzed using deductive qualitative content analysis. A total of 40 mental health professionals participated across the 3 studies (study 1: n=18; study 2: n=13; study 3: n=9). Results: Study participation and app usage rates were low across all studies. Six core features for a transdiagnostic, therapy-accompanying app were identified: mood checks, library, reminders, goals and tasks, emergency kit, and questionnaires. Additionally, the integration of mental health apps into daily routines was influenced by various drivers and barriers. The most significant barriers included technological issues and practical constraints, such as limited time and resources. The most important driver was the perceived improvement in treatment quality. Conclusions: Overall, psychotherapists were generally open to using a therapy-accompanying mental health app. However, study participation and app usage remained low. As psychotherapists act as gatekeepers for patients’ use of mental health apps, their needs should be prioritized in the development and implementation of such apps. Trial Registration: German Clinical Trials Register DRKS00031258; https://drks.de/search/en/trial/DRKS00031258/details %M 40198916 %R 10.2196/65788 %U https://formative.jmir.org/2025/1/e65788 %U https://doi.org/10.2196/65788 %U http://www.ncbi.nlm.nih.gov/pubmed/40198916 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57368 %T Psychological eHealth Interventions for Patients With Cardiovascular Diseases: Systematic Review and Meta-Analysis %A Su,Jing Jing %A Lin,Rose %A Batalik,Ladislav %A Wong,Arkers Kwan Ching %A Grace,Sherry L %+ Elaine C. Hubbard Center for Nursing Research on Aging, School of Nursing, University of Rochester, 255 Crittenden Blvd, Rochester, NY, 14642, United States, 1 (585) 276 6833, sinyirose_lin@urmc.rochester.edu %K cardiovascular diseases %K eHealth %K digital health %K iCBT %K mental health %K psychological intervention %K cognitive behavioral therapy %K CBT %K depression %K heart %K cardiology %K psychological %K anxiety %K high-risk %K systematic review %K meta-analysis %K CVD %K evidence-based %K psychosocial %K GRADE approach %K Cochrane Risk of Bias Tool %K internet-based %K psychological therapy %K psychotherapy %D 2025 %7 7.4.2025 %9 Review %J J Med Internet Res %G English %X Background: Psychological distress is recognized as an independent risk factor for cardiovascular diseases (CVDs), contributing to increased morbidity and mortality. While eHealth is increasingly used to deliver psychological interventions, their effectiveness for patients with CVDs remains unclear. Objective: This meta-analysis aimed to evaluate the effects of eHealth psychological interventions for patients with CVDs. Methods: Eligible studies were retrieved from 5 databases (Embase, Medline, PubMed, CINAHL, and Cochrane Library), covering the period from database inception to December 2024. Randomized controlled trials (RCTs) investigating the effect of evidence-based psychological eHealth interventions to improve psychosocial well-being and cardiovascular outcomes for people with CVDs were included. The Cochrane Risk of Bias tool (version 2) was used to judge the methodological quality of reviewed studies. RevMan (version 5.3) was used for meta-analysis. Results: A total of 12 RCTs, comprising 2319 participants from 10 countries, were included in the review. The results demonstrated significant alleviation of depressive symptoms for patients receiving psychological eHealth intervention compared to controls (number of paper included in that particular analysis, n=7; standardized mean difference=–0.30, 95% CI –0.47 to –0.14; I2=57%; P<.001). More specifically, in 6 trials where internet-based cognitive behavioral therapy was delivered, a significant alleviation of depressive symptoms was achieved (standardized mean difference=–0.39, 95% CI –0.56 to –0.21; I2=53%; P<.001). There was no significant change in anxiety or quality of life. Synthesis without meta-analysis regarding stress, adverse events, and cardiovascular events showed inconclusive findings. Conclusions: Psychological eHealth interventions, particularly internet-based cognitive behavioral therapy, can significantly reduce depressive symptoms among patients with CVDs. A multidisciplinary approach is crucial for comprehensively improving psychological and cardiovascular outcomes. Future studies should explore integrating persuasive design features into eHealth and involving mental health professionals for intervention delivery. Trial Registration: PROSPERO CRD42023452276; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023452276 %M 40194269 %R 10.2196/57368 %U https://www.jmir.org/2025/1/e57368 %U https://doi.org/10.2196/57368 %U http://www.ncbi.nlm.nih.gov/pubmed/40194269 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68544 %T Exploring Engagement With and Effectiveness of Digital Mental Health Interventions in Young People of Different Ethnicities: Systematic Review %A Bakhti,Rinad %A Daler,Harmani %A Ogunro,Hephzibah %A Hope,Steven %A Hargreaves,Dougal %A Nicholls,Dasha %+ Department of Brain Sciences, Division of Psychiatry, Imperial College London, Du Cane Road, London, W12 0NN, United Kingdom, 44 020 7594 1069, r.bakhti@imperial.ac.uk %K digital mental health interventions %K young people %K ethnicity %K engagement %K effectiveness %K artificial intelligence %K AI %D 2025 %7 7.4.2025 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of mental health difficulties among young people has risen in recent years, with 75% of mental disorders emerging before the age of 24 years. The identification and treatment of mental health issues earlier in life improves later-life outcomes. The COVID-19 pandemic spurred the growth of digital mental health interventions (DMHIs), which offer accessible support. However, young people of different ethnicities face barriers to DMHIs, such as socioeconomic disadvantage and cultural stigma. Objective: This review aimed to summarize and evaluate the engagement with and effectiveness of DMHIs among young people of different ethnicities. Methods: A systematic search was conducted in MEDLINE, Embase, and PsycINFO for studies published between January 2019 and May 2024, with an update in September 2024. The inclusion criteria were participants aged <25 years using DMHIs from various ethnic backgrounds. Three reviewers independently screened and selected the studies. Data on engagement (eg, use and uptake) and effectiveness (eg, clinical outcomes and symptom improvement) were extracted and synthesized to compare findings. Studies were assessed for quality using the Mixed Methods Appraisal Tool. Results: The final search yielded 67 studies, of which 7 (10%) met inclusion criteria. There were 1853 participants across the 7 studies, all from high-income countries. Participants were predominantly aged 12 to 25 years, with representation of diverse ethnic identities, including Black, Asian, Hispanic, mixed race, and Aboriginal individuals. Engagement outcomes varied, with culturally relatable, low-cost interventions showing higher retention and user satisfaction. Linguistic barriers and country of origin impeded the effectiveness of some interventions, while near-peer mentorship, coproduction, and tailored content improved the effectiveness of DMHIs. While initial results are promising, small sample sizes, heterogeneity in outcome assessments, and a paucity of longitudinal data impeded robust comparisons and generalizability. Conclusions: DMHIs show potential as engaging and effective mental health promotional tools for young people of different ethnicities, especially when coproduced and culturally relatable. Initial data suggest that interventions facilitating near-peer mentoring, linguistic adaptation, low cost, and cultural relatability have improved engagement and effectiveness. Future research should focus on developing a consensus definition of DMHIs, exploring DMHIs in children aged <12 years, and conducting detailed qualitative and quantitative research on use factors and treatment efficacy of DMHIs for young people of different ethnicities. Trial Registration: PROSPERO CRD42024544364; https://tinyurl.com/yk5jt8yk %M 40194267 %R 10.2196/68544 %U https://www.jmir.org/2025/1/e68544 %U https://doi.org/10.2196/68544 %U http://www.ncbi.nlm.nih.gov/pubmed/40194267 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e67190 %T Health Care Professionals' Engagement With Digital Mental Health Interventions in the United Kingdom and China: Mixed Methods Study on Engagement Factors and Design Implications %A Zhang,Zheyuan %A Sun,Sijin %A Moradbakhti,Laura %A Hall,Andrew %A Mougenot,Celine %A Chen,Juan %A Calvo,Rafael A %K burnout %K digital mental health interventions %K engagement %K eHealth %K design %K health care professional %K health care workers %K United Kingdom %K UK %K China %K Chinese %K occupational stress %K mixed-methods %K stigma %K well-being %K mental health %K digital health %K occupational health %D 2025 %7 4.4.2025 %9 %J JMIR Ment Health %G English %X Background: Mental health issues like occupational stress and burnout, compounded with the after-effects of COVID-19, have affected health care professionals (HCPs) around the world. Digital mental health interventions (DMHIs) can be accessible and effective in supporting well-being among HCPs. However, low engagement rates of DMHIs are frequently reported, limiting the potential effectiveness. More evidence is needed to reveal the factors that impact HCPs’ decision to adopt and engage with DMHIs. Objective: This study aims to explore HCPs’ motivation to engage with DMHIs and identify key factors affecting their engagement. Amongst these, we include cultural factors impacting DMHI perception and engagement among HCPs. Methods: We used a mixed method approach, with a cross-sectional survey (n=438) and semistructured interviews (n=25) with HCPs from the United Kingdom and China. Participants were recruited from one major public hospital in each country. Results: Our results demonstrated a generally low engagement rate with DMHIs among HCPs from the 2 countries. Several key factors that affect DMHI engagement were identified, including belonging to underrepresented cultural and ethnic groups, limited mental health knowledge, low perceived need, lack of time, needs for relevance and personal-based support, and cultural elements like self-stigma. The results support recommendations for DMHIs for HCPs. Conclusions: Although DMHIs can be an ideal alternative mental health support for HCPs, engagement rates among HCPs in China and the United Kingdom are still low due to multiple factors and barriers. More research is needed to develop and evaluate tailored DMHIs with unique designs and content that HCPs can engage from various cultural backgrounds. %R 10.2196/67190 %U https://mental.jmir.org/2025/1/e67190 %U https://doi.org/10.2196/67190 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65412 %T Assessing the Cultural Fit of a Digital Sleep Intervention for Refugees in Germany: Qualitative Study %A Blomenkamp,Maja %A Kiesel,Andrea %A Baumeister,Harald %A Lehr,Dirk %A Unterrainer,Josef %A Sander,Lasse B %A Spanhel,Kerstin %+ Institute of Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstr. 29, Freiburg, D-79104, Germany, 49 761 203 5530, kerstin.spanhel@mps.uni-freiburg.de %K Ukraine %K eHealth %K sleep disturbances %K low-threshold treatment %K culturally sensitive treatment %K refugee %K digital sleep %K Germany %K digital intervention %K interview %K content analysis %K qualitative study %K mental burden %K mental health care %K electronic health %K digital health %D 2025 %7 3.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital interventions have been suggested to facilitate access to mental health care for refugees, who experience structural, linguistic, and cultural barriers to mental health care. Sleep-e, a digital sleep intervention originally developed for German teachers, has been culturally adapted for refugees in Germany mainly coming from African and Middle East countries. With the increasing number of refugees from Ukraine and the associated diversity of cultural backgrounds among refugees in Germany, it is essential to assess whether existing digital interventions are culturally appropriate for this target group as well. Objective: The study aimed to investigate the perceived cultural appropriateness of Sleep-e in both its original and culturally adapted versions among refugees in Germany, hereby exploring and possibly contrasting the needs of refugees coming from Ukraine and other countries of origin. Methods: Overall, 13 refugees (6 from Ukraine, 23-66 years old; and 7 from other countries, 26-41 years old) participated in the study. Each participant went through parts of the original or culturally adapted version of the digital sleep intervention, with 5 participants going through both versions. A total of 17 semistructured interviews (11 for the adapted, 6 for the nonadapted intervention version) and 9 think-aloud sessions (6 for the adapted, 3 for the nonadapted intervention version) were conducted to assess cultural appropriateness, suggestions for adaptations, and perceived relevance. Data were transcribed, categorized, and analyzed using structured qualitative content analysis. Results: The findings showed key differences in the perceived appropriateness and identification between the 2 refugee groups and the 2 intervention versions. Ukrainian participants expressed positive (n=70) and negative (n=56) feedback on the adapted intervention version, which revealed identity conflicts, as the adapted intervention version was targeted at a refugee population with whom they could not fully identify (18 negative feedback quotes concerning the refugee example characters). Whereas they identified with the European context in the original version, they found the problems described less relevant to their experiences. In contrast, participating refugees from other countries found the culturally adapted version more comprehensible and culturally appropriate (55 positive and 5 negative feedback quotes). No significant usability issues were reported, but several participants highlighted the need for an individualization of the intervention content. Conclusions: Neither the original nor culturally adapted version of the digital sleep intervention fully met the needs of all refugee groups, highlighting the complexity of culturally adapting digital interventions for this population. Particularly, the identity conflict of participating Ukrainian refugees regarding the refugee context suggests that adaptation should go beyond regional considerations and consider the dynamics of social identity. These findings emphasize the relevance of including co-design processes with different refugee populations to ensure broad identification and, herewith, cultural appropriateness of digital interventions. Trial Registration: German Clinical Trials Register DRKS00036484; https://drks.de/search/de/trial/DRKS00036484 %M 40179371 %R 10.2196/65412 %U https://formative.jmir.org/2025/1/e65412 %U https://doi.org/10.2196/65412 %U http://www.ncbi.nlm.nih.gov/pubmed/40179371 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e72414 %T Exploring the Relationship Between Cyberchondria and Suicidal Ideation: Cross-Sectional Mediation Analysis %A Xu,Richard Huan %A Liang,Xiao %A Starcevic,Vladan %+ Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, ST-538, Hung Hom, Kowloon, Hong Kong, China (Hong Kong), 852 27664199, richard.xu@polyu.edu.hk %K cyberchondria %K suicidal ideation %K distress %K structural equation modeling %K mediation analysis %D 2025 %7 2.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The proliferation of internet-based health information has intensified cyberchondria, or anxiety resulting from excessive health-related searches. The relationship between cyberchondria and suicidal ideation remains underexplored, although there are indications that people with high levels of cyberchondria may also be suicidal. Understanding this relationship is critical, given rising digital health-seeking behaviors and the need to mitigate suicide risk. Emerging evidence suggests that psychological distress can mediate the relationship between cyberchondria and suicidal ideation. However, to the best of our knowledge, no research has directly examined these associations. Objective: This study had two aims. The first was to examine the relationship between cyberchondria and suicidal ideation in a sample of the general Chinese population. The second aim was to investigate the possible role of psychological distress, reflecting the symptoms of depression and anxiety, as a mediator in the relationship between cyberchondria and suicidal ideation. Methods: Data were obtained from a cross-sectional and web-based survey conducted in 2024. Structural equation modeling analysis was used to assess the hypothesized association between cyberchondria and suicidal ideation, as well as the mediating effect of psychological distress on this association. The Cyberchondria Severity Scale-12 items, Suicidal Ideation Attributes Scale, and Kessler Psychological Distress Scale-10 items were used to measure cyberchondria, suicidal ideation, and psychological distress, respectively. Standardized (β) estimates, along with their 95% CIs, were calculated for all structural paths, adjusting for participants’ background characteristics. Results: A total of 2415 individuals completed the questionnaire (response rate=98.5%). Scores on the Cyberchondria Severity Scale-12 items ranged from 12 to 60, with the mean score being 40 (SD 7.9). The mean score on the Suicidal Ideation Attributes Scale was 12.7 (SD 9.9). Scores on the Kessler Psychological Distress Scale-10 items ranged from 10 to 50, and the mean score was 22 (SD 6.9). Cyberchondria, suicidal ideation, and psychological distress were significantly correlated. Structural equation modeling revealed a significant association between cyberchondria and psychological distress (β=.281; P<.001), between psychological distress and suicidal ideation (β=.504; P<.001), and between cyberchondria and suicidal ideation (β=.107; P<.001). The indirect effect of cyberchondria on suicidal ideation through psychological distress was also significant (β=.142; P<.001). Conclusions: The main contribution of this study is that it highlights an important relationship between cyberchondria and suicidal ideation, with a direct and statistically significant association between these variables. Their relationship is also mediated by psychological distress, which reflects the role of depressive and anxiety symptoms. %M 40173445 %R 10.2196/72414 %U https://www.jmir.org/2025/1/e72414 %U https://doi.org/10.2196/72414 %U http://www.ncbi.nlm.nih.gov/pubmed/40173445 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e72354 %T Is the Pinball Machine a Blind Spot in Serious Games Research? %A Eckardt,Jens Peter %K serious games %K research %K interventions %K arcade technology %K digital game paradigm %K pinball gaming %K arcade gaming %K executive functions %K neurodiversity %K cognitive training %K therapeutic interventions %D 2025 %7 2.4.2025 %9 %J JMIR Serious Games %G English %X %R 10.2196/72354 %U https://games.jmir.org/2025/1/e72354 %U https://doi.org/10.2196/72354 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e73034 %T Authors’ Reply: Is the Pinball Machine a Blind Spot in Serious Games Research? %A Rodríguez Timaná,Luis Carlos %A Castillo García,Javier Ferney %A Bastos Filho,Teodiano %A Ocampo González,Alvaro Alexander %A Hincapié Monsalve,Nazly Rocio %A Valencia Jimenez,Nicolas Jacobo %K serious games %K research %K interventions %K arcade technology %K digital game paradigm %K pinball gaming %K arcade gaming %K executive functions %K neurodiversity %K cognitive training %K therapeutic interventions %D 2025 %7 2.4.2025 %9 %J JMIR Serious Games %G English %X %R 10.2196/73034 %U https://games.jmir.org/2025/1/e73034 %U https://doi.org/10.2196/73034 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e64619 %T Extended Reality–Enhanced Mental Health Consultation Training: Quantitative Evaluation Study %A Hiley,Katherine %A Bi-Mohammad,Zanib %A Taylor,Luke %A Burgess-Dawson,Rebecca %A Patterson,Dominic %A Puttick-Whiteman,Devon %A Gay,Christopher %A Hiscoe,Janette %A Munsch,Chris %A Richardson,Sally %A Knowles-Lee,Mark %A Beecham,Celia %A Ralph,Neil %A Chatterjee,Arunangsu %A Mathew,Ryan %A Mushtaq,Faisal %+ School of Psychology, Faculty of Medicine & Health, University of Leeds, Woodhouse, Leeds, LS2 9JT, United Kingdom, 44 07525418924, f.mushtaq@leeds.ac.uk %K mental health %K training %K consultation %K extended reality %K virtual reality %K augmented reality %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Med Educ %G English %X Background: The use of extended reality (XR) technologies in health care can potentially address some of the significant resource and time constraints related to delivering training for health care professionals. While substantial progress in realizing this potential has been made across several domains, including surgery, anatomy, and rehabilitation, the implementation of XR in mental health training, where nuanced humanistic interactions are central, has lagged. Objective: Given the growing societal and health care service need for trained mental health and care workers, coupled with the heterogeneity of exposure during training and the shortage of placement opportunities, we explored the feasibility and utility of a novel XR tool for mental health consultation training. Specifically, we set out to evaluate a training simulation created through collaboration among software developers, clinicians, and learning technologists, in which users interact with a virtual patient, “Stacey,” through a virtual reality or augmented reality head-mounted display. The tool was designed to provide trainee health care professionals with an immersive experience of a consultation with a patient presenting with perinatal mental health symptoms. Users verbally interacted with the patient, and a human instructor selected responses from a repository of prerecorded voice-acted clips. Methods: In a pilot experiment, we confirmed the face validity and usability of this platform for perinatal and primary care training with subject-matter experts. In our follow-up experiment, we delivered personalized 1-hour training sessions to 123 participants, comprising mental health nursing trainees, general practitioner doctors in training, and students in psychology and medicine. This phase involved a comprehensive evaluation focusing on usability, validity, and both cognitive and affective learning outcomes. Results: We found significant enhancements in learning metrics across all participant groups. Notably, there was a marked increase in understanding (P<.001) and motivation (P<.001), coupled with decreased anxiety related to mental health consultations (P<.001). There were also significant improvements to considerations toward careers in perinatal mental health (P<.001). Conclusions: Our findings show, for the first time, that XR can be used to provide an effective, standardized, and reproducible tool for trainees to develop their mental health consultation skills. We suggest that XR could provide a solution to overcoming the current resource challenges associated with equipping current and future health care professionals, which are likely to be exacerbated by workforce expansion plans. %M 40173446 %R 10.2196/64619 %U https://mededu.jmir.org/2025/1/e64619 %U https://doi.org/10.2196/64619 %U http://www.ncbi.nlm.nih.gov/pubmed/40173446 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68249 %T Examining the Client Experience of Digital Tools in Blended Care Therapy: Qualitative Interview Study %A Lattie,Emily G %A Beltzer,Miranda %A Varra,Alethea %A Chen,Connie E %A Lungu,Anita %+ , Lyra Health, 270 East Lane, Burlingame, CA, 94010, United States, 1 (877) 505 7147, elattie@lyrahealth.com %K anxiety %K depression %K blended care therapy %K mental health care %K digital mental health %K digital tools %K qualitative interviews %K Lyra Care Therapy %K video lesson %K symptom assessment %K written exercise %K thematic analysis %K LCT model %K therapeutic value %K client experience %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Lyra Health’s short-term blended care therapy model, Lyra Care Therapy (LCT), has demonstrated effectiveness at scale. In LCT, clients participate in synchronous telehealth sessions and asynchronous guided practice sessions, in which they are provided with digital tools to reinforce key concepts and skills. These digital tools include animated video lessons that use storytelling to show characters learning and implementing new skills from therapy, written psychoeducational materials, interactive exercises that prompt reflection and skills practice, symptom assessments, and messaging with therapists. Past research on LCT found that time spent in therapy sessions and viewing digital video lessons predicts improvements in depression and anxiety symptoms. Objective: This study aims to explore the client experience of LCT digital tools and to understand clients’ perceived benefits and challenges of using digital tools while in LCT. Methods: In total, 12 ethnically and racially diverse adults (5 male, 6 female, and 1 pangender) who had graduated from LCT in the previous 4 months participated in semistructured interviews. Interviews focused on experiences with the digital components of LCT (ie, video lessons, symptom assessments, and written exercises). Transcripts were analyzed using thematic analytic methods to determine the benefits and challenges associated with components of the LCT model. Results: In total, 3 primary themes were generated through thematic analysis. These themes centered around supporting knowledge and skill development, the benefits and challenges associated with the range of digital tools, and the combination of flexibility and accountability promoting positive change. First, we summarize the ways in which guided practice sessions allow clients to develop additional knowledge and learn skills related to their mental health and well-being. Then, we describe how the range of digital tools included in LCT presents different benefits and challenges for clients. Finally, we discuss how flexibility inherent in having both synchronous and asynchronous sessions, along with the accountability from a provider, encourages clients to continue to practice skills related to their mental health and well-being. Conclusions: Results provide insights into the unique contributions of different components of the LCT model on therapeutic gains. While perceived time constraints and content preferences can impact engagement with digital tools, overall the digital tools were perceived as carrying significant value for participants in the LCT program. %M 40173439 %R 10.2196/68249 %U https://formative.jmir.org/2025/1/e68249 %U https://doi.org/10.2196/68249 %U http://www.ncbi.nlm.nih.gov/pubmed/40173439 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64068 %T Escape Game to Promote Students’ Mental Health Outcomes in the Aftermaths of COVID-19 Pandemic: Protocol for a Mixed Methods Study Evaluating a Cocreated Intervention %A Labrosse,David %A Vié,Clara %A Harb,Mireille %A Montagni,Ilaria %+ Bordeaux Population Health U1219, Inserm, University of Bordeaux, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 05 47 30 42 80, ilaria.montagni@u-bordeaux.fr %K Escape game %K pilot randomized controlled trial %K Covid-19 %K cocreation %K students %K mobile phone %D 2025 %7 2.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic and the protracted lockdowns have heavily impacted university students’ mental health. Digital Escape Games represent a good means to reach students and propose them solutions for their psychological well-being. Objective: This study aimed to evaluate a cocreated digital Escape Game on students’ mental health in the aftermath of the COVID-19 pandemic, called EscapeCovid Game. The evaluation of the effectiveness of this stand-alone intervention concerns mental health outcomes (mental health literacy, appraisal and change of beliefs about mental health, management of emotions, and development of coping strategies) and the appreciation and relevance of the game. Methods: A randomized controlled trial with pre- and posttest data collection (online questionnaires with validated scales) is conducted among 500 students in Bordeaux, France, to evaluate the EscapeCovid Game cocreated with students, researchers, health professionals, and web developers. A subsample of students is randomly selected for responding to a semistructured interview following a mixed methods design. Recruitment is done through mail invitations from student associations and presentations in university classes. Half of the sample of the trial plays the Escape Game, while the other half receives an email with mental health–related information. Within the game, students discuss their personal experiences. The text is further used for the qualitative analyses. The whole study is carried out online. Results: The EscapeCovid Game has been developed, tested, and finalized by the end of March 2023. As of November 4, 2024, a total of 191 students have answered the baseline questionnaire (90 intervention vs 101 control). A total of 23 students have played the game and 53 are in the control arm. Among participants, by the end of September 20, 2023, twenty were interviewed (10 intervention and 10 control) reaching sample saturation. According to preliminary results, the EscapeCovid Game has had a positive impact on all defined outcomes, while the email has been effective in increasing knowledge on resources available and on coping strategies and meditation techniques. We expect the trial to be completed by the end of June 2025. Conclusions: The mixed methods findings of this study are due to demonstrate the effectiveness of the EscapeCovid Game in improving students’ mental health outcomes. Preliminary results from the qualitative substudy are promising: in the aftermath of the COVID-19 crisis, this intervention is intended to promote players’ mental health through gamification, knowledge transfer, and a learning-by-doing approach. Trial Registration: ClinicalTrials.gov NCT06720792; https://clinicaltrials.gov/study/NCT06720792 International Registered Report Identifier (IRRID): DERR1-10.2196/64068 %M 40173436 %R 10.2196/64068 %U https://www.researchprotocols.org/2025/1/e64068 %U https://doi.org/10.2196/64068 %U http://www.ncbi.nlm.nih.gov/pubmed/40173436 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54062 %T Evaluation of an Online-Based Self-Help Program for Patients With Panic Disorder: Randomized Controlled Trial %A Lalk,Christopher %A Väth,Teresa %A Hanraths,Sofie %A Pruessner,Luise %A Timm,Christina %A Hartmann,Steffen %A Barnow,Sven %A Rubel,Julian %+ Clinical Psychology and Psychotherapy of Adulthood, Institute of Psychology, University Osnabrück, Lise-Meitner-Straße 3, Osnabrück, 49076, Germany, 49 541 969 76, christopher.lalk@uni-osnabrueck.de %K internet-based CBT %K agoraphobia %K well-being %K iCBT %K internet-based intervention %K panic disorder with and without agoraphobia %K panic disorder %K self-help %K quality of life %K effectiveness %K online %K self-help intervention %K panic symptoms %K well-being %K daily functioning %D 2025 %7 2.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Panic disorder is an anxiety disorder marked by severe fear of panic attacks in the absence of causes. Agoraphobia is a related anxiety disorder, which involves fear and avoidance of specific situations in which escape or help may be difficult. Both can be debilitating and impair well-being. One treatment option may be internet-based cognitive behavioral therapy (iCBT), which allows large-scale application and may overcome treatment barriers for some individuals. Objective: This study aimed to evaluated the effectiveness of a novel online self-help intervention for panic disorder with or without agoraphobia. As our primary hypotheses, we expected the intervention to improve panic and agoraphobia symptoms and well-being. Our secondary hypotheses entailed improvements in daily functioning, mental health literacy, working ability, and health care use in the intervention group. Methods: German-speaking patients (N=156) aged 18-65 years with internet access and a diagnosis of panic disorder with or without agoraphobia were recruited for this randomized controlled trial. The intervention group (n=82) received access to a 12-week online self-help program entailing psychoeducation, cognitive restructuring, exposure, and mindfulness elements. The control group (n=72) received care as usual during the study period and was offered the prospect of using the program after 12 weeks. The primary outcomes were assessed via the Panic and Agoraphobia Scale (PAS) and the WHO (World Health Organization)-5 Well-Being Index (WHO-5). Mixed effect models were computed using multivariate imputation by chained equation for the analysis of intervention effects. Results: In the intervention group, participants completed on average 7.3 out of 12 (60.8%) modules, and 27 out of 82 (32.1%) participants finished the whole course. Changes in PAS revealed a significant effect in favor of the intervention group (t110.1=–2.22, Padj=.03) with a small to moderate effect size (d=–0.37, 95% CI –0.70 to –0.04). No significant effect was found for the second primary outcome WHO-5 (t149.8=1.35, Padj=.09) or the secondary outcomes. Improvements were observed in anxiety (t206.8=–4.12; P<.001; Cohen d=–0.60, 95% CI –0.089 to –0.32) and depression (t257.4=–3.20; P<.001; Cohen d=–0.41 95% CI –0.66 to –0.16). No negative effects were associated with the intervention (t125=–1.14, P=.26). Conclusions: The presented online intervention can help reduce the core symptomatology of panic disorder and agoraphobia, as well as anxiety symptoms and associated depression. No effects were found for well-being and secondary outcomes. This may be due to higher illness burden in the intervention group and possibly the COVID pandemic, which caused unique challenges to patients suffering from panic disorder. Therefore, further research and intervention adaptations may be warranted to improve these outcomes. Trial Registration: German Clinical Trials Register DRKS00023800; https://drks.de/search/en/trial/DRKS00023800 %M 40173444 %R 10.2196/54062 %U https://www.jmir.org/2025/1/e54062 %U https://doi.org/10.2196/54062 %U http://www.ncbi.nlm.nih.gov/pubmed/40173444 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67782 %T AI-Enhanced Virtual Reality Self-Talk for Psychological Counseling: Formative Qualitative Study %A Zisquit,‪Moreah %A Shoa,Alon %A Oliva,Ramon %A Perry,Stav %A Spanlang,Bernhard %A Brunstein Klomek,Anat %A Slater,Mel %A Friedman,Doron %+ Baruch Ivcher School of Psychology, Reichman University, Baruch Ivcher School of Psychology, Ha'universita 8, Herzliya, Israel, 972 523091406, Zisquit.moreah@post.runi.ac.il %K virtual human %K large language model %K virtual reality %K self-talk %K psychotherapy %K artificial intelligence %K AI %D 2025 %7 2.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Access to mental health services continues to pose a global challenge, with current services often unable to meet the growing demand. This has sparked interest in conversational artificial intelligence (AI) agents as potential solutions. Despite this, the development of a reliable virtual therapist remains challenging, and the feasibility of AI fulfilling this sensitive role is still uncertain. One promising approach involves using AI agents for psychological self-talk, particularly within virtual reality (VR) environments. Self-talk in VR allows externalizing self-conversation by enabling individuals to embody avatars representing themselves as both patient and counselor, thus enhancing cognitive flexibility and problem-solving abilities. However, participants sometimes experience difficulties progressing in sessions, which is where AI could offer guidance and support. Objective: This formative study aims to assess the challenges and advantages of integrating an AI agent into self-talk in VR for psychological counseling, focusing on user experience and the potential role of AI in supporting self-reflection, problem-solving, and positive behavioral change. Methods: We carried out an iterative design and development of a system and protocol integrating large language models (LLMs) within VR self-talk during the first two and a half years. The design process addressed user interface, speech-to-text functionalities, fine-tuning the LLMs, and prompt engineering. Upon completion of the design process, we conducted a 3-month long exploratory qualitative study in which 11 healthy participants completed a session that included identifying a problem they wanted to address, attempting to address this problem using self-talk in VR, and then continuing self-talk in VR but this time with the assistance of an LLM-based virtual human. The sessions were carried out with a trained clinical psychologist and followed by semistructured interviews. We used applied thematic analysis after the interviews to code and develop key themes for the participants that addressed our research objective. Results: In total, 4 themes were identified regarding the quality of advice, the potential advantages of human-AI collaboration in self-help, the believability of the virtual human, and user preferences for avatars in the scenario. The participants rated their desire to engage in additional such sessions at 8.3 out of 10, and more than half of the respondents indicated that they preferred using VR self-talk with AI rather than without it. On average, the usefulness of the session was rated 6.9 (SD 0.54), and the degree to which it helped solve their problem was rated 6.1 (SD 1.58). Participants specifically noted that human-AI collaboration led to improved outcomes and facilitated more positive thought processes, thereby enhancing self-reflection and problem-solving abilities. Conclusions: This exploratory study suggests that the VR self-talk paradigm can be enhanced by LLM-based agents and presents the ways to achieve this, potential pitfalls, and additional insights. %M 40173447 %R 10.2196/67782 %U https://formative.jmir.org/2025/1/e67782 %U https://doi.org/10.2196/67782 %U http://www.ncbi.nlm.nih.gov/pubmed/40173447 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63405 %T Integrating Virtual Reality, Neurofeedback, and Cognitive Behavioral Therapy for Auditory Verbal Hallucinations (Hybrid): Protocol of a Pilot, Unblinded, Single-Arm Interventional Study %A Spark,Jessica %A Rowe,Elise %A Alvarez-Jimenez,Mario %A Bell,Imogen %A Byrne,Linda %A Dzafic,Ilvana %A Ellinghaus,Carli %A Lavoie,Suzie %A Lum,Jarrad %A McLean,Brooke %A Thomas,Neil %A Thompson,Andrew %A Wadley,Greg %A Whitford,Thomas %A Wood,Stephen %A Yuen,Hok Pan %A Nelson,Barnaby %+ Orygen, 35 Poplar Rd, Parkville, 3052, Australia, 61 399669100, elise.rowe@unimelb.edu.au %K psychosis %K first episode psychosis %K schizophrenia %K virtual reality %K neurofeedback %K EEG %K auditory verbal hallucinations %K voices %K cognitive behavior therapy %K youth mental health %K pilot study %K paracusias %K paracusis %K treatment %K medication %K psychotic disorder %K efficacy %K neuroscience %K psychology %K hybrid %K adolescent %K Australia %D 2025 %7 1.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Current treatments for schizophrenia and other psychotic disorders have limited efficacy, with high rates of nonresponse to “gold standard” treatments. New approaches are therefore urgently required. Objective: The aims of this pilot study are to investigate the feasibility, acceptability, safety, and usability of Hybrid treatment (primary aim); and to explore Hybrid’s treatment efficacy and engagement of treatment targets (secondary aim). The primary aim will be assessed via face-to-face user experience surveys on a (self-assessed) 5-point Likert scale (and qualitative open-ended questions) examining: (1) acceptability, (2) helpfulness, (3) engagement, and (4) perceived safety. We will also examine consent and completion rates, and the number of sessions attended. Our threshold for moving on to efficacy trials will be at least 70% of our participants to rate 3 and above (which corresponds to agree or strongly agree) that the intervention package was acceptable, feasible, and safe. The secondary aims will be assessed by observing whether individuals achieve self-directed modulation of high-β neurophysiological activity (neural target) and progression upwards through the VR-based exposure hierarchy (psychological target), and by assessing symptom change scores. This study developed a new treatment approach for auditory verbal hallucinations, a major symptom of psychotic disorders, that integrates advances in psychological therapy (cognitive behavioral therapy for psychosis), technology (virtual reality, VR), and neuroscience (electroencephalography-based neurofeedback). Methods: Hybrid takes a “symptom capture” approach using individually tailored VR-based exposure exercises. Participants (N=10) will receive the intervention package weekly over 12 face-to-face sessions. Here, participants will be progressively exposed to symptom triggers and develop methods of downregulating neural activity associated with these symptoms (neurofeedback component) while concurrently receiving clinician-delivered cognitive behavioral therapy for psychosis. Results: As of February 2025, Hybrid has commenced (unblinded) recruitment activities from Orygen clinical services in Northwestern Melbourne, Australia. A total of 75 individuals have been approached and 64 individuals have been prescreened (41 individuals were deemed eligible, 15 individuals were ineligible, and 8 individuals declined or did not respond to contact attempts) and 5 individuals have been included in the study. Of the 5 individuals who have commenced the Hybrid treatment, 4 are actively engaged in the program and 1 individual has withdrawn. We expect recruitment to conclude in July 2025 and for the results to be published in 2026. Conclusions: The Hybrid study is piloting a novel approach that has the potential to address the shortcomings of current treatments for psychotic symptoms. If there is favorable evidence for the acceptability, feasibility, safety and usability of Hybrid, the study team will move on to efficacy trials. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12624000357550; https://tinyurl.com/24ey8hpy International Registered Report Identifier (IRRID): PRR1-10.2196/63405 %M 40168662 %R 10.2196/63405 %U https://www.researchprotocols.org/2025/1/e63405 %U https://doi.org/10.2196/63405 %U http://www.ncbi.nlm.nih.gov/pubmed/40168662 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66904 %T Exploring Technical Features to Enhance Control in Videoconferencing Psychotherapy: Quantitative Study on Clinicians’ Perspectives %A Cataldo,Francesco %A Chang,Shanton %A Mendoza,Antonette %A Buchanan,George %A Van Dam,Nicholas %+ School of Computing and Information System, University of Melbourne, Grattan Street, Melbourne, 3052, Australia, 61 0390355511, fcataldo@student.unimelb.edu.au %K videoconference psychotherapy %K control %K therapeutic relationship %K therapeutic alliance %K videoconference technologies %K technological features %K video %K telepsychiatry %K videoconferencing %K psychotherapy %K mental health %K mental %K therapy %K therapist %K videoconference %K platform %K psychology %K psychologist %D 2025 %7 1.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic required psychologists and other mental health professionals to use videoconferencing platforms. Previous research has highlighted therapists’ hesitation toward adopting the medium since they find it hard to establish control over videoconferencing psychotherapy (VCP). An earlier study provided a set of potential features that may help enhance psychologists’ control in their videoconference sessions, such as screen control functionality, emergency call functionality, eye contact functionality, zooming in and out functionality, and an interactive interface with other apps and software. Objective: This study aims to investigate whether introducing technical features might improve clinicians’ control over their video sessions. Additionally, it seeks to understand the role of the video in therapists’ VCP experience from a technical and relationship point of view. Methods: A total of 121 mental health professionals responded to the survey, but only 86 participants provided complete data. Exploratory Factor Analysis was used to scrutinize the data collected. A total of three factors were identified: (1) “challenges in providing VCP,” (2) “features to enhance the therapeutic relationship,” and (3) “enhancing control.” Path analysis was used to observe the relationship between factors on their own and with adjustment to participants’ areas of expertise and year in practice. Results: This study highlighted a relationship between the three identified factors. It was found that introducing certain features reduced therapists' challenges in the provision of VCP. Moreover, the additional features provided therapists with enhanced control over their VCP sessions. A path analysis was conducted to investigate the relationships between the factors loaded. The results of the analysis revealed a significant relationship between “challenges in VCP” and “features to enhance the therapeutic relationship” (adjusted beta [Adjβ]=–0.54, 95% CI 0.29-0.79; P<.001). Additionally, a significant positive relationship was found between “features to enhance the therapeutic relationship” and “enhancing control” (Adjβ=0.25, 95% CI 0.15-0.35; P<.001). Furthermore, there was an indirect effect of “challenges in providing VCP” on “enhancing control” (Adjβ=0.13, 95% CI 0.05-0.22; P=.001) mediated by “features to enhance TR.” The analysis identified the factor “features to enhance TR” (effect size=0.25) as key for improving clinicians’ performance and control. Conclusions: This study demonstrates that technology may help improve therapists’ VCP experiences by implementing features that respond to their need for enhanced control. By augmenting therapists’ control, clinicians can effectively serve their patients and facilitate successful therapy outcomes. Moreover, this study confirms the video as a third agent that prevents therapists from affecting clients’ reality due to technical and relational limits. Additionally, this study supports the general system theory, which allowed for the incorporation of video in our exploration and helped explain its agency in VCP. %M 40168042 %R 10.2196/66904 %U https://www.jmir.org/2025/1/e66904 %U https://doi.org/10.2196/66904 %U http://www.ncbi.nlm.nih.gov/pubmed/40168042 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e65356 %T Psychotherapy Access Barriers and Interest in Digital Mental Health Interventions Among Adults With Treatment Needs: Survey Study %A Starvaggi,Isabella %A Lorenzo-Luaces,Lorenzo %+ , Indiana University Bloomington, 1101 E 10th St, Bloomington, IN, 47405, United States, 1 (812) 855 2012, irstarva@iu.edu %K psychotherapy %K internet-based cognitive behavior therapy %K internet-based interventions %K guided self-help %K public health %K treatment access barriers %K digital mental health %K treatment attitudes %D 2025 %7 1.4.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital mental health interventions (DMHIs) are a promising approach to reducing the public health burden of mental illness. DMHIs are efficacious, can provide evidence-based treatment with few resources, and are highly scalable relative to one-on-one face-to-face psychotherapy. There is potential for DMHIs to substantially reduce unmet treatment needs by circumventing structural barriers to treatment access (eg, cost, geography, and time). However, epidemiological research on perceived barriers to mental health care use demonstrates that attitudinal barriers, such as the lack of perceived need for treatment, are the most common self-reported reasons for not accessing care. Thus, the most important barriers to accessing traditional psychotherapy may also be barriers to accessing DMHIs. Objective: This study aimed to explore whether attitudinal barriers to traditional psychotherapy access might also serve as barriers to DMHI uptake. We explored the relationships between individuals’ structural versus attitudinal barriers to accessing psychotherapy and their indicators of potential use of internet-delivered guided self-help (GSH). Methods: We collected survey data from 971 US adults who were recruited online via Prolific and screened for the presence of psychological distress. Participants provided information about demographic characteristics, current symptoms, and the use of psychotherapy in the past year. Those without past-year psychotherapy use (640/971, 65.9%) answered questions about perceived barriers to psychotherapy access, selecting all contributing barriers to not using psychotherapy and a primary barrier. Participants also read detailed information about a GSH intervention. Primary outcomes were participants’ self-reported interest in the GSH intervention and self-reported likelihood of using the intervention if offered to them. Results: Individuals who had used psychotherapy in the past year reported greater interest in GSH than those who had not (odds ratio [OR] 2.38, 95% CI 1.86-3.06; P<.001) and greater self-reported likelihood of using GSH (OR 2.25, 95% CI 1.71-2.96; P<.001). Attitudinal primary barriers (eg, lack of perceived need; 336/640, 52.5%) were more common than structural primary barriers (eg, money or insurance; 244/640, 38.1%). Relative to endorsing a structural primary barrier, endorsing an attitudinal primary barrier was associated with lower interest in GSH (OR 0.44, 95% CI 0.32-0.6; across all 3 barrier types, P<.001) and lower self-reported likelihood of using GSH (OR 0.61, 95% CI 0.43-0.87; P=.045). We found no statistically significant differences in primary study outcomes by race or ethnicity or by income, but income had a statistically significant relationship with primary barrier type (ORs 0.27-3.71; P=.045). Conclusions: Our findings suggest that attitudinal barriers to traditional psychotherapy use may also serve as barriers to DMHI use, suggesting that disregarding the role of attitudinal barriers may limit the reach of DMHIs. Future research should seek to further understand the relationship between general treatment-seeking attitudes and attitudes about DMHIs to inform the design and marketing of DMHIs. %M 40168039 %R 10.2196/65356 %U https://mental.jmir.org/2025/1/e65356 %U https://doi.org/10.2196/65356 %U http://www.ncbi.nlm.nih.gov/pubmed/40168039 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e64098 %T Digital Health Resilience and Well-Being Interventions for Military Members, Veterans, and Public Safety Personnel: Environmental Scan and Quality Review %A Allen,Rashell R %A Malik,Myrah A %A Aquin,Carley %A Herceg,Lucijana %A Brémault-Phillips,Suzette %A Sevigny,Phillip R %+ School and Clinical Child Psychology, Faculty of Education, University of Alberta, 1121-87 Avenue, Edmonton, AB, T6G2G5, Canada, 1 7804920415, wozniak@ualberta.ca %K public safety personnel %K veteran %K military member %K web-based program %K resources %K resilience %K mobile app %K quality review %K well-being %K military %K environmental %K review %D 2025 %7 1.4.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Accessible mental health care, delivered via mobile apps or web-based services, may be essential for military members, public safety personnel (PSP), and veterans, as they report numerous barriers to seeking in-person care and are at an increased risk for a number of psychological disorders. Objective: We aimed to identify, describe, and evaluate apps, resource banks (RBs), and web-based programs (WBPs), referred to as digital mental health interventions (DMHIs), recommended for military members, PSP, and veterans. A multidimensional and multisystemic view of resilience and well-being were maintained throughout this environmental scan. Methods: Information was gathered from a comprehensive review of peer-reviewed literature, a Google search, and a targeted search of websites relevant to the study populations. DMHIs aimed at supporting resilience or well-being were included in the review, including those published in peer-reviewed articles, and those offered to these populations without research or literature backing their use. Results: In total, 69 DMHIs were identified in this study, including 42 apps, 19 RBs, and 8 WBPs, and were described based on 3 questions related to purpose, strategies, and evidence from the adapted Mobile App Rating Scale and the Mobile App Rating Scale. Each WBP and RB was then reviewed via the adapted Mobile App Rating Scale and each app via the Alberta Rating Index for Apps (ARIA). Overall, 24 (35%) of the DMHIs were recommended for military members, 20 (29%) for PSP, and 41 (59%) for veterans. The most common aim across apps, RBs, and WBPs was to increase happiness and well-being, and the most common strategies were advice, tips, and skills training. In total, 2 apps recommended for military members—PTSD Coach and Virtual Hope Box—received a high rating on the ARIA subscales and have also been trialed in pilot randomized control trial (RCT) and RCT evaluations, respectively, with positive initial results. Similarly, 2 apps recommended for PSP—PeerConnect and R2MR—have been trialed in non-RCT studies, with partially positive outcomes or little to no contradictory evidence and received a high rating on the ARIA. Finally, 2 apps recommended for veteran populations—PTSD Coach and VetChange—received high ratings on the ARIA and have been trialed via pilot-RCT and RCT studies, respectively, with positive outcomes. Conclusions: In conclusion, there is a need for efficacy and effectiveness trials for DMHIs for military members, PSP, and veterans to ensure that they are effectively meeting the population’s needs. While there appears to be many promising DMHIs, further research is needed before these interventions continue to be promoted as effective and widely distributed. %M 40168068 %R 10.2196/64098 %U https://mhealth.jmir.org/2025/1/e64098 %U https://doi.org/10.2196/64098 %U http://www.ncbi.nlm.nih.gov/pubmed/40168068 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67545 %T Videoconference-Delivered Acceptance and Commitment Therapy for Family Caregivers of People With Dementia: Pilot Randomized Controlled Trial %A Han,Areum %A Oster,Robert %A Yuen,Hon %A Jenkins,Jeremy %A Hawkins,Jessica %A Edwards,Lauren %+ , Department of Occupational Therapy, University of Alabama at Birmingham, SHPB 339, 1720 2nd Avenue South, Birmingham, AL, 35294, United States, 1 2059752882, ahan@uab.edu %K acceptance and commitment therapy %K Alzheimer disease %K caregivers %K dementia %K depression %K web-based intervention %K quality of life %K randomized controlled trial %K stress %K videoconferencing %D 2025 %7 31.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Family caregivers of individuals with dementia face significant mental health challenges. Acceptance and commitment therapy (ACT) has emerged as a promising intervention for improving these caregivers’ mental health. While various delivery modes of ACT have been explored, there is a need for evidence on the efficacy of videoconference-delivered ACT programs for this population. Objective: This pilot randomized controlled trial, conducted in the United States, aims to assess the effects of a videoconference-delivered, therapist-guided ACT program on reducing depressive symptoms and improving other mental health outcomes among family caregivers with depression who give care to individuals with dementia, compared to a control group that received psychoeducation materials only. Methods: This 2-arm, parallel-group pilot randomized controlled trial randomly assigned 33 family caregivers to either a 10-week videoconference-delivered ACT program (n=16, 48%) or a control group that received psychoeducation materials alone (n=17, 52%). Depressive symptoms (primary outcome) were measured using the Patient Health Questionnaire-9. Secondary outcomes included anxiety, stress, psychological quality of life (QoL), caregiver burden, predeath grief, guilt, and ACT process measures. Outcomes were assessed in the pretest, posttest (10-12 weeks after pretest), and a 3-month follow-up (3 months after posttest, approximately 5-6 months after pretest). An intent-to-treat approach was used for all outcome analyses. Linear mixed-effects models for repeated measures were used to analyze outcomes. Results: The ACT group reported significantly greater improvements in stress (P=.043) and psychological QoL (P=.014) in the posttest compared to the control group. Within the ACT group, participants experienced a significant decrease in depressive symptoms, with a mean (SE) change of –6.09 (1.16) points (95% CI –8.42 to –3.76; P<.001) in the posttest and –6.71 (1.45) points (95% CI –9.63 to –3.81; P<.001) in the 3-month follow-up. These changes exceed the estimated minimal clinically important difference on the Patient Health Questionnaire-9. In addition, the ACT group reported significant improvements in anxiety, stress, psychological QoL, caregiver burden, predeath grief, guilt, values-driven action, and experiential avoidance at both posttest and 3-month follow-up. A sensitivity analysis, excluding 1 participant with near-outlier data, revealed statistically significant between-group differences in depressive symptoms at posttest (P=.037); stress at posttest (P<.001) and in 3-month follow-up (P=.001); psychological QoL at posttest (P<.001); caregiver burden at posttest (P=.003) and in 3-month follow-up (P=.003); predeath grief in 3-month follow-up (P=.031); and values-driven action at posttest (P=.032). Conclusions: The videoconference-delivered ACT program showed promise in improving mental health outcomes and ACT processes among family caregivers with depression who give care to individuals with dementia. Future studies should aim to replicate these findings with larger, more diverse caregiver populations and explore the long-term efficacy of videoconference-delivered ACT programs. Trial Registration: ClinicalTrials.gov NCT05043441; https://clinicaltrials.gov/study/NCT05043441 %M 40163859 %R 10.2196/67545 %U https://formative.jmir.org/2025/1/e67545 %U https://doi.org/10.2196/67545 %U http://www.ncbi.nlm.nih.gov/pubmed/40163859 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e68362 %T Mental Health Professionals’ Technology Usage and Attitudes Toward Digital Health for Psychosis: Comparative Cross-Sectional Survey Study %A Zhang,Xiaolong %A Berry,Natalie %A Di Basilio,Daniela %A Richardson,Cara %A Eisner,Emily %A Bucci,Sandra %K digital mental health %K psychosis %K attitudes %K implementation %K smartphone app %D 2025 %7 31.3.2025 %9 %J JMIR Ment Health %G English %X Background: Digital health technologies (DHTs) for psychosis have been developed and tested rapidly in recent years. However, research examining mental health professionals’ views on the use of DHTs for people with psychosis is limited. Given the increased accessibility and availability of DHTs for psychosis, an up-to-date understanding of staff perception of DHTs for psychosis is warranted. Objective: In this study, we aimed to investigate mental health professionals’ usage of technology and their perception of service users’ technology usage; their views toward the use of DHTs for psychosis, including their concerns; and barriers for implementing DHTs in a mental health setting. Methods: Two cross-sectional surveys were distributed to mental health care staff who had experience of working with individuals experiencing psychosis in the United Kingdom. Survey 1 (from April 2018 to September 2020) was distributed to 3 local UK National Health Service (NHS) trusts in Northwest England; survey 2 was administered nationally across 31 UK NHS trusts or health boards (from November 2022 to March 2024). The COVID-19 pandemic occurred between the 2 survey periods. Data were analyzed descriptively. Results: A total of 155 and 352 participants completed surveys 1 and 2, respectively. Staff reported high levels of technology ownership and usage in both surveys. In general, staff expressed positive views regarding the use of DHTs for psychosis; however, barriers and concerns, including affordability, digital literacy, and potential negative effects on service users’ mental health, were also reported. We did not find notable changes in terms of staff use of digital technology in clinical practice over time. Conclusions: Staff sampled from a broad and diverse range expressed consistent optimism about the potential implementation of DHTs in practice, though they also noted some concerns regarding safety and access. While the COVID-19 pandemic is frequently regarded as a catalyst for the adoption of digital health care tools, the sustainability of this transition from traditional to digital health care appeared to be suboptimal. To address staff concerns regarding safety and potentially facilitate the implementation of DHTs, systematic evaluation of adverse effects of using DHTs and dissemination of evidence are needed. Organizational support and training should be offered to staff to help address barriers and increase confidence in recommending and using DHTs with service users. %R 10.2196/68362 %U https://mental.jmir.org/2025/1/e68362 %U https://doi.org/10.2196/68362 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e67234 %T Efficacy of a Web-Based Integrated Growth Mindset Intervention on Reducing Anxiety Among Social Work and Counseling Practicum Trainees: Protocol for a 2-Arm Randomized Controlled Trial %A Wang,Yongyi %A Xi,An %A Wong,Stella S K %A Yam,Kong %A Leung,Janet Tsin Yee %A Zhu,Shimin %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, Room GH348, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, 999077, China (Hong Kong), 852 27665787, jasmine.zhu@polyu.edu.hk %K implicit theory %K growth mindset %K social work students %K counselling students %K practicum %K anxiety %D 2025 %7 27.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Practicum is indispensable for the development of professional practitioners; yet, trainees may encounter psychological distress, especially anxiety, brought on by new challenges. Research stated that a positive mindset promotes better learning and mental status. Well-designed interventions have been shown to relieve anxiety and help trainees thrive in their practicums and professions. The proposed study adapted an integrated intervention, We-SMILE (Web-Based Single-Session Intervention of Mindset on Intelligence, Failure, and Emotion), for improving prepracticum anxiety and coping. We-SMILE has the potential to be a low-intensity self-help prepracticum intervention to support students in adjusting their mindsets and overcoming the challenges in practicum. Objective: Using a 2-arm randomized controlled trial, this study aims to examine the efficacy of We-SMILE on reducing anxiety (primary outcome) and enhancing psychological status, psychological well-being, learning orientation, academic self-efficacy, and confidence (secondary outcomes). Methods: A total of 117 students will be recruited from the social work and counseling programs and randomly assigned to existing prepracticum training (training as usual [TAU]) or that plus the We-SMILE. Participants will be assessed repeatedly at 3 time points: baseline, 2 weeks post intervention, and 8 weeks post intervention. The outcomes will be measured by validated items and scales on anxiety, mindsets, psychological well-being, and the Failure Mindset Scale. Recruitment for the pilot study was initiated in May 2024 during social work and counseling prepracticum briefing sessions. Participants were randomly assigned to the intervention or TAU group. The intention-to-treat (ITT) analysis principle and linear regression–based maximum likelihood multilevel models will be used for data analysis. Results: This study has received research ethics approval in May 2024. Participant recruitment started at the end of May 2024, and enrollment was ongoing as of when this protocol was submitted. Data collection and analyses are expected to be complete in 2025. Conclusions: The randomized controlled trial will compare the efficacy of the We-SMILE intervention group and the TAU group. The results of this study will benefit practicum students, fieldwork supervisors, and social work and counseling programs. Trial Registration: ClinicalTrials.gov NCT06509802; https://tinyurl.com/36vkwd63 International Registered Report Identifier (IRRID): DERR1-10.2196/67234 %M 40146991 %R 10.2196/67234 %U https://www.researchprotocols.org/2025/1/e67234 %U https://doi.org/10.2196/67234 %U http://www.ncbi.nlm.nih.gov/pubmed/40146991 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65786 %T Mindfulness-Based Cognitive Therapy–Game: An Ironic Way to Treat Internet Gaming Disorder %A Kim,Jaehyun %A Oh,Hayoung %A Yoon,Anderson Sungmin %+ , College of Computing and Informatics, Sungkyunkwan University, 25-2, Sungkyunkwan-ro, Jongno-gu, Seoul, 03063, Republic of Korea, 82 01053895996, hyoh79@skku.edu %K cognitive behavior therapy %K psychosocial intervention %K video games %K internet gaming disorder %K internet addiction %K mindfulness %K mental health %D 2025 %7 27.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X Internet gaming disorder (IGD) affects 3% of the global population and poses an increasing risk due to advancements in technology. However, there is currently no definitive treatment for this condition. IGD is not a primary disorder but rather a result of “self-prescription” in response to emotional stressors. Unlike conventional mental health treatments that focus on the disorder itself, it is crucial to provide alternative activities that can alleviate negative emotions. This paper extends the concept of the self-medication hypothesis and integrates it with cognitive models of cognitive behavioral therapy and mindfulness-based cognitive therapy. In addition, it introduces the mindfulness-based cognitive therapy–game (MBCT-G), a program designed to explore alternative activities through gaming, focusing on the processes of response and reward, which are not typically emphasized in traditional treatments. This study serves as the theoretical foundation for the development of MBCT-G. MBCT-G aims to train individuals in positive coping strategies that alleviate psychological distress, offering a novel approach to treating self-prescription disorders such as IGD. %M 40146992 %R 10.2196/65786 %U https://www.jmir.org/2025/1/e65786 %U https://doi.org/10.2196/65786 %U http://www.ncbi.nlm.nih.gov/pubmed/40146992 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65693 %T Treatment of Substance Use Disorders With a Mobile Phone App Within Rural Collaborative Care Management (Senyo Health): Protocol for a Mixed Methods Randomized Controlled Trial %A Oesterle,Tyler S %A Bormann,Nicholas L %A Paul,Margaret M %A Breitinger,Scott A %A Lai,Benjamin %A Smith,Jamie L %A Stoppel,Cindy J %A Arndt,Stephan %A Williams,Mark D %+ Department of Psychiatry, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 284 2511, bormann.nicholas@mayo.edu %K substance-related disorders %K mobile apps %K primary care %K clinical trial %K substance use disorder %K SUD %K addiction treatment %K telemedicine %K telepsychiatry %K care management %K community-based care %K behavioral health program %D 2025 %7 26.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 worsened an already existing problem in substance use disorder (SUD) treatment. However, it helped transform the use of telehealth, which particularly benefits rural America. The lack of specialty addiction treatment in rural areas places the onus on primary care providers. Screening, brief intervention, and referral to treatment (SBIRT) is an evidenced-based strategy commonly used in primary care settings to target SUD outcomes and related behaviors. The integration of telehealth tools within the SBIRT pathway may better sustain the program in primary care. Building on Mayo Clinic’s experience with collaborative care management (CoCM) for mental health treatment, we built a digitally native, integrated, behavioral health CoCM platform using a novel mobile app and web-based provider platform called Senyo Health. Objective: This protocol describes a novel use of the SBIRT pathway using Senyo Health to complement existing CoCM integration within primary care to deliver SUD treatment to rural patients lacking other access. We hypothesize that this approach will improve SUD-related outcomes within rural primary care clinics. Methods: Senyo Health is a digital tool to facilitate the use of SBIRT in primary care. It contains a web-based platform for clinician and staff use and a patient-facing mobile phone app. The app includes 16 learning modules along with data collection tools and a chat function for communicating directly with a licensed drug counselor. Beta-testing is currently underway to examine opportunities to improve Senyo Health prior to the start of the trial. We describe the development of Senyo Health and its therapeutic content and data collection instruments. We also describe our evaluation strategy including our measurement plan to assess implementation through a process guided by Consolidated Framework for Implementation Research methods and effectiveness through a waitlist control trial. A randomized controlled trial will occur where 30 participants are randomly assigned to immediately start the Senyo intervention compared to a waitlist control group of 30 participants who will start the active intervention after a 12-week delay. Results: The Senyo Health app was launched in May 2023, and the most recent update was in August 2024. Our funding period began in September 2023 and will conclude in July 2027. This protocol defines a novel implementation strategy for leveraging a digitally native, clinical platform that enables the delivery of CoCM to target an SUD-specific patient population. Our trial will begin in June 2025. Conclusions: We present a theory of change and study design to assess the impact of a novel and patient-centered mobile app to support the SBIRT approach to SUD in primary care settings. Trial Registration: ClinicalTrials.gov NCT06743282; http://clinicaltrials.gov/ct2/show/NCT06743282 International Registered Report Identifier (IRRID): PRR1-10.2196/65693 %M 40138685 %R 10.2196/65693 %U https://www.researchprotocols.org/2025/1/e65693 %U https://doi.org/10.2196/65693 %U http://www.ncbi.nlm.nih.gov/pubmed/40138685 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e64617 %T An Interpretable Model With Probabilistic Integrated Scoring for Mental Health Treatment Prediction: Design Study %A Kelly,Anthony %A Jensen,Esben Kjems %A Grua,Eoin Martino %A Mathiasen,Kim %A Van de Ven,Pepijn %+ Department of Electronic and Computer Engineering, University of Limerick, Castletroy, Limerick, V94 T9PX, Ireland, 353 087545973, anthony.kelly@ul.ie %K machine learning %K mental health %K Monte Carlo dropout %K explainability %K explainable AI %K XAI %K artificial intelligence %K AI %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: Machine learning (ML) systems in health care have the potential to enhance decision-making but often fail to address critical issues such as prediction explainability, confidence, and robustness in a context-based and easily interpretable manner. Objective: This study aimed to design and evaluate an ML model for a future decision support system for clinical psychopathological treatment assessments. The novel ML model is inherently interpretable and transparent. It aims to enhance clinical explainability and trust through a transparent, hierarchical model structure that progresses from questions to scores to classification predictions. The model confidence and robustness were addressed by applying Monte Carlo dropout, a probabilistic method that reveals model uncertainty and confidence. Methods: A model for clinical psychopathological treatment assessments was developed, incorporating a novel ML model structure. The model aimed at enhancing the graphical interpretation of the model outputs and addressing issues of prediction explainability, confidence, and robustness. The proposed ML model was trained and validated using patient questionnaire answers and demographics from a web-based treatment service in Denmark (N=1088). Results: The balanced accuracy score on the test set was 0.79. The precision was ≥0.71 for all 4 prediction classes (depression, panic, social phobia, and specific phobia). The area under the curve for the 4 classes was 0.93, 0.92, 0.91, and 0.98, respectively. Conclusions: We have demonstrated a mental health treatment ML model that supported a graphical interpretation of prediction class probability distributions. Their spread and overlap can inform clinicians of competing treatment possibilities for patients and uncertainty in treatment predictions. With the ML model achieving 79% balanced accuracy, we expect that the model will be clinically useful in both screening new patients and informing clinical interviews. %M 40138679 %R 10.2196/64617 %U https://medinform.jmir.org/2025/1/e64617 %U https://doi.org/10.2196/64617 %U http://www.ncbi.nlm.nih.gov/pubmed/40138679 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59527 %T Patients’ and Health Care Professionals’ Expectations of Virtual Therapeutic Agents in Outpatient Aftercare: Qualitative Survey Study %A Immel,Diana %A Hilpert,Bernhard %A Schwarz,Patricia %A Hein,Andreas %A Gebhard,Patrick %A Barton,Simon %A Hurlemann,René %+ Department of Psychiatry, School of Medicine and Health Sciences, Carl von Ossietzky Universität Oldenburg, Hermann-Ehlers-Str. 7, Oldenburg, 26160, Germany, 49 441961517, diana.immel@uni-oldenburg.de %K socially interactive agent %K e-mental health %K mental illness %K mental disorder %K depression %K major depressive disorder %K suicide prevention %K suicidal ideation %K outpatient aftercare %K artificial intelligence %K virtual therapeutic assistant %K public health %K digital technology %K digital intervention %K digital health care %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression is a serious mental health condition that can have a profound impact on the individual experiencing the disorder and those providing care. While psychotherapy and medication can be effective, there are gaps in current approaches, particularly in outpatient care. This phase is often associated with a high risk of relapse and readmission, and patients often report a lack of support. Socially interactive agents represent an innovative approach to the provision of assistance. Often powered by artificial intelligence, these virtual agents can interact socially and elicit humanlike emotions. In health care, they are used as virtual therapeutic assistants to fill gaps in outpatient aftercare. Objective: We aimed to explore the expectations of patients with depression and health care professionals by conducting a qualitative survey. Our analysis focused on research questions related to the appearance and role of the assistant, the assistant-patient interaction (time of interaction, skills and abilities of the assistant, and modes of interaction) and the therapist-assistant interaction. Methods: A 2-part qualitative study was conducted to explore the perspectives of the 2 groups (patients and care providers). In the first step, care providers (n=30) were recruited during a regional offline meeting. After a short presentation, they were given a link and were asked to complete a semistructured web-based questionnaire. Next, patients (n=20) were recruited from a clinic and were interviewed in a semistructured face-to-face interview. Results: The survey findings suggested that the assistant should be a multimodal communicator (voice, facial expressions, and gestures) and counteract negative self-evaluation. Most participants preferred a female assistant or wanted the option to choose the gender. In total, 24 (80%) health care professionals wanted a selectable option, while patients exhibited a marked preference for a female or diverse assistant. Regrading patient-assistant interaction, the assistant was seen as a proactive recipient of information, and the patient as a passive one. Gaps in aftercare could be filled by the unlimited availability of the assistant. However, patients should retain their autonomy to avoid dependency. The monitoring of health status was viewed positively by both groups. A biofeedback function was desired to detect early warning signs of disease. When appropriate to the situation, a sense of humor in the assistant was desirable. The desired skills of the assistant can be summarized as providing structure and emotional support, especially warmth and competence to build trust. Consistency was important for the caregiver to appear authentic. Regarding the assistant–care provider interaction, 3 key areas were identified: objective patient status measurement, emergency suicide prevention, and an information tool and decision support system for health care professionals. Conclusions: Overall, the survey conducted provides innovative guidelines for the development of virtual therapeutic assistants to fill the gaps in patient aftercare. %M 40138692 %R 10.2196/59527 %U https://formative.jmir.org/2025/1/e59527 %U https://doi.org/10.2196/59527 %U http://www.ncbi.nlm.nih.gov/pubmed/40138692 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64746 %T Use of e-Mental Health Tools for Suicide Prevention in Clinical Practice by Mental Health Professionals in NSW, Australia: Cross-Sectional Survey %A Hood,Carol %A Hunt,Sally %A Metse,Alexandra P %A Hodder,Rebecca K %A Colyvas,Kim %A Sheather-Reid,Rachel %A Duerden,David %A Bowman,Jenny %+ , School of Psychological Sciences, The University of Newcastle, College of Engineering, Science and Environment, Callaghan, 2308, Australia, 61 2 4921 5958, Carol.Hood@uon.edu.au %K suicide prevention %K digital mental health %K mental health professionals %K peer support %K internet %K mobile apps %K clinical practice %K cross-sectional survey %K Australia %K e-mental health tools %D 2025 %7 26.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a significant global health concern. In the context of increased demand for mental health services and workforce shortages, exacerbated by the COVID-19 pandemic, electronic mental health (eMH) tools represent a promising means of augmenting mental health care generally and for suicide prevention specifically. A significant research gap exists however with respect to the use and uptake of eMH tools, especially electronic mental health tools for suicide prevention (eMH-SP). Objective: This study aimed to investigate the use of eMH tools by Australian mental health professionals, both in general and with respect to suicide prevention specifically, examining changes in use since COVID-19. Further, it explored factors associated with frequent use of eMH-SP, including sociodemographic and professional characteristics. Methods: A web-based cross-sectional survey was conducted across 15 local health districts (LHDs) in New South Wales, Australia, from May 2022 to July 2023. The sample was drawn from over 10,000 mental health professionals working in government services statewide. The survey explored the use of electronic mental health tools for general mental health issues (eMH-gen) and eMH-SP, explored the changes in the use of both since COVID-19, and used multivariable logistic regression to identify factors associated with the current use of eMH-SP. Results: Among 469 participants, increased use since COVID-19 was reported by over half (247/469, 52.7%) for eMH-gen, and by approximately one-third (141/386, 36.6%) for eMH-SP. The proportion reporting frequent use increased significantly from before to after COVID-19 for both eMH-gen (243/469, 51.8% to 283/469, 60.3%; P<.001) and eMH-SP (152/386, 39.4% to 170/385, 44.2%; P=.01). Since COVID-19, the most frequently used types of eMH tools for eMH-gen and eMH-SP, respectively, were information sites (231/469, 49.3% and 130/385, 33.8%), phone/online counseling (173/469, 36.9% and 130/385, 33.8%), and apps (145/469, 30.9% and 107/385, 27.8%). Professionals more likely to use eMH-SP frequently were females (odds ratio [OR] 3.32, 95% CI 1.88-5.87; P<.001) compared with males; peer workers (OR 2.17, 95% CI 1.0-4.71; P<.001) compared with nurses; those located in regional/rural LHDs (OR 1.65, 95% CI 1.04-2.61; P=.03) compared with metropolitan LHDs; and those practicing in emergency health care settings (OR 8.31, 95% CI 2.17-31.75; P=.03) compared with inpatient settings. Conclusions: The study’s findings highlight the increasing adoption of eMH tools and delivery of remote care by mental health professionals and provide valuable new insights into sociodemographic factors associated with the use of eMH for suicide prevention specifically. Continued research on the role eMH is playing is essential for guiding policy, optimizing resources, and enhancing mental health care and suicide prevention efforts. %M 40138690 %R 10.2196/64746 %U https://www.jmir.org/2025/1/e64746 %U https://doi.org/10.2196/64746 %U http://www.ncbi.nlm.nih.gov/pubmed/40138690 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e69820 %T Prompt Engineering an Informational Chatbot for Education on Mental Health Using a Multiagent Approach for Enhanced Compliance With Prompt Instructions: Algorithm Development and Validation %A Waaler,Per Niklas %A Hussain,Musarrat %A Molchanov,Igor %A Bongo,Lars Ailo %A Elvevåg,Brita %+ Department of Computer Science, UiT The Arctic University of Norway, Hansine Hansens vei 54, Tromsø, N-9037, Norway, 47 776 44056, pwa011@uit.no %K schizophrenia %K mental health %K prompt engineering %K AI in health care %K AI safety %K self-reflection %K limiting scope of AI %K large language model %K LLM %K GPT-4 %K AI transparency %K adaptive learning %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR AI %G English %X Background: People with schizophrenia often present with cognitive impairments that may hinder their ability to learn about their condition. Education platforms powered by large language models (LLMs) have the potential to improve the accessibility of mental health information. However, the black-box nature of LLMs raises ethical and safety concerns regarding the controllability of chatbots. In particular, prompt-engineered chatbots may drift from their intended role as the conversation progresses and become more prone to hallucinations. Objective: This study aimed to develop and evaluate a critical analysis filter (CAF) system that ensures that an LLM-powered prompt-engineered chatbot reliably complies with its predefined instructions and scope while delivering validated mental health information. Methods: For a proof of concept, we prompt engineered an educational chatbot for schizophrenia powered by GPT-4 that could dynamically access information from a schizophrenia manual written for people with schizophrenia and their caregivers. In the CAF, a team of prompt-engineered LLM agents was used to critically analyze and refine the chatbot’s responses and deliver real-time feedback to the chatbot. To assess the ability of the CAF to re-establish the chatbot’s adherence to its instructions, we generated 3 conversations (by conversing with the chatbot with the CAF disabled) wherein the chatbot started to drift from its instructions toward various unintended roles. We used these checkpoint conversations to initialize automated conversations between the chatbot and adversarial chatbots designed to entice it toward unintended roles. Conversations were repeatedly sampled with the CAF enabled and disabled. In total, 3 human raters independently rated each chatbot response according to criteria developed to measure the chatbot’s integrity, specifically, its transparency (such as admitting when a statement lacked explicit support from its scripted sources) and its tendency to faithfully convey the scripted information in the schizophrenia manual. Results: In total, 36 responses (3 different checkpoint conversations, 3 conversations per checkpoint, and 4 adversarial queries per conversation) were rated for compliance with the CAF enabled and disabled. Activating the CAF resulted in a compliance score that was considered acceptable (≥2) in 81% (7/36) of the responses, compared to only 8.3% (3/36) when the CAF was deactivated. Conclusions: Although more rigorous testing in realistic scenarios is needed, our results suggest that self-reflection mechanisms could enable LLMs to be used effectively and safely in educational mental health platforms. This approach harnesses the flexibility of LLMs while reliably constraining their scope to appropriate and accurate interactions. %M 39992720 %R 10.2196/69820 %U https://ai.jmir.org/2025/1/e69820 %U https://doi.org/10.2196/69820 %U http://www.ncbi.nlm.nih.gov/pubmed/39992720 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66191 %T Transdiagnostic Compulsivity Traits in Problematic Use of the Internet Among UK Residents: Cross-Sectional Network Analysis Study %A Liu,Chang %A Chamberlain,Samuel %A Ioannidis,Konstantinos %A Tiego,Jeggan %A Grant,Jon %A Yücel,Murat %A Hellyer,Peter %A Lochner,Christine %A Hampshire,Adam %A Albertella,Lucy %+ School of Psychological Sciences, Monash University, Level 5, 18 Innovation Walk, Wellington Road, Clayton, 3800, Australia, 61 07 33620222, chang.liu7@monash.edu %K compulsivity %K problematic use of the internet %K network analysis %K perfectionism %K reward drive %K cognitive rigidity %K transdiagnostic %K PUI %K mental health %K intrapersonal factor %K cognitive %K internet use %K network %D 2025 %7 26.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The societal and public health costs of problematic use of the internet (PUI) are increasingly recognized as a concern across all age groups, presenting a growing challenge for mental health research. International scientific initiatives have emphasized the need to explore the potential roles of personality features in PUI. Compulsivity is a key personality trait associated with PUI and has been recognized by experts as a critical factor that should be prioritized in PUI research. Given that compulsivity is a multidimensional construct and PUI encompasses diverse symptoms, different underlying mechanisms are likely involved. However, the specific relationships between compulsivity dimensions and PUI symptoms remain unclear, limiting our understanding of compulsivity’s role in PUI. Objective: This study aimed to clarify the unique relationships among different dimensions of compulsivity, namely, perfectionism, reward drive, cognitive rigidity, and symptoms of PUI using a symptom-based network approach. Methods: A regularized partial-correlation network was fitted using a large-scale sample from the United Kingdom. Bridge centrality analysis was conducted to identify bridge nodes within the network. Node predictability analysis was performed to assess the self-determination and controllability of the nodes within the network. Results: The sample comprised 122,345 individuals from the United Kingdom (51.4% female, age: mean 43.7, SD 16.5, range 9-86 years). The analysis identified several strong mechanistic relationships. The strongest positive intracluster edge was between reward drive and PUI4 (financial consequences due to internet use; weight=0.11). Meanwhile, the strongest negative intracluster edge was between perfectionism and PUI4 (financial consequences due to internet use; weight=0.04). Cognitive rigidity showed strong relationships with PUI2 (internet use for distress relief; weight=0.06) and PUI3 (internet use for loneliness or boredom; weight=0.07). Notably, reward drive (bridge expected influence=0.32) and cognitive rigidity (bridge expected influence=0.16) were identified as key bridge nodes, positively associated with PUI symptoms. Meanwhile, perfectionism exhibited a negative association with PUI symptoms (bridge expected influence=–0.05). The network’s overall mean predictability was 0.37, with PUI6 (compulsion, predictability=0.55) showing the highest predictability. Conclusions: The findings reveal distinct relationships between different dimensions of compulsivity and individual PUI symptoms, supporting the importance of choosing targeted interventions based on individual symptom profiles. In addition, the identified bridge nodes, reward drive, and cognitive rigidity may represent promising targets for PUI prevention and intervention and warrant further investigation. %M 40137076 %R 10.2196/66191 %U https://www.jmir.org/2025/1/e66191 %U https://doi.org/10.2196/66191 %U http://www.ncbi.nlm.nih.gov/pubmed/40137076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69828 %T Evaluating a Digital Health Tool Designed to Improve Low Sexual Desire in Women: Mixed-Methods Implementation Science Study %A Brotto,Lori A %A Stephenson,Kyle R %A Marshall,Nisha %A Balvan,Mariia %A Okara,Yaroslava %A Mahar,Elizabeth A %+ Department of Obstetrics and Gynaecology, University of British Columbia, 2775 Laurel Street, Department of Gynaecology, Vancouver, BC, V5Z1M9, Canada, 1 6048754111 ext 68898, lori.brotto@ubc.ca %K implementation science %K sexual interest/arousal disorder (SIAD) %K sexuality %K internet interventions %K online therapy %K telehealth %K online interventions %K web-based therapeutic programs/interventions %K online CBT/MBT treatment %K female sexual dysfunction %K eHealth %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual health difficulties affect up to 30% of women, with desire and arousal problems being the most prevalent. While cognitive behavioral therapy and mindfulness-based therapy are effective treatments, access is limited by barriers such as specialist shortages, cost, and embarrassment. Web-based interventions offer a potential solution by providing self-paced, cost-effective treatments. eSense, a digital health program, offers cognitive behavioral therapy and mindfulness-based therapy skills targeted to women with low sexual desire, and previous trials find eSense to be highly feasible and efficacious. Objective: The goal of the present implementation science study was to use the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance of Implementation) framework to assess the integration of eSense into several sexual health clinics. We chose the RE-AIM framework because it addresses both dissemination (eg, reach) and implementation of an intervention. Methods: A total of 14 specialty clinics participated, and we report on the reported experiences of those clinics in implementing eSense. We also examined responses from 12 women on waitlists to receive sex therapy or sexual medicine care. Results: Per clinic outcomes, all aspects of implementation (reach, effectiveness, adoption, implementation, and maintenance) were in the moderate to high range for clinics, reporting that offering eSense helped them overcome negative feelings associated with their long clinic waitlists. The majority expressed a need for eSense and could see how it overcame the limitations of traditional therapy. Nearly all expressed a wish to continue offering eSense to patients after the implementation study was complete. One caveat was that half of the clinics noted cost as a key issue for future implementation, and one-third noted that the administrative burden of implementing eSense as a standard of care may be challenging. For individual users, the majority expressed an interest in knowing more about eSense and a desire to use eSense, though most of these did not complete the program in its entirety. Users experienced a significant improvement in sex-related distress with no clinically meaningful change in other outcomes and a high level of satisfaction with eSense. Most also reported doing things differently in their sexual lives after participating in eSense. Conclusions: We found that eSense demonstrates potential as a digital intervention for sexual difficulties for women, particularly concerning its moderate implementation outcomes and also because of its ability to reduce sexual distress. Future studies should address the barriers identified for broader adoption of eSense in clinical settings. Trial Registration: ClinicalTrials.gov NCT05168371; https://clinicaltrials.gov/study/NCT05168371 %M 40132194 %R 10.2196/69828 %U https://www.jmir.org/2025/1/e69828 %U https://doi.org/10.2196/69828 %U http://www.ncbi.nlm.nih.gov/pubmed/40132194 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e68165 %T Effectiveness of General Practitioner Referral Versus Self-Referral Pathways to Guided Internet-Delivered Cognitive Behavioral Therapy for Depression, Panic Disorder, and Social Anxiety Disorder: Naturalistic Study %A Bjarke,Jill %A Gjestad,Rolf %A Nordgreen,Tine %K referral pathway %K GP-referral %K self-referral %K guided internet-delivered cognitive behavioral therapy %K ICBT %K routine care clinic %K depression %K panic disorder %K social anxiety disorder %K psychological therapy %K referrals %K cognitive %K behavioral therapy %K anxiety %K SAD %K treatment effectiveness %K mental health %K pathways %D 2025 %7 25.3.2025 %9 %J JMIR Ment Health %G English %X Background: Therapist-guided, internet-delivered cognitive behavioral therapy (guided ICBT) appears to be efficacious for depression, panic disorder (PD), and social anxiety disorder (SAD) in routine care clinical settings. However, implementation of guided ICBT in specialist mental health services is limited partly due to low referral rates from general practitioners (GP), which may stem from lack of awareness, limited knowledge of its effectiveness, or negative attitudes toward the treatment format. In response, self-referral systems were introduced in mental health care about a decade ago to improve access to care, yet little is known about how referral pathways may affect treatment outcomes in guided ICBT. Objective: This study aims to compare the overall treatment effectiveness of GP referral and self-referral to guided ICBT for patients with depression, PD, or SAD in a specialized routine care clinic. This study also explores if the treatment effectiveness varies between referral pathways and the respective diagnoses. Methods: This naturalistic open effectiveness study compares treatment outcomes from pretreatment to posttreatment and from pretreatment to 6-month follow-up across 2 referral pathways. All patients underwent module-based guided ICBT lasting up to 14 weeks. The modules covered psychoeducation, working with negative or automatic thoughts, exposure training, and relapse prevention. Patients received weekly therapist guidance through asynchronous messaging, with therapists spending an average of 10‐30 minutes per patient per week. Patients self-reported symptoms before, during, immediately after, and 6 months posttreatment. Level and change in symptom severity were measured across all diagnoses. Results: In total, 460 patients met the inclusion criteria, of which 305 were GP-referred (“GP” group) and 155 were self-referred (“self” group). Across the total sample, about 60% were female, and patients had a mean age of 32 years and average duration of disorder of 10 years. We found no significant differences in pretreatment symptom levels between referral pathways and across the diagnoses. Estimated effect sizes based on linear mixed modeling showed large improvements from pretreatment to posttreatment and from pretreatment to follow-up across all diagnoses, with statistically significant differences between referral pathways (GP: 0.97‐1.22 vs self: 1.34‐1.58, P<.001-.002) and for the diagnoses separately: depression (GP: 0.86‐1.26, self: 1.97‐2.07, P<.001-.02), PD (GP: 1.32‐1.60 vs self: 1.64‐2.08, P=.06-.02) and SAD (GP: 0.80‐0.99 vs self: 0.99‐1.19, P=.18-.22). Conclusions: Self-referral to guided ICBT for depression and PD appears to yield greater treatment outcomes compared to GP referrals. We found no difference in outcome between referral pathway for SAD. This study underscores the potential of self-referral pathways to enhance access to evidence-based psychological treatment, improve treatment outcomes, and promote sustained engagement in specialist mental health services. Future studies should examine the effect of the self-referral pathway when it is implemented on a larger scale. %R 10.2196/68165 %U https://mental.jmir.org/2025/1/e68165 %U https://doi.org/10.2196/68165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70508 %T Adolescent Cyberbullying and Cyber Victimization: Longitudinal Study Before and During COVID-19 %A Schulz,Peter Johannes %A Boldi,Marc-Olivier %A van Ackere,Ann %+ Faculty of Communication, Culture and Society, Università della Svizzera Italiana, Via G. Buffi 13, Lugano, 6900, Switzerland, 41 58666724, schulzp@usi.ch %K cyberbullying and cyber victimization among adolescents %K COVID-19 %K panel study %K longitudinal data analysis %K parental communication %K exposure to violent media content %D 2025 %7 25.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescent cyberbullying has been a persistent issue, exacerbated by the shift to remote learning and increased screen time during the COVID-19 pandemic. These changes have sparked concerns about potential increases in cyberbullying and its associated risks. Objective: This study aims to explore how factors such as age, exposure to violent media, parental communication quality, internet access, sex, and sibling relationships influence cyberbullying behavior at school. Additionally, we examine how the COVID-19 pandemic may have altered these dynamics. Methods: Leveraging a panel dataset, we examine the same group of adolescents both before and during the pandemic. The analysis focused on identifying relationships between the selected factors and cyberbullying perpetration and victimization, with an emphasis on the dynamics introduced by the COVID-19 pandemic. Results: Perceived quality of parental communication was found to reduce the risk of both cyberbullying perpetration and victimization, with the former effect becoming more pronounced during the COVID-19 pandemic. Exposure to violent media increased both cyberbullying perpetration and victimization, but the effect on perpetration decreased during the COVID-19 pandemic. The well-established correlation between internet access and both cyberbullying perpetration and victimization remained unaffected by COVID-19. Surprisingly, adolescents with siblings were less likely to become victims or perpetrators of school-related cyberbullying, irrespective of the pandemic. Conclusions: In hindsight, COVID-19, functioning as a kind of natural experiment, has provided us with a unique opportunity to examine the effects of a global event, forcing major behavioral changes on the persistent challenge of cyberbullying in middle schools. %M 40132197 %R 10.2196/70508 %U https://www.jmir.org/2025/1/e70508 %U https://doi.org/10.2196/70508 %U http://www.ncbi.nlm.nih.gov/pubmed/40132197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e62870 %T Facilitators and Barriers to Digital Mental Health Interventions for Depression, Anxiety, and Stress in Adolescents and Young Adults: Scoping Review %A Zhu,Shimin %A Wang,Yongyi %A Hu,Yuxi %+ Department of Applied Social Sciences, Hong Kong Polytechnic University, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong SAR, 999077, China (Hong Kong), 852 27665787, jasmine.zhu@polyu.edu.hk %K digital mental health interventions %K adolescents %K young adults %K common mental disorders %K thematic analysis %K relative frequency of occurrence %D 2025 %7 24.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Digital mental health interventions (DMHIs) offer unique strengths as emerging services with practical applications for adolescents and young adults (AYAs) experiencing depression, anxiety, and stress. Although promising, acceptance and participation in DMHIs vary across interventions, participants, and contexts. It is essential to delineate and synthesize the factors that promote or hinder DMHI use. Objective: This review aims to assess and synthesize the facilitators and barriers to accessing DMHIs for depression, anxiety, and stress in AYAs through a scoping review. Methods: A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, PsycINFO, CNKI, OpenGrey, and APA PsycExtra, up to October 31, 2023. Articles examining facilitators and barriers to DMHIs among AYAs with disorders or symptoms of depression, anxiety, and stress were included. Data synthesis and analysis involved quality assessment, thematic analysis, and relative frequency meta-analysis. Results: A total of 27 records met the eligibility criteria, and 14 facilitators and 13 barriers were identified across the external, intervention, and individual levels. The relative frequency meta-analysis indicated that factors influencing AYAs’ use of DMHIs varied based on delivery modes. Among these factors, “quality and effect” emerged as the predominant theme—high quality and effect served as the primary facilitator, while low quality and effect acted as a barrier across both portable and nonportable devices, as well as single and multiple platforms. Conclusions: The uptake of DMHIs among AYAs is influenced by a complex interplay of facilitators and barriers, particularly those related to quality and effect. Our syntheses provide crucial guidance for intervention designers, emphasizing the importance of user-centered approaches that balance scientific rigor with engaging and adaptive features. Enhancing the alignment of DMHIs with adolescent needs can improve both adoption and real-world mental health impact. Trial Registration: PROSPERO CRD42023479880; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023479880 %R 10.2196/62870 %U https://www.jmir.org/2025/1/e62870 %U https://doi.org/10.2196/62870 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59691 %T Optimizing Testimonials for Behavior Change in a Digital Intervention for Binge Eating: Human-Centered Design Study %A Rooper,Isabel R %A Ortega,Adrian %A Massion,Thomas A %A Lakhtakia,Tanvi %A Kruger,Macarena %A Parsons,Leah M %A Lipman,Lindsay D %A Azubuike,Chidiebere %A Tack,Emily %A Obleada,Katrina T %A Graham,Andrea K %K health behavior %K health narratives %K binge eating %K user engagement %K personalization %K behavior change %K digital health %K intervention %K human-centered design %K behavioral health %K preferences %D 2025 %7 21.3.2025 %9 %J JMIR Form Res %G English %X Background: Testimonials from credible sources are an evidence-based strategy for behavior change. Behavioral health interventions have used testimonials to promote health behaviors (eg, physical activity and healthy eating). Integrating testimonials into eating disorder (ED) interventions poses a nuanced challenge because ED testimonials can promote ED behaviors. Testimonials in ED interventions must therefore be designed carefully. Some optimal design elements of testimonials are known, but questions remain about testimonial speakers, messaging, and delivery, especially for ED interventions. Objective: We sought to learn how to design and deliver testimonials focused on positive behavior change strategies within our multisession digital binge eating intervention. Methods: We applied human-centered design methods to learn users’ preferences for testimonial speakers, messaging, and delivery (modalities, over time, and as “nudges” for selecting positive behavior change strategies they could practice). We recruited target users of our multisession intervention to complete design sessions. Adults (N=22, 64% self-identified as female; 32% as non-Hispanic Black, 41% as non-Hispanic White, and 27% as Hispanic) with recurrent binge eating and obesity completed individual interviews. Data were analyzed using methods from thematic analysis. Results: Most participants preferred designs with testimonials (vs without) for their motivation and validation of the intervention’s efficacy. A few distrusted testimonials for appearing too “commercial” or personally irrelevant. For speakers, participants preferred sociodemographically tailored testimonials and were willing to report personal data in the intervention to facilitate tailoring. For messaging, some preferred testimonials with “how-to” advice, whereas others preferred “big picture” success stories. For delivery interface, participants were interested in text, video, and multimedia testimonials. For delivery over time, participants preferred testimonials from new speakers to promote engagement. When the intervention allowed users to choose between actions (eg, behavioral strategies), participants preferred testimonials to be available across all actions but said that selectively delivering a testimonial with one action could “nudge” them to select it. Conclusions: Results indicated that intervention users were interested in testimonials. While participants preferred sociodemographically tailored testimonials, they said different characteristics mattered to them, indicating that interventions should assess users’ most pertinent identities and tailor testimonials accordingly. Likewise, users’ divided preferences for testimonial messaging (ie, “big picture” vs “how-to”) suggest that optimal messaging may differ by user. To improve the credibility of testimonials, which some participants distrusted, interventions could invite current users to submit testimonials for future integration in the intervention. Aligned with nudge theory, our findings indicate testimonials could be used as “nudges” within interventions—a ripe area for further inquiry—though future work should test if delivering a testimonial only with the nudged choice improves its uptake. Further research is needed to validate these design ideas in practice, including evaluating their impact on behavior change toward improving ED behaviors. %R 10.2196/59691 %U https://formative.jmir.org/2025/1/e59691 %U https://doi.org/10.2196/59691 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53399 %T Profiling Generalized Anxiety Disorder on Social Networks: Content and Behavior Analysis %A Alhazzaa,Linah %A Curcin,Vasa %+ , Department of Informatics, King's College London, Strand, London, WC2R 2LS, United Kingdom, 44 2078365454, linah.alhazzaa@kcl.ac.uk %K generalized anxiety disorder %K mental health %K Twitter %K social media analysis %K natural language processing %D 2025 %7 20.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite a dramatic increase in the number of people with generalized anxiety disorder (GAD), a substantial number still do not seek help from health professionals, resulting in reduced quality of life. With the growth in popularity of social media platforms, individuals have become more willing to express their emotions through these channels. Therefore, social media data have become valuable for identifying mental health status. Objective: This study investigated the social media posts and behavioral patterns of people with GAD, focusing on language use, emotional expression, topics discussed, and engagement to identify digital markers of GAD, such as anxious patterns and behaviors. These insights could help reveal mental health indicators, aiding in digital intervention development. Methods: Data were first collected from Twitter (subsequently rebranded as X) for the GAD and control groups. Several preprocessing steps were performed. Three measurements were defined based on Linguistic Inquiry and Word Count for linguistic analysis. GuidedLDA was also used to identify the themes present in the tweets. Additionally, users’ behaviors were analyzed using Twitter metadata. Finally, we studied the correlation between the GuidedLDA-based themes and users’ behaviors. Results: The linguistic analysis indicated differences in cognitive style, personal needs, and emotional expressiveness between people with and without GAD. Regarding cognitive style, there were significant differences (P<.001) for all features, such as insight (Cohen d=1.13), causation (Cohen d=1.03), and discrepancy (Cohen d=1.16). Regarding personal needs, there were significant differences (P<.001) in most personal needs categories, such as curiosity (Cohen d=1.05) and communication (Cohen d=0.64). Regarding emotional expressiveness, there were significant differences (P<.001) for most features, including anxiety (Cohen d=0.62), anger (Cohen d=0.72), sadness (Cohen d=0.48), and swear words (Cohen d=2.61). Additionally, topic modeling identified 4 primary themes (ie, symptoms, relationships, life problems, and feelings). We found that all themes were significantly more prevalent for people with GAD than for those without GAD (P<.001), along with significant effect sizes (Cohen d>0.50; P<.001) for most themes. Moreover, studying users’ behaviors, including hashtag participation, volume, interaction pattern, social engagement, and reactive behaviors, revealed some digital markers of GAD, with most behavior-based features, such as the hashtag (Cohen d=0.49) and retweet (Cohen d=0.69) ratios, being statistically significant (P<.001). Furthermore, correlations between the GuidedLDA-based themes and users’ behaviors were also identified. Conclusions: Our findings revealed several digital markers of GAD on social media. These findings are significant and could contribute to developing an assessment tool that clinicians could use for the initial diagnosis of GAD or the detection of an early signal of worsening in people with GAD via social media posts. This tool could provide ongoing support and personalized coping strategies. However, one limitation of using social media for mental health assessment is the lack of a demographic representativeness analysis. %M 40112289 %R 10.2196/53399 %U https://www.jmir.org/2025/1/e53399 %U https://doi.org/10.2196/53399 %U http://www.ncbi.nlm.nih.gov/pubmed/40112289 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56975 %T Effectiveness of Digital Lifestyle Interventions on Depression, Anxiety, Stress, and Well-Being: Systematic Review and Meta-Analysis %A Brinsley,Jacinta %A O'Connor,Edward J %A Singh,Ben %A McKeon,Grace %A Curtis,Rachel %A Ferguson,Ty %A Gosse,Georgia %A Willems,Iris %A Marent,Pieter-Jan %A Szeto,Kimberley %A Firth,Joseph %A Maher,Carol %+ Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, 108 North Terrace, Adelaide, 5000, Australia, 61 8 8302 6558, jacinta.brinsley@unisa.edu.au %K depression %K anxiety %K stress %K well-being %K mental health %K lifestyle intervention %K physical activity %K sleep %K diet %K digital health %K mobile phone %D 2025 %7 20.3.2025 %9 Review %J J Med Internet Res %G English %X Background: There is a growing body of robust evidence to show that lifestyle behaviors influence mental health outcomes. Technology offers an accessible and cost-effective implementation method for interventions, yet the study of the effectiveness of interventions to date has been specific to the mode of delivery, population, or behavior. Objective: The primary aim of this review was to comprehensively evaluate the effectiveness of digital lifestyle interventions for improving symptoms of depression, anxiety, stress, and well-being as coprimary outcomes in adults. The secondary aim was to explore the technological, methodological, intervention-specific, and population-specific characteristics that were associated with major changes in mental health outcomes. Methods: A systematic search was conducted across the MEDLINE, CINAHL, Embase, Emcare, PsycINFO, and Scopus databases to identify studies published between January 2013 and January 2023. Randomized controlled trials of lifestyle interventions (physical activity, sleep, and diet) that were delivered digitally; reported changes in symptoms of depression, anxiety, stress, or well-being in adults (aged ≥18 years); and were published in English were included. Multiple authors independently extracted data, which was evaluated using the 2011 Levels of Evidence from the Oxford Centre for Evidence-Based Medicine. Inverse-variance random-effects meta-analyses were used for data analysis. The primary outcome was the change in symptoms of depression, anxiety, stress, and well-being as measured by validated self-report of clinician-administered outcomes from pre- to postintervention. Subgroup analyses were conducted to determine whether results differed based on the target lifestyle behavior, delivery method, digital features, design features, or population characteristics. Results: Of the 14,356 studies identified, 61 (0.42%) were included. Digital lifestyle interventions had a significant small-to-medium effect on depression (standardized mean difference [SMD] −0.37; P<.001), a small effect on anxiety (SMD −0.29; P<.001) and stress (SMD −0.17; P=.04), and no effect on well-being (SMD 0.14; P=.15). Subgroup analyses generally suggested that effects were similar regardless of the delivery method or features used, the duration and frequency of the intervention, the population, or the lifestyle behavior targeted. Conclusions: Overall, these results indicate that delivering lifestyle interventions via a range of digital methods can have significant positive effects on depression (P<.001), anxiety (P<.001), and stress (P=.04) for a broad range of populations, while effects on well-being are inconclusive. Future research should explore how these interventions can be effectively implemented and embedded within health care with a concerted focus on addressing digital health equity. Trial Registration: PROSPERO CRD42023428908; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023428908 %M 40112295 %R 10.2196/56975 %U https://www.jmir.org/2025/1/e56975 %U https://doi.org/10.2196/56975 %U http://www.ncbi.nlm.nih.gov/pubmed/40112295 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64459 %T A Brief Cognitive Behavioral Therapy–Based Digital Intervention for Reducing Hazardous Alcohol Use in South Korea: Development and Prospective Pilot Study %A Kwon,Manjae %A Moon,Daa Un %A Kang,Minjae %A Jung,Young-Chul %K alcohol %K hazardous alcohol use %K digital intervention %K cognitive behavioral therapy %K mobile apps %K prevention %K therapy-based %K cognitive behavioral %K alcohol use %K South Korea %K prospective pilot study %K pilot study %K alcohol consumption %K death %K disability %K chronic medical condition %K digital health interventions %K traditional treatment methods %K Korean %K hazardous drinking %K acceptability %K feasibility %K smartphone app %K alcohol use disorder %K psychiatric symptoms %K mobile phone %D 2025 %7 19.3.2025 %9 %J JMIR Form Res %G English %X Background: Alcohol consumption is a leading cause of death and disability worldwide, associated with numerous acute and chronic medical conditions. Digital health interventions offer a promising solution to overcome barriers associated with traditional treatment methods, providing accessible, scalable, and cost-effective means to support individuals in reducing hazardous drinking. Objective: This pilot study aims to evaluate the feasibility, acceptability, and preliminary efficacy of the Sober smartphone app in individuals with hazardous alcohol use. Methods: This single-group, pre- and postpilot study included 20 participants with risky alcohol use, identified using the Alcohol Use Disorder Identification Test. Participants used the Sober app for 4 weeks, incorporating cognitive behavioral therapy–based interventions. Feasibility was assessed by study and session completion rates, acceptability by participant satisfaction and perceived usefulness, and preliminary efficacy by changes in alcohol consumption and psychiatric symptoms. Semistructured interviews with participants and clinicians provided qualitative perspectives on the app’s usability, efficacy, and areas for improvement. Results: Of the 20 enrolled participants, 17 completed the study. The app demonstrated high feasibility with an 85% (17/20) study completion rate, and 59% (10/17) completed all cognitive behavioral therapy sessions. Participants reported positive acceptability, with average satisfaction and usefulness ratings of 3.8 and 3.7 of 5, respectively. Preliminary efficacy outcomes showed significant improvements: abstinence days increased from 67% to 85% (z=−3.17; P=.002), heavy drinking episodes decreased from 3.3 to 1.9 (t16=−2.97; P=.003), and total alcohol consumption reduced from 456.8 to 195.9 mL (t16=3.16; P=.002). Alcohol Use Disorder Identification Test scores dropped from 17.5 to 10.7 (t16=4.51; P<.001). Additionally, depression (Patient Health Questionnaire-9) scores decreased from 5.8 to 4.4 (t16=2.91; P=.01), and anxiety (Generalized Anxiety Disorder-7) scores from 3.4 to 2.1 (z=−2.80; P=.005). No adverse events were reported. Qualitative analysis found participants valued daily logging but noted usability issues, while clinicians called for tailored goals, enhanced communication features, and age-specific content. Conclusions: The mobile app Sober shows promise as an effective tool for reducing hazardous alcohol consumption and improving related psychiatric symptoms. The study demonstrated high feasibility and positive acceptability, with significant preliminary efficacy in reducing alcohol use. Qualitative findings provided actionable evidence for refining the app’s usability and clinical integration. Further research through a randomized controlled trial is warranted to confirm these findings and optimize the app’s features and content. Trial Registration: ClinicalTrials.gov NCT06502756; https://clinicaltrials.gov/study/NCT06502756 %R 10.2196/64459 %U https://formative.jmir.org/2024/1/e64459 %U https://doi.org/10.2196/64459 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e67682 %T AI Chatbots for Psychological Health for Health Professionals: Scoping Review %A Baek,Gumhee %A Cha,Chiyoung %A Han,Jin-Hui %K artificial intelligence %K AI chatbot %K psychological health %K health professionals %K burnout %K scoping review %D 2025 %7 19.3.2025 %9 %J JMIR Hum Factors %G English %X Background: Health professionals face significant psychological burdens including burnout, anxiety, and depression. These can negatively impact their well-being and patient care. Traditional psychological health interventions often encounter limitations such as a lack of accessibility and privacy. Artificial intelligence (AI) chatbots are being explored as potential solutions to these challenges, offering available and immediate support. Therefore, it is necessary to systematically evaluate the characteristics and effectiveness of AI chatbots designed specifically for health professionals. Objective: This scoping review aims to evaluate the existing literature on the use of AI chatbots for psychological health support among health professionals. Methods: Following Arksey and O’Malley’s framework, a comprehensive literature search was conducted across eight databases, covering studies published before 2024, including backward and forward citation tracking and manual searching from the included studies. Studies were screened for relevance based on inclusion and exclusion criteria, among 2465 studies retrieved, 10 studies met the criteria for review. Results: Among the 10 studies, six chatbots were delivered via mobile platforms, and four via web-based platforms, all enabling one-on-one interactions. Natural language processing algorithms were used in six studies and cognitive behavioral therapy techniques were applied to psychological health in four studies. Usability was evaluated in six studies through participant feedback and engagement metrics. Improvements in anxiety, depression, and burnout were observed in four studies, although one reported an increase in depressive symptoms. Conclusions: AI chatbots show potential tools to support the psychological health of health professionals by offering personalized and accessible interventions. Nonetheless, further research is required to establish standardized protocols and validate the effectiveness of these interventions. Future studies should focus on refining chatbot designs and assessing their impact on diverse health professionals. %R 10.2196/67682 %U https://humanfactors.jmir.org/2025/1/e67682 %U https://doi.org/10.2196/67682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e68549 %T Integration of Psychiatric Advance Directives Into the Patient-Accessible Electronic Health Record: Exploring the Promise and Limitations %A Schwarz,Julian %A Meier-Diedrich,Eva %A Scholten,Matthé %A Stephenson,Lucy %A Torous,John %A Wurster,Florian %A Blease,Charlotte %+ Center for Mental Health, Department of Psychiatry and Psychotherapy, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 33638 83 501, Julian.Schwarz@mhb-fontane.de %K advance statements %K advance choice documents %K advance care planning %K mental health %K online record access %K patient accessible electronic health records %K interoperability %K fast healthcare interoperability eesources %K FHIR %K self-binding directives %K mobile phone %D 2025 %7 18.3.2025 %9 Viewpoint %J J Med Internet Res %G English %X Psychiatric advance directives (PAD), also known as advance statements or advance choice documents, are legal documents that enable people with mental health conditions to specify their treatment preferences in advance for possible future crises. Subtypes of PADs include crisis cards, joint crisis plans, and self-binding directives (also known as Ulysses contracts). These instruments are intended to improve service user involvement and need orientation in the care of mental crises and to avoid traumatization through unwanted treatment. The existing evidence suggests that people who complete a PAD tend to work more cooperatively with their clinician and experience fewer involuntary hospital admissions. Nevertheless, PADs have not been successfully mainstreamed into care due to multiple barriers to the implementation of PADs, mainly around the completion of PADs and their accessibility and use in crises. The reasons for this include the lack of support in the completion process and acceptance problems, especially on the part of professionals. The research to date primarily recommends support for service users from facilitators, such as peer support workers, and training for all stakeholders. In this article, we argue that while these approaches can help to solve completion and acceptance challenges, they are not sufficient to ensure access to PADs in crises. To ensure accessibility, we propose digital PADs, which offer considerable potential for overcoming these aforementioned barriers. Embedded in national health data infrastructures, PADs could be completed and accessed by service users themselves, possibly with the support of facilitators, and retrieved by any clinic in an emergency. We highlight the strengths and limitations of digital PADs and point out that the proposed solutions must be developed collaboratively and take into account digital inequalities to be effective support for people with serious mental health conditions. %M 40100260 %R 10.2196/68549 %U https://www.jmir.org/2025/1/e68549 %U https://doi.org/10.2196/68549 %U http://www.ncbi.nlm.nih.gov/pubmed/40100260 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57789 %T A Trauma Support App for Young People: Co-design and Usability Study %A Thell,Maria %A Edvardsson,Kerstin %A Aljeshy,Reem %A Ibrahim,Kalid %A Warner,Georgina %+ Child Health and Parenting, Department of Public Health and Caring Science, Uppsala University, BMC, Husargatan 3, Uppsala, 751 23, Sweden, 46 18 471 6632, georgina.warner@uu.se %K co-design %K young people %K trauma %K app development %K usability testing %D 2025 %7 18.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: One of the most common reasons young people with mental health issues, such as posttraumatic stress disorder, do not seek help is stigma, which digital support tools could help address. However, there is a lack of trauma support apps specifically designed for young people. Involving the target group in such projects has been shown to produce more engaging and effective results. Objective: This study aimed to apply a child rights–based participatory approach to develop a trauma support app with young people. Methods: Seven young people (aged 14-19 years; 3 males and 4 females) with experiences of trauma were recruited as coresearchers. A child rights–based framework guided the working process. The app was developed through a series of Design Studio workshops and home assignments, using the manualized intervention Teaching Recovery Techniques as the foundation for its content. The coresearchers were trained in research methodology and conducted usability testing with other young people (n=11) using the think-aloud method, the System Usability Scale (SUS), and qualitative follow-up questions. Results: A functional app prototype was developed using a no-code platform, incorporating various trauma symptom management techniques. These techniques covered psychoeducation, normalization, relaxation, and cognitive shifting, presented in multiple formats, including text, audio, and video. The contributions of the coresearchers to the design can be categorized into 3 areas: mechanics (rules and interactions shaping the app’s structure), dynamics (user-visible elements, such as the outcome when pressing a button), and aesthetics (the emotional responses the app aimed to evoke in users during interaction). Beyond influencing basic aesthetics, the coresearchers placed significant emphasis on user experience and the emotional responses the app could evoke. SUS scores ranged from 67.5 to 97.5, with the vast majority exceeding 77.5, indicating good usability. However, usability testing revealed several issues, generally of lower severity. For instance, video content required improvements, such as reducing light flickering in some recordings and adding rewind and subtitle selection options. Notably, the feature for listening to others’ stories was removed to minimize emotional burden, shifting the focus to text formats with more context. Conclusions: Young people who have experienced trauma can actively participate in the cocreation of a mental health intervention, offering valuable insights into the needs and preferences of their peers. Applying a child rights–based framework to their involvement in a research project supported the fulfillment of the Convention on the Rights of the Child Article 12. %M 40100259 %R 10.2196/57789 %U https://formative.jmir.org/2025/1/e57789 %U https://doi.org/10.2196/57789 %U http://www.ncbi.nlm.nih.gov/pubmed/40100259 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e70982 %T Digital Wellness Programs in the Workplace: Meta-Review %A Amirabdolahian,Saeed %A Pare,Guy %A Tams,Stefan %+ , Research Chair in Digital Health, HEC Montréal, 3000 Cote-Ste-Catherine Road, Montreal, QC, H3T 2A7, Canada, 1 514 340 6812, guy.pare@hec.ca %K digital wellness programs %K corporate wellness %K health interventions %K efficacy %K acceptability %K meta-review %K mHealth %K eHealth %D 2025 %7 14.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Corporate wellness programs are increasingly using digital technologies to promote employee health. Digital wellness programs (DWPs) refer to initiatives that deliver health interventions through digital tools. Despite a growing body of evidence on DWPs, the literature remains fragmented across multiple health domains. Objective: This study aims to provide a comprehensive synthesis of existing research on the efficacy (eg, impact on employee’s physical health, mental well-being, behavioral changes, and absenteeism) and acceptability (eg, engagement, perceived usefulness, and adoption) of employer-provided DWPs. Specifically, we aim to map the extent, range, and nature of research on this topic; summarize key findings; identify gaps; and facilitate knowledge dissemination. Methods: We conducted a meta-review of studies published between 2000 and 2023. We adopted a database-driven search approach, including the MEDLINE, PsycINFO, ProQuest Central, and Web of Science Core Collection databases. The inclusion criteria consisted of (1) review articles; (2) publications in English, French, or German; (3) studies reporting on digital health interventions implemented in organizations; (4) studies reporting on nonclinical or preclinical employee populations; and (5) studies assessing the efficacy and acceptability of employer-provided DWPs. We performed a descriptive numerical summary and thematic analysis of the included studies. Results: Out of 593 nonduplicate studies screened, 29 met the inclusion criteria. The most investigated health domains included mental health (n=19), physical activity (n=8), weight management (n=6), unhealthy behavior change (n=4), and sleep management (n=2). In total, 24 reviews focused on the efficacy of DWPs, primarily in relation to health-related outcomes (eg, stress and weight), while fewer reviews addressed organization-related outcomes (eg, burnout and absenteeism). Four reviews explored the mechanisms of action, and 3 assessed the acceptability of DWPs using various measures. Overall, the findings support the efficacy and acceptability of DWPs, although significant gaps persist, particularly regarding the durability of outcomes, the role of technology, and the causal mechanisms underlying behavioral change. Conclusions: While DWPs show promise across a variety of health domains, several aspects of their effectiveness remain underexplored. Practitioners should capitalize on existing evidence of successful DWPs while acknowledging the limitations in the literature. %M 40085840 %R 10.2196/70982 %U https://www.jmir.org/2025/1/e70982 %U https://doi.org/10.2196/70982 %U http://www.ncbi.nlm.nih.gov/pubmed/40085840 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65228 %T Digital Cognitive Behavioral Therapy–Based Treatment for Insomnia, Nightmares, and Posttraumatic Stress Disorder Symptoms in Survivors of Wildfires: Pilot Randomized Feasibility Trial %A Isaac,Fadia %A Klein,Britt %A Nguyen,Huy %A Watson,Shaun %A Kennedy,Gerard A %+ Institute of Health and Wellbeing, Federation University Australia, University Drive, Mt Helen, Victoria, 3350, Australia, 61 353276717, fadia.isaac@hotmail.com %K insomnia %K nightmares %K posttraumatic stress disorder %K PTSD %K wildfires %K cognitive behavioral therapy for insomnia %K CBTi %K exposure, relaxation, and rescripting therapy %K ERRT %K Sleep Best-i %K mobile health %K mHealth %K digital health %K computer %K eHealth %K bushfires %D 2025 %7 14.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Symptoms of insomnia, nightmares, and trauma are highly prevalent. However, there are significant barriers to accessing evidence-based treatments for these conditions, leading to poor mental health outcomes. Objective: This pilot trial evaluated the feasibility of a 4-week, digital self-paced intervention combining cognitive behavioral therapy for insomnia and exposure, relaxation, and rescripting therapy for nightmares in survivors of wildfires from Australia, Canada, and the United States. Methods: Study participants were recruited between May 2023 and December 2023 through social media platforms, workshops, conferences, and radio interviews. Participants had to meet at least one of the following criteria: a score of ≥8 on the Insomnia Severity Index, a score of ≥3 on the Nightmare Disorder Index, or a score of ≥31 on the PTSD Checklist for DSM-5. In total, 30 survivors of wildfires were allocated to either the treatment group (n=16, 53%) or the waitlist control group (n=14, 47%) in a sequential manner. Participants’ ages ranged from 18 to 79 years, with a mean age of 52.50 (SD 16.26) years. The cohort consisted of 63% (19/30) female and 37% (11/30) male participants. Participants also completed self-report secondary outcome measures, including the Generalized Anxiety Disorder–7, the Patient Health Questionnaire–9, and the Pittsburgh Sleep Quality Index, via the HealthZone digital platform. Assessments were conducted at baseline, the posttreatment time point, and the 3-month follow-up, with the waitlist group undergoing an additional assessment at the pretreatment time point, after 4 weeks of waiting and before crossing over to treatment. This study used intention-to-treat analysis as a primary analysis and per-protocol analysis as a secondary analysis. Results: Mixed-effects linear regression models and difference-in-differences analyses were used to assess the intervention’s effects. The intention-to-treat analysis revealed significant improvements over time (main effect of time), with a 1.64-point reduction (P=.001) on the Nightmare Disorder Index and 10.64-point reduction (P=.009) on the PTSD Checklist for DSM-5 at the postintervention time point. No significant changes were observed in insomnia symptoms. On the secondary measures, there was an interaction effect of condition × time, with a 2.22-point reduction (P<.001) on the Pittsburgh Sleep Quality Index, and a main effect of time, with a 6.48-point reduction (P<.001) on the Patient Health Questionnaire–9. No changes were detected on the Generalized Anxiety Disorder–7. The per-protocol analysis yielded comparable results for both the primary and secondary measures. Conclusions: The findings of this pilot trial demonstrated a reduction in nightmares and trauma symptoms. Future research studies should aim at evaluating the intervention in a more definitive trial with a larger sample size. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000415606; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385054 %M 40085843 %R 10.2196/65228 %U https://humanfactors.jmir.org/2025/1/e65228 %U https://doi.org/10.2196/65228 %U http://www.ncbi.nlm.nih.gov/pubmed/40085843 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63636 %T Measuring Mental Health in 2 Brazilian University Centers: Protocol for a Cohort Survey %A Di Santi,Talita %A Nascimento,Ariana Gomes %A Fukuti,Pedro %A Marchisio,Vinnie %A Araujo do Amaral,Gian Carlo %A Vaz,Camille Figueiredo Peternella %A Carrijo,Luiz David Finotti %A Oliveira,Lilian Cristie de %A Costa,Luiz Octávio da %A Mancini Marion Konieczniak,Elisângela %A Zuppi Garcia,Luana Aparecida %A Cabrelon Jusevicius,Vanessa Cristina %A Humes,Eduardo de Castro %A Rossi Menezes,Paulo %A Miguel,Euripedes %A Caye,Arthur %+ Department of Psychiatry, Faculty of Medicine, University of São Paulo, Ovidio Pires St Sao Paulo, São Paulo, 05403-903, Brazil, 55 11995580667, tadisanti@gmail.com %K study design %K university students %K mental health screening %K longitudinal survey %K college students %D 2025 %7 14.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Global concern for the mental well-being of university students is on the rise. Recent studies estimate that around 30% of students experience mental health disorders, and nearly 80% of these individuals do not receive adequate treatment. Brazil, home to around eight million university students, lacks sufficient research addressing their mental health. To address this gap, we aim to conduct a longitudinal mental health survey at 2 Brazilian universities. Objective: This paper outlines the research protocol for a web-based mental health survey designed to assess the well-being of Brazilian university students. Methods: The survey targets undergraduate students (N=8028) from 2 institutions: UniFAJ (Centro Universitário de Jaguariúna) and UniMAX (Centro Universitário Max Planck). Students will be invited to respond to self-reported questionnaires, including theSMILE-U (lifestyle and quality of life), the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) self-rated level 1 cross-cutting symptom measure, and a brief version of the Adult Self-Report Scale for attention-deficit/hyperactivity disorder. Students who exceed thresholds for conditions such as depression, anxiety, and attention-deficit/hyperactivity disorder will receive additional diagnostic instruments. The survey will be conducted annually, tracking individual and group trajectories and enrolling new cohorts each year. Data will be analyzed using cross-sectional and longitudinal methods, focusing on descriptive, associative, and trajectory analyses. Results: The first wave of data collection began in February 2024 and is expected to conclude in December 2024. As of October 2024, a total of 2034 of 7455 (27.2 in 100) eligible students had completed the questionnaire. Cross-sectional statistical analysis is planned to commence immediately after data collection and is expected to be completed by June 2025. Conclusions: This survey uses a scalable, cost-effective design to evaluate mental health conditions among Brazilian university students. The longitudinal framework facilitates the monitoring of mental health trends, supports the development of targeted interventions, and informs policy initiatives in higher education. Trial Registration: OSF Registries OSF.IO/AM5WS; https://doi.org/10.17605/OSF.IO/AM5WS International Registered Report Identifier (IRRID): DERR1-10.2196/63636 %M 40085140 %R 10.2196/63636 %U https://www.researchprotocols.org/2025/1/e63636 %U https://doi.org/10.2196/63636 %U http://www.ncbi.nlm.nih.gov/pubmed/40085140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65391 %T BePresent Universal Internet-Based Parenting Intervention: Single-Arm Pre-Post Intervention Study %A Mishina,Kaisa %A Baumel,Amit %A Kinnunen,Malin %A Ristkari,Terja %A Heinonen,Emmi %A Hinkka-Yli-Salomäki,Susanna %A Sourander,Andre %+ Research Centre for Child Psychiatry, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3, Turku, 20014, Finland, 358 50 310 135, kaemka@utu.fi %K parent training %K universal intervention %K online intervention %K irritability %K conduct problems %K hyperactivity %K preschool %K mental health %K strongest families %K positive parenting %K parenting skills %K parent-child relationships %K parent satisfaction %K BePresent %K feasibility study %K single-arm pre-post intervention study %D 2025 %7 13.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based parenting programs have great potential to promote positive parent-child relationships as well as to reach and engage parents. Objective: This study aimed to assess the universal internet-based BePresent parenting intervention for families with 3-year-old children and how it influences the child’s behavior and daily-life situations assessed by parents. The first aim of the study was to assess the change from baseline to follow-up in child hyperactivity and conduct problems, affective reactivity, and daily activities. The second aim was to assess intervention completion rates. The third aim was to evaluate parent satisfaction with the intervention. The fourth aim was to assess all outcomes by comparing those who completed the intervention and those who did not. Methods: We conducted a single-arm pre- and postintervention study. Parents attending their child’s 3-year health check-up were recruited from children’s health clinics. The intervention was an unguided internet-based parenting program consisting of 5 modules. Self-reported measures were collected at baseline and at an 8-week follow-up. Linear mixed-effects models were used to analyze the changes from baseline to follow-up. Results: Altogether, 752 parents registered, and 515 started the intervention. Of those, 36% (n=183) completed the intervention. Parents reported high satisfaction with the intervention: the majority (68.8%–84.9%) were satisfied with various aspects of the program, and 89.9% said the intervention provided information about positive parenting skills. The findings show significant decreases with small effect sizes in parents’ ratings of child hyperactivity (P=.03; d=0.12) and conduct problems (P=.001; d=0.20) between baseline and the 8-week follow-up. A similar finding was observed in the parent ratings of child irritability (P≤.001; d=0.27) using the Affective Reactivity Index. Parents reported improvement in the daily functioning of their child when it was measured with a questionnaire adapted from the Barkley Home Situations Questionnaire (P=.01; d=0.14). Conclusions: Universal digital interventions have the potential to be implemented widely in community settings to improve knowledge and positive parenting skills. However, there is a need to assess the efficacy of digital universal interventions using randomized controlled designs and to examine additional ways to increase adherence to universal programs. %M 40080811 %R 10.2196/65391 %U https://www.jmir.org/2025/1/e65391 %U https://doi.org/10.2196/65391 %U http://www.ncbi.nlm.nih.gov/pubmed/40080811 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67454 %T Teen Perspectives on Integrating Digital Mental Health Programs for Teens Into Public Libraries (“I Was Always at the Library”): Qualitative Interview Study %A Knapp,Ashley A %A Cohen,Katherine %A Kruzan,Kaylee P %A Kornfield,Rachel %A Herrera,Miguel %A Pederson,Aderonke B %A Lee,Sydney %A Macapagal,Kathryn %A Roulston,Chantelle A %A Clarke,Kaleigh %A Wijaya,Clarisa %A Simmons,Robert %A Jackson,Latonia %A Kour,Simrandeep %A Franco,Sandra %A Mohr,David C %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 750 North Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125033751, ashley.knapp@northwestern.edu %K public libraries %K digital mental health %K teens %K youth %K adolescents %K anxiety %K mental health %K implementation %K safe spaces %K mobile phone %K smartphone %D 2025 %7 13.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Rising rates of anxiety among teens necessitate innovative approaches for implementing evidence-based mental health support. Public libraries, seen as safe spaces for patrons with marginalized identities, offer free public services such as broadband internet access. Many teens spend significant amounts of time in their local libraries due to the safety of this space as well as the trusted adults working there. The American Library Association has shifted its priorities to focus more on mental health through employing social workers and providing mental health programs. As such, public libraries may be promising sites for the implementation of digital mental health (DMH) programs for teens. Objective: This study aimed to examine how teens who attended their local public library experienced and managed their anxiety, what mental health supports they were interested in receiving, and how DMH programs and public libraries can meet their needs. Methods: We interviewed 16 teens aged 12-18 (mean 15.2, SD 2.0) years who used the library frequently at the time of the interviews. Of these teen patrons, 56% (9/16) identified as female, 31% (5/16) identified as male, and 12% (2/16) identified as nonbinary. Most (11/16, 69%) identified as either White or Black or African American individuals, with the remainder (5/16, 31%) identifying as Hispanic or Latino or Chinese American individuals or with ≥2 races. The interviews were individual and semistructured, designed to elicit recommendations for designing and implementing digital tools in libraries to improve teen mental health. Interview transcripts were coded by multiple coders using thematic analysis to synthesize key themes. Results: Teens reported experiencing uncontrollability, unpredictability, and anger related to their anxiety, which they managed using strategies such as guided breathing, distress tolerance, and social connection. They also talked about other helpful management techniques (eg, progressive muscle relaxation, journaling, and mood tracking). Teens underscored the importance of pairing mood tracking with daily activities to reveal patterns. They also stressed the significance of context and anxiety severity when choosing anxiety management strategies. Teens underscored the centrality of the public library in their lives and their view of it as a safe space where they can easily access resources and connect with friends and trusted adults. When considering the design of a DMH program implemented in libraries, they suggested including personalization for different identities, gamification, and simple navigation. Teens emphasized the importance of protecting their privacy within digital programs and that their end goal was to use the skills learned in the DMH program offline. Conclusions: Teens who frequently used their local public library expressed interest in receiving digital tools via libraries to help them manage anxiety. Their recommendations will help inform future research on the adaptation and implementation of DMH programs for teens in public libraries. %M 40080819 %R 10.2196/67454 %U https://formative.jmir.org/2025/1/e67454 %U https://doi.org/10.2196/67454 %U http://www.ncbi.nlm.nih.gov/pubmed/40080819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63251 %T Telemedicine Prescribing by US Mental Health Care Providers: National Cross-Sectional Survey %A Cummins,Mollie R %A Ivanova,Julia %A Soni,Hiral %A Robbins,Zoe %A Bunnell,Brian E %A López,Esteban %A Welch,Brandon M %K telemedicine %K telehealth %K telemental %K provider %K professional %K experience %K attitude %K opinion %K perception %K perspective %K prescribing %K prescription %K drug %K pharmacology %K pharmacotherapy %K pharmaceutic %K pharmaceutical %K medication %K mental health %K digital health %K informatics %K buprenorphine %K ketamine %K cross sectional %K survey %K questionnaire %D 2025 %7 11.3.2025 %9 %J JMIR Form Res %G English %X Background: In the postpandemic era, telemedicine continues to enable mental health care access for many people, especially persons living in areas with mental health care provider shortages. However, as lawmakers consider long-term telemedicine policy decisions, some question the safety and appropriateness of prescribing via telemedicine, and whether there should be requirements for in-person evaluation, especially for controlled substances. Objective: Our objective was to assess US telemental health care provider perceptions of comfort and perceived safety in prescribing medications, including controlled substances, via telemedicine. Methods: We conducted a web-based, cross-sectional survey of US telemental health care providers who prescribe via telemedicine, using nonprobability, availability sampling of a national telehealth research panel from February 13 to April 28, 2024. We used descriptive statistics, visualization, and thematic analysis to analyze results. We assessed differences in response distribution by health care provider licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry) using the Mann-Whitney U test. Results: A total of 115 screened and eligible panelists completed the survey. Overall, participants indicated high levels of comfort with prescribing via telemedicine, with 84% (102/115) of health care providers indicating they strongly agree with the statement indicating comfort in prescribing medications via telemedicine. However, participants indicated less comfort in prescribing if they have never seen a patient in person, or if the patient is located out-of-state. Most participants indicated they can safely prescribe controlled substances via telemedicine, without having previously provided care to a patient in person. However, 14.8% (17/115) to 19.1% (30/115) of health care providers (by schedule) felt that they could rarely or never safely prescribe controlled substances. There were some differences in perception of comfort and safety by licensure and specialty. Among controlled substance schedules, participants indicated the least perceived safety with schedule IV medications, and the most safety with schedule II and III medications. Conclusions: These health care providers were highly comfortable prescribing both scheduled and unscheduled medications via telemedicine. Comfort and perceived safety with telemedicine prescribing varied somewhat by licensure type (physician vs nonphysician) and specialty (psychiatry vs nonpsychiatry). Perceived safety varied moderately for scheduled medications (controlled substances), especially for schedule IV and V medications. Participants indicated use of adaptive strategies to prescribe safely depending upon the clinical context. In ongoing efforts, we are analyzing additional survey results and conducting qualitative research related to telemedicine prescribing. A strong understanding of prescriber perspectives and experience with telemedicine prescribing is needed to support excellent clinical practice and effective policy making in the United States. %R 10.2196/63251 %U https://formative.jmir.org/2025/1/e63251 %U https://doi.org/10.2196/63251 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e56978 %T Gamified Adaptive Approach Bias Modification in Individuals With Methamphetamine Use History From Communities in Sichuan: Pilot Randomized Controlled Trial %A Shen,Danlin %A Jiao,Jianping %A Zhang,Liqun %A Liu,Yanru %A Liu,Xiang %A Li,Yuanhui %A Zhang,Tianjiao %A Li,Dai %A Hao,Wei %K digital therapeutics %K substance use disorder %K game %K pilot RCT %K randomized controlled trial %K methamphetamine %K psychiatric %K gamified design %K engagement %K effectiveness %K smartphone app %K cognitive bias modification %D 2025 %7 10.3.2025 %9 %J JMIR Serious Games %G English %X Background: Cognitive bias modification (CBM) programs have shown promise in treating psychiatric conditions, but they can be perceived as boring and repetitive. Incorporating gamified designs and adaptive algorithms in CBM training may address this issue and enhance engagement and effectiveness. Objectives: This study aims to gather preliminary data and assess the preliminary efficacy of an adaptive approach bias modification (A-ApBM) paradigm in reducing cue-induced craving in individuals with methamphetamine use history. Methods: A randomized controlled trial with 3 arms was conducted. Individuals aged 18‐60 years with methamphetamine dependence and at least 1 year of methamphetamine use were recruited from 12 community-based rehabilitation centers in Sichuan, China. Individuals with the inability to fluently operate a smartphone and the presence of mental health conditions other than methamphetamine use disorder were excluded. The A-ApBM group engaged in ApBM training using a smartphone app for 4 weeks. The A-ApBM used an adaptive algorithm to dynamically adjust the difficulty level based on individual performance. Cue-induced craving scores and relapses were assessed using a visual analogue scale at baseline, postintervention, and at week-16 follow-up. Results: A total of 136 participants were recruited and randomized: 48 were randomized to the A-ApBM group, 48 were randomized to the static approach bias modification (S-ApBM) group, and 40 were randomized to the no-intervention control group. The A-ApBM group showed a significant reduction in cue-induced craving scores at postintervention compared with baseline (Cohen d=0.34; P<.01; 95% CI 0.03-0.54). The reduction remained significant at the week-16 follow-up (Cohen d=0.40; P=.01; 95% CI 0.18-0.57). No significant changes were observed in the S-ApBM and control groups. Conclusions: The A-ApBM paradigm with gamified designs and dynamic difficulty adjustments may be an effective intervention for reducing cue-induced craving in individuals with methamphetamine use history. This approach improves engagement and personalization, potentially enhancing the effectiveness of CBM programs. Further research is needed to validate these findings and explore the application of A-ApBM in other psychiatric conditions. Trial Registration: ClinicalTrials.gov NCT05794438; https://clinicaltrials.gov/study/NCT05794438 %R 10.2196/56978 %U https://games.jmir.org/2025/1/e56978 %U https://doi.org/10.2196/56978 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66321 %T Online Safety When Considering Self-Harm and Suicide-Related Content: Qualitative Focus Group Study With Young People, Policy Makers, and Social Media Industry Professionals %A La Sala,Louise %A Sabo,Amanda %A Michail,Maria %A Thorn,Pinar %A Lamblin,Michelle %A Browne,Vivienne %A Robinson,Jo %+ Orygen, 35 Poplar Road, Parkville, 3052, Australia, 61 3 9966 9512, louise.lasala@orygen.org.au %K young people %K suicide prevention %K self-harm %K social media %K online safety %K policy %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Young people are disproportionately impacted by self-harm and suicide, and concerns exist regarding the role of social media and exposure to unsafe content. Governments and social media companies have taken various approaches to address online safety for young people when it comes to self-harm and suicide; however, little is known about whether key stakeholders believe current approaches are fit-for-purpose. Objective: From the perspective of young people, policy makers and professionals who work within the social media industry, this study aimed to explore (1) the perceived challenges and views regarding young people communicating on social media about self-harm and suicide, and (2) what more social media companies and governments could be doing to address these issues and keep young people safe online. Methods: This qualitative study involved 6 focus groups with Australian young people aged 12-25 years (n=7), Australian policy makers (n=14), and professionals from the global social media industry (n=7). Framework analysis was used to summarize and chart the data for each stakeholder group. Results: In total, 3 primary themes and six subthemes are presented: (1) challenges and concerns, including the reasons for, and challenges related to, online communication about self-harm and suicide as well as reasoning with a deterministic narrative of harm; (2) roles and responsibilities regarding online safety and suicide prevention, including who is responsible and where responsibility starts and stops, as well as the need for better collaborations; and (3) future approaches and potential solutions, acknowledging the limitations of current safety tools and policies, and calling for innovation and new ideas. Conclusions: Our findings highlight tensions surrounding roles and responsibilities in ensuring youth online safety and offer perspectives on how social media companies can support young people discussing self-harm and suicide online. They also support the importance of cross-industry collaborations and consideration of social media in future suicide prevention solutions intended to support young people. %M 40063940 %R 10.2196/66321 %U https://www.jmir.org/2025/1/e66321 %U https://doi.org/10.2196/66321 %U http://www.ncbi.nlm.nih.gov/pubmed/40063940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60435 %T Generative AI–Enabled Therapy Support Tool for Improved Clinical Outcomes and Patient Engagement in Group Therapy: Real-World Observational Study %A Habicht,Johanna %A Dina,Larisa-Maria %A McFadyen,Jessica %A Stylianou,Mona %A Harper,Ross %A Hauser,Tobias U %A Rollwage,Max %+ Limbic Ltd, Kemp House, 128 City Road, London, EC1V 2NX, United Kingdom, 44 020 3818 3240, max@limbic.ai %K artificial intelligence %K National Health Service %K NHS Talking Therapies %K mental health %K therapy support tool %K cognitive behavioral therapy %K CBT %K chatbot %K conversational agent %K clinical %K patient engagement %K therapist %K treatment %K medication %K depression %K anxiety disorder %K exercise %K observational study %K control group %K patient adherence %D 2025 %7 10.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy (CBT) is a highly effective treatment for depression and anxiety disorders. Nonetheless, a substantial proportion of patients do not respond to treatment. The lack of engagement with therapeutic materials and exercises between sessions, a necessary component of CBT, is a key determinant of unsuccessful treatment. Objective: The objective of this study was to test whether the deployment of a generative artificial intelligence (AI)–enabled therapy support tool, which helps patients to engage with therapeutic materials and exercises in between sessions, leads to improved treatment success and patient treatment adherence compared with the standard delivery of CBT exercises through static workbooks. Methods: We conducted a real-world observational study of 244 patients receiving group-based CBT in 5 of the United Kingdom’s National Health Service Talking Therapies services, comparing 150 (61.5%) patients who used the AI-enabled therapy support tool to 94 (38.5%) patients who used the standard delivery of CBT exercises. The groups were equivalent with respect to the content of the CBT materials and the human-led therapy sessions; however, the intervention group received support from the AI-enabled therapy support tool in conducting CBT exercises. Results: Patients using the AI-enabled therapy support tool exhibited greater attendance at therapy sessions and fewer dropouts from treatment. Furthermore, these patients demonstrated higher reliable improvement, recovery, and reliable recovery rates when compared to the control group, which was related to the degree of use of the AI-enabled therapy support tool. Moreover, we found that engagement with AI-supported CBT interventions, relative to psychoeducational materials, predicted better treatment adherence and treatment success, highlighting the role of personalization in the intervention’s effectiveness. To investigate the mechanisms of these effects further, we conducted a separate qualitative experiment in a nonclinical sample of users (n=113). Results indicated that users perceived the AI-enabled therapy support tool as most useful for discussing their problems to gain awareness and clarity of their situation as well as learning how to apply coping skills and CBT techniques in their daily lives. Conclusions: Our results show that an AI-enabled, personalized therapy support tool in combination with human-led group therapy is a promising avenue to improve the efficacy of and adherence to mental health care. %M 40063074 %R 10.2196/60435 %U https://www.jmir.org/2025/1/e60435 %U https://doi.org/10.2196/60435 %U http://www.ncbi.nlm.nih.gov/pubmed/40063074 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e50326 %T Effects and Acceptability of a 1-Week Home-Based Virtual Reality Training for Supporting the Management of Stress and Anxiety: Randomized Pilot Trial %A Pallavicini,Federica %A Orena,Eleonora %A Arnoldi,Lisa %A Achille,Federica %A Stefanini,Stefano %A Cassa,Maddalena %A Pepe,Alessandro %A Veronese,Guido %A Bernardelli,Luca %A Sforza,Francesca %A Fascendini,Sara %A Defanti,Carlo Alberto %A Gemma,Marco %A Clerici,Massimo %A Riva,Giuseppe %A Mantovani,Fabrizia %+ Department of Human Sciences for Education “Riccardo Massa”, University of Milano-Bicocca, Piazza dell’Ateneo Nuovo 1, 20126, Milan, 20100, Italy, 39 02 64484944, federica.pallavicini@unimib.it %K virtual reality %K relaxation %K anxiety %K depression %K emotions %K health care professionals %K health care workers %K hospital %K randomized clinicial trial %K hospitals %D 2025 %7 6.3.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) is helpful for the management of stress and anxiety. However, current interventions have limitations related to location (ie, therapist’s office or hospitals) and content (ie, virtual experiences only for relaxation). Objective: This randomized pilot trial aims to investigate the efficacy and acceptability of a brief remote VR-based training for supporting stress and anxiety management in a sample of Italian health care workers. Methods: A total of 29 doctors and nurses (n=21; 72% female; mean age 35.6, SD 10.3 years) were recruited and randomized to a VR intervention group or a control group in a passive control condition. Participants assigned to the VR intervention group received remote VR-based training consisting of 3 sessions at home delivered in 1 week using the VR psychoeducational experience “MIND-VR” and the 360° relaxing video “The Secret Garden.” The primary outcome measures were stress, anxiety, depression, and the knowledge of stress and anxiety assessed at baseline and posttreatment. We also evaluated the immediate effect of the remote VR-based training sessions on the perceived state of anxiety and negative and positive emotions. The secondary outcome measure was the usability at home of the VR system and content. Results: The VR intervention significantly reduced stress levels as assessed by the Perceived Stress Scale (6.46, 95% CI 2.77 to 10.5; P=.046) and increased the knowledge of stress and anxiety, as evaluated by the ad hoc questionnaire adopted (–2.09, 95% CI –3.86 to –0.529; P=.046). However, the home-based VR training did not yield similar reductions in stress, anxiety, and depression levels as assessed by the Depression, Anxiety, and Stress Scale-21 items or in trait anxiety as evaluated through the State-Trait Anxiety Inventory Form Y-1. After the home training sessions with VR, there was a significant decrease in anxiety, anger, and sadness and an increase in happiness levels. Analyses of the questionnaires on usability indicated that the health care workers found using the VR system at home easy and without adverse effects related to cybersickness. Of 33 participants, 29 (88%) adhered to the protocol. Conclusions: The results of this randomized pilot study suggest that a week-long home VR intervention, created with content created specifically for this purpose and available free of charge, can help individuals manage stress and anxiety, encouraging further research investigating the potential of remote VR interventions to support mental health. Trial Registration: ClinicalTrials.gov NCT04611399; https://tinyurl.com/scxunprd %M 40053782 %R 10.2196/50326 %U https://games.jmir.org/2025/1/e50326 %U https://doi.org/10.2196/50326 %U http://www.ncbi.nlm.nih.gov/pubmed/40053782 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65785 %T Comparison of an AI Chatbot With a Nurse Hotline in Reducing Anxiety and Depression Levels in the General Population: Pilot Randomized Controlled Trial %A Chen,Chen %A Lam,Kok Tai %A Yip,Ka Man %A So,Hung Kwan %A Lum,Terry Yat Sang %A Wong,Ian Chi Kei %A Yam,Jason C %A Chui,Celine Sze Ling %A Ip,Patrick %K AI chatbot %K anxiety %K depression %K effectiveness %K artificial intelligence %D 2025 %7 6.3.2025 %9 %J JMIR Hum Factors %G English %X Background: Artificial intelligence (AI) chatbots have been customized to deliver on-demand support for people with mental health problems. However, the effectiveness of AI chatbots in tackling mental health problems among the general public in Hong Kong remains unclear. Objective: This study aimed to develop a local AI chatbot and compare the effectiveness of the AI chatbot with a conventional nurse hotline in reducing the level of anxiety and depression among individuals in Hong Kong. Methods: This study was a pilot randomized controlled trial conducted from October 2022 to March 2023, involving 124 participants allocated randomly (1:1 ratio) into the AI chatbot and nurse hotline groups. Among these, 62 participants in the AI chatbot group and 41 in the nurse hotline group completed both the pre- and postquestionnaires, including the GAD-7 (Generalized Anxiety Disorder Scale-7), PHQ-9 (Patient Health Questionnaire-9), and satisfaction questionnaire. Comparisons were conducted using independent and paired sample t tests (2-tailed) and the χ2 test to analyze changes in anxiety and depression levels. Results: Compared to the mean baseline score of 5.13 (SD 4.623), the mean postdepression score in the chatbot group was 3.68 (SD 4.397), which was significantly lower (P=.008). Similarly, a reduced anxiety score was also observed after the chatbot test (pre vs post: mean 4.74, SD 4.742 vs mean 3.4, SD 3.748; P=.005), respectively. No significant differences were found in the pre-post scores for either depression (P=.38) or anxiety (P=.19). No statistically significant difference was observed in service satisfaction between the two platforms (P=.32). Conclusions: The AI chatbot was comparable to the traditional nurse hotline in alleviating participants’ anxiety and depression after responding to inquiries. Moreover, the AI chatbot has shown potential in alleviating short-term anxiety and depression compared to the nurse hotline. While the AI chatbot presents a promising solution for offering accessible strategies to the public, more extensive randomized controlled studies are necessary to further validate its effectiveness. Trial Registration: ClinicalTrials.gov NCT06621134; https://clinicaltrials.gov/study/NCT06621134 %R 10.2196/65785 %U https://humanfactors.jmir.org/2025/1/e65785 %U https://doi.org/10.2196/65785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64672 %T Health Information Scanning and Seeking in Diverse Language, Cultural and Technological Media Among Latinx Adolescents: Cross-Sectional Study %A DuPont-Reyes,Melissa J %A Villatoro,Alice P %A Tang,Lu %+ , Departments of Sociomedical Sciences and Epidemiology, Columbia University Irving Medical Center, 722 West 168th Street, Room 942, New York, NY, 10032, United States, 1 212 305 0120, md3027@cumc.columbia.edu %K adolescent behaviors %K mental health %K Latino %K social media %K adolescent %K media use %K internet use %K health information seeking %K health information scanning %K mobile phone %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Continuous scientific and policy debate regarding the potential harm and/or benefit of media and social media on adolescent health has resulted, in part, from a deficiency in robust scientific evidence. Even with a lack of scientific consensus, public attitudes, and sweeping social media prohibitions have swiftly ensued. A focus on the diversity of adolescents around the world and their diverse use of language, culture, and social media is absent from these discussions. Objective: This study aims to guide communication policy and practice, including those addressing access to social media by adolescent populations. This study assesses physical and mental health information scanning and seeking behaviors across diverse language, cultural, and technological media and social media among Latinx adolescent residents in the United States. This study also explores how Latinx adolescents with mental health concerns use media and social media for support. Methods: In 2021, a cross-sectional survey was conducted among 701 US-based Latinx adolescents aged 13-20 years to assess their health-related media use. Assessments ascertained the frequency of media use and mental and physical health information scanning and seeking across various media technologies (eg, TV, podcasts, and social media) and language and cultural types (ie, Spanish, Latinx-tailored English, and general English). Linear regression models were used to estimate adjusted predicted means of mental and physical health information scanning and seeking across diverse language and cultural media types, net personal and family factors, in the full sample and by subsamples of mental health symptoms (moderate-high vs none-mild). Results: Among Latinx adolescents, media and social media use was similar across mental health symptoms. However, Latinx adolescents with moderate-high versus none-mild symptoms more often scanned general English media and social media for mental health information (P<.05), although not for physical health information. Also, Latinx adolescents with moderate-high versus none-mild symptoms more often sought mental health information on Latinx-tailored and general English media, and social media (P<.05); a similar pattern was found for physical health information seeking. In addition, Latinx adolescents with moderate-high versus none-mild symptoms often sought help from family and friends for mental and physical health problems and health care providers for mental health only (P<.05). Conclusions: While media and social media usage was similar across mental health, Latinx adolescents with moderate-high symptoms more often encountered mental health content in general English media and social media and turned to general English- and Latinx-tailored media and social media more often for their health concerns. Together these study findings suggest more prevalent and available mental health content in general English versus Spanish language and Latinx-tailored media and underscore the importance of providing accessible, quality health information across diverse language, cultural, and technological media and social networks as a viable opportunity to help improve adolescent health. %M 40053766 %R 10.2196/64672 %U https://www.jmir.org/2025/1/e64672 %U https://doi.org/10.2196/64672 %U http://www.ncbi.nlm.nih.gov/pubmed/40053766 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e63279 %T Testing a Dashboard Intervention for Tracking Digital Social Media Activity in Clinical Care of Individuals With Mood and Anxiety Disorders: Protocol and Design Considerations for a Pragmatic Randomized Trial %A Nesbitt,Brittany %A Virgadamo,Danielle %A Aguirre,Carlos %A DeCamp,Matthew %A Dredze,Mark %A Harrigian,Keith %A Lhaksampa,Tenzin %A Meuchel,Jennifer M %A Meyer,Aja M %A Walker,Alex %A Zirikly,Ayah %A Chisolm,Margaret S %A Zandi,Peter P %A Miller,Leslie %+ Johns Hopkins University School of Medicine, 5500 East Lombard St, Baltimore, MD, 21224, United States, 1 410 550 0091, lmille84@jhmi.edu %K digital mental health %K mental health %K dashboards %K psychiatry %K measurement-based care %K electronic communication %K social media %K depression %K anxiety %K personal health information %D 2025 %7 5.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mood and anxiety disorders are prevalent mental health diagnoses. Numerous studies have shown that measurement-based care, which is used to monitor patient symptoms, functioning, and treatment progress and help guide clinical decisions and collaboration on treatment goals, can improve outcomes in patients with these disorders. Including digital information regarding patients’ electronic communications and social media activity is an innovative approach to augmenting measurement-based care. Recent data indicate interest and willingness from both mental health clinicians and patients to share this type of digital information in treatment sessions. However, the clinical benefit of systematically doing this has been minimally evaluated. Objective: This study aims to develop an electronic dashboard for tracking patients’ digital social activity and a protocol for a pragmatic randomized trial to test the feasibility and efficacy of using the dashboard in real-world clinical care of patients with depression or anxiety disorders. Methods: We developed a personalized electronic dashboard that tracks patients’ electronic communications and social media activity, visualizes data on these interactions through key graphics and figures, and provides a tool that can be readily integrated into routine clinical care for use by clinicians and patients during treatment sessions. We then designed a randomized trial to evaluate the feasibility and effectiveness of using the electronic dashboard in real-world care compared to treatment as usual. The trial included patients aged ≥12 years with a mood or anxiety disorder who were receiving treatment in outpatient psychiatry clinics in the Johns Hopkins Health System and the Kennedy Krieger Institute. The primary outcome includes changes in patient-rated depression symptoms. Secondary outcomes include changes in patient-rated anxiety symptoms and overall functioning. Exploratory analyses examine the impact of the intervention on measures of therapeutic alliance and the detection of clinically actionable targets. Results: We successfully developed an electronic dashboard for tracking patients’ electronic communications and social media activity, and we implemented a protocol for evaluating the feasibility and efficacy of using the dashboard in routine care for mood or anxiety disorders. The protocol was approved by the Johns Hopkins University School of Medicine Institutional Review Board. In this study, we report the technological, ethical, and pragmatic considerations in developing the dashboard and testing it in a real-world setting. Conclusions: The integration of an electronic dashboard to monitor digital social activity in mental health care treatment is novel. This study examines the feasibility and effectiveness of the dashboard and the challenges in implementing this protocol. The lessons learned from developing and implementing the study will inform ongoing discussions about the value of gathering collateral information on patients’ digital social activity and how to do so in a way that is acceptable and clinically effective. Trial Registration: ClinicalTrials.gov NCT03925038; https://clinicaltrials.gov/study/NCT03925038 International Registered Report Identifier (IRRID): DERR1-10.2196/63279 %M 40053788 %R 10.2196/63279 %U https://www.researchprotocols.org/2025/1/e63279 %U https://doi.org/10.2196/63279 %U http://www.ncbi.nlm.nih.gov/pubmed/40053788 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e63486 %T Adapting a Self-Guided eHealth Intervention Into a Tailored Therapist-Guided eHealth Intervention for Survivors of Colorectal Cancer %A Lyhne,Johanne Dam %A Smith,Allan ‘Ben’ %A Carstensen,Tina Birgitte Wisbech %A Beatty,Lisa %A Bamgboje-Ayodele,Adeola %A Klein,Britt %A Jensen,Lars Henrik %A Frostholm,Lisbeth %K fear of cancer recurrence %K therapist-guided %K self-guided %K online intervention %K colorectal cancer %K digital health %K psychosocial intervention %K survivorship %K eHealth %K adaptation %K survivors %K oncologists %K therapists %K acceptability %K mobile phone %D 2025 %7 5.3.2025 %9 %J JMIR Cancer %G English %X Therapist-guided eHealth interventions have been shown to engage users more effectively and achieve better outcomes than self-guided interventions when addressing psychological symptoms. Building on this evidence, this viewpoint aimed to describe the adaptation of iConquerFear, a self-guided eHealth intervention targeting fear of cancer recurrence, into a therapist-guided version (TG-iConquerFear) tailored specifically for survivors of colorectal cancer (CRC). The goal was to optimize patient outcomes while minimizing the need for extensive resources. The adaptation process followed the Information System research framework, which facilitated a systematic integration of knowledge and iterative testing. Drawing on insights from the original iConquerFear development, as well as feedback from end users, oncologists, and therapists, we began by identifying areas for improvement. These insights formed the foundation for the first design cycle. Initial internal testing revealed the need for several adjustments to enhance the intervention. While the core concept of iConquerFear remained unchanged, we made significant modifications to improve access by optimizing the platform for mobile devices, to support adherence by expanding the exercises, and to equip therapists with tools such as reflective questions and a monitoring control panel. External field testing with 5 survivors of CRC provided further validation. Participants reported a high level of acceptability, and their feedback guided additional minor points to consider incorporating in future versions. This study illustrates how a self-guided eHealth intervention can be successfully adapted into a therapist-guided format for fear of cancer recurrence, tailored to meet the needs of survivors of CRC. The described approach serves as a valuable framework for integrating therapist guidance into similar interventions, ensuring their relevance and effectiveness for targeted populations.Trial Registration: ClinicalTrials.gov NCT04287218; https://clinicaltrials.gov/study/NCT04287218 International Registered Report Identifier (IRRID): RR2-10.1186/s12885-020-06731-6 %R 10.2196/63486 %U https://cancer.jmir.org/2025/1/e63486 %U https://doi.org/10.2196/63486 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67891 %T Competency of Large Language Models in Evaluating Appropriate Responses to Suicidal Ideation: Comparative Study %A McBain,Ryan K %A Cantor,Jonathan H %A Zhang,Li Ang %A Baker,Olesya %A Zhang,Fang %A Halbisen,Alyssa %A Kofner,Aaron %A Breslau,Joshua %A Stein,Bradley %A Mehrotra,Ateev %A Yu,Hao %+ RAND, 1200 S Hayes St, Arlington, VA, United States, 1 5088433901, rmcbain@rand.org %K depression %K suicide %K mental health %K large language model %K chatbot %K digital health %K Suicidal Ideation Response Inventory %K ChatGPT %K suicidologist %K artificial intelligence %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: With suicide rates in the United States at an all-time high, individuals experiencing suicidal ideation are increasingly turning to large language models (LLMs) for guidance and support. Objective: The objective of this study was to assess the competency of 3 widely used LLMs to distinguish appropriate versus inappropriate responses when engaging individuals who exhibit suicidal ideation. Methods: This observational, cross-sectional study evaluated responses to the revised Suicidal Ideation Response Inventory (SIRI-2) generated by ChatGPT-4o, Claude 3.5 Sonnet, and Gemini 1.5 Pro. Data collection and analyses were conducted in July 2024. A common training module for mental health professionals, SIRI-2 provides 24 hypothetical scenarios in which a patient exhibits depressive symptoms and suicidal ideation, followed by two clinician responses. Clinician responses were scored from –3 (highly inappropriate) to +3 (highly appropriate). All 3 LLMs were provided with a standardized set of instructions to rate clinician responses. We compared LLM responses to those of expert suicidologists, conducting linear regression analyses and converting LLM responses to z scores to identify outliers (z score>1.96 or <–1.96; P<0.05). Furthermore, we compared final SIRI-2 scores to those produced by health professionals in prior studies. Results: All 3 LLMs rated responses as more appropriate than ratings provided by expert suicidologists. The item-level mean difference was 0.86 for ChatGPT (95% CI 0.61-1.12; P<.001), 0.61 for Claude (95% CI 0.41-0.81; P<.001), and 0.73 for Gemini (95% CI 0.35-1.11; P<.001). In terms of z scores, 19% (9 of 48) of ChatGPT responses were outliers when compared to expert suicidologists. Similarly, 11% (5 of 48) of Claude responses were outliers compared to expert suicidologists. Additionally, 36% (17 of 48) of Gemini responses were outliers compared to expert suicidologists. ChatGPT produced a final SIRI-2 score of 45.7, roughly equivalent to master’s level counselors in prior studies. Claude produced an SIRI-2 score of 36.7, exceeding prior performance of mental health professionals after suicide intervention skills training. Gemini produced a final SIRI-2 score of 54.5, equivalent to untrained K-12 school staff. Conclusions: Current versions of 3 major LLMs demonstrated an upward bias in their evaluations of appropriate responses to suicidal ideation; however, 2 of the 3 models performed equivalent to or exceeded the performance of mental health professionals. %M 40053817 %R 10.2196/67891 %U https://www.jmir.org/2025/1/e67891 %U https://doi.org/10.2196/67891 %U http://www.ncbi.nlm.nih.gov/pubmed/40053817 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67386 %T Internet-Based Cognitive Behavioral Therapy for Preventing Postpartum Depressive Symptoms Among Pregnant Individuals With Depression: Multicenter Randomized Controlled Trial in China %A Duan,Chen-Chi %A Zhang,Chen %A Xu,Hua-Lin %A Tao,Jing %A Yu,Jia-Le %A Zhang,Dan %A Wu,Shan %A Zeng,Xiu %A Zeng,Wan-Ting %A Zhang,Zhi-Yin %A Dennis,Cindy-Lee %A Liu,Han %A Wu,Jia-Ying %A Mol,Ben Willem J %A Huang,He-Feng %A Wu,Yan-Ting %+ Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, No.419, Fangxie Rd, Shanghai, 200000, China, 86 17321218018, yanting_wu@163.com %K antenatal depression %K postpartum depression %K internet-based cognitive behavioral therapy %K randomized controlled trial %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Women are particularly vulnerable to depression during pregnancy, which is one of the strongest risk factors for developing postpartum depression (PPD). Addressing antenatal depressive symptoms in these women is crucial for preventing PPD. However, little is known about the effectiveness of internet-based cognitive behavioral therapy (ICBT) in preventing PPD in this high-risk group. Objective: This study aims to evaluate the short- and long-term effects of ICBT in preventing PPD among women with antenatal depressive symptoms. Methods: Participants were screened for antenatal depressive symptoms using the Edinburgh Postnatal Depression Scale (EPDS) and randomly allocated (1:1) to either the ICBT group (receiving weekly online modules starting antenatally and continuing into early postpartum) or the control group (observed without treatment). Follow-up assessments were conducted up to 12 months postpartum, and data were analyzed using generalized estimating equations. The primary outcome was the prevalence of depressive symptoms at 6 weeks postpartum. A subgroup analysis based on the severity of antenatal depressive symptoms was also performed. The secondary outcomes included the long-term effects of ICBT on maternal depression, as well as its impact on anxiety, sleep quality, social support, parenting stress, co-parenting relationships, and infant development. Results: Between August 2020 and September 2021, 300 pregnant individuals were recruited from 5 centers across China. No significant differences were observed in depressive symptoms at 6 weeks postpartum (P=.18) or at any longer-term follow-up time points (P=.18). However, a post hoc subgroup analysis showed that participants with antenatal EPDS scores of 10-12 in the ICBT group had a lower risk of developing depression during the first year postpartum (odds ratio 0.534, 95% CI 0.313-0.912; P=.02), but this was not observed for participants with more severe depression. Additionally, this subgroup demonstrated higher levels of co-parenting relationships (P=.02). Conclusions: Among individuals with antenatal depression, ICBT did not prevent the development of PPD. However, ICBT may be a preferable option for those with mild to moderate antenatal depressive symptoms. Future research is needed to explore modifications to ICBT to address more severe depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000033433; https://www.chictr.org.cn/showproj.html?proj=54482 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06728-5 %M 40053801 %R 10.2196/67386 %U https://www.jmir.org/2025/1/e67386 %U https://doi.org/10.2196/67386 %U http://www.ncbi.nlm.nih.gov/pubmed/40053801 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65859 %T A Digital Pornography Education Prototype Co-Designed With Young People: Formative Evaluation %A Turvey,Jake %A Raggatt,Michelle %A Wright,Cassandra J C %A Davis,Angela C %A Temple-Smith,Meredith J %A Lim,Megan S C %K pornography %K education %K website %K prototyping %K evaluation %K sexual health %K sexual wellbeing %K pornography literacy %K young people %K youth %K adolescents %K The Gist %K sexual education %K Australia %K efficacy %K digital health %K co-design %D 2025 %7 4.3.2025 %9 %J JMIR Form Res %G English %X Background: Interventions to help young people make sense of sex and relationships in the context of widely available pornography are becoming increasingly supported in school settings. However, young people who experience disruptions to their education often have less access to such programs. Digital platforms may offer a more accessible method to deliver tailored sexual health and pornography literacy to young people who are disengaged from mainstream schooling, or who experience other types of structural disadvantage. Objective: This study aimed to describe the formative evaluation of “The Gist” a co-designed online sexual health education and pornography literacy prototype designed to meet the sexual health information needs of structurally marginalized young people in Australia. Methods: We conducted iterative workshops with 33 young people aged between 15 and 24 years recruited from an alternative education school in Melbourne, Australia. Through interactive activities, participants evaluated the overall prototype design, including its usability, desirability, inclusiveness, and potential for impact. Results: Participants reported The Gist to be easy to use (17/20, 85%) and safe (19/23, 83%), with “hot” branding (25/30, 83%). However, perceived content relevance was dependent on the participants’ existing level of sexual health knowledge and experience, with only 31% (7/23) agreeing that “The Gist feels like it was made for me.” The interactive learning activities such as the debunked (myth-busting) and quiz features were among the most used and well-liked on The Gist platform. Low unprompted engagement with the prototype outside of facilitated workshop settings also confirmed previous researcher postulations that The Gist as a standalone digital platform is unlikely to meet the needs of this population group. Further design refinements are needed to improve user experience, including more interactive activities and visual information in place of heavily text-based features. Conclusions: This study provides important insights into the design and sexual health information needs of structurally marginalized young people. Further research is needed to assess the overall efficacy of The Gist prototype, as well as its ability to positively influence young people’s sexual attitudes, beliefs, and behaviors. Future iterations should consider hybrid or face-to-face delivery models to better capture student engagement. %R 10.2196/65859 %U https://formative.jmir.org/2025/1/e65859 %U https://doi.org/10.2196/65859 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e67000 %T Diaphragmatic Breathing Interfaces to Promote Relaxation for Mitigating Insomnia: Pilot Study %A Lai,Yi-Jen %A Chiu,Hsiao-Yean %A Wu,Ko-Chiu %A Chang,Chun-Wei %+ , Department of Interaction Design, National Taipei University of Technology, Rm. 701-4, Design Building,, No.1 Sec.3 Zhongxiao E Rd, Da'an District, Taipei, 10608, Taiwan, 886 02 2771 2171 ext 4574, kochiuwu@mail.ntut.edu.tw %K brief behavioral treatment for insomnia %K sleep self-efficacy %K mobile health %K mHealth %K breathing training cognitive load %K attention %K gamification %K diaphragmatic breathing %K insomnia %K sleep %K games %K relaxation %K breathing %K breathing guidance %K questionnaire %K mental %K cognition %D 2025 %7 4.3.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: Brief behavioral treatment for insomnia is an effective short-term therapy focusing on stimulus control and sleep restriction to enhance sleep quality. As a crucial part of this therapy, diaphragmatic breathing is often recommended when patients fail to fall asleep within 30 minutes. With the rise of health apps and gamification, these tools are increasingly seen as effective ways to boost self-efficacy and user engagement; however, traditional games tend to increase attention, which can negatively impact sleep and contradicts the aim of sleep therapy. This study thus explored the potential for gamification techniques to promote relaxation without disrupting sleep processes. Objective: The study developed 4 breathing guidance mechanisms, ranging from concrete to abstract: number countdown, zoom-in/out, up/down, and color gradients. The objective was to explore the relationship between game mechanics, cognitive load, relaxation effects, and attention as well as to understand how different designs impact users with varying levels of insomnia. Methods: The study was conducted in 2 phases. The first phase involved a questionnaire on the 4 guidance mechanisms. In the second phase, 33 participants classified by insomnia severity completed a Sleep Self-Efficacy Scale. They then engaged in 5 minutes of diaphragmatic breathing using each of the 4 interfaces. Relaxation effects were measured using heart rate variability via a smartwatch, attention and relaxation levels via an electroencephalogram device, and respiratory rate via a smartphone. Participants also completed the Game Experience Questionnaire and NASA Task Load Index, followed by user interviews. Results: The results indicated that competence, immersion, and challenge significantly influenced cognitive load. Specifically, competence and immersion reduced cognitive load, while challenge, negative affect, and positive affect were correlated with relaxation. Negative affect showed a positive correlation with the mean root mean square of successive differences, while positive affect exhibited a negative correlation with the mean root mean square of successive differences. Cognitive load was found to affect both relaxation and attention, with a negative correlation between mental demand and attention and a positive correlation between temporal demand and respiratory rate. Sleep self-efficacy was negatively correlated with temporal demand and negative affect and positively correlated with competence and immersion. Conclusions: Interfaces offering moderate variability and neither overly abstract nor too concrete guidance are preferable. The up/down interface was most effective, showing the best overall relaxation effect. Conversely, the number countdown interface was stress-inducing, while the zoom-in/out interface had a significant impact on insomnia-related issues, making them less suitable for insomnia-related breathing exercises. Participants showed considerable variability in their response to the color gradient interface. These findings underscore the importance of carefully considering game design elements in relaxation training. It is essential that breathing guidance designs account for the impact of the game experience to effectively promote relaxation in users. %M 40053714 %R 10.2196/67000 %U https://games.jmir.org/2025/1/e67000 %U https://doi.org/10.2196/67000 %U http://www.ncbi.nlm.nih.gov/pubmed/40053714 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66341 %T Assessing Short-Video Dependence for e-Mental Health: Development and Validation Study of the Short-Video Dependence Scale %A Jiang,AnHang %A Li,Shuang %A Wang,HuaBin %A Ni,HaoSen %A Chen,HongAn %A Dai,JunHong %A Xu,XueFeng %A Li,Mei %A Dong,Guang-Heng %+ Zhejiang Key Laboratory for Research in Assessment of Cognitive Impairments, No. 2318, Yuhangtang Rd, Yuhang District, Hangzhou, 311121, China, 86 15968849698, maylee530@126.com %K short-video dependence %K problematic short-video use %K cutoff point %K scale development %K mental health %K short video %K internet addiction %K latent profile analysis %K exploratory factor analysis %K confirmatory factor analysis %D 2025 %7 4.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Short-video dependence (SVD) has become a significant mental health issue around the world. The lack of scientific tools to assess SVD hampers further advancement in this area. Objective: This study aims to develop and validate a scientific tool to measure SVD levels, ensuring a scientifically determined cutoff point. Methods: We initially interviewed 115 highly engaged short-video users aged 15 to 63 years. Based on the summary of the interview and references to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for behavioral addictions, we proposed the first version of the short-video dependence scale (SVDS). We then screened the items through item analysis (second version) and extracted common factors using exploratory factor analysis (third version) and confirmatory factor analysis (final version). Convergent validity was tested with other scales (Chinese Internet Addiction Scale [CIAS] and DSM-5). Finally, we tested the validity of the final version in 16,038 subjects and set the diagnostic cutoff point through latent profile analysis and receiver operating characteristic curve analysis. Results: The final version of the SVDS contained 20 items and 4 dimensions, which showed strong structural validity (Kaiser-Meyer-Olkin value=0.94) and internal consistency (Cronbach α=.93), and good convergent validity (rCIAS=0.61 and rDSM-5=0.68), sensitivity (0.77, 0.83, 0.87, and 0.62 for each of the 4 dimensions), and specificity (0.75, 0.87, 0.80, and 0.79 for each of the 4 dimensions). Additionally, an SVDS score of 58 was determined as the best cutoff score, and latent profile analysis identified a 5-class model for SVD. Conclusions: We developed a tool to measure SVD levels and established a threshold to differentiate dependent users from highly engaged nondependent users. The findings provide opportunities for further research on the impacts of short-video use. %M 40053762 %R 10.2196/66341 %U https://www.jmir.org/2025/1/e66341 %U https://doi.org/10.2196/66341 %U http://www.ncbi.nlm.nih.gov/pubmed/40053762 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e60096 %T Understanding Appropriation of Digital Self-Monitoring Tools in Mental Health Care: Qualitative Analysis %A de Thurah,Lena %A Kiekens,Glenn %A Weermeijer,Jeroen %A Uyttebroek,Lotte %A Wampers,Martien %A Bonnier,Rafaël %A Myin-Germeys,Inez %K digital self-monitoring %K technology appropriation %K experience sampling method %K mental health care %K mental health %K self-monitoring %K digital health %K adoption %K implementation %K thematic %K usability %K interview %K experience %K attitude %K opinion %K perception %K perspective %K acceptance %D 2025 %7 3.3.2025 %9 %J JMIR Hum Factors %G English %X Background: Digital self-monitoring tools, such as the experience sampling method (ESM), enable individuals to collect detailed information about their mental health and daily life context and may help guide and support person-centered mental health care. However, similar to many digital interventions, the ESM struggles to move from research to clinical integration. To guide the implementation of self-monitoring tools in mental health care, it is important to understand why and how clinicians and clients adopted, adapted, and incorporated these tools in practice. Objective: Therefore, this study examined how clinicians and clients within a psychiatric center appropriated an ESM-based self-monitoring tool within their therapy. Methods: Twelve clinicians and 24 clients participated in the piloting of the ESM tool, IMPROVE. After utilizing the tool, 7 clinicians and 11 clients took part in semistructured interviews. A thematic framework analysis was performed focusing on participants’ prior knowledge and expectations, actual use in practice, and potential future use of ESM tools. Results: Many participants experienced that the ESM tool provided useful information about clients’ mental health, especially when clinicians and clients engaged in collaborative data interpretation. However, clinicians experienced several mismatches between system usability and their technical competencies, and many clients found it difficult to comply with the self-assessments. Importantly, most participants wanted to use digital self-monitoring tools in the future. Conclusions: Clinicians’ and clients’ choice to adopt and integrate self-monitoring tools in their practice seems to depend upon the perceived balance between the added benefits and the effort required to achieve them. Enhancing user support or redesigning ESM tools to reduce workload and data burden could help overcome implementation barriers. Future research should involve end users in the development of ESM self-monitoring tools for mental health care and further investigate the perspectives of nonadopters. %R 10.2196/60096 %U https://humanfactors.jmir.org/2025/1/e60096 %U https://doi.org/10.2196/60096 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64251 %T The Effect of Predicted Compliance With a Web-Based Intervention for Anxiety and Depression Among Latin American University Students: Randomized Controlled Trial %A Benjet,Corina %A Zainal,Nur Hani %A Albor,Yesica %A Alvis-Barranco,Libia %A Carrasco Tapia,Nayib %A Contreras-Ibáñez,Carlos C %A Cortés-Morelos,Jacqueline %A Cudris-Torres,Lorena %A de la Peña,Francisco R %A González,Noé %A Gutierrez-Garcia,Raúl A %A Vargas-Contreras,Eunice %A Medina-Mora,Maria Elena %A Patiño,Pamela %A Gildea,Sarah M %A Kennedy,Chris J %A Luedtke,Alex %A Sampson,Nancy A %A Petukhova,Maria V %A Zubizarreta,Jose R %A Cuijpers,Pim %A Kazdin,Alan E %A Kessler,Ronald C %+ Department of Health Care Policy, Harvard Medical School, 180 Longwood Avenue, Boston, MA, 02115, United States, 1 617 432 3587, kessler@hcp.med.harvard.edu %K anxiety %K depression %K web-based cognitive behavioral therapy %K compliance %K randomized controlled trial %D 2025 %7 28.2.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Web-based cognitive behavioral therapy (wb-CBT) is a scalable way to reach distressed university students. Guided wb-CBT is typically superior to self-guided wb-CBT over short follow-up periods, but evidence is less clear over longer periods. Objective: This study aimed to compare short-term (3 months) and longer-term (12 months) aggregate effects of guided and self-guided wb-CBT versus treatment as usual (TAU) in a randomized controlled trial of Colombian and Mexican university students and carry out an initially unplanned secondary analysis of the role of differential predicted compliance in explaining these differences. Methods: The 1319 participants, recruited either through email and social media outreach invitations or from waiting lists of campus mental health clinics, were undergraduates (1038/1319, 78.7% female) with clinically significant baseline anxiety (Generalized Anxiety Disorder–7 score≥10) or depression (Patient Health Questionnaire–9 score≥10). The intervention arms comprised guided wb-CBT with weekly asynchronous written human feedback, self-guided wb-CBT with the same content as the guided modality, and TAU as provided at each university. The prespecified primary outcome was joint remission (Generalized Anxiety Disorder–7 score=0-4 and Patient Health Questionnaire–9 score=0-4). The secondary outcome was joint symptom reduction (mean scores on the Patient Health Questionnaire Anxiety and Depression Scale) at 3 and 12 months after randomization. Results: As reported previously, 3-month outcomes were significantly better with guided wb-CBT than self-guided wb-CBT (P=.02) or TAU (P=.02). However, subsequent follow-up showed that 12-month joint remission (adjusted risk differences=6.0-6.5, SE 0.4-0.5, and P<.001 to P=.007; adjusted mean differences=2.70-2.69, SE 0.7-0.8, and P<.001 to P=.001) was significantly better with self-guided wb-CBT than with the other interventions. Participants randomly assigned to the guided wb-CBT arm spent twice as many minutes logged on as those in the self-guided wb-CBT arm in the first 12 weeks (mean 12.5, SD 36.9 vs 5.9, SD 27.7; χ21=107.1, P<.001), whereas participants in the self-guided wb-CBT arm spent twice as many minutes logged on as those in the guided wb-CBT arm in weeks 13 to 52 (mean 0.4, SD 7.5 vs 0.2, SD 4.4; χ21=10.5, P=.001). Subgroup analysis showed that this longer-term superiority of self-guided wb-CBT was confined to the 40% (528/1319) of participants with high predicted self-guided wb-CBT compliance beyond 3 months based on a counterfactual nested cross-validated machine learning model. The 12-month outcome differences were nonsignificant across arms among other participants (all P>.05). Conclusions: The results have important practical implications for precision intervention targeting to maximize longer-term wb-CBT benefits. Future research needs to investigate strategies to increase sustained guided wb-CBT use once guidance ends. Trial Registration: ClinicalTrials.gov NCT04780542; https://www.clinicaltrials.gov/study/NCT04780542 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-022-06255-3 %M 40053727 %R 10.2196/64251 %U https://mental.jmir.org/2025/1/e64251 %U https://doi.org/10.2196/64251 %U http://www.ncbi.nlm.nih.gov/pubmed/40053727 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55603 %T Evaluation of the Clear Fear Smartphone App for Young People Experiencing Anxiety: Uncontrolled Pre– and Post–Follow-Up Study %A Samele,Chiara %A Urquia,Norman %A Edwards,Rachel %A Donnell,Katie %A Krause,Nihara %+ , stem4, Connect House, 133-137 Alexandra Road, Wimbledon, London, SW19 7JY, United Kingdom, 44 7956396375, dr.nihara.krause@stem4.org.uk %K mental health %K anxiety %K depression %K emotional and behavioral difficulties %K mobile phone app %K cognitive behavioral therapy %K digital tool %K young people %K mobile phone %D 2025 %7 28.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health apps are proving to be an important tool for increasing access to psychological therapies early on, particularly with rising rates of anxiety and depression in young people. Objective: We aimed to assess the usability, acceptability, safety, and effectiveness of a new app, Clear Fear, developed to help young people manage symptoms of anxiety using the principles of cognitive behavioral therapy. Methods: The Clear Fear app was developed to provide cognitive behavioral strategies to suit anxiety disorders. An uncontrolled pre– and post–follow-up design over a 9-week period was used to assess the app and its effects. This study comprised 3 phases: baseline (stage 1), post–app familiarization phase (stage 2), and follow-up (stage 3). Eligible participants were aged between 16 and 25 years with mild to moderate anxiety but not currently receiving treatment or in contact with specialist mental health services or using other interventions or apps to help monitor or manage their mental health. A community sample was recruited via advertisements, relevant websites, and social media networks. Eligible participants completed standardized self-report tools and questionnaires at each study stage. These measured probable symptoms of anxiety (7-item Generalized Anxiety Disorder scale) and depression (Mood and Feelings Questionnaire); emotional and behavioral difficulties (Strengths and Difficulties Questionnaire); and feedback on the usability, accessibility, and safety of the app. Mean scores at baseline and follow-up were compared using paired 2-tailed t tests or Wilcoxon signed rank tests. Qualitative data derived from open-ended questions were coded and entered into NVivo (version 10) for analysis. Results: A total of 48 young people entered the study at baseline, with 37 (77%) completing all outcome measures at follow-up. The sample was mostly female (37/48, 77%). The mean age was 20.1 (SD 2.1) years. In total, 48% (23/48) of the participants reached the threshold for probable anxiety disorder, 56% (27/48) had positive scores for probable depression, and 75% (36/48) obtained a total score of “very high” on the Strengths and Difficulties Questionnaire for emotional and behavioral difficulties. The app was well received, offering reassurance, practical and immediate help to manage symptoms, and encouragement to seek help, and was generally found easy to use. A small minority (3/48, 6%) found the app difficult to navigate. The Clear Fear app resulted in statistically significant reductions in probable symptoms of anxiety (t36=2.6, 95% CI 0.41-3.53; P=.01) and depression (z=2.3; P=.02) and behavioral and emotional difficulties (t47=4.5, 95% CI 3.67-9.65; P<.001), representing mostly medium to large standardized effect sizes. Conclusions: The Clear Fear app was found to be usable, acceptable, safe, and effective in helping manage symptoms of anxiety and depression and emotional and behavioral difficulties. %M 40053764 %R 10.2196/55603 %U https://formative.jmir.org/2025/1/e55603 %U https://doi.org/10.2196/55603 %U http://www.ncbi.nlm.nih.gov/pubmed/40053764 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58341 %T Web-Based Application for Reducing Methamphetamine Use Among Aboriginal and Torres Strait Islander People: Randomized Waitlist Controlled Trial %A Reilly,Rachel %A McKetin,Rebecca %A Barzi,Federica %A Degan,Tayla %A Ezard,Nadine %A Conigrave,Katherine %A Butt,Julia %A Roe,Yvette %A Wand,Handan %A Quinn,Brendan %A Longbottom,Wade %A Treloar,Carla %A Dunlop,Adrian %A Ward,James %+ School of Psychology, University of Adelaide, North Terrace, Adelaide, 5005, Australia, 61 881284216, rachel.reilly@sahmri.com %K methamphetamine %K Aboriginal and Torres Strait Islander Health %K web-based intervention %K randomised controlled trial %K therapeutic program %K methamphetamine use %K substance use %K digital interventions %K treatment %K psychosocial wellbeing %K effectiveness %K app %K psychosocial distress %K mobile phone %D 2025 %7 28.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital interventions can help to overcome barriers to care, including stigma, geographical distance, and a lack of culturally appropriate treatment options. “We Can Do This” is a web-based app that was designed with input from cultural advisors and end users to support Aboriginal and Torres Strait Islander people seeking to stop or reduce their use of methamphetamine and increase psychosocial well-being. Objective: This study aimed to evaluate the effectiveness of the “We Can Do This” web-based app as a psychosocial treatment for Aboriginal and Torres Strait Islander people who use methamphetamine. Methods: The web app was evaluated using a randomized waitlist controlled parallel group trial. Participants were Aboriginal and Torres Strait Islander people aged 16 years or older who self-identified as having used methamphetamine at least weekly for the past 3 months. Participants were randomized on a 1:1 ratio to receive either access to the web-based app for 6 weeks or a waitlist control group. Both groups received access to a website with harm minimization information. The primary outcome was days of methamphetamine use in the past 4 weeks assessed at 1, 2, and 3 months post randomization. Secondary outcomes included severity of methamphetamine dependence (Severity of Dependence Scale [SDS]), psychological distress (Kessler 10 [K10]), help-seeking behavior, and days spent out of role due to methamphetamine use. Results: Participants (N=210) were randomized to receive either access to the web-based app (n=115) or the waitlist control condition (n=95). Follow-up was 63% at 1 month, 57% at 2 months, and 54% at 3 months. There were no significant group differences in days of methamphetamine use in the past 4 weeks at 1 the month (mean difference 0.2 days, 95% CI –1.5 to –2), 2 months (mean difference 0.6 days, 95% CI –1 to 2.4 days) or 3 months (mean difference 1.4 days, 95% CI –0.3 to 3.3 days) follow-up. There were no significant group differences in K10 scores, SDS scores, days out of role, or help-seeking at any of the 3 follow-up timepoints. There was poor adherence to the web-based app, only 20% of participants in the intervention group returned to the web-based app after their initial log-in. Participants cited personal issues and forgetting about the web-based app as the most common reasons for nonadherence. Conclusions: We found poor engagement with this web-based app. The web-based app had no significant effects on methamphetamine use or psychosocial well-being. Poor adherence and low follow-up hindered our ability to accurately evaluate the effectiveness of the web-based app. Future web-based apps for this population need to consider methods to increase participant engagement. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000134123p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376088 International Registered Report Identifier (IRRID): RR2-10.2196/14084 %M 40053754 %R 10.2196/58341 %U https://www.jmir.org/2025/1/e58341 %U https://doi.org/10.2196/58341 %U http://www.ncbi.nlm.nih.gov/pubmed/40053754 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e56066 %T A Narrative Review to Identify Promising Approaches for Digital Health Interventions to Support Emotion Regulation for Adolescents With Attention-Deficit/Hyperactivity Disorder %A Murray,Aja Louise %A Thye,Melissa %A Obsuth,Ingrid %A Cai,Shufang %A Lui,Michael %A Orr,Corina %A Saravanan,Anusha %+ Department of Psychology, University of Edinburgh, 7 George Square, Edinburgh, EH8 9JZ, United Kingdom, 44 0131 650 3455, aja.murray@ed.ac.uk %K attention-deficit/hyperactivity disorder %K ADHD %K digital health intervention %K adolescence %K emotion regulation %K emotion dysregulation %K mobile phone %K emotion %K teens %K youths %K narrative review %K support %K development %K design %K regulation %K young people %K evaluation %K neurodiversity %K neurodivergent %K attention deficit %K neurodiverse %K neuroscience %K mental health %K digital mental health %D 2025 %7 27.2.2025 %9 Viewpoint %J JMIR Ment Health %G English %X Emotion regulation difficulties affect many adolescents with attention-deficit/hyperactivity disorder (ADHD), and previous research has highlighted a need for accessible interventions to support them in this domain, especially in real-life contexts. Digital health interventions (DHIs) can be embedded in adolescents’ daily lives and thus offer considerable promise for meeting this need. However, there is a lack of information to guide the development of suitable emotion regulation DHIs for this population. The goal of this study is, therefore, to identify recommendations to guide the development of emotion regulation DHIs for adolescents with ADHD. This narrative review synthesizes diverse relevant evidence to inform their development, including promising therapeutic approaches and components and relevant design and development considerations. We find that there is very little direct evidence of “what works” for emotion regulation DHIs and emotion regulation interventions more generally for adolescents with ADHD; however, we identify promising therapeutic approaches for new DHIs. We also recommend following a co-design or coproduction approach with adolescents with ADHD, including exploring elements designed to motivate and engage young people to support sustained adherence. We conclude that DHIs are a promising approach for emotion regulation interventions for adolescents with ADHD, could draw on a range of existing therapeutic approaches, and should be co-designed with users themselves. %M 40053767 %R 10.2196/56066 %U https://mental.jmir.org/2025/1/e56066 %U https://doi.org/10.2196/56066 %U http://www.ncbi.nlm.nih.gov/pubmed/40053767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62680 %T Probing Public Perceptions of Antidepressants on Social Media: Mixed Methods Study %A Zhu,Jianfeng %A Zhang,Xinyu %A Jin,Ruoming %A Jiang,Hailong %A Kenne,Deric R %K antidepressant %K AskaPatient %K natural language processing %K BERTopic %K large language models %K Reddit %D 2025 %7 26.2.2025 %9 %J JMIR Form Res %G English %X Background: Antidepressants are crucial for managing major depressive disorders; however, nonadherence remains a widespread challenge, driven by concerns over side effects, fear of dependency, and doubts about efficacy. Understanding patients’ experiences is essential for improving patient-centered care and enhancing adherence, which prioritizes individual needs in treatment. Objective: This study aims to gain a deeper understanding of patient experiences with antidepressants, providing insights that health care providers, families, and communities can develop into personalized treatment strategies. By integrating patient-centered care, these processes may improve satisfaction and adherence with antidepressants. Methods: Data were collected from AskaPatient and Reddit, analyzed using natural language processing and large language models. Analytical techniques included sentiment analysis, emotion detection, personality profiling, and topic modeling. Furthermore, demographic variations in patient experiences were also examined to offer a comprehensive understanding of discussions around antidepressants. Results: Sentiment and emotion analysis revealed that the majority of discussions (21,499/36,253, 59.3%) expressed neutral sentiments, with negative sentiments following closely (13,922/36,253, 38.4%). The most common emotions were fear (16,196/36,253, 44.66%) and sadness (12,507/36,253, 34.49%). The largest topic, “Mental Health and Relationships,” accounted for 11.69% (3755/36,253) of the discussions, which indicated a significant focus on managing mental health conditions. Discussions around nonadherence were marked by fear, followed by sadness, while self-care discussions showed a notable trend of sadness. Conclusions: These psychological insights into public perceptions of antidepressants provide a foundation for developing tailored, patient-centered treatment approaches that align with individual needs, enhancing both effectiveness and empathy of care. %R 10.2196/62680 %U https://formative.jmir.org/2025/1/e62680 %U https://doi.org/10.2196/62680 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69602 %T Automated Digital Safety Planning Interventions for Young Adults: Qualitative Study Using Online Co-design Methods %A Meyerhoff,Jonah %A Popowski,Sarah A %A Lakhtakia,Tanvi %A Tack,Emily %A Kornfield,Rachel %A Kruzan,Kaylee P %A Krause,Charles J %A Nguyen,Theresa %A Rushton,Kevin %A Pisani,Anthony R %A Reddy,Madhu %A Van Orden,Kimberly A %A Mohr,David C %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 North Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125031232, jonah.meyerhoff@northwestern.edu %K mental health services %K technology %K therapy %K computer assisted %K SMS text messaging %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults in the United States are experiencing accelerating rates of suicidal thoughts and behaviors but have the lowest rates of formal mental health care. Digital suicide prevention interventions have the potential to increase access to suicide prevention care by circumventing attitudinal and structural barriers that prevent access to formal mental health care. These tools should be designed in collaboration with young adults who have lived experience of suicide-related thoughts and behaviors to optimize acceptability and use. Objective: This study aims to identify the needs, preferences, and features for an automated SMS text messaging–based safety planning service to support the self-management of suicide-related thoughts and behaviors among young adults. Methods: We enrolled 30 young adults (age 18-24 years) with recent suicide-related thoughts and behaviors to participate in asynchronous remote focus groups via an online private forum. Participants responded to researcher-posted prompts and were encouraged to reply to fellow participants—creating a threaded digital conversation. Researcher-posted prompts centered on participants’ experiences with suicide-related thought and behavior-related coping, safety planning, and technologies for suicide-related thought and behavior self-management. Focus group transcripts were analyzed using thematic analysis to extract key needs, preferences, and feature considerations for an automated SMS text messaging–based safety planning tool. Results: Young adult participants indicated that an automated digital SMS text message–based safety planning intervention must meet their needs in 2 ways. First, by empowering them to manage their symptoms on their own and support acquiring and using effective coping skills. Second, by leveraging young adults’ existing social connections. Young adult participants also shared 3 key technological needs of an automated intervention: (1) transparency about how the intervention functions, the kinds of actions it does and does not take, the limits of confidentiality, and the role of human oversight within the program; (2) strong privacy practices—data security around how content within the intervention and how private data created by the intervention would be maintained and used was extremely important to young adult participants given the sensitive nature of suicide-related data; and (3) usability, convenience, and accessibility were particularly important to participants—this includes having an approachable and engaging message tone, customizable message delivery options (eg, length, number, content focus), and straightforward menu navigation. Young adult participants also highlighted specific features that could support core coping skill acquisition (eg, self-tracking, coping skill idea generation, reminders). Conclusions: Engaging young adults in the design process of a digital suicide prevention tool revealed critical considerations that must be addressed if the tool is to effectively expand access to evidence-based care to reach young people at risk for suicide-related thoughts and behaviors. Specifically, automated digital safety planning interventions must support building skillfulness to cope effectively with suicidal crises, deepening interpersonal connections, system transparency, and data privacy. %M 40009840 %R 10.2196/69602 %U https://formative.jmir.org/2025/1/e69602 %U https://doi.org/10.2196/69602 %U http://www.ncbi.nlm.nih.gov/pubmed/40009840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59875 %T Person-Specific Analyses of Smartphone Use and Mental Health: Intensive Longitudinal Study %A Cerit,Merve %A Lee,Angela Y %A Hancock,Jeffrey %A Miner,Adam %A Cho,Mu-Jung %A Muise,Daniel %A Garròn Torres,Anna-Angelina %A Haber,Nick %A Ram,Nilam %A Robinson,Thomas N %A Reeves,Byron %+ Graduate School of Education, Stanford University, 520 Galvez Mall, Stanford, CA, 94305, United States, 1 650 723 21 46, mervecer@stanford.edu %K media use %K mental health %K mHealth %K uHealth %K digital health %K precision mental health %K idiographic analysis %K person-specific modeling %K p-technique %K longitudinal study %K precision interventions %K smartphones %K idiosyncrasy %K psychological well-being %K canonical correlation analysis %K United States %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Contrary to popular concerns about the harmful effects of media use on mental health, research on this relationship is ambiguous, stalling advances in theory, interventions, and policy. Scientific explorations of the relationship between media and mental health have mostly been found null or have small associations, with the results often blamed on the use of cross-sectional study designs or imprecise measures of media use and mental health. Objective: This exploratory empirical demonstration aims to answer whether mental health effects are associated with media use experiences by (1) redirecting research investments to granular and intensive longitudinal recordings of digital experiences to build models of media use and mental health for single individuals over the course of 1 year, (2) using new metrics of fragmented media use to propose explanations of mental health effects that will advance person-specific theorizing in media psychology, and (3) identifying combinations of media behaviors and mental health symptoms that may be more useful for studying media effects than single measures of dosage and affect or assessments of clinical symptoms related to specific disorders. Methods: The activity on individuals’ smartphone screens was recorded every 5 seconds when devices were in use over 1 year, resulting in a dataset of 6,744,013 screenshots and 123 fortnightly surveys from 5 adult participants. Each participant contributed between 0.8 and 2.7 million screens. Six media use metrics were derived from smartphone metadata. Fortnightly surveys captured symptoms of depression, attention-deficit/hyperactivity disorder, state anxiety, and positive affect. Idiographic filter models (p-technique canonical correlation analyses) were applied to explore person-specific associations. Results: Canonical correlations revealed substantial person-specific associations between media use and mental health, ranging from r=0.82 (P=.008) to r=0.92 (P=.03). The specific combinations of media use metrics and mental health dimensions were different for each person, reflecting significant individual variability. For instance, the media use canonical variate for 1 participant was characterized by higher loadings for app-switching, which, in combination with other behaviors, correlated strongly with a mental health variate emphasizing anxiety symptoms. For another, prolonged screen time, alongside other media use behaviors, contributed to a mental health variate weighted more heavily toward depression symptoms. These within-person correlations are among the strongest reported in this literature. Conclusions: Results suggest that the relationships between media use and mental health are highly individualized, with implications for the development of personalized models and precision smartphone-informed interventions in mental health. We discuss how our approach can be extended generally, while still emphasizing the importance of idiographic approaches. This study highlights the potential for granular, longitudinal data to reveal person-specific patterns that can inform theory development, personalized screening, diagnosis, and interventions in mental health. %M 39808832 %R 10.2196/59875 %U https://formative.jmir.org/2025/1/e59875 %U https://doi.org/10.2196/59875 %U http://www.ncbi.nlm.nih.gov/pubmed/39808832 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59829 %T Formative Evaluation of Suicide Prevention Websites for Men: Qualitative Study with Men at Risk of Suicide and with Potential Gatekeepers %A Reifegerste,Doreen %A Wagner,Anna J M %A Huber,Lisa %A Fastuca,Manuel %+ School of Public Health, Bielefeld University, Universitaetsstrasse 25, Bielefeld, 33615, Germany, 49 521 10667 ext 807, doreen.reifegerste@uni-bielefeld.de %K mental health %K suicide prevention %K men’s health %K evaluation %K website %K gatekeeper %K suicide %K male %K suicide risk %K digital communication %K intervention %K suicidal behavior %K digital intervention %K digital media %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The suicide rate among men exceeds that of women worldwide. One important measure in suicide prevention for men is digital communication interventions, as they enable easy and anonymous access to information resources. This is especially important for men who might not be reached by traditional, in-person prevention methods. Thus, as part of an interdisciplinary project on suicide prevention for men, two specific digital communication prevention measures were developed: (1) a website to inform men at risk about suicide prevention, and (2) a website to educate potential gatekeepers who are in contact with men at risk of suicide about appropriate life-saving measures. Both websites needed evaluation to explore how they are perceived by (1) men and by (2) potential gatekeepers of men at risk of suicide. This is crucial, as existing research lacks formative evaluation that informs the development of intervention communication materials. Objective: This study aimed to analyze whether these websites were perceived as (1) comprehensible and engaging, (2) authentic and trustworthy, as well as (3) useful by (potential) users. Furthermore, we examined (4) additional ideas for effective communication about suicide prevention. Methods: We conducted (1) individual videoconference interviews with 24 men to evaluate the website and (2) four focus groups with 8 gatekeepers in each group (32 participants) to evaluate the online education program. The focus group sample was equally distributed regarding gender and age. Recruitment was conducted together with a field research partner who posted adverts on Facebook and Instagram (Meta) to reach as many potential participants as possible in an efficient way. All participants were asked to evaluate the intervention materials using a fictitious scenario of a man experiencing a mental health crisis before the interviews or focus groups took place. Results: The videos were perceived as (1) catchy, comprehensible, and empathetic, but too long for a short introduction. A balanced mix of emotional and informative content was considered appropriate and helpful. The health information provided was perceived as (2) serious and trustworthy due to citing scientific institutions and video material of men who had experienced suicidal ideation. (3) The intervention’s applicability for men experiencing acute crisis was critiqued, but it was regarded as very useful for comprehensive information. (4) Further communication channels and addressing other male subgroups or gender identities were presented as possible extensions of the program. Conclusions: Effective suicide prevention research should address both the groups at risk and their support network. Digital communication interventions can provide low-threshold access. Videos with personalized examples are important to give men someone to identify with, which validates their emotional responses and supports their self-esteem, while videos with experts provide relevant and credible information. %M 40009838 %R 10.2196/59829 %U https://formative.jmir.org/2025/1/e59829 %U https://doi.org/10.2196/59829 %U http://www.ncbi.nlm.nih.gov/pubmed/40009838 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64867 %T Provider Perspectives on the Use of Mental Health Apps, and the BritePath App in Particular, With Adolescents at Risk for Suicidal Behavior: Qualitative Study %A Lynch,Frances %A Cavese,Julie %A Fulton,Lucy %A Vuckovic,Nancy %A Brent,David %+ , Kaiser Permanente Center for Health Research, 3800 N Interstate Ave, Portland, OR, 97227, United States, 1 503 335 2400, frances.lynch@kpchr.org %K depression %K adolescent %K suicidality %K safety plan %K mental health %K apps %K suicide %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Many youth with significant mental health concerns face limited access to mental health services. Digital programs, such as mobile apps designed to address mental health issues, have the potential to expand access to strategies for managing these conditions. However, few mental health apps are specifically designed for youth experiencing severe concerns, such as suicidal ideation. BritePath is a new app developed to enhance communication and interaction between providers and youth at risk for suicidal behavior. Objective: This study aims to explore health care providers’ opinions and concerns regarding the use of mental health apps for youth at significant risk of suicidal behavior. Methods: We conducted individual semistructured interviews with 17 providers across 7 states. Interviews were conducted via video, recorded, and transcribed. Codes were developed using a team-based approach, with discrepancies resolved through team discussions. Results: Most providers were aware of mental health apps in general and expressed interest in trying the BritePath app with patients experiencing depression, suicidality, or both. Analyses identified 4 key themes related to mental health apps: (1) almost all providers viewed mental health apps as an adjunct to, rather than a replacement for, psychotherapy visits; (2) most providers were concerned about the cost of apps and youth access to them; (3) providers noted the challenge of maintaining patient engagement with apps over time; and (4) providers were concerned about patient privacy, in terms of both data shared with app developers and data privacy within families. Analyses of providers’ opinions specifically about the BritePath app identified 4 additional themes: (1) providers believed that access to safety plans within BritePath could be beneficial for youth at risk for suicidal behavior; (2) providers reported that BritePath’s interactive features could enhance communication between providers and youth; (3) providers appreciated BritePath’s flexibility and the ability for both youth and providers to tailor its content to individual needs; and (4) providers expressed concerns about integrating BritePath into clinical workflows within health systems. Conclusions: The use of mental health apps is expanding, yet there is limited understanding of how to effectively integrate these tools into mental health treatment. Providers are increasingly referring patients to mental health apps, and most expressed interest in trying the BritePath app for patients with depression, suicidality, or both. However, providers also identified several concerns, particularly regarding privacy and safety. %M 40009843 %R 10.2196/64867 %U https://humanfactors.jmir.org/2025/1/e64867 %U https://doi.org/10.2196/64867 %U http://www.ncbi.nlm.nih.gov/pubmed/40009843 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57907 %T The Moderated Mediating Effects of Social Media Identity and Loneliness on the Relationship Between Problematic Internet Use and Mental Health in China: Nationwide Cross-Sectional Questionnaire Study %A Liu,Chenxi %A Liu,Yushu %A Liu,Chaojie %A Lin,Rujiao %A Wang,Xi %A Zhang,Xinyi %A Wu,Yibo %A Wang,Dan %+ School of Management, Hubei University of Chinese Medicine, 16 Huangjiahu West Rd, Hongshan District, Wuhan, 430065, China, 86 13476237004, 815310016@qq.com %K problematic internet use %K loneliness %K anxiety %K depression %K mediation and moderation model %D 2025 %7 26.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health disorders are a major public health challenge, and problematic internet use (PIU) may play an important role in this issue. However, the underlying mechanisms of PIU and its effects on mental health have not yet been elucidated. Objective: This study examines the mediating effect of loneliness on the relationship between PIU and mental health, as well as the moderating effect of social media identity on the relationships among PIU, loneliness, and mental health. Methods: A cross-sectional questionnaire survey was conducted on 21,292 participants recruited using a multistage stratified sampling strategy from 31 provinces/regions in mainland China from June 20 to August 31, 2022. This study assesses PIU (PIU questionnaire-short form-6), depression (9-item Patient Health Questionnaire [PHQ-9]), anxiety (7-item Generalized Anxiety Disorder scale [GAD-7]), loneliness (3-item loneliness scale), and social media identity (identity bubble reinforcement scale). Additionally, we collected the sociodemographic characteristics of the participants. Participants whose total score of PHQ-9≥15 or total score of GAD-7≥10 were considered to have moderate or severe symptoms of depression or anxiety, respectively. A moderated mediation model was established to examine the mediating effect of loneliness on the association between PIU and mental health outcomes (depression and anxiety), moderated by social media identity. Results: Approximately 22.80% (4854/21,292) and 14.20% (3023/21,292) of the respondents reported moderate or severe symptoms of depression and anxiety, respectively. Loneliness significantly mediated the association between PIU and mental health outcomes, explaining 42.53% and 45.48% of the total effect of PIU on depression and anxiety, respectively. Social media identity significantly moderated the associations between PIU and depression (β=0.002, 95% CI 0.001-0.002), PIU and anxiety (β=0.001, 95% CI 0.000-0.002), loneliness and depression (β=0.010, 95% CI 0.007-0.013), and loneliness and anxiety (β=0.007, 95% CI 0.004-0.010), but not between PIU and loneliness (β=0.000, 95% CI –0.003 to 0.003). Higher levels of social media identity were significantly associated with lower levels of loneliness (β=–0.018, 95% CI –0.020 to –0.016). Conclusions: Addressing loneliness may serve as a valuable approach to mitigate the impact of PIU on mental health outcomes. However, social media identity poses a significant challenge in addressing health issues linked to PIU. %M 40009436 %R 10.2196/57907 %U https://www.jmir.org/2025/1/e57907 %U https://doi.org/10.2196/57907 %U http://www.ncbi.nlm.nih.gov/pubmed/40009436 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64451 %T More Cyberbullying, Less Happiness, and More Injustice—Psychological Changes During the Pericyberbullying Period: Quantitative Study Based on Social Media Data %A Liu,Xingyun %A Liu,Miao %A Kang,Xin %A Han,Nuo %A Liao,Yuehan %A Ren,Zhihong %+ , Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, No 382 Xiongchu Avenue, Hongshan District, Wuhan, 430079, China, 86 13627131550, ren@ccnu.edu.cn %K cyberbullying %K pericyberbullying period %K social media %K well-being %K morality %K suicide risk %K personality traits %D 2025 %7 25.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The phenomenon of cyberbullying is becoming increasingly severe, and many studies focus on the negative psychological impacts of cyberbullying survivors. However, current survey methods cannot provide direct and reliable evidence of the short-term psychological effects of cyberbullying survivors, as it is impractical to measure psychological changes before and after such an unpredictable event in a short period. Objective: This study aims to explore the psychological impacts of cyberbullying on survivors during the pericyberbullying period, defined as the critical time frame surrounding the first cyberbullying incident, encompassing the psychological changes before, during, and after the event. Methods: We collected samples from 60 cyberbullying survivors (experimental group, 94/120, 78% female) and 60 individuals who have not experienced cyberbullying (control group, matched by sex, location, and number of followers) on Sina Weibo, a social media platform developed by Sina Corporation. During the pericyberbullying period, we retrospectively measured psychological traits 3 months before and after the first cyberbullying incident for both groups. Social media data and predictive models were used to identify survivors’ internal psychological traits, including happiness, suicide risk, personality traits, and moral perceptions of the external environment. Network analysis was then performed to explore the interplay between cyberbullying experiences and psychological characteristics. Results: During the pericyberbullying period, survivors exhibited significantly reduced happiness (t59=2.14; P=.04), marginally increased suicide risk, and significant changes in the Big 5 personality traits, including decreased conscientiousness (t59=2.27; P=.03), agreeableness (t59=2.79; P=.007), and extraversion (t59=2.26; P=.03), alongside increased neuroticism (t59=–3.42; P=.001). Regarding moral perceptions of the external environment, survivors showed significant increases in communicative moral motivation (t59=–2.62; P=.011) and FairnessVice (t59=–2.20; P=.03), with a marginal rise in PurityVice (t59=–1.88; P=.07). In contrast, the control group exhibited no significant changes during the same time frame. Additionally, network analysis revealed that beyond cyberbullying experiences, core psychological characteristics in the network were neuroticism, conscientiousness, and Oxford Happiness. Conclusions: By leveraging noninvasive retrospective social media data, this study provides novel insights into the short-term psychological impacts of cyberbullying during the pericyberbullying period. The findings highlight the need for timely interventions focusing on enhancing survivors’ happiness, reducing suicide risk, adjusting personality traits, and rebuilding moral cognition to mitigate the negative effects of cyberbullying. %M 39998871 %R 10.2196/64451 %U https://www.jmir.org/2025/1/e64451 %U https://doi.org/10.2196/64451 %U http://www.ncbi.nlm.nih.gov/pubmed/39998871 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64303 %T Culturally Adapted Guided Internet-Based Cognitive Behavioral Therapy for Hong Kong People With Depressive Symptoms: Randomized Controlled Trial %A Pan,Jia-Yan %A Rafi,Jonas %+ Department of Social Work, Hong Kong Baptist University, AAB1026, 10/F, Academic and Administration Building, 15 Baptist University Road, Baptist University Road Campus, Hong Kong Baptist University, Kowloon Tong, KLN, Hong Kong, China (Hong Kong), 852 34116415, jiayan@hkbu.edu.hk %K Internet-based cognitive behavioral therapy %K depression %K Chinese %K Hong Kong, culturally adapted internet intervention %D 2025 %7 25.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: A significant number of individuals with depression in Hong Kong remain undiagnosed and untreated through traditional face-to-face psychotherapy. Internet-based cognitive behavioral therapy (iCBT) has emerged as a tool to improve access to mental health services. However, iCBT remains underdeveloped in Chinese communities, particularly in Hong Kong. Objective: This study aims to (1) develop and evaluate the effectiveness of a culturally and linguistically appropriate guided iCBT program for Hong Kong Chinese with depressive symptoms, and (2) explore their treatment adherence. Methods: An 11-week guided iCBT program, “Confront and Navigate Depression Online” (CANDO), consisting of 8 online modules, was developed and implemented for Hong Kong residents. The program was accessible via either an online platform (web-based iCBT) or a smartphone app (app-based iCBT). A 3-arm randomized controlled trial was conducted, with participants recruited through open recruitment and referrals from 2 local non-governmental organizations. A total of 402 eligible participants with mild to moderate depressive symptoms were randomly allocated into 3 groups: (1) web-based iCBT (n=139); (2) app-based iCBT (n=131); and (3) waitlist control (WLC) group (n=132), who transitioned to the web-based iCBT group after waiting for 11 weeks. Therapist support was provided by a clinical psychologist through 3 counseling sessions and weekly assignment feedback. The primary outcomes were the Beck Depression Inventory-II (BDI-II) and the 9-item Patient Health Questionnaire (PHQ-9), while the secondary outcome measures included the 12-item General Health Questionnaire (GHQ-12), the Chinese Automatic Thoughts Questionnaire (CATQ), and the Chinese Affect Scale (CAS). These scales were administered at preintervention, postintervention, and at 3-month and 6-month follow-up assessments. Data analysis was conducted using linear mixed effects modeling, adhering to the intent-to-treat principle. Results: Participants in both the web- and app-based iCBT groups reported significant improvements compared with the WLC group on all primary (P<.001) and secondary measures (P<.001 and P=.009) at posttreatment. Large between-group effect sizes were observed in the reduction of depressive symptoms, with Cohen's d value of 1.07 (95% CI 0.81-1.34) for the web-based group and 1.15 (95% CI 0.88-1.43) for the app-based group on the BDI-II. Additionally, the web- and app-based groups showed effect sizes of 0.78 (95% CI 0.52-1.04) and 0.95 (95% CI 0.63-1.27) on PHQ-9, respectively. Medium to large effect sizes were observed for secondary outcomes at posttreatment. These positive effects were maintained at both the 3- and 6-month follow-ups, with medium to large within-group effect sizes. The adherence rate in the 2 iCBT groups was 154 out of 270 (57.0%) for completing all 8 online modules and 152 out of 270 (56.3%) for attending all 4 counseling sessions (including an intake interview). The recovery rate, as measured by the BDI-II at posttreatment, was 35 out of 90 (39%) for the web-based group and 36 out of 91 (40%) for the app-based group, compared with 3 out of 112 (3%) in the WLC group. Conclusions: Culturally and linguistically adapted iCBT is an effective and feasible treatment for Hong Kong Chinese with mild to moderate depressive symptoms, demonstrating a satisfactory recovery rate and treatment adherence. ICBT offers an accessible and viable alternative to face-to-face interventions in Hong Kong. The Hong Kong government should allocate more resources and support the use of iCBT as a tool to treat people with depressive symptoms. Trial Registration: ClinicalTrials.gov (NCT04388800); https://clinicaltrials.gov/study/NCT04388800 %M 39998865 %R 10.2196/64303 %U https://www.jmir.org/2025/1/e64303 %U https://doi.org/10.2196/64303 %U http://www.ncbi.nlm.nih.gov/pubmed/39998865 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e68221 %T Exploring the Impact of Digital Peer Support Services on Meeting Unmet Needs Within an Employee Assistance Program: Retrospective Cohort Study %A Nagra,Harpreet %A Mines,Robert A %A Dana,Zara %+ Supportiv, 2222 Harold Way, Berkeley, CA, 94704, United States, 1 800 845 0015, harpreet@supportiv.com %K digital peer support %K peer support %K EAPs %K cost-effectiveness %K SROI %D 2025 %7 25.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The World Health Organization estimates that 1 in 4 people worldwide will experience a mental disorder in their lifetime, highlighting the need for accessible support. Objective: This study evaluates the integration of digital peer support (DPS) into an employee assistance program (EAP), testing 3 hypotheses: (1) DPS may be associated with changes in EAP counseling utilization within a 5-session model; (2) DPS users experience reduced sadness, loneliness, and stress; and (3) DPS integration generates a positive social return on investment (SROI). Methods: The study analyzed EAP utilization within a 5-session model using pre-post analysis, sentiment changes during DPS chats via natural language processing models, and SROI outcomes. Results: Among 587 DPS chats, 432 (73.6%) occurred after business hours, emphasizing the importance of 24/7 availability. A matched cohort analysis (n=72) showed that DPS reduced therapy sessions by 2.07 per participant (P<.001; Cohen d=1.77). Users’ messages were evaluated for sentiments of sadness, loneliness, and stress on a 1-10 scale. Significant reductions were observed: loneliness decreased by 55.04% (6.91 to 3.11), sadness by 57.5% (6.84 to 2.91), and stress by 56.57% (6.78 to 2.95). SROI analysis demonstrated value-to-investment ratios of US $1.66 (loneliness), US $2.50 (stress), and US $2.58 (sadness) per dollar invested. Conclusions: Integrating DPS into EAPs provides significant benefits, including increased access, improved emotional outcomes, and a high SROI, reinforcing its value within emotional health support ecosystems. %M 39998863 %R 10.2196/68221 %U https://humanfactors.jmir.org/2025/1/e68221 %U https://doi.org/10.2196/68221 %U http://www.ncbi.nlm.nih.gov/pubmed/39998863 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e63497 %T Patterns of Skills Review in Smartphone Cognitive Behavioral Therapy for Depression: Observational Study of Intervention Content Use %A Bernstein,Emily E %A Daniel,Katharine E %A Miyares,Peyton E %A Hoeppner,Susanne S %A Bentley,Kate H %A Snorrason,Ivar %A Fisher,Lauren B %A Greenberg,Jennifer L %A Weingarden,Hilary %A Harrison,Oliver %A Wilhelm,Sabine %+ University of Virginia, 560 Ray C Hunt Drive, Charlottesville, 22903, United States, 1 434 924 2495, ked4fd@virginia.edu %K smartphone %K cognitive behavioral therapy %K engagement %K depression %K mental health %K Mindset %K mHealth %K mobile health %K app %K digital health %K mobile phone %D 2025 %7 24.2.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Smartphones could enhance access to effective cognitive behavioral therapy (CBT). Users may frequently and flexibly access bite-size CBT content on personal devices, review and practice skills, and thereby achieve better outcomes. Objective: We explored the distribution of actual interactions participants had with therapeutic content in a trial of smartphone CBT for depression and whether interactions were within assigned treatment modules or revisits to prior module content (ie, between-module interactions). Methods: We examined the association between the number of within- and between-module interactions and baseline and end-of-treatment symptom severity during an 8-week, single-arm open trial of a therapist-guided CBT for depression mobile health app. Results: Interactions were more frequent early in treatment and modestly declined in later stages. Within modules, most participants consistently made more interactions than required to progress to the next module and tended to return to all types of content rather than focus on 1 skill. By contrast, only 15 of 26 participants ever revisited prior module content (median number of revisits=1, mode=0, IQR 0-4). More revisits were associated with more severe end-of-treatment symptom severity after controlling for pretreatment symptom severity (P<.05). Conclusions: The results suggest that the frequency of use is an insufficient metric of engagement, lacking the nuance of what users are engaging with and when during treatment. This lens is essential for developing personalized recommendations and yielding better treatment outcomes. Trial Registration: ClinicalTrials.gov NCT05386329; https://clinicaltrials.gov/study/NCT05386329?term=NCT05386329 %M 39993308 %R 10.2196/63497 %U https://mental.jmir.org/2025/1/e63497 %U https://doi.org/10.2196/63497 %U http://www.ncbi.nlm.nih.gov/pubmed/39993308 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e46441 %T Comparing Digital Versus Face-to-Face Delivery of Systemic Psychotherapy Interventions: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Erasmus,Pieter %A Borrmann,Moritz %A Becker,Jule %A Kuchinke,Lars %A Meinlschmidt,Gunther %+ , Department of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University Berlin, Stromstrasse 3b, Berlin, 10555, Germany, 49 30 300 117 710, gunther.meinlschmidt@ipu-berlin.de %K systemic psychotherapy %K family therapy %K adolescent %K systematic review %K meta-analysis %K face to face %K digital %K remote %K distance %K telehealth %K delivery modality %D 2025 %7 24.2.2025 %9 Review %J Interact J Med Res %G English %X Background: As digital mental health delivery becomes increasingly prominent, a solid evidence base regarding its efficacy is needed. Objective: This study aims to synthesize evidence on the comparative efficacy of systemic psychotherapy interventions provided via digital versus face-to-face delivery modalities. Methods: We followed PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for searching PubMed, Embase, Cochrane CENTRAL, CINAHL, PsycINFO, and PSYNDEX and conducting a systematic review and meta-analysis. We included randomized controlled trials comparing mental, behavioral, and somatic outcomes of systemic psychotherapy interventions using self- and therapist-guided digital versus face-to-face delivery modalities. The risk of bias was assessed with the revised Cochrane Risk of Bias tool for randomized trials. Where appropriate, we calculated standardized mean differences and risk ratios. We calculated separate mean differences for nonaggregated analysis. Results: We screened 3633 references and included 12 articles reporting on 4 trials (N=754). Participants were youths with poor diabetic control, traumatic brain injuries, increased risk behavior likelihood, and parents of youths with anorexia nervosa. A total of 56 outcomes were identified. Two trials provided digital intervention delivery via videoconferencing: one via an interactive graphic interface and one via a web-based program. In total, 23% (14/60) of risk of bias judgments were high risk, 42% (25/60) were some concerns, and 35% (21/60) were low risk. Due to heterogeneity in the data, meta-analysis was deemed inappropriate for 96% (54/56) of outcomes, which were interpreted qualitatively instead. Nonaggregated analyses of mean differences and CIs between delivery modalities yielded mixed results, with superiority of the digital delivery modality for 18% (10/56) of outcomes, superiority of the face-to-face delivery modality for 5% (3/56) of outcomes, equivalence between delivery modalities for 2% (1/56) of outcomes, and neither superiority of one modality nor equivalence between modalities for 75% (42/56) of outcomes. Consequently, for most outcome measures, no indication of superiority or equivalence regarding the relative efficacy of either delivery modality can be made at this stage. We further meta-analytically compared digital versus face-to-face delivery modalities for attrition (risk ratio 1.03, 95% CI 0.52-2.03; P=.93) and number of sessions attended (standardized mean difference –0.11; 95% CI –1.13 to –0.91; P=.83), finding no significant differences between modalities, while CIs falling outside the range of the minimal important difference indicate that equivalence cannot be determined at this stage. Conclusions: Evidence on digital and face-to-face modalities for systemic psychotherapy interventions is largely heterogeneous, limiting conclusions regarding the differential efficacy of digital and face-to-face delivery. Nonaggregated and meta-analytic analyses did not indicate the superiority of either delivery condition. More research is needed to conclude if digital and face-to-face delivery modalities are generally equivalent or if—and in which contexts—one modality is superior to another. Trial Registration: PROSPERO CRD42022335013; https://tinyurl.com/nprder8h %M 39993307 %R 10.2196/46441 %U https://www.i-jmr.org/2025/1/e46441 %U https://doi.org/10.2196/46441 %U http://www.ncbi.nlm.nih.gov/pubmed/39993307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56230 %T Improving Maternal Mental Health and Weight Control With a Mindfulness Blended Care Approach: Insights From a Randomized Controlled Trial %A Hassdenteufel,Kathrin %A Müller,Mitho %A Abele,Harald %A Brucker,Sara Yvonne %A Graf,Johanna %A Zipfel,Stephan %A Bauer,Armin %A Jakubowski,Peter %A Pauluschke-Fröhlich,Jan %A Wallwiener,Markus %A Wallwiener,Stephanie %+ Department of Obstetrics and Gynecology, University Hospital Heidelberg, Im Neuenheimer Feld 440, 69120 Heidelberg, Heidelberg, 69120, Germany, 49 15238492062, Kathrin.hassdenteufel@med.uni-heidelberg.de %K peripartum mental health %K digital intervention %K depression %K anxiety %K personal coaching %K ehealth %K pregnancy %K maternal mental health %K weight gain %K mindfulness-based intervention %K coaching %K randomized controlled clinical trial %K postpartum %K treatment %K electronic %K effectiveness %K women %K digital intervention %D 2025 %7 24.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Perinatal maternal mental health problems, such as depression and anxiety, are highly prevalent during pregnancy and post partum. Electronic mindfulness-based interventions (eMBIs) are a promising treatment option, which can be provided in a low-threshold, cost-effective manner. However, research underscores the fact that face-to-face coaching sessions are more effective than solely digital methods. A blended care approach (eMBI with direct face-to-face coaching) could amplify the therapeutic impact on maternal mental health and weight gain during the perinatal period. Objective: We investigated whether combining an eMBI intervention with face-to-face personal support significantly improves maternal mental health, and whether the intervention can influence weight gain in affected women during pregnancy. Methods: A community-based sample of 460 pregnant women with a singleton pregnancy who screened positive for depression was enrolled in a multicenter randomized controlled trial (RCT) including the University Hospitals of Heidelberg and Tübingen as well as more than 200 gynecological practices within the state of Baden-Württemberg in Germany between February 2019 and October 2020. Participating women were randomized 1:1 to the control group (CG) or intervention group (IG) that received access to an 8-week pregnancy-adapted eMBI between the 29th and 36th gestational week. In a subanalysis, we grouped participants in those receiving only the initial face-to-face coaching session at recruitment (no personal coaching) and those with ≥2 personal coaching sessions. Primary outcome measures were severity of depressive symptoms using the Edinburgh Postnatal Depression Scale, anxiety using the State-Trait Anxiety Inventory, the Pregnancy-Related Anxiety Questionnaire, the Freiburg Mindfulness Inventory, and the Patient Health Questionnaire; secondary outcome measure, BMI. Results: In the final sample, 137 CG women and 102 IG women received only one coaching session, whereas 37 CG women and 40 IG women received at least 2 (mean 2.3, SD 0.7) coaching sessions. The analyses were adjusted for significant confounders. The IG’s mindfulness scores increased significantly (F1.873,344.619=4.560, P=.01, η²=0.024, ω²=0.012) regardless of coaching frequency. Both general anxiety (F12,129=2.361, P=.01, η²=0.0180, ω²=0.100) and depression symptoms (F4.758, 699.423=3.033, P=.01, η²=0.020, ω²=0.009) were significantly lower in the group that received ≥2 coaching sessions than in the no-personal-coaching group. In the group receiving ≥2 coaching sessions, BMI generally was lower in the IG than in the CG (F3.555,444.416=4.732, P=.002, η²=0.036, ω²=0.013). Conclusions: Adding a minimal amount of PC to the digital eMBI increased mindfulness and decreased birth-related anxiety, symptoms of depression, and anxiety in at-risk pregnant women. Favorable effects on gestational weight gain were found in the respective IGs, the strongest effect being within the PC group. This blended digital health approach amplifies the effectiveness of the digital intervention. Trial Registration: German Clinical Trials Register DRKS00017210; https://www.drks.de/search/de/trial/DRKS00017210 %M 39992700 %R 10.2196/56230 %U https://www.jmir.org/2025/1/e56230 %U https://doi.org/10.2196/56230 %U http://www.ncbi.nlm.nih.gov/pubmed/39992700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69621 %T Digital Health Interventions to Improve Mental Health in Patients With Cancer: Umbrella Review %A Zhong,Chuhan %A Luo,Xian %A Tan,Miaoqin %A Chi,Jing %A Guo,Bingqian %A Tang,Jianyao %A Guo,Zihan %A Deng,Shisi %A Zhang,Yujie %A Wu,Yanni %+ Nanfang Hospital, Southern Medical University, No 1838 Guangzhou Avenue North, Baiyun District, Guangdong Province, Guangzhou, 510515, China, 86 18818860076, yanniwuSMU@126.com %K digital health care services %K mental health care %K oncology %K digital delivery modality %K umbrella review %K PRISMA %D 2025 %7 21.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Mental health plays a key role across the cancer care continuum, from prognosis and active treatment to survivorship and palliative care. Digital health technologies offer an appealing, cost-effective tool to address psychological needs. Objective: This umbrella review aims to summarize and evaluate the available evidence on the efficacy of digital health interventions for improving mental health and psychosocial outcomes for populations with cancer. Methods: Literature searches were conducted in Embase, PsycINFO, PubMed, CINAHL, the Cochrane Library, and Web of Science from their inception to February 4, 2024. Systematic reviews (with or without meta-analysis) investigating the efficacy of digital health interventions for psychosocial variables in patients with cancer were included. Quality was assessed using the Assessing the Methodological Quality of Systematic Reviews-2 tool. Results: In total, 78 systematic reviews were included in this review. Among diverse delivery modalities and types of digital interventions, websites and smartphone apps were the most commonly used. Depression was the most frequently addressed, followed by quality of life, anxiety, fatigue, and distress. The qualities of the reviews ranged from critically low to high. Generally, despite great heterogeneity in the strength and credibility of the evidence, digital health interventions were shown to be effective for mental health in patients with cancer. Conclusions: Taken together, digital health interventions show benefits for patients with cancer in improving mental health. Various gaps were identified, such as little research specifically focusing on older adult patients with cancer, a scarcity of reporting high-precision emotion management, and insufficient attention to other certain mood indicators. Further exploration of studies with standardized and rigorous approaches is required to inform practice. Trial Registration: PROSPERO CRD42024565084; https://tinyurl.com/4cbxjeh9 %M 39984165 %R 10.2196/69621 %U https://www.jmir.org/2025/1/e69621 %U https://doi.org/10.2196/69621 %U http://www.ncbi.nlm.nih.gov/pubmed/39984165 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64178 %T Examining the Implementation of the Italian Version of the Teen Online Problem-Solving Program Coupled With Remote Psychological Support: Protocol for a Randomized Controlled Trial %A Corti,Claudia %A Papini,Marta %A Strazzer,Sandra %A Borgatti,Renato %A Romaniello,Romina %A Poggi,Geraldina %A Storm,Fabio Alexander %A Urgesi,Cosimo %A Jansari,Ashok %A Wade,Shari L %A Bardoni,Alessandra %+ , Scientific Institute, IRCCS E. Medea, Via Don Luigi Monza, 20, Bosisio Parini, 23842, Italy, 39 031 877111, claudia.corti@lanostrafamiglia.it %K telerehabilitation %K acquired brain injury %K executive functioning %K pediatric %K problem-solving %K computer %D 2025 %7 21.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pediatric acquired brain injury (ABI) is frequently associated with cognitive and socioemotional alterations. Therefore, targeted rehabilitation to improve everyday functioning, particularly executive functioning (EF), is needed to limit the possible deterioration of cognitive abilities and behavior over time and the associated social and psychological costs. Objective: In this paper, we present the protocol for a phase-2 randomized controlled trial (RCT) aimed at examining the feasibility and efficacy of a web-based intervention (ie, the Italian version of the Teen Online Problem-Solving [I-TOPS] intervention) to improve problem-solving abilities versus an active-control, web-based intervention (ie, wellness intervention) providing health and wellness content. Methods: A double-blinded, phase-2 RCT will be conducted to guarantee controls on data quality and findings. In total, 42 adolescents will be recruited from a rehabilitation institute and individually randomly assigned in a 1:1 ratio to receive the I-TOPS intervention or the web-based wellness intervention. Both interventions will include 10 core sessions and will be delivered remotely using a web-based platform. Participants allocated to both interventions and their caregivers will independently complete the learning modules in an everyday setting using their computer. The I-TOPS intervention’s core sessions will target the EF domain (eg, planning, emotion regulation, and social skills), while all the contents of the wellness intervention will be aimed at providing psychoeducation on ABI sequelae and supporting health and wellness. Participants assigned to the I-TOPS intervention will also receive bimonthly direct training in problem-solving coupled with remote support from a psychologist. Feasibility data and efficacy outcomes on both adolescents’ and parents’ functioning will be assessed. Cognitive abilities in the EF domain and behavioral and psychological functioning (ie, internalizing and externalizing symptoms) of the adolescents will be evaluated via performance-based measures, administered remotely using the Google Meet platform, and paper-and-pencil questionnaires; parents’ well-being will be assessed through paper-and-pencil questionnaires. Efficacy will be evaluated immediately after training and at 6-month follow-up. Results: This study started on February 26, 2021, and ended on February 28, 2023. A total of 42 adolescents were enrolled and randomly assigned to the 2 study groups, 34 (81%) completed the intervention and posttreatment evaluation (I-TOPS: n=19 and wellness intervention: n=15) and 31 performed follow-up evaluation (I-TOPS: n=18 and wellness intervention: n=13). Data analysis on feasibility and efficacy will be performed after protocol publication, and the results will be published in the form of a paper in a relevant journal in 2025. Conclusions: This double-blinded, phase-2 RCT could extend knowledge on the best rehabilitation practices to adopt with the survivors of pediatric ABI by providing evidence-based data currently lacking for the Italian context. If this study yields positive results, a larger, multicenter, phase-3 RCT could be planned and delivered to examine program cost-effectiveness in a larger sample. Trial Registration: ClinicalTrials.gov NCT05169788; https://clinicaltrials.gov/study/NCT05169788 International Registered Report Identifier (IRRID): DERR1-10.2196/64178 %M 39984161 %R 10.2196/64178 %U https://www.researchprotocols.org/2025/1/e64178 %U https://doi.org/10.2196/64178 %U http://www.ncbi.nlm.nih.gov/pubmed/39984161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63898 %T Digital Interventions for Older People Experiencing Homelessness: Systematic Scoping Review %A Adams,Emily %A Donaghy,Eddie %A Sanders,Caroline %A Wolters,Maria Klara %A Ng,Lauren %A St-Jean,Christa %A Galan,Ryan %A Mercer,Stewart William %+ Advanced Care Research Centre, Usher Institute, University of Edinburgh, BioQuarter (Gate, 5-7), 3 Little France Rd, Edinburgh, EH16 4U, United Kingdom, 44 0131 651 7869, stewart.mercer@ed.ac.uk %K homeless %K technology %K digital exclusion %K elderly %K rough sleeping %K digital intervention %K older people %K homelessness %K systematic scoping review %K aging %K premature mortality %K indicators %K scoping review %K databases %K thematic analysis %K telehealth %K mhealth %K ehealth %D 2025 %7 21.2.2025 %9 Review %J J Med Internet Res %G English %X Background: older people experiencing homelessness can have mental and physical indicators of aging several decades earlier than the general population and experience premature mortality due to age-related chronic conditions. Digital interventions could positively impact the health and well-being of homeless people. However, increased reliance on digital delivery may also perpetuate digital inequalities for socially excluded groups. The potential triple disadvantage of being older, homeless, and digitally excluded creates a uniquely problematic situation warranting further research. Few studies have synthesized available literature on digital interventions for older people experiencing homelessness. Objective: This scoping review examined the use, range, and nature of digital interventions available to older people experiencing homelessness and organizations supporting them. Methods: The scoping review followed Arksey and O’Malley’s proposed methodology, PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, and recent Joanna Briggs Institute guidelines. We searched 14 databases. Gray literature sources were searched to supplement the electronic database search. A narrative synthesis approach was conducted on the included articles, and common themes were identified inductively through thematic analysis. Results: A total of 19,915 records were identified through database and gray literature searching. We identified 10 articles reporting on digital interventions that had a clearly defined a participant age group of >50 years or a mean participant age of >50 years. A total of 9 of 10 studies were published in the United States. The study design included descriptive studies, uncontrolled pilot studies, and pilot randomized controlled trials. No studies aimed to deliver an intervention exclusively to older people experiencing homelessness or organizations that supported them. Four types of intervention were identified: telecare for people experiencing homelessness, distributing technology to enable digital inclusion, text message reminders, and interventions delivered digitally. Interventions delivered digitally included smoking cessation support, vocational training, physical activity promotion, and cognitive behavioral therapy. Overall, the included studies demonstrated evidence for the acceptability and feasibility of digital interventions for older people experiencing homelessness, and all 10 studies reported some improvements in digital inclusion or enhanced engagement among participants. However, several barriers to digital interventions were identified, particularly aspects related to digital inclusion, such as infrastructure, digital literacy, and age. Proposed facilitators for digital interventions included organizational and peer support. Conclusions: Our findings highlight a paucity of evaluated digital interventions targeted at older people experiencing homelessness. However, the included studies demonstrated evidence of the acceptability and feasibility of digital interventions for older people experiencing homelessness. Further research on digital interventions that provide services and support older people experiencing homelessness is required. Future interventions must address the barriers older people experiencing homelessness face when accessing digital technology with the input of those with lived experience of homelessness. Trial Registration: OSF Registries OSF.IO/7QGTY; https://doi.org/10.17605/OSF.IO/7QGTY %M 39984162 %R 10.2196/63898 %U https://www.jmir.org/2025/1/e63898 %U https://doi.org/10.2196/63898 %U http://www.ncbi.nlm.nih.gov/pubmed/39984162 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e63622 %T Multimodal Digital Phenotyping Study in Patients With Major Depressive Episodes and Healthy Controls (Mobile Monitoring of Mood): Observational Longitudinal Study %A Aledavood,Talayeh %A Luong,Nguyen %A Baryshnikov,Ilya %A Darst,Richard %A Heikkilä,Roope %A Holmén,Joel %A Ikäheimonen,Arsi %A Martikkala,Annasofia %A Riihimäki,Kirsi %A Saleva,Outi %A Triana,Ana Maria %A Isometsä,Erkki %+ , Department of Computer Science, Aalto University, Konemiehentie 2, Espoo, 02150, Finland, 358 505632634, talayeh.aledavood@aalto.fi %K digital health %K mental disorders %K depression %K digital phenotyping %K smartphones %K mobile devices %K multisensor %K mobile phone %D 2025 %7 21.2.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mood disorders are among the most common mental health conditions worldwide. Wearables and consumer-grade personal digital devices create digital traces that can be collected, processed, and analyzed, offering a unique opportunity to quantify and monitor individuals with mental disorders in their natural living environments. Objective: This study comprised (1) 3 subcohorts of patients with a major depressive episode, either with major depressive disorder, bipolar disorder, or concurrent borderline personality disorder, and (2) a healthy control group. We investigated whether differences in behavioral patterns could be observed at the group level, that is, patients versus healthy controls. We studied the volume and temporal patterns of smartphone screen and app use, communication, sleep, mobility, and physical activity. We investigated whether patients or controls exhibited more homogenous temporal patterns of activity when compared with other individuals in the same group. We examined which variables were associated with the severity of depression. Methods: In total, 188 participants were recruited to complete a 2-phase study. In the first 2 weeks, data from bed sensors, actigraphy, smartphones, and 5 sets of daily questions were collected. In the second phase, which lasted up to 1 year, only passive smartphone data and biweekly 9-item Patient Health Questionnaire data were collected. Survival analysis, statistical tests, and linear mixed models were performed. Results: Survival analysis showed no statistically significant difference in adherence. Most participants did not stay in the study for 1 year. Weekday location variance showed lower values for patients (control: mean –10.04, SD 2.73; patient: mean –11.91, SD 2.50; Mann-Whitney U [MWU] test P=.004). Normalized entropy of location was lower among patients (control: mean 2.10, SD 1.38; patient: mean 1.57, SD 1.10; MWU test P=.05). The temporal communication patterns of controls were more diverse compared to those of patients (MWU test P<.001). In contrast, patients exhibited more varied temporal patterns of smartphone use compared to the controls. We found that the duration of incoming calls (β=–0.08, 95% CI –0.12 to –0.04; P<.001) and the SD of activity magnitude (β=–2.05, 95% CI –4.18 to –0.20; P=.02) over the 14 days before the 9-item Patient Health Questionnaire records were negatively associated with depression severity. Conversely, the duration of outgoing calls showed a positive association with depression severity (β=0.05, 95% CI 0.00-0.09; P=.02). Conclusions: Our work shows the important features for future analyses of behavioral markers of mood disorders. However, among outpatients with mild to moderate depressive disorders, the group-level differences from healthy controls in any single modality remain relatively modest. Therefore, future studies need to combine data from multiple modalities to detect more subtle differences and identify individualized signatures. The high dropout rates for longer study periods remain a challenge and limit the generalizability. %M 39984168 %R 10.2196/63622 %U https://mental.jmir.org/2025/1/e63622 %U https://doi.org/10.2196/63622 %U http://www.ncbi.nlm.nih.gov/pubmed/39984168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56418 %T Depression Self-Care Apps’ Characteristics and Applicability to Older Adults: Systematic Assessment %A Yin,Ruoyu %A Rajappan,Dakshayani %A Martinengo,Laura %A Chan,Frederick H F %A Smith,Helen %A Griva,Konstadina %A Subramaniam,Mythily %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Clinical Sciences Building, Singapore, 308232, Singapore, 65 65138572, l.tudor.car@imperial.ac.uk %K older adults %K elder %K elderly %K mental health %K mental illness %K mental disorders %K mHealth %K mobile health %K mobile application %K app %K application %K smartphone %K depression %K self-care %K mobile apps %K systematic assessment %K assessment %K effectiveness %K self-care %K Android app %K mental health apps %K mobile interventions %K behaviour %K therapy %K mood monitoring %K adaptations %K online communities %K impairments %D 2025 %7 21.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression affects 32% of older adults. Loneliness and social isolation are common risk factors for depression in older adults. Mobile apps can connect users and are also effective in depression management in the general population. However, older adults have specific needs in terms of the content of depression self-care interventions and their accessibility. It remains unknown whether existing apps for depression self-care are applicable to older adults. Objective: The initial aim of this assessment was to systematically identify interactive depression self-care apps specifically designed for older adults. As we did not find any, we assessed the applicability of existing depression self-care apps to the needs of older adult users. Methods: Using an established app assessment methodology, we searched for Android and iOS interactive mental health apps providing self-care for depression in English and Chinese in the 42Matters database, Chinese Android app stores, and the first 10 pages of Google and Baidu. We developed an assessment rubric based on extensive revision of the literature. The rubric consisted of the following sections: general characteristics of the apps (eg, developer, platform, and category), app content (eg, epidemiology and risk factors of depression in older adults, techniques to improve mood and well-being), and technical aspects (eg, accessibility, privacy and confidentiality, and engagement). Results: We identified 23 apps (n=19, 82.6%, English and n=4, 17.4%, Chinese apps), with 5 (21.7%) iOS-only apps, 3 (13%) Android-only apps, and 15 (65.2%) apps on both platforms. None specifically targeted older adults with depression. All apps were designed by commercial companies and were free to download. Most of the apps incorporated cognitive behavior therapy, mood monitoring, or journaling. All but 3 (13%) apps had a privacy and confidentiality policy. In addition, 14 (60.9%) apps covered depression risk factors in older adults, and 3 (13%) apps delivered information about depression epidemiology in older adults via a chatbot. Furthermore, 17 (73.9%) apps mentioned other topics relevant to older adults, such as pain management, grief, loneliness, and social isolation. Around 30% (n=7) of the apps were supported by an online forum. Common accessibility issues included a lack of adaptations for users with visual or hearing impairments and incompatibility with larger font sizes in the phone settings. Conclusions: There are no depression apps developed specifically for older adults. Available mobile apps have limited applicability to older adults in terms of their clinical and technical features. Depression self-care apps should aim to incorporate content relevant to older adults, such as grief and loss; include online communities; and improve accessibility to adapt to potential health impairments in older adults. %M 39983112 %R 10.2196/56418 %U https://www.jmir.org/2025/1/e56418 %U https://doi.org/10.2196/56418 %U http://www.ncbi.nlm.nih.gov/pubmed/39983112 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e60432 %T Exploring the Ethical Challenges of Conversational AI in Mental Health Care: Scoping Review %A Rahsepar Meadi,Mehrdad %A Sillekens,Tomas %A Metselaar,Suzanne %A van Balkom,Anton %A Bernstein,Justin %A Batelaan,Neeltje %+ Department of Psychiatry, Amsterdam Public Health, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands, 31 204444444, m.rahseparmeadi@ggzingeest.nl %K chatbot %K mHealth %K mobile health %K ethics %K mental health %K conversational agent %K artificial intelligence %K psychotherapy %K scoping review %K conversational agents %K digital technology %K natural language processing %K qualitative %K psychotherapist %D 2025 %7 21.2.2025 %9 Review %J JMIR Ment Health %G English %X Background: Conversational artificial intelligence (CAI) is emerging as a promising digital technology for mental health care. CAI apps, such as psychotherapeutic chatbots, are available in app stores, but their use raises ethical concerns. Objective: We aimed to provide a comprehensive overview of ethical considerations surrounding CAI as a therapist for individuals with mental health issues. Methods: We conducted a systematic search across PubMed, Embase, APA PsycINFO, Web of Science, Scopus, the Philosopher’s Index, and ACM Digital Library databases. Our search comprised 3 elements: embodied artificial intelligence, ethics, and mental health. We defined CAI as a conversational agent that interacts with a person and uses artificial intelligence to formulate output. We included articles discussing the ethical challenges of CAI functioning in the role of a therapist for individuals with mental health issues. We added additional articles through snowball searching. We included articles in English or Dutch. All types of articles were considered except abstracts of symposia. Screening for eligibility was done by 2 independent researchers (MRM and TS or AvB). An initial charting form was created based on the expected considerations and revised and complemented during the charting process. The ethical challenges were divided into themes. When a concern occurred in more than 2 articles, we identified it as a distinct theme. Results: We included 101 articles, of which 95% (n=96) were published in 2018 or later. Most were reviews (n=22, 21.8%) followed by commentaries (n=17, 16.8%). The following 10 themes were distinguished: (1) safety and harm (discussed in 52/101, 51.5% of articles); the most common topics within this theme were suicidality and crisis management, harmful or wrong suggestions, and the risk of dependency on CAI; (2) explicability, transparency, and trust (n=26, 25.7%), including topics such as the effects of “black box” algorithms on trust; (3) responsibility and accountability (n=31, 30.7%); (4) empathy and humanness (n=29, 28.7%); (5) justice (n=41, 40.6%), including themes such as health inequalities due to differences in digital literacy; (6) anthropomorphization and deception (n=24, 23.8%); (7) autonomy (n=12, 11.9%); (8) effectiveness (n=38, 37.6%); (9) privacy and confidentiality (n=62, 61.4%); and (10) concerns for health care workers’ jobs (n=16, 15.8%). Other themes were discussed in 9.9% (n=10) of the identified articles. Conclusions: Our scoping review has comprehensively covered ethical aspects of CAI in mental health care. While certain themes remain underexplored and stakeholders’ perspectives are insufficiently represented, this study highlights critical areas for further research. These include evaluating the risks and benefits of CAI in comparison to human therapists, determining its appropriate roles in therapeutic contexts and its impact on care access, and addressing accountability. Addressing these gaps can inform normative analysis and guide the development of ethical guidelines for responsible CAI use in mental health care. %M 39983102 %R 10.2196/60432 %U https://mental.jmir.org/2025/1/e60432 %U https://doi.org/10.2196/60432 %U http://www.ncbi.nlm.nih.gov/pubmed/39983102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63407 %T The Mediating Role of Meaning-Making in the Relationship Between Mental Time Travel and Positive Emotions in Stress-Related Blogs: Big Data Text Analysis Research %A Chen,Yidi %A Zheng,Lei %A Ma,Jinjin %A Zhu,Huanya %A Gan,Yiqun %+ School of Humanities and Social Sciences, Beijing Forestry University, No. 35 Qinghua East Road, Beijing, 100083, China, 86 01062336834, ydchen@bjfu.edu.cn %K stress %K meaning-making %K mental time travel %K big data %K mini meta-analysis %K text analysis %K coping mechanisim %K Weibo %K post %K web crawler %K positive emotion %K emotion %K meta-analysis %K anxiety %K depression %K mental health %K ecological momentary assessment %K EMA %K stress model %K natural language processing %K NLP %D 2025 %7 21.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the ubiquity of stress, a key focus of stress research is exploring how to better coexist with stress. Objective: This study conducted text analysis on stress-related Weibo posts using a web crawler to investigate whether these posts contained positive emotions, as well as elements of mental time travel and meaning-making. A mediation model of mental time travel, meaning-making, and positive emotions was constructed to examine whether meaning-making triggered by mental time travel can foster positive emotions under stress. Methods: Using Python 3.8, the original public data from active Weibo users were crawled, yielding 331,711 stress-related posts. To avoid false positives, these posts were randomly divided into two large samples for cross-validation (sample 1: n=165,374; sample 2: n=166,337). Google’s natural language processing application programming interface was used for word segmentation, followed by text and mediation analysis using the Chinese psychological analysis system “Wenxin.” A mini–meta-analysis of the mediation path coefficients was conducted. Text analysis identified mental time travel words, meaning-making words, and positive emotion words in stress-related posts. Results: The constructed mediation model of mental time travel words (time words), meaning-making words (causal and insightful words), and positive poststress emotions validated positive adaptation following stress. A mini–meta-analysis of two different mediation models constructed in the two subsamples indicated a stable mediation effect across the 2 random subsamples. The combined effect size (B) obtained was .013 (SE 0.003, 95% CI 0.007-0.018; P<.001), demonstrating that meaning-making triggered by mental time travel in stress-related blog posts can predict positive emotions under stress. Conclusions: Individuals can adapt positively to stress by engaging in meaning-making processes that are triggered by mental time travel and reflected in their social media posts. The study’s mediation model confirmed that mental time travel leads to meaning-making, which fosters positive emotional responses to stress. Mental time travel serves as a psychological strategy to facilitate positive adaptation to stressful situations. %M 39900590 %R 10.2196/63407 %U https://www.jmir.org/2025/1/e63407 %U https://doi.org/10.2196/63407 %U http://www.ncbi.nlm.nih.gov/pubmed/39900590 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65214 %T Behavior Change Support Systems for Self-Treating Procrastination: Systematic Search in App Stores and Analysis of Motivational Design Archetypes %A Kirchner-Krath,Jeanine %A Schmidt-Kraepelin,Manuel %A Schmähl,Katharina %A Schütz,Christoph %A Morschheuser,Benedikt %A Sunyaev,Ali %+ Department of Economics and Management, Karlsruhe Institute of Technology, Kaiserstraße 89, Karlsruhe, D-76133, Germany, 49 72160844062, manuel.schmidt-kraepelin@kit.edu %K procrastination %K mobile apps %K cluster analysis %K motivational design %K persuasive technology %K behavior change support systems %K behavior change techniques %K mobile health %K mHealth %K mobile phone %K artificial intelligence %K AI %D 2025 %7 20.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The phenomenon of procrastination refers to an individual’s conscious decision to postpone the completion of tasks despite being aware of its adverse consequences in the future. Extant research in this field shows that procrastination is associated with increased levels of anxiety and stress and the likelihood of developing depression and calls for the development of suitable interventions that support individuals in making lasting positive changes to their procrastination behaviors. In parallel, practice has produced a plethora of behavior change support systems (BCSSs) that aim to provide a low-threshold, accessible alternative to in-person therapeutic approaches. Most of these BCSSs can be considered motivational BCSSs that combine functional, utilitarian components with hedonic and eudaimonic design elements to empower self-treatment. Although early studies have suggested the potential benefits of such BCSSs, research on understanding their specific design characteristics and support of individuals in self-treating procrastination is still in its infancy. Objective: In response to this gap between practice and research, we aimed to analyze and systemize the multitude of practical design efforts in motivational BCSSs for the self-treatment of procrastination and identify the main design archetypes that have emerged. Methods: We conducted a 3-step research approach. First, we identified 127 behavior change support apps for procrastination through a systematic screening process in the German and US Apple App Store and Google Play Store. Second, we systematically coded the identified apps in terms of the behavior change techniques targeted by their functional design and hedonic or eudaimonic design elements. Third, we conducted a 2-step cluster analysis to identify archetypes of motivational design in behavior change support apps to combat procrastination. Results: A variety of motivational designs have been developed and implemented in practice, and our analysis identified five main archetypes: (1) structured progress monitor, (2) self-improvement guide, (3) productivity adventure, (4) emotional wellness coach, and (5) social focus companion. The identified archetypes target different psychological determinants of procrastination and successfully use a variety of hedonic and eudaimonic design elements that extend beyond the current state of research. Conclusions: The results of our study provide a foundation for future research endeavors that aim to examine the comparative effects of motivational design archetypes and develop more effective interventions tailored to individual needs. For practitioners, the findings reveal the contemporary design space of motivational BCSSs to support the self-treatment of procrastination and may serve as blueprints that can guide the design of future systems. For individuals seeking support and health professionals treating procrastination, our study systemizes the landscape of apps, thereby facilitating the selection of one that best aligns with the patient’s individual needs. %M 39977017 %R 10.2196/65214 %U https://www.jmir.org/2025/1/e65214 %U https://doi.org/10.2196/65214 %U http://www.ncbi.nlm.nih.gov/pubmed/39977017 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e54221 %T Cognitive Training for Emotion-Related Impulsivity and Rumination: Protocol for a Pilot Randomized Waitlist-Controlled Trial %A Allen,K J D %A Elliott,Matthew V %A Ronold,Eivind Haga %A Mason,Liam %A Rajgopal,Nandini %A Hammar,Åsa %A Johnson,Sheri L %+ Department of Psychology, University of California, Berkeley, Postal code 2010, 2121 Berkeley Way, Berkeley, CA, 94720, United States, 1 219 669 4491, jd.allen@berkeley.edu %K cognitive control %K cognitive training %K emotion regulation %K emotional response inhibition %K emotional working memory %K executive function %K impulsivity %K rumination %K transdiagnostic %K urgency %D 2025 %7 19.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Inhibitory deficits are common in psychopathology. Emotion-related impulsivity (ERI) and rumination are general risk factors for psychiatric distress that are similarly associated with dysfunctional inhibition—particularly in affective contexts. A number of cognitive remediation procedures have been developed to improve inhibitory control; however, most remediation programs focus on “cold” cognition independent of affective processing. This pilot trial will gather preliminary evidence for a new cognitive training intervention targeting “hot” affective control (ie, inhibitory functions during elevated emotional arousal) in a transdiagnostic sample of adults who report heightened emotion dysregulation. Objective: This manuscript describes a protocol for a pilot randomized waitlist-controlled trial to assess changes in ERI and rumination after neurobehavioral affective control training (N-ACT), an 8-week cognitive training intervention designed to improve emotional response inhibition and emotional working memory. Our primary aim is to evaluate the efficacy, feasibility, and acceptability of N-ACT in reducing rumination and ERI, which we respectively conceptualize as complementary cognitive and behavioral consequences of emotion dysregulation. Secondarily, we will examine whether N-ACT leads to improvements in inhibitory control and, more distally, psychopathology symptoms. Methods: The final sample will comprise 80 adults who report high ERI or rumination. Participants will be randomized to (1) begin the N-ACT program without delay or (2) join a waitlist condition and then complete N-ACT. Exclusion criteria include active alcohol or substance use disorders, psychosis, and suicide risk. At the baseline and postintervention time points, participants will complete measures of emotion dysregulation and psychiatric symptoms, as well as a neuropsychological assessment of inhibitory control. Individuals assigned to the control group will undergo an identical assessment before joining the waitlist, followed by parallel assessments before and after N-ACT. Results: This trial is funded by support from the University of California Board of Regents and the Peder Sather Foundation (funding period: October 2022-September 2025). Recruitment is scheduled to begin in spring 2025. We will begin data analysis once data collection is complete, which is planned to occur in fall 2025. Conclusions: This pilot randomized waitlist-controlled trial is designed to assess the initial efficacy, feasibility, and acceptability of N-ACT, a novel cognitive remediation approach developed to address 2 key contributors to psychopathology: ERI and rumination. The N-ACT program uses computerized adaptive behavioral tasks to strengthen the affective control processes theoretically and empirically linked to ERI and rumination. We hope this work will help inform future studies with sufficient statistical power to ascertain whether enhancing affective control through cognitive training (N-ACT) produces downstream reductions in psychiatric symptoms via improved emotion regulation. Trial Registration: ClinicalTrials.gov NCT06226467; https://www.clinicaltrials.gov/study/NCT06226467; Open Science Framework Registry rak5z; https://osf.io/rak5z International Registered Report Identifier (IRRID): PRR1-10.2196/54221 %M 39970439 %R 10.2196/54221 %U https://www.researchprotocols.org/2025/1/e54221 %U https://doi.org/10.2196/54221 %U http://www.ncbi.nlm.nih.gov/pubmed/39970439 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67567 %T Cost Utility Analysis of Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder: Randomized Controlled Trial %A Zhou,Wenjing %A Chen,Yan %A Wu,Herui %A Zhao,Hao %A Li,Yanzhi %A Shi,Guangduoji %A Wang,Wanxin %A Liu,Yifeng %A Liao,Yuhua %A Zhang,Huimin %A Gao,Caihong %A Hao,Jiejing %A Le,Gia Han %A McIntyre,Roger S %A Han,Xue %A Lu,Ciyong %+ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, No.74 Zhongshan Road 2, Guangzhou, 510080, China, 86 13610355985, luciyong@mail.sysu.edu.cn %K cost utility analysis %K CUA %K cost-effectiveness %K economic evaluation %K costs %K quality of life %K internet-based cognitive behavioral therapy %K ICBT %K digital psychiatry %K major depressive disorder %K depression %K China %D 2025 %7 19.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Unguided internet-based cognitive behavioral therapy (ICBT) has been proven effective for major depressive disorder (MDD). However, few studies have examined its cost-effectiveness in low-resource countries and under nonspecialist routine care. Objective: This study aimed to evaluate the short- and long-term cost utility of unguided ICBT compared to a waitlist control for persons with MDD from the perspectives of society and the health care system. Methods: This analysis was implemented alongside an 8-week 2-arm randomized controlled trial with a 12-month follow-up period conducted in Shenzhen, China. Outcomes including cost and health utility were collected at the pretreatment and posttreatment time points and 3, 6, and 12 months after the intervention. Direct medical costs and indirect costs were prospectively collected using the hospital information system and the Sheehan Disability Scale. Health outcomes were measured using the Chinese version of the Short-Form Six-Dimension health index. The primary outcome was incremental cost utility ratio (ICUR) expressed as the difference in costs between 2 therapies by the difference in quality-adjusted life years (QALYs). The seemingly unrelated regression model and the bootstrap method were performed to estimate adjusted ICURs. Cost-effectiveness planes and cost-effectiveness acceptability curves were used to demonstrate uncertainty. A series of scenario analyses were conducted to verify the robustness of base-case results. Results: In total, 244 participants with MDD were randomly allocated to the ICBT (n=122, 50%) or waitlist control (n=122, 50%) groups. At the pretreatment time point, no statistically significant difference was observed in direct medical cost (P=.41), indirect cost (P=.10), or health utility (P=.11) between the 2 groups. In the base-case analysis, the ICBT group reported higher direct medical costs and better quality of life but lower total costs at the posttreatment time point. The adjusted ICURs at the posttreatment time point were CN ¥–194,720.38 (US $–26,551.50; 95% CI CN ¥–198,766.78 to CN ¥–190,673.98 [US $–27,103.20 to US $–25,999.70]) and CN ¥49,700.33 (US $6776.99; 95% CI CN ¥46,626.34-CN ¥52,774.31 [US $6357.83-$7196.15]) per QALY from the societal and health care system perspectives, respectively, with a probability of unguided ICBT being cost-effective of 75.93% and 54.4%, respectively, if the willingness to pay was set at 1 time the per-capita gross domestic product. In the scenario analyses, the probabilities increased to 76.85% and 77.61%, respectively, indicating the potential of ICBT to be cost-effective over the long term. Conclusions: Unguided ICBT is a cost-effective treatment for MDD. This intervention not only helps patients with MDD improve clinically but also generates societal savings. These findings provide health economic evidence for a potential scalable MDD treatment method in low- and middle-income countries. Trial Registration: Chinese Clinical Trial Registry (ChiCTR) ChiCTR2100046425; https://tinyurl.com/bdcrj4zv %M 39970426 %R 10.2196/67567 %U https://www.jmir.org/2025/1/e67567 %U https://doi.org/10.2196/67567 %U http://www.ncbi.nlm.nih.gov/pubmed/39970426 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68419 %T Designing Values Elicitation Technologies for Mental Health and Chronic Care Integration: User-Centered Design Approach %A Rooper,Isabel R %A Liem,William W %A Burla,Martha %A Gordon,Jacob %A Baez,Lara M %A Kornfield,Rachel %A Berry,Andrew B L %+ , Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, 625 N Michigan Ave, Ste 2100, Chicago, IL, 60611, United States, 1 312 503 4910, andrew.berry@northwestern.edu %K chronic care management %K anxiety %K depression %K values elicitation %K eHealth %K patient-centered care %K technology-enabled services %K human-centered design %K multimorbidity %K user-centered design %K multiple chronic conditions %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with multiple chronic conditions (MCCs) and mental health challenges such as depression or anxiety have complex health needs and experience significant challenges with care coordination. Approaches to enhance care for patients with MCCs typically focus on eliciting patients’ values to identify and align treatment priorities across patients and providers. However, these efforts are often hindered by both systems- and patient-level barriers, which are exacerbated for patients with co-occurring mental health symptoms. Technology-enabled services (TES) offer a promising avenue to facilitate values elicitation and promote patient-centered care for these patients, though TES have not yet been tailored to their unique needs. Objective: This study aimed to identify design and implementation considerations for TES that facilitate values elicitation among patients with MCCs and depression or anxiety. We sought to understand the preferences of both clinicians and patients for TES that could bridge the gap between mental and physical health care. Methods: Using human-centered design methods, we conducted 7 co-design workshops with 18 participants, including primary care clinicians, mental health clinicians, and patients with MCCs and depression or anxiety. Participants were introduced to TES prototypes that used various formats (eg, worksheets and artificial intelligence chatbots) to elicit and communicate patients’ values. Prototypes were iteratively refined based on participant feedback. Data from these sessions were analyzed using reflexive thematic analysis to uncover themes related to service, technology, and implementation considerations. Results: Three primary themes were identified. (1) Service considerations: TES should help patients translate elicited values into actionable treatment plans and include low-burden, flexible activities to accommodate fluctuations in their mental health symptoms. Both patients and clinicians indicated that TES could be valuable for improving appointment preparation and patient-provider communication through interpersonal skill-building. (2) Technology considerations: Patients expressed openness to TES prototypes that used artificial intelligence, particularly those that provided concise summaries of appointment priorities. Visual aids and simplified language were highlighted as essential features to support accessibility for neurodiverse patients. (3) Implementation considerations: Clinicians and patients favored situating values elicitation in mental health care settings over primary care and preferred self-guided TES that patients could complete independently before appointments. Conclusions: Findings indicate that TES can address the unique needs of patients with MCCs and mental health challenges by facilitating values-based care. Key design considerations include ensuring TES flexibility to account for fluctuating mental health symptoms, facilitating skill-building for effective communication, and creating user-friendly technology interfaces. Future research should explore how TES can be integrated into health care settings to enhance care coordination and support patient-centered treatment planning. By aligning TES design with patient and clinician preferences, there is potential to bridge gaps in care for this complex patient population. %M 39970432 %R 10.2196/68419 %U https://formative.jmir.org/2025/1/e68419 %U https://doi.org/10.2196/68419 %U http://www.ncbi.nlm.nih.gov/pubmed/39970432 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65379 %T Digital Isolation and Dementia Risk in Older Adults: Longitudinal Cohort Study %A Deng,Cheng %A Shen,Na %A Li,Guangzhou %A Zhang,Ke %A Yang,Shijun %+ Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1277 Jiefang Avenue, Wuhan, 430022, China, 86 13971132795, yangsj1218@163.com %K dementia %K digital isolation %K cognitive decline %K older adults %K elderly %K geriatric %K longitudinal cohort study %K cognitive impairment %K aging %K social isolation %K risk %K digital engagement %D 2025 %7 19.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Dementia poses a significant global health challenge, characterized by progressive cognitive decline and functional impairment. With the aging global population, dementia prevalence is projected to surge, reaching an estimated 153 million cases by 2050. While the impact of traditional social isolation on dementia risk has been extensively studied, the influence of digital isolation, a phenomenon unique to the digital age, remains underexplored. Objective: This study aimed to investigate the association between digital isolation and dementia risk among older adults, hypothesizing that higher levels of digital isolation significantly increase the risk of developing dementia. Methods: We conducted a longitudinal cohort study using data from the National Health and Aging Trends Study (NHATS), analyzing 8189 participants aged 65 years and older from the 3rd (2013) to the 12th wave (2022). Digital isolation was quantified using a composite digital isolation index, derived from participants’ usage of digital devices, electronic communication, internet access, and engagement in online activities. Participants were stratified into low isolation and moderate to high isolation groups. Dementia incidence was assessed using cognitive tests and proxy reports. Cox proportional hazards models were used to estimate the association between digital isolation and dementia risk, adjusting for potential confounders including sociodemographic factors, baseline health conditions, and lifestyle variables. Results: The moderate to high isolation group demonstrated a significantly elevated risk of dementia compared with the low isolation group. In the discovery cohort, the adjusted hazard ratio (HR) was 1.22 (95% CI 1.01-1.47, P=.04), while the validation cohort showed an HR of 1.62 (95% CI 1.27-2.08, P<.001). The pooled analysis across both cohorts revealed an adjusted HR of 1.36 (95% CI 1.16-1.59, P<.001). Kaplan-Meier curves corroborated a higher incidence of dementia in the moderate to high isolation group. Conclusions: Our findings indicate that digital isolation is a significant risk factor for dementia among older adults. This study underscores the importance of digital engagement in mitigating dementia risk and suggests that promoting digital literacy and access to digital resources should be integral components of public health strategies aimed at dementia prevention. %M 39969956 %R 10.2196/65379 %U https://www.jmir.org/2025/1/e65379 %U https://doi.org/10.2196/65379 %U http://www.ncbi.nlm.nih.gov/pubmed/39969956 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e63484 %T Toward a New Conceptual Framework for Digital Mental Health Technologies: Scoping Review %A Hopkin,Gareth %A Coole,Holly %A Edelmann,Francesca %A Ayiku,Lynda %A Branson,Richard %A Campbell,Paul %A Cooper,Sophie %A Salmon,Mark %K digital mental health %K digital health %K mental health %K eHealth %K categorization %K conceptual %K framework %K regulation %K synthesis %K review methods %K review methodology %K systematic %D 2025 %7 19.2.2025 %9 %J JMIR Ment Health %G English %X Background: Digital mental health technologies (DMHTs) are becoming more widely available and are seen as having the potential to improve the quality of mental health care. However, conversations around the potential impact of DMHTs can be impacted by a lack of focus on the types of technologies that are available. Several frameworks that could apply to DMHTs are available, but they have not been developed with comprehensive methods and have limitations. Objective: To address limitations with current frameworks, we aimed to identify existing literature on the categorization of DMHTs, to explore challenges with categorizing DMHTs for specific purposes, and to develop a new conceptual framework. Methods: We used an iterative approach to develop the framework. First, we completed a rapid review of the literature to identify studies that provided domains that could be used to categorize DMHTs. Second, findings from this review and associated issues were discussed by an expert working group, including professionals from a wide range of relevant settings. Third, we synthesized findings to develop a new conceptual framework. Results: The rapid review identified 3603 unique results, and hand searching identified another 3 potentially relevant papers. Of these, 24 papers were eligible for inclusion, which provided 10 domains to categorize DMHTs. The expert working group proposed a broad framework and based on the findings of the review and group discussions, we developed a new conceptual framework with 8 domains that represent important characteristics of DMHTs. These 8 domains are population, setting, platform or system, purpose, type of approach, human interaction, human responsiveness, and functionality. Conclusions: This conceptual framework provides a structure for various stakeholders to define the key characteristics of DMHTs. It has been developed with more comprehensive methods than previous attempts with similar aims. The framework can facilitate communication within the field and could undergo further iteration to ensure it is appropriate for specific purposes. %R 10.2196/63484 %U https://mental.jmir.org/2025/1/e63484 %U https://doi.org/10.2196/63484 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66056 %T Development and Validation of Prediction Models for Perceived and Unmet Mental Health Needs in the Canadian General Population: Model-Based Synthetic Estimation Study %A Wang,Jianli %A Orpana,Heather %A Carrington,André %A Kephart,George %A Vasiliadis,Helen-Maria %A Leikin,Benjamin %K population risk prediction %K development %K validation %K perceived mental health need %K unmet mental health need %D 2025 %7 19.2.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Research has shown that perceptions of a mental health need are closely associated with service demands and are an important dimension in needs assessment. Perceived and unmet mental health needs are important factors in the decision-making process regarding mental health services planning and resources allocation. However, few prediction tools are available to be used by policy and decision makers to forecast perceived and unmet mental health needs at the population level. Objective: We aim to develop prediction models to forecast perceived and unmet mental health needs at the provincial and health regional levels in Canada. Methods: Data from 2018, 2019, and 2020 Canadian Community Health Survey and Canadian Urban Environment were used (n=65,000 each year). Perceived and unmet mental health needs were measured by the Perceived Needs for Care Questionnaire. Using the 2018 dataset, we developed the prediction models through the application of regression synthetic estimation for the Atlantic, Central, and Western regions. The models were validated in the 2019 and 2020 datasets at the provincial level and in 10 randomly selected health regions by comparing the observed and predicted proportions of the outcomes. Results: In 2018, a total of 17.82% of the participants reported perceived mental health need and 3.81% reported unmet mental health need. The proportions were similar in 2019 (18.04% and 3.91%) and in 2020 (18.1% and 3.92%). Sex, age, self-reported mental health, physician diagnosed mood and anxiety disorders, self-reported life stress and life satisfaction were the predictors in the 3 regional models. The individual based models had good discriminative power with C statistics over 0.83 and good calibration. Applying the synthetic models in 2019 and 2020 data, the models had the best performance in Ontario, Quebec, and British Columbia; the absolute differences between observed and predicted proportions were less than 1%. The absolute differences between the predicted and observed proportion of perceived mental health needs in Newfoundland and Labrador (−4.16% in 2020) and Prince Edward Island (4.58% in 2019) were larger than those in other provinces. When applying the models in the 10 selected health regions, the models calibrated well in the health regions in Ontario and in Quebec; the absolute differences in perceived mental health needs ranged from 0.23% to 2.34%. Conclusions: Predicting perceived and unmet mental health at the population level is feasible. There are common factors that contribute to perceived and unmet mental health needs across regions, at different magnitudes, due to different population characteristics. Therefore, predicting perceived and unmet mental health needs should be region specific. The performance of the models at the provincial and health regional levels may be affected by population size. %R 10.2196/66056 %U https://publichealth.jmir.org/2025/1/e66056 %U https://doi.org/10.2196/66056 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59575 %T Continuous Improvement of Chronic Tinnitus Through a 9-Month Smartphone-Based Cognitive Behavioral Therapy: Randomized Controlled Trial %A Walter,Uso %A Pennig,Stefan %A Bleckmann,Lothar %A Röschmann-Doose,Kristina %A Wittig,Thomas %A Thomsen,Jörn %A Schlee,Winfried %+ G Pohl-Boskamp GmbH & Co KG, Kieler Straße 11, Hohenlockstedt, 25551, Germany, 49 4826 59 457, j.thomsen@pohl-boskamp.de %K tinnitus %K chronic tinnitus %K mobile health app %K mHealth %K mobile app %K application %K smartphone %K digital health %K digital technology %K digital intervention %K cognitive behavioral therapy %K randomized controlled trial %K statistical analysis %D 2025 %7 18.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Tinnitus is the perception of sound without an external auditive stimulus and can be a severe burden for affected patients. Medical guidelines recommend cognitive behavioral therapy (CBT) for tinnitus treatment, which effectively improves tinnitus-related distress and anxiety. Objective: This study investigates the outcome of a 9-month smartphone-based CBT for patients with tinnitus. Methods: The randomized controlled clinical trial in this study investigates the efficacy of a smartphone-based CBT for 187 patients with chronic tinnitus over a 9-month treatment period. In the initial 3 months, a waiting list design was applied, and in the subsequent study phase, the data of both treatment groups were collectively analyzed. The scores on the Tinnitus Questionnaire (TQ); 9-item Patient Health Questionnaire (PHQ-9); 9-item Self-Efficacy, Optimism, Pessimism (SWOP-K9) questionnaire; and 20-item Perceived Stress Questionnaire (PSQ-20) were assessed as endpoints after 3 and 9 months of treatment. Results: We observed a statistically significant reduction in the tinnitus burden in patients who received the smartphone-based CBT intervention. Although no changes were observed initially in the TQ sum scores in the waiting control group (baseline mean, 37.8, SD 4.7; 3 months mean 37.5, SD 4.8; analysis of covariance [ANCOVA] P=.52), the scores significantly decreased once the app-based CBT had commenced. Data pooled from both groups revealed significant reduction in the TQ sum score by 12.49 (SD 1.44) (ANCOVA, P<.001) and 18.48 (SD 1.85) (ANCOVA, P<.001) points after 3 and 9 months, respectively, which was also clinically important. The calculated Cohen d was 1.38. Similarly, the scores on PSQ-20 (–9.14 points; ANCOVA, P<.001), PHQ-9 (–2.47 points; ANCOVA, P<.001), and SWOP-K9 (0.17 points; ANCOVA, P<.001) were significantly improved at the end of the therapy, with corresponding intermediate effect sizes after 9 months. Conclusions: The data in our study provide evidence of statistically significant, clinically relevant, and continuous benefits of an app-based CBT intervention in patients with chronic tinnitus. Trial Registration: Deutsches Register Klinischer Studien DRKS00022973; https://drks.de/search/de/trial/DRKS00022973 %M 39965780 %R 10.2196/59575 %U https://www.jmir.org/2025/1/e59575 %U https://doi.org/10.2196/59575 %U http://www.ncbi.nlm.nih.gov/pubmed/39965780 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65245 %T Digital Mental Health Screening, Feedback, and Referral System for Teens With Socially Complex Needs: Protocol for a Randomized Controlled Trial Integrating the Teen Assess, Check, and Heal System into Pediatric Primary Care %A Stiles-Shields,Colleen %A Bobadilla,Gabriella %A Reyes,Karen %A Gustafson,Erika L %A Lowther,Matthew %A Smith,Dale L %A Frisbie,Charles %A Antognini,Camilla %A Dyer,Grace %A MacCarthy,Rae %A Martinengo,Nicolò %A Morris,Guy %A Touranachun,Alissa %A Wilkens,Kimberlee M %A Julion,Wrenetha A %A Karnik,Niranjan S %+ Institute for Juvenile Research, Department of Psychiatry, University of Illinois Chicago, 1747 W. Roosevelt Road, Chicago, IL, 60608, United States, 1 3124131128, ecss@uic.edu %K teens %K primary care %K digital mental health %K low intensity treatments %K disparities %D 2025 %7 18.2.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Teens with socially complex needs—those who face multiple and potentially overlapping adversities—are disproportionately affected by several barriers to mental health screening and treatment. Pediatric primary care (PPC) is a typically low-stigmatized setting for teens that is visited at least annually. As such, implementing digital mental health tools (DMH), as low-intensity treatments in PPCs may increase the reach of such tools for teens with socially complex needs. Objective: This study aimed to evaluate the Teen Assess, Check, and Heal (TeACH) System in comparison to a control condition while integrated into PPCs at 2 Medical Centers serving teen patients in Chicago, Illinois. Through collaboration with key players throughout the design and implementation planning phases, the TeACH System is hypothesized to increase teen patient self-reported engagement with DMH and address specific individual-level barriers to mental health care, compared with a digital psychoeducation control condition. Methods: Eligible participants will be recruited through PPC clinics housed within the University of Illinois Chicago (UIC) and Rush University Medical Center (RUSH). Recruitment involves invitations from research staff members and primary care clinicians and staff members, as well as posting flyers with QR codes at the specified clinics. All participants complete a brief demographic survey, baseline survey, and Kiddie-Computerized Adaptive Tests Anxiety Module. Participants are randomized to receive either the control condition (digital evidence-based workbook) or the intervention (TeACH System Feedback and Resources). All randomized participants will then be invited to complete an immediate and 1-week follow-up survey. The primary outcomes assess changes in engagement with DMH (ie, likelihood to use DMH for anxiety and actual DMH use) and individual-level barriers to mental health care (ie, symptom understanding and confidence to act). Descriptive analyses will be conducted to characterize the sample and usability ratings of the TeACH System. Linear or generalized linear mixed effects regression models will examine differences in primary outcomes over time. Results: Recruitment began in July 2024 and data collection is expected to be completed by August 2025. To date, 122 teens have assented to complete study activities, 80 have been randomized (an additional 24 teens have had subthreshold anxiety symptoms and were therefore not randomized), and 42 teens have completed the 1-week follow-up assessment. Conclusions: This study will provide preliminary feasibility data that may inform how the TeACH System and other DMH low-intensity treatments might better engage and support teens with socially complex needs. Trial Registration: ClinicalTrials.gov NCT05466929; https://clinicaltrials.gov/study/NCT05466929 International Registered Report Identifier (IRRID): DERR1-10.2196/65245 %M 39965196 %R 10.2196/65245 %U https://www.researchprotocols.org/2025/1/e65245 %U https://doi.org/10.2196/65245 %U http://www.ncbi.nlm.nih.gov/pubmed/39965196 %0 Journal Article %@ 2817-1705 %I JMIR Publications %V 4 %N %P e63701 %T Predicting Satisfaction With Chat-Counseling at a 24/7 Chat Hotline for the Youth: Natural Language Processing Study %A Hornstein,Silvan %A Lueken,Ulrike %A Wundrack,Richard %A Hilbert,Kevin %+ Department of Psychology, Humboldt-Universität zu Berlin, Wolfgang Köhler-Haus, Rudower Ch 18, Berlin, 12489, Germany, 49 15753685796, silvan.hornstein@hu-berlin.de %K digital mental health %K mental illness %K mental disorder %K adolescence %K chat counseling %K machine learning %K artificial intelligence %K large language model %K natural language processing %K deep learning %D 2025 %7 18.2.2025 %9 Original Paper %J JMIR AI %G English %X Background: Chat-based counseling services are popular for the low-threshold provision of mental health support to youth. In addition, they are particularly suitable for the utilization of natural language processing (NLP) for improved provision of care. Objective: Consequently, this paper evaluates the feasibility of such a use case, namely, the NLP-based automated evaluation of satisfaction with the chat interaction. This preregistered approach could be used for evaluation and quality control procedures, as it is particularly relevant for those services. Methods: The consultations of 2609 young chatters (around 140,000 messages) and corresponding feedback were used to train and evaluate classifiers to predict whether a chat was perceived as helpful or not. On the one hand, we trained a word vectorizer in combination with an extreme gradient boosting (XGBoost) classifier, applying cross-validation and extensive hyperparameter tuning. On the other hand, we trained several transformer-based models, comparing model types, preprocessing, and over- and undersampling techniques. For both model types, we selected the best-performing approach on the training set for a final performance evaluation on the 522 users in the final test set. Results: The fine-tuned XGBoost classifier achieved an area under the receiver operating characteristic score of 0.69 (P<.001), as well as a Matthews correlation coefficient of 0.25 on the previously unseen test set. The selected Longformer-based model did not outperform this baseline, scoring 0.68 (P=.69). A Shapley additive explanations explainability approach suggested that help seekers rating a consultation as helpful commonly expressed their satisfaction already within the conversation. In contrast, the rejection of offered exercises predicted perceived unhelpfulness. Conclusions: Chat conversations include relevant information regarding the perceived quality of an interaction that can be used by NLP-based prediction approaches. However, to determine if the moderate predictive performance translates into meaningful service improvements requires randomized trials. Further, our results highlight the relevance of contrasting pretrained models with simpler baselines to avoid the implementation of unnecessarily complex models. Trial Registration: Open Science Framework SR4Q9; https://osf.io/sr4q9 %M 39965198 %R 10.2196/63701 %U https://ai.jmir.org/2025/1/e63701 %U https://doi.org/10.2196/63701 %U http://www.ncbi.nlm.nih.gov/pubmed/39965198 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e60754 %T Promises and Pitfalls of Internet Search Data in Mental Health: Critical Review %A Loch,Alexandre Andrade %A Kotov,Roman %K privacy %K stigma %K online %K prevention %K internet %K search data %K mental health %K health care %K clinical information %K World Health Organization %K WHO %K digital health %K mental illness %K digital technologies %K social network %K mobile health %K mHealth %D 2025 %7 18.2.2025 %9 %J JMIR Ment Health %G English %X The internet is now integral to everyday life, and users’ web-based search data could be of strategic importance in mental health care. As shown by previous studies, internet searches may provide valuable insights into an individual’s mental state and could be of great value in early identification and helping in pathways to care. Internet search data can potentially provide real-time identification (eg, alert mechanisms for timely interventions). In this paper, we discuss the various problems related to the use of these data in research and clinical practice, including privacy concerns, integration with clinical information, and technical limitations. We also propose solutions to address these issues and provide possible future directions. %R 10.2196/60754 %U https://mental.jmir.org/2025/1/e60754 %U https://doi.org/10.2196/60754 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56289 %T User Personas for eHealth Regarding the Self-Management of Depressive Symptoms in People Living With HIV: Mixed Methods Study %A Zhao,Ting %A Tang,Chulei %A Ma,Jun %A Yan,Huang %A Su,Xinyi %A Zhong,Xueyuan %A Wang,Honghong %+ Xiangya School of Nursing, Central South University, Yuelu District, Changsha, 410013, China, 86 731 89665663, honghong_wang@hotmail.com %K HIV %K depressive symptoms %K depression %K self-management %K eHealth %K personas %D 2025 %7 17.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth has enormous potential to support the self-management of depressive symptoms in people living with HIV. However, a lack of personalization is an important barrier to user engagement with eHealth. According to goal-directed design, personalized eHealth requires the identification of user personas before concrete design to understand the goals and needs of different users. Objective: This study aimed to identify user personas for eHealth regarding the self-management of depressive symptoms in people living with HIV and explore the goals and needs of different user personas for future eHealth. Methods: We used an explanatory sequential mixed methods design at the First Hospital of Changsha City, Hunan Province, China, from April to October 2022. In the quantitative phase, 572 people living with HIV completed validated questionnaires with questions related to demographics, self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Latent profile analysis was performed to identify different user personas. In the qualitative phase, 43 one-to-one semistructured interviews across different user personas were conducted, transcribed verbatim, and analyzed using conventional content analysis. The findings from both phases were integrated during the interpretation phase. Results: Three types of user personas could be identified, including “high-level self-managers” (254/572, 44.4%), “medium-level self-managers” (283/572, 49.5%), and “low-level self-managers” (35/572, 6.1%). High-level self-managers had relatively high levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. High-level self-managers had a positive attitude toward using eHealth for the self-management of depressive symptoms and desired access to self-management support for depressive symptoms from eHealth with high usability. Medium-level self-managers had relatively medium levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Medium-level self-managers felt burdened by using eHealth for the self-management of depressive symptoms and preferred to access self-management support for HIV from eHealth with privacy. Low-level self-managers had relatively low levels of self-efficacy, self-management abilities of depressive symptoms, and eHealth literacy. Low-level self-managers had an acceptable attitude toward using eHealth for the self-management of depressive symptoms and desired access to professional guidance from eHealth with privacy and no cost (“free of charge”). Conclusions: The 3 user personas shed light on the possibility of personalized eHealth to support the self-management of depressive symptoms in different people living with HIV. Further research is needed to examine the generalizability of the user personas across study sites. %M 39960763 %R 10.2196/56289 %U https://www.jmir.org/2025/1/e56289 %U https://doi.org/10.2196/56289 %U http://www.ncbi.nlm.nih.gov/pubmed/39960763 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e64017 %T Mental Health Changes in US Transgender Adults Beginning Hormone Therapy Via Telehealth: Longitudinal Cohort Study %A Corman,Jae Downing %A Hughto,Jaclyn M W %A Shireman,Theresa I %A Baker,Kellan %A Steinle,Kate %A Forcier,Michelle %+ FOLX Health, 1 Boston Pl, Ste 2600, Boston, MA, 02108, United States, 1 617 792 6855, jae@folxhealth.com %K transgender %K LGBT persons %K telehealth %K depression %K anxiety %K suicide %K mental health %K adult %K virtual care %K longitudinal cohort study %K gender-affirming hormone therapy %K United States %K observational study %K adolescent %K mobile health %D 2025 %7 14.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Gender-affirming hormone therapy (GAHT) has shown potential for improving mental health outcomes among transgender and gender-diverse adults. How clinical outcomes change among adults receiving GAHT via telehealth across the United States is not well known. Objective: This study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in depression, anxiety, and suicide ideation over a 3-month period. Methods: This cohort study evaluated the relationship between initiating GAHT via a telehealth clinic and changes in mental health over a 3-month period. Data were collected at baseline and 3 months later among adults who had their first GAHT visit between August and November 2023. The study included adults aged 18 years and older initiating GAHT for the first time, with a final sample of 342 adults across 43 states (192 initiated estrogen and 150 initiated testosterone therapy). The primary outcomes were depression symptoms using the Patient Health Questionnaire-9 (PHQ-9), anxiety symptoms using the General Anxiety Disorder-7 (GAD-7), and suicide ideation in the past 2 weeks. Results: Before GAHT initiation, 40% (136/342) of participants reported depression (PHQ-9 ≥10), 36% (120/342) reported anxiety (GAD-7 ≥8), and 25% (91/342) reported suicidal ideation. By follow-up, significant reductions were observed in PHQ-9 (−2.4, 95% CI −3.0 to −1.8) and GAD-7 scores (−1.5, 95% CI −2.0 to −1.0). Among those with elevated symptoms, 40% (48/120) to 42% (56/133) achieved a clinically meaningful response (≥50% reduction in baseline scores), and 27% (36/133) to 28% (33/120) achieved remission (PHQ-9 or GAD-7 score <5). Of those with suicide ideation at baseline, 60% (50/83) had none at follow-up. Conclusions: This study highlights the important relationship between telehealth-delivered GAHT and mental health, emphasizing the importance of accessible and timely care. %M 39951700 %R 10.2196/64017 %U https://www.jmir.org/2025/1/e64017 %U https://doi.org/10.2196/64017 %U http://www.ncbi.nlm.nih.gov/pubmed/39951700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55583 %T Effectiveness of an Internet-Based, Self-Guided, Short-Term Mindfulness Training (ISSMT) Program for Relieving Depressive Symptoms in the Adult Population in China: Single-Blind, Randomized Controlled Trial %A Zhu,Tingfei %A Zhang,Liuyi %A Weng,Wenqi %A Gan,Ruochen %A Sun,Limin %A Wei,Yanping %A Zhu,Yueping %A Yu,Hongyan %A Xue,Jiang %A Chen,Shulin %+ Department of Psychology and Behavioral Sciences, Zhejiang University, No.148 Tianmushan Road, Hangzhou, China, 86 18958001648, chenshulin@zju.edu.cn %K internet-based %K self-guided %K short-term %K mindfulness %K depression %K randomized controlled trial %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is a significant global public health issue, and in China, access to mental health services remains limited despite high demand. Research has shown that mindfulness can effectively alleviate depressive symptoms and that telehealth solutions offer a promising avenue for addressing this service gap. Despite this potential, there are currently few studies in China focusing on short-term online mindfulness training. Most existing online mindfulness studies relied on traditional 8-week programs, which can be challenging for participant adherence due to limited accessibility and high dropout rates. Additionally, limited research exists on short-term online mindfulness interventions, and findings remain inconsistent. Objective: This study aimed to develop and evaluate an internet-based, self-guided, short-term mindfulness training (ISSMT) program based on the Monitor and Acceptance Theory (MAT) to reduce depression symptoms. Methods: The ISSMT program was delivered via an online platform, “Hi Emotion,” and was accessible to the general public. Interested individuals aged 18 years and older were randomized into either the ISSMT group or a wait-list control group. Participants in the ISSMT group received daily reminders to participate in a 15- to 20-minute session over a 14-day training period. Measurements, including mindfulness and depressive symptoms, were collected at baseline and weekly for the subsequent 3 weeks. Results: A total of 205 adults participated in the 14-day online intervention. Linear mixed models were used to analyze both per-protocol (PP) and intention-to-treat (ITT) samples. Compared with the wait-list control group, participants in the ISSMT group showed significant improvements in mindfulness (Cohen d=0.44 for ITT; Cohen d=0.55 for PP) and reductions in depressive symptoms (Cohen d=0.50 for ITT; Cohen d=0.53 for PP). Furthermore, participants expressed high acceptance of this training format with a relatively low dropout rate (<40%). Conclusions: The ISSMT program based on the MAT effectively enhanced mindfulness and alleviated depressive symptoms. This intervention could be considered for integration into psychosocial service systems to improve mental health outcomes and help bridge the gap between limited resources and the high demand for services in China. Future research should focus on personalizing these programs and incorporating advanced technologies to enhance their effectiveness and user engagement. Trial Registration: Open Science Framework; https://doi.org/10.17605/OSF.IO/8P4V6 %M 39946708 %R 10.2196/55583 %U https://www.jmir.org/2025/1/e55583 %U https://doi.org/10.2196/55583 %U http://www.ncbi.nlm.nih.gov/pubmed/39946708 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54608 %T Relative Preference for In-Person, Telehealth, Digital, and Pharmacologic Mental Health Care After the COVID-19 Pandemic: Cross-Sectional Questionnaire Study %A Parsons,E Marie %A Figueroa,Zoë G %A Hiserodt,Michele %A Cornelius,Talea %A Otto,Michael W %+ Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Boston, MA, 02115, United States, 1 617 353 9610, mariepar@bu.edu %K stigma %K digital CBT %K age %K generalized anxiety disorder %K insomnia %K adult %K telehealth %K digital health %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Most adults and children in the United States fail to receive timely care for mental health symptoms, with even worse rates of care access for individuals who belong to racial and ethnic minority groups. Digital (ie, app-based) care has proven to be an efficacious and empirically supported treatment option with the potential to address low rates of care and reduce care disparities, yet little is known about the relative preference for such treatment. Furthermore, the rapid adoption of telehealth care during the COVID-19 pandemic may have shifted care preferences. Objective: This study aimed to examine relative treatment preferences for 4 different types of mental health care: in-person psychological care, telehealth psychological care, digital treatment, or pharmacologic care. Care preferences were also examined relative to potential predictors of care use (ie, gender, race, age, stigma, discrimination, and level of shame). Methods: In this cross-sectional online survey study of adults (N=237, mean age 35 years, range 19-68 years), we ranked 4 mental health care modalities based on care preference: (1) in-person care, (2) telehealth care, (3) digital care, and (4) pharmacologic care. Preference for treatment modality was assessed based on vignette presentation for generalized anxiety disorder and insomnia. In addition, participants completed self-report questionnaires for demographics, symptom severity, and psychological and stigma-related variables. Results: We found no difference in overall preference for in-person versus both telehealth and digital care. For both generalized anxiety disorder and insomnia, participants preferred in-person care to telehealth care, although this finding was attenuated amongst older participants for insomnia treatment. Participants’ depressed mood was associated with a greater relative preference for pharmacologic care. There was no evidence of differential preference for digital care according to demographics, symptom severity, or psychological and stigma-related variables. Conclusions: These results indicate that digital care now competes well in terms of treatment preference with in-person, telehealth, and pharmacologic treatment options. %M 39946715 %R 10.2196/54608 %U https://www.jmir.org/2025/1/e54608 %U https://doi.org/10.2196/54608 %U http://www.ncbi.nlm.nih.gov/pubmed/39946715 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66696 %T Analyzing Themes, Sentiments, and Coping Strategies Regarding Online News Coverage of Depression in Hong Kong: Mixed Methods Study %A Chen,Sihui %A Ngai,Cindy Sing Bik %A Cheng,Cecilia %A Hu,Yangna %+ Department of Chinese and Bilingual Studies, Hong Kong Polytechnic University, AG502, Hung Hom, Kowloon, China (Hong Kong), 852 27667465, cindy.sb.ngai@polyu.edu.hk %K online news coverage %K depression %K natural language processing %K NLP %K latent Dirichlet allocation %K LDA %K sentiment %K coping strategies %K content analysis %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression, a highly prevalent global mental disorder, has prompted significant research concerning its association with social media use and its impact during Hong Kong’s social unrest and COVID-19 pandemic. However, other mainstream media, specifically online news, has been largely overlooked. Despite extensive research conducted in countries, such as the United States, Australia, and Canada, to investigate the latent subthemes, sentiments, and coping strategies portrayed in depression-related news, the landscape in Hong Kong remains unexplored. Objective: This study aims to uncover the latent subthemes presented in the online news coverage of depression in Hong Kong, examine the sentiment conveyed in the news, and assess whether coping strategies have been provided in the news for individuals experiencing depression. Methods: This study used natural language processing (NLP) techniques, namely the latent Dirichlet allocation topic modeling and the Valence Aware Dictionary and Sentiment Reasoner (VADER) sentiment analysis, to fulfill the first and second objectives. Coping strategies were rigorously assessed and manually labeled with designated categories by content analysis. The online news was collected from February 2019 to May 2024 from Hong Kong mainstream news websites to examine the latest portrayal of depression, particularly during and after the social unrest and the COVID-19 pandemic. Results: In total, 2435 news articles were retained for data analysis after the news screening process. A total of 7 subthemes were identified based on the topic modeling results. Societal system, law enforcement, global recession, lifestyle, leisure, health issues, and US politics were the latent subthemes. Moreover, the overall news exhibited a slightly positive sentiment. The correlations between the sentiment scores and the latent subthemes indicated that the societal system, law enforcement, health issues, and US politics revealed negative tendencies, while the remainder leaned toward a positive sentiment. The coping strategies for depression were substantially lacking; however, the categories emphasizing information on skills and resources and individual adjustment to cope with depression emerged as the priority focus. Conclusions: This pioneering study used a mixed methods approach where NLP was used to investigate latent subthemes and underlying sentiment in online news. Content analysis was also performed to examine available coping strategies. The findings of this research enhance our understanding of how depression is portrayed through online news in Hong Kong and the preferable coping strategies being used to mitigate depression. The potential impact on readers was discussed. Future research is encouraged to address the mentioned implications and limitations, with recommendations to apply advanced NLP techniques to a new mental health issue case or language. %M 39946170 %R 10.2196/66696 %U https://www.jmir.org/2025/1/e66696 %U https://doi.org/10.2196/66696 %U http://www.ncbi.nlm.nih.gov/pubmed/39946170 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65206 %T The Effect of the Virtual Reality–Based Biofeedback Intervention DEEP on Stress, Emotional Tension, and Anger in Forensic Psychiatric Inpatients: Mixed Methods Single-Case Experimental Design %A Klein Haneveld,Lisa %A Dekkers,Tessa %A Bouman,Yvonne H A %A Scholten,Hanneke %A Weerdmeester,Joanneke %A Kelders,Saskia M %A Kip,Hanneke %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, The Netherlands, 31 619210156, l.kleinhaneveld@transfore.nl %K virtual reality %K VR %K diaphragmatic breathing %K biofeedback %K DEEP %K forensic psychiatry %K mental health %K stress %K single-case experimental design %K experience sampling method %D 2025 %7 12.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Decreasing aggression through stress reduction is an important part of forensic psychiatric treatment. DEEP is an experience-based virtual reality intervention that uses biofeedback to train diaphragmatic breathing and increase relaxation. Although DEEP has shown promising results in reducing stress and anxiety in students and adolescents in special education, it has not been examined in forensic psychiatric populations. Objective: This study aimed to evaluate DEEP’s potential to reduce stress, emotional tension, and anger in forensic psychiatric inpatients. Methods: A mixed methods, alternating treatment, single-case experimental design was conducted with 6 Dutch forensic inpatients. For 20 days, participants engaged in 4 DEEP sessions. Experience sampling was used for continuous monitoring of stress, emotional tension, and anger twice daily. A repeated linear mixed model was used as a primary statistical approach for analyzing the experience sampling data as well as visual analyses. Finally, semistructured interviews were conducted with participants and health care professionals to compare quantitative with qualitative results. Results: Of the 6 participants, 3 (50%) completed all 4 DEEP sessions, while the other 3 (50%) missed one session due to technical difficulties or absence from the inpatient clinic. P1 showed a significant reduction of stress after session 2 (β=–.865; P=.005). No significant changes over time were found, although an experienced effect was reported during the interviews. P2 showed no significant results. They reported the sessions as being repetitive, with no experienced effect. P3 showed a momentary increase of emotional tension after the first session (β=–.053; P=.002), but no changes were observed over time. No experienced effects were reported in the interview. P4 did not show significant results over time, and was hesitant to report clear experienced effects. P5 showed a significant decline of emotional tension (β=–.012; P=.006), stress (β=–.014; P=.007), and anger (β=–.007; P=.02) over time. They also reported short-term experienced effects in the interview. P6 showed a significant decline of stress over time (β=–.029; P<.001) and reported experiencing substantial effects. Finally, health care professionals reported a relaxing effect of DEEP in their patients but did not expect many long-term effects because no clear behavioral changes were observed. Conclusions: DEEP shows promise in teaching deep breathing techniques to forensic psychiatric inpatients, potentially decreasing stress, emotional tension, and anger in some patients. However, DEEP is not a one-size-fits-all intervention that supports every patient because the effectiveness on the outcome measures varied among participants. To increase effectiveness, emphasis should be put on supporting patients to transfer deep breathing skills into their daily lives. This highlights the importance for the structural integration of DEEP into current treatment protocols. %M 39938081 %R 10.2196/65206 %U https://formative.jmir.org/2025/1/e65206 %U https://doi.org/10.2196/65206 %U http://www.ncbi.nlm.nih.gov/pubmed/39938081 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e66665 %T Identifying Adolescent Depression and Anxiety Through Real-World Data and Social Determinants of Health: Machine Learning Model Development and Validation %A Mardini,Mamoun T %A Khalil,Georges E %A Bai,Chen %A DivaKaran,Aparna Menon %A Ray,Jessica M %K social determinants of health %K adolescents %K anxiety %K depression %K machine learning %K real-world data %K teenagers %K youth %K XGBoost %K cross-validation technique %K SHapley Additive exPlanation %K mental health %K mental disorder %K mental illness %K health outcomes %K clinical data %D 2025 %7 12.2.2025 %9 %J JMIR Ment Health %G English %X Background: The prevalence of adolescent mental health conditions such as depression and anxiety has significantly increased. Despite the potential of machine learning (ML), there is a shortage of models that use real-world data (RWD) to enhance early detection and intervention for these conditions. Objective: This study aimed to identify depression and anxiety in adolescents using ML techniques on RWD and social determinants of health (SDoH). Methods: We analyzed RWD of adolescents aged 10‐17 years, considering various factors such as demographics, prior diagnoses, prescribed medications, medical procedures, and laboratory measurements recorded before the onset of anxiety or depression. Clinical data were linked with SDoH at the block-level. Three separate models were developed to predict anxiety, depression, and both conditions. Our ML model of choice was Extreme Gradient Boosting (XGBoost) and we evaluated its performance using the nested cross-validation technique. To interpret the model predictions, we used the Shapley additive explanation method. Results: Our cohort included 52,054 adolescents, identifying 12,572 with anxiety, 7812 with depression, and 14,019 with either condition. The models achieved area under the curve values of 0.80 for anxiety, 0.81 for depression, and 0.78 for both combined. Excluding SDoH data had a minimal impact on model performance. Shapley additive explanation analysis identified gender, race, educational attainment, and various medical factors as key predictors of anxiety and depression. Conclusions: This study highlights the potential of ML in early identification of depression and anxiety in adolescents using RWD. By leveraging RWD, health care providers may more precisely identify at-risk adolescents and intervene earlier, potentially leading to improved mental health outcomes. %R 10.2196/66665 %U https://mental.jmir.org/2025/1/e66665 %U https://doi.org/10.2196/66665 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59656 %T Interventions for Digital Addiction: Umbrella Review of Meta-Analyses %A Lu,Peng %A Qiu,Jiamin %A Huang,Shiqi %A Wang,Xinman %A Han,Shasha %A Zhu,Sui %A Ning,Youjing %A Zeng,Fang-fang %A Yuan,Yuan %+ Department of Chinese International Education, Chinese Language and Culture College, Huaqiao University, No 8 Jiageng Road, Xiamen, 361021, China, 86 6068002, yuanyuan361021@163.com %K digital addiction %K interventions %K umbrella reviews %K systematic review %K internet addiction %K loneliness %K quality of life %K well-being %K internet %K psychological %K pharmacological treatment %K cognitive behavioral therapy %D 2025 %7 11.2.2025 %9 Review %J J Med Internet Res %G English %X Background: Numerous studies have explored interventions to reduce digital addiction outcomes, but inconclusive evidence makes it difficult for decision-makers, managers, and clinicians to become familiar with all available literature and find appropriate interventions. Objective: This study aims to summarize and assess the certainty of evidence of interventions proposed to decrease digital addiction from published meta-analyses. Methods: An umbrella review of published meta-analyses was performed. We searched PubMed, Cochrane Library, Web of Science, and Embase for meta-analyses published up to February 2024. Eligible studies evaluated interventions using randomized controlled trials, nonrandomized controlled trials, or quasi-experimental studies and were assessed for methodological quality using Assessment of Multiple Systematic Reviews version 2. A random effects model was used to analyze data, considering heterogeneity and publication bias. Grading of Recommendations, Assessment, Development, and Evaluations was applied to assess evidence with certainty. Results: A total of 5 studies assessing 21 associations were included in the umbrella review, of which 4 (80%) were high-quality meta-analyses. Weak evidence was observed in 19 associations, whereas null associations appeared in the remaining 2 associations. These associations pertained to 8 interventions (group counseling, integrated internet addiction [IA] prevention programs, psychosocial interventions, reality therapy, self-control training programs, cognitive behavioral therapy, interventions to reduce screen time in children, and exercise) and 9 outcomes (self-control, self-esteem, internet gaming disorder symptoms, time spent gaming, IA scores, screen use time, interpersonal sensitivity longlines, anxiety, and depression). Cognitive behavioral therapy reduces anxiety (standardized mean difference [SMD] 0.939, 95% CI 0.311 to 1.586), internet gaming disorder symptoms (SMD 1.394, 95% CI 0.664 to 2.214), time spent gaming (SMD 1.259, 95% CI, 0.311 to 2.206), and IA scores (SMD –2.097, 95% CI –2.814 to –1.381). Group counseling had a large effect on improving self-control (SMD 1.296, 95% CI 0.269 to 2.322) and reducing IA levels (SMD –1.417, 95% CI –1.836 to –0.997). Exercise intervention reduced IA scores (SMD –2.322, 95% CI –3.212 to –1.431), depression scores (SMD –1.421, 95% CI –2.046 to –797), and interpersonal sensitivity scores (SMD –1.433, 95% CI –2.239 to –0.627). Conclusions: The evidence indicates that current interventions to reduce digital addiction are weak. Data from more and better-designed studies with larger sample sizes are needed to establish robust evidence. Trial Registration: PROSPERO CRD42024528173; crd.york.ac.uk/PROSPERO/display_record.php?RecordID=528173 %M 39933164 %R 10.2196/59656 %U https://www.jmir.org/2025/1/e59656 %U https://doi.org/10.2196/59656 %U http://www.ncbi.nlm.nih.gov/pubmed/39933164 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e62955 %T Assessing the Relationship Between the Type of Internet Use and Internet Addiction in Early and Middle Adolescents: Cross-Sectional Study From Qatar %A Chemnad,Khansa %A Aziz,Maryam %A Al- Harahsheh,Sanaa %A Abdelmoneium,Azza %A Baghdady,Ahmed %A Alsayed Hassan,Diana %A Ali,Raian %+ Department of Public Health, College of Health Sciences, QU Health, Qatar University, PO Box 2713, Doha, Qatar, 974 31576271, dalsayed@qu.edu.qa %K internet addiction %K internet use %K early adolescence %K middle adolescence %K mobile phone %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: With the increasing prevalence of digital technology, adolescent internet addiction (IA) has become a global concern. Excessive internet use, especially among adolescents, has been linked to various negative outcomes such as poor academic performance, social isolation, and mental health issues. Conducted among adolescents of Arab origin, our study addressed the limitations of the literature, which predominantly focuses on Western, educated, industrialized, rich, and democratic populations. Objective: This study aimed to differentiate between essential and nonessential internet use and how they relate to IA in early and middle adolescents, as well as the relationship between subjective happiness with the amount of time spent on nonessential internet use and IA. Methods: A cross-sectional survey was conducted among 377 students from 16 schools in Qatar. The survey measured essential and nonessential internet use, subjective happiness with nonessential use, and IA symptoms using the Internet Addiction Diagnostic Questionnaire, as well as participant demographics. To explore age-specific associations, participants were categorized into early (age 11-13 years) and middle (age 14-17 years) adolescents. Factorial analysis, multiple regression, and logistic regression were used for statistical analysis. Results: Nonessential internet use significantly predicted IA in both early (P<.001) and middle (P<.001) adolescents, with early adolescents showing a stronger association. Subjective happiness with nonessential internet use negatively predicted IA only in middle adolescents (P<.001) as greater dissatisfaction led to a higher IA risk. Essential internet use did not predict IA in either group. Conclusions: Differentiating between essential and nonessential internet use is crucial in understanding IA. This study highlights the importance of developmental differences in shaping IA symptoms. The findings suggest that interventions aimed at addressing IA should be age specific and focus on addressing nonessential use specifically rather than considering internet use and screen time in general as a single entity. Cultural and regional factors also play a role in shaping internet use patterns and IA in the Middle East, necessitating context-specific, culturally sensitive approaches to IA prevention. %M 39928940 %R 10.2196/62955 %U https://humanfactors.jmir.org/2025/1/e62955 %U https://doi.org/10.2196/62955 %U http://www.ncbi.nlm.nih.gov/pubmed/39928940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56203 %T Efficacy of a Blended Low-Intensity Internet-Delivered Psychological Program in Patients With Multimorbidity in Primary Care: Randomized Controlled Trial %A Monreal-Bartolomé,Alicia %A Castro,Adoración %A Pérez-Ara,M Ángeles %A Gili,Margalida %A Mayoral,Fermín %A Hurtado,María Magdalena %A Varela Moreno,Esperanza %A Botella,Cristina %A García-Palacios,Azucena %A Baños,Rosa M %A López-Del-Hoyo,Yolanda %A García-Campayo,Javier %A Montero-Marin,Jesus %+ Aragon Institute for Health Research, IIS Aragon, C. de Pedro Cerbuna, 12, Zaragoza, 50009, Spain, 34 686 673 302, jgarcamp@gmail.com %K multimorbidity %K depression %K type 2 diabetes %K low back pain %K primary care %K blended %K internet %K randomized controlled trial %K RCT %D 2025 %7 10.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Multimorbidity is a highly prevalent phenomenon whose presence causes a profound physical, psychological, and economic impact. It hinders help seeking, diagnosis, quality of care, and adherence to treatment, and it poses a significant dilemma for present-day health care systems. Objective: This study aimed to assess the effectiveness of improved treatment as usual (iTAU) combined with a blended low-intensity psychological intervention delivered using information and communication technologies for the treatment of multimorbidity (depression and type 2 diabetes or low back pain) in primary care settings. Methods: A 2-armed, parallel-group, superiority randomized controlled trial was designed for this study. Participants diagnosed with depression and either type 2 diabetes or low back pain (n=183) were randomized to “intervention + iTAU” (combining a face-to-face intervention with a supporting web-based program) or “iTAU” alone. The main outcome consisted of a standardized composite score to consider (1) severity of depressive symptoms and (2a) diabetes control or (2b) pain intensity and physical disability 3 months after the end of treatment as the primary end point. Differences between the groups were estimated using mixed effects linear regression models, and mediation evaluations were conducted using path analyses to evaluate the potential mechanistic role of positive and negative affectivity and openness to the future. Results: At 3-month follow-up, the intervention + iTAU group (vs iTAU) exhibited greater reductions in composite multimorbidity score (B=–0.34, 95% CI –0.64 to –0.04; Hedges g=0.39) as well as in depression and negative affect and improvements in perceived health, positive affect, and openness to the future. Similar positive effects were observed after the intervention, including improvements in physical disability. No significant differences were found in glycosylated hemoglobin, pain intensity, or disability at 3-month follow-up (P=.60; P=.79; and P=.43, respectively). Path analyses revealed that the intervention had a significant impact on the primary outcome, mediated by both positive and negative affect (positive affect: indirect effect=–0.15, bootstrapped 95% CI –0.28 to –0.03; negative affect: indirect effect=–0.14, bootstrapped 95% CI –0.28 to –0.02). Conclusions: This study supports the efficacy of a low-intensity psychological intervention applied in a blended format on multimorbidity in primary care. It justifies the exploration of the conceptualization of depression in type 2 diabetes as well as the analysis of the implementation of such interventions in routine clinical practice. Trial Registration: ClinicalTrials.gov NCT03426709; https://clinicaltrials.gov/study/NCT03426709 International Registered Report Identifier (IRRID): RR2-10.1186/S12888-019-2037-3 %M 39928931 %R 10.2196/56203 %U https://www.jmir.org/2025/1/e56203 %U https://doi.org/10.2196/56203 %U http://www.ncbi.nlm.nih.gov/pubmed/39928931 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64414 %T Physician Perspectives on the Potential Benefits and Risks of Applying Artificial Intelligence in Psychiatric Medicine: Qualitative Study %A Stroud,Austin M %A Curtis,Susan H %A Weir,Isabel B %A Stout,Jeremiah J %A Barry,Barbara A %A Bobo,William V %A Athreya,Arjun P %A Sharp,Richard R %+ Biomedical Ethics Program, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 538 6502, sharp.richard@mayo.edu %K artificial intelligence %K machine learning %K digital health %K mental health %K psychiatry %K depression %K interviews %K family medicine %K physicians %K qualitative %K providers %K attitudes %K opinions %K perspectives %K ethics %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: As artificial intelligence (AI) tools are integrated more widely in psychiatric medicine, it is important to consider the impact these tools will have on clinical practice. Objective: This study aimed to characterize physician perspectives on the potential impact AI tools will have in psychiatric medicine. Methods: We interviewed 42 physicians (21 psychiatrists and 21 family medicine practitioners). These interviews used detailed clinical case scenarios involving the use of AI technologies in the evaluation, diagnosis, and treatment of psychiatric conditions. Interviews were transcribed and subsequently analyzed using qualitative analysis methods. Results: Physicians highlighted multiple potential benefits of AI tools, including potential support for optimizing pharmaceutical efficacy, reducing administrative burden, aiding shared decision-making, and increasing access to health services, and were optimistic about the long-term impact of these technologies. This optimism was tempered by concerns about potential near-term risks to both patients and themselves including misguiding clinical judgment, increasing clinical burden, introducing patient harms, and creating legal liability. Conclusions: Our results highlight the importance of considering specialist perspectives when deploying AI tools in psychiatric medicine. %M 39928397 %R 10.2196/64414 %U https://mental.jmir.org/2025/1/e64414 %U https://doi.org/10.2196/64414 %U http://www.ncbi.nlm.nih.gov/pubmed/39928397 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e69294 %T Does the Digital Therapeutic Alliance Exist? Integrative Review %A Malouin-Lachance,Amylie %A Capolupo,Julien %A Laplante,Chloé %A Hudon,Alexandre %K psychotherapy %K mental health %K psychiatry %K artificial intelligence %K therapeutic alliance %K digital interventions %K chatbot %K psychology %D 2025 %7 7.2.2025 %9 %J JMIR Ment Health %G English %X Background: Mental health disorders significantly impact global populations, prompting the rise of digital mental health interventions, such as artificial intelligence (AI)-powered chatbots, to address gaps in access to care. This review explores the potential for a “digital therapeutic alliance (DTA),” emphasizing empathy, engagement, and alignment with traditional therapeutic principles to enhance user outcomes. Objective: The primary objective of this review was to identify key concepts underlying the DTA in AI-driven psychotherapeutic interventions for mental health. The secondary objective was to propose an initial definition of the DTA based on these identified concepts. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) for scoping reviews and Tavares de Souza’s integrative review methodology were followed, encompassing systematic literature searches in Medline, Web of Science, PsycNet, and Google Scholar. Data from eligible studies were extracted and analyzed using Horvath et al’s conceptual framework on a therapeutic alliance, focusing on goal alignment, task agreement, and the therapeutic bond, with quality assessed using the Newcastle-Ottawa Scale and Cochrane Risk of Bias Tool. Results: A total of 28 studies were identified from an initial pool of 1294 articles after excluding duplicates and ineligible studies. These studies informed the development of a conceptual framework for a DTA, encompassing key elements such as goal alignment, task agreement, therapeutic bond, user engagement, and the facilitators and barriers affecting therapeutic outcomes. The interventions primarily focused on AI-powered chatbots, digital psychotherapy, and other digital tools. Conclusions: The findings of this integrative review provide a foundational framework for the concept of a DTA and report its potential to replicate key therapeutic mechanisms such as empathy, trust, and collaboration in AI-driven psychotherapeutic tools. While the DTA shows promise in enhancing accessibility and engagement in mental health care, further research and innovation are needed to address challenges such as personalization, ethical concerns, and long-term impact. %R 10.2196/69294 %U https://mental.jmir.org/2025/1/e69294 %U https://doi.org/10.2196/69294 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64396 %T The Efficacy of Conversational AI in Rectifying the Theory-of-Mind and Autonomy Biases: Comparative Analysis %A Rządeczka,Marcin %A Sterna,Anna %A Stolińska,Julia %A Kaczyńska,Paulina %A Moskalewicz,Marcin %+ Institute of Philosophy, Maria Curie-Skłodowska University, Pl. Marii Curie-Skłodowskiej 4, pok. 204, Lublin, 20-031, Poland, 48 815375481, marcin.rzadeczka@umcs.pl %K cognitive bias %K conversational artificial intelligence %K artificial intelligence %K AI %K chatbots %K digital mental health %K bias rectification %K affect recognition %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: The increasing deployment of conversational artificial intelligence (AI) in mental health interventions necessitates an evaluation of their efficacy in rectifying cognitive biases and recognizing affect in human-AI interactions. These biases are particularly relevant in mental health contexts as they can exacerbate conditions such as depression and anxiety by reinforcing maladaptive thought patterns or unrealistic expectations in human-AI interactions. Objective: This study aimed to assess the effectiveness of therapeutic chatbots (Wysa and Youper) versus general-purpose language models (GPT-3.5, GPT-4, and Gemini Pro) in identifying and rectifying cognitive biases and recognizing affect in user interactions. Methods: This study used constructed case scenarios simulating typical user-bot interactions to examine how effectively chatbots address selected cognitive biases. The cognitive biases assessed included theory-of-mind biases (anthropomorphism, overtrust, and attribution) and autonomy biases (illusion of control, fundamental attribution error, and just-world hypothesis). Each chatbot response was evaluated based on accuracy, therapeutic quality, and adherence to cognitive behavioral therapy principles using an ordinal scale to ensure consistency in scoring. To enhance reliability, responses underwent a double review process by 2 cognitive scientists, followed by a secondary review by a clinical psychologist specializing in cognitive behavioral therapy, ensuring a robust assessment across interdisciplinary perspectives. Results: This study revealed that general-purpose chatbots outperformed therapeutic chatbots in rectifying cognitive biases, particularly in overtrust bias, fundamental attribution error, and just-world hypothesis. GPT-4 achieved the highest scores across all biases, whereas the therapeutic bot Wysa scored the lowest. Notably, general-purpose bots showed more consistent accuracy and adaptability in recognizing and addressing bias-related cues across different contexts, suggesting a broader flexibility in handling complex cognitive patterns. In addition, in affect recognition tasks, general-purpose chatbots not only excelled but also demonstrated quicker adaptation to subtle emotional nuances, outperforming therapeutic bots in 67% (4/6) of the tested biases. Conclusions: This study shows that, while therapeutic chatbots hold promise for mental health support and cognitive bias intervention, their current capabilities are limited. Addressing cognitive biases in AI-human interactions requires systems that can both rectify and analyze biases as integral to human cognition, promoting precision and simulating empathy. The findings reveal the need for improved simulated emotional intelligence in chatbot design to provide adaptive, personalized responses that reduce overreliance and encourage independent coping skills. Future research should focus on enhancing affective response mechanisms and addressing ethical concerns such as bias mitigation and data privacy to ensure safe, effective AI-based mental health support. %M 39919295 %R 10.2196/64396 %U https://mental.jmir.org/2025/1/e64396 %U https://doi.org/10.2196/64396 %U http://www.ncbi.nlm.nih.gov/pubmed/39919295 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59524 %T Unraveling Online Mental Health Through the Lens of Early Maladaptive Schemas: AI-Enabled Content Analysis of Online Mental Health Communities %A Ang,Beng Heng %A Gollapalli,Sujatha Das %A Du,Mingzhe %A Ng,See-Kiong %+ Integrative Sciences and Engineering Programme, NUS Graduate School, National University of Singapore, University Hall, Tan Chin Tuan Wing Level 5, #05-03 21 Lower Kent Ridge Road, Singapore, 119077, Singapore, 65 92983451, bengheng.ang@u.nus.edu %K early maladaptive schemas %K large language models %K online mental health communities %K case conceptualization %K prompt engineering %K artificial intelligence %K AI %D 2025 %7 7.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Early maladaptive schemas (EMSs) are pervasive, self-defeating patterns of thoughts and emotions underlying most mental health problems and are central in schema therapy. However, the characteristics of EMSs vary across demographics, and despite the growing use of online mental health communities (OMHCs), how EMSs manifest in these online support-seeking environments remains unclear. Understanding these characteristics could inform the design of more effective interventions powered by artificial intelligence to address online support seekers’ unique therapeutic needs. Objective: We aimed to uncover associations between EMSs and mental health problems within OMHCs and examine features of EMSs as they are reflected in OMHCs. Methods: We curated a dataset of 29,329 posts from widely accessed OMHCs, labeling each with relevant schemas and mental health problems. To identify associations, we conducted chi-square tests of independence and calculated odds ratios (ORs) with the dataset. In addition, we developed a novel group-level case conceptualization technique, leveraging GPT-4 to extract features of EMSs from OMHC texts across key schema therapy dimensions, such as schema triggers and coping responses. Results: Several associations were identified between EMSs and mental health problems, reflecting how EMSs manifest in online support-seeking contexts. Anxiety-related problems typically highlighted vulnerability to harm or illness (OR 5.64, 95% CI 5.34-5.96; P<.001), while depression-related problems emphasized unmet interpersonal needs, such as social isolation (OR 3.18, 95% CI 3.02-3.34; P<.001). Conversely, problems with eating disorders mostly exemplified negative self-perception and emotional inhibition (OR 1.89, 95% CI 1.45-2.46; P<.001). Personality disorders reflected themes of subjugation (OR 2.51, 95% CI 1.86-3.39; P<.001), while posttraumatic stress disorder problems involved distressing experiences and mistrust (OR 5.04, 95% CI 4.49-5.66; P<.001). Substance use disorder problems reflected negative self-perception of failure to achieve (OR 1.83, 95% CI 1.35-2.49; P<.001). Depression, personality disorders, and posttraumatic stress disorder were also associated with 12, 9, and 7 EMSs, respectively, emphasizing their complexities and the need for more comprehensive interventions. In contrast, anxiety, eating disorder, and substance use disorder were related to only 2 to 3 EMSs, suggesting that these problems are better addressed through targeted interventions. In addition, the EMS features extracted from our dataset averaged 13.27 (SD 3.05) negative features per schema, with 2.65 (SD 1.07) features per dimension, as supported by existing literature. Conclusions: We uncovered various associations between EMSs and mental health problems among online support seekers, highlighting the prominence of specific EMSs in each problem and the unique complexities of each problem in terms of EMSs. We also identified EMS features as expressed by support seekers in OMHCs, reinforcing the relevance of EMSs in these online support-seeking contexts. These insights are valuable for understanding how EMS are characterized in OMHCs and can inform the development of more effective artificial intelligence–powered tools to enhance support on these platforms. %M 39919286 %R 10.2196/59524 %U https://www.jmir.org/2025/1/e59524 %U https://doi.org/10.2196/59524 %U http://www.ncbi.nlm.nih.gov/pubmed/39919286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63799 %T Urban-Rural Differences in the Association Between Internet Use Trajectories and Depressive Symptoms in Chinese Adolescents: Longitudinal Observational Study %A Liu,Yujie %A Ge,Xin %A Wang,Ying %A Yang,Xue %A Liu,Shangbin %A Xu,Chen %A Xiang,Mi %A Hu,Fan %A Cai,Yong %+ Public Health Research Center, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, 1111 Xianxia Road, Shanghai, 200335, China, 86 021 63846590 ext 776198, caiyong202028@hotmail.com %K internet use %K trajectory %K depressive symptoms %K adolescent %K urban %K rural %D 2025 %7 7.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet use exhibits diverse trajectories during adolescence, which may contribute to depressive symptoms. Currently, it remains unclear whether the association between internet use trajectories and depressive symptoms varies between urban and rural areas. Objective: This study aimed to investigate the association between internet use trajectories and adolescent depressive symptoms and to explore variation in this association between urban and rural areas. Methods: This longitudinal study used 3-wave data from the 2014-2018 China Family Panel Study. Weekly hours of internet use and depressive symptoms were measured using self-reported questionnaires. Latent class growth modeling was performed to identify the trajectories of internet use. Multivariable logistic regressions were used to examine the association between internet use trajectories and depressive symptoms, stratified by rural and urban residence. Results: Participants were 2237 adolescents aged 10 to 15 years at baseline (mean age 12.46, SD 1.73 years). Two latent trajectory classes of internet use were identified: the low-growth group (n=2008, 89.8%) and the high-growth group (n=229, 10.2%). The high-growth group was associated with higher odds of depressive symptoms (OR 1.486, 95% CI 1.065-2.076) compared to the low-growth group. In the stratified analysis, the association between internet use trajectories and depressive symptoms was significant solely among rural adolescents (OR 1.856, 95% CI 1.164-2.959). Conclusions: This study elucidates urban-rural differences in the associations between trajectories of internet use and adolescent depressive symptoms. Our findings underscore the importance of prioritizing interventions for rural adolescents’ internet use behaviors to mitigate negative effects on their mental health. %M 39919294 %R 10.2196/63799 %U https://www.jmir.org/2025/1/e63799 %U https://doi.org/10.2196/63799 %U http://www.ncbi.nlm.nih.gov/pubmed/39919294 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e62974 %T The Safety of Digital Mental Health Interventions: Findings and Recommendations From a Qualitative Study Exploring Users’ Experiences, Concerns, and Suggestions %A Taher,Rayan %A Stahl,Daniel %A Shergill,Sukhi %A Yiend,Jenny %+ Department of Psychosis Studies, King’s College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 020 7848 0002, jenny.yiend@kcl.ac.uk %K digital mental health %K safety %K user perspective %K patient perspective %K qualitative %K risks %K risk mitigation %K deterioration %K nonresponse %K data safety %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The literature around the safety of digital mental health interventions (DMHIs) is growing. However, the user/patient perspective is still absent from it. Understanding the user/patient perspective can ensure that professionals address issues that are significant to users/patients and help direct future research in the field. Objective: This qualitative study aims to explore DMHI users’ experiences, views, concerns, and suggestions regarding the safety of DMHIs. Methods: We included individuals aged 18 years old or older, having experience in using a DMHI, and can speak and understand English without the need for a translator. Fifteen individual interviews were conducted. Deductive thematic analysis was used to analyze the data. Results: The analysis of the interview transcripts yielded 3 main themes: Nonresponse: A Concern, a Risk, and How Users Mitigate It, Symptom Deterioration and Its Management, and Concerns Around Data Privacy and How to Mitigate Them. Conclusions: The results of this study led to 7 recommendations on how the safety of DMHIs can be improved: provide “easy access” versions of key information, use “approved by...” badges, anticipate and support deterioration, provide real-time feedback, acknowledge the lack of personalization, responsibly manage access, and provide genuine crisis support. These recommendations arose from users’ experiences and suggestions. If implemented, these recommendations can improve the safety of DMHIs and enhance users’ experience. %M 39919292 %R 10.2196/62974 %U https://humanfactors.jmir.org/2025/1/e62974 %U https://doi.org/10.2196/62974 %U http://www.ncbi.nlm.nih.gov/pubmed/39919292 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65140 %T Improving the Utility, Safety, and Ethical Use of a Passive Mood-Tracking App for People With Bipolar Disorder Using Coproduction: Qualitative Focus Group Study %A Astill Wright,Laurence %A Moore,Matthew %A Reeves,Stuart %A Vallejos,Elvira Perez %A Morriss,Richard %+ Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 823 1294, laurence.astillwright@nottingham.ac.uk %K mood monitoring %K ecological momentary assessment %K EMA %K passive ecological momentary assessment %K passive EMA %K bipolar disorder %K implementation %K qualitative %K mobile phone %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Coproduction with users of new digital technology, such as passive mood monitoring, is likely to improve its utility, safety, and successful implementation via improved design and consideration of how such technology fits with their daily lives. Mood-monitoring interventions are commonly used by people with bipolar disorder (BD) and have promising potential for digitization using novel technological methods. Objective: This study aims to explore how a passive behavioral monitoring platform, Remote Assessment of Disease and Relapse, would meet the needs of people with BD by specifically considering purpose and function, diversity of need, personal preference, essential components and potential risks, and harms and mitigation strategies through an iterative coproduction process. Methods: A total of 17 people with BD were recruited via national charities. We conducted 3 web-based focus groups as a part of an iterative coproduction process in line with responsible research and innovation principles and with consideration of clinical challenges associated with BD. Data were analyzed thematically. Results were cross-checked by someone with lived experience of BD. Results: Focus groups were transcribed and analyzed using thematic analysis. Six themes were identified as follows: (1) the purpose of using the app, (2) desired features, (3) when to use the app, (4) risks of using the app, (5) sharing with family and friends, and (6) sharing with health care professionals. Conclusions: People with BD who are interested in using passive technology to monitor their mood wish to do so for a wide variety of purposes, identifying several preferences and potential risks. Principally, people with BD wished to use this novel technology to aid them in self-managing their BD with greater insight and a better understanding of potential triggers. We discuss key features that may aid this functionality and purpose, including crisis plans and sharing with others. Future development of passive mood-monitoring technologies should not assume that the involvement of formal mental health services is desired. %M 39918865 %R 10.2196/65140 %U https://formative.jmir.org/2025/1/e65140 %U https://doi.org/10.2196/65140 %U http://www.ncbi.nlm.nih.gov/pubmed/39918865 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e56185 %T Utility of Digital Phenotyping Based on Wrist Wearables and Smartphones in Psychosis: Observational Study %A Yang,Zixu %A Heaukulani,Creighton %A Sim,Amelia %A Buddhika,Thisum %A Abdul Rashid,Nur Amirah %A Wang,Xuancong %A Zheng,Shushan %A Quek,Yue Feng %A Basu,Sutapa %A Lee,Kok Wei %A Tang,Charmaine %A Verma,Swapna %A Morris,Robert J T %A Lee,Jimmy %K schizophrenia %K psychosis %K digital phenotyping %K wrist wearables %K mobile phone %D 2025 %7 5.2.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Digital phenotyping provides insights into an individual’s digital behaviors and has potential clinical utility. Objective: In this observational study, we explored digital biomarkers collected from wrist-wearable devices and smartphones and their associations with clinical symptoms and functioning in patients with schizophrenia. Methods: We recruited 100 outpatients with schizophrenia spectrum disorder, and we collected various digital data from commercially available wrist wearables and smartphones over a 6-month period. In this report, we analyzed the first week of digital data on heart rate, sleep, and physical activity from the wrist wearables and travel distance, sociability, touchscreen tapping speed, and screen time from the smartphones. We analyzed the relationships between these digital measures and patient baseline measurements of clinical symptoms assessed with the Positive and Negative Syndrome Scale, Brief Negative Symptoms Scale, and Calgary Depression Scale for Schizophrenia, as well as functioning as assessed with the Social and Occupational Functioning Assessment Scale. Linear regression was performed for each digital and clinical measure independently, with the digital measures being treated as predictors. Results: Digital data were successfully collected from both the wearables and smartphones throughout the study, with 91% of the total possible data successfully collected from the wearables and 82% from the smartphones during the first week of the trial—the period under analysis in this report. Among the clinical outcomes, negative symptoms were associated with the greatest number of digital measures (10 of the 12 studied here), followed by overall measures of psychopathology symptoms, functioning, and positive symptoms, which were each associated with at least 3 digital measures. Cognition and cognitive/disorganization symptoms were each associated with 1 or 2 digital measures. Conclusions: We found significant associations between nearly all digital measures and a wide range of symptoms and functioning in a community sample of individuals with schizophrenia. These findings provide insights into the digital behaviors of individuals with schizophrenia and highlight the potential of using commercially available wrist wearables and smartphones for passive monitoring in schizophrenia. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-046552 %R 10.2196/56185 %U https://mhealth.jmir.org/2025/1/e56185 %U https://doi.org/10.2196/56185 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e66158 %T Exploring User Experience and the Therapeutic Relationship of Short-Term Avatar-Based Psychotherapy: Qualitative Pilot Study %A Jang,Byeul %A Yuh,Chisung %A Lee,Hyeri %A Shin,Yu-Bin %A Lee,Heon-Jeong %A Kang,Eun Kyoung %A Heo,Jeongyun %A Cho,Chul-Hyun %K avatar-based psychotherapy %K telehealth %K therapeutic relationship %K user experience %K anonymity %K nonverbal communication %K mental health %K mobile phone %D 2025 %7 5.2.2025 %9 %J JMIR Hum Factors %G English %X Background: The rapid advancement of telehealth has led to the emergence of avatar-based psychotherapy (ABP), which combines the benefits of anonymity with nonverbal communication. With the adoption of remote mental health services, understanding the efficacy and user experience of ABP has become increasingly important. Objective: This study aimed to explore the user experience and therapeutic relationship formation in short-term ABP environments, focusing on psychological effects, user satisfaction, and critical factors for implementation. Methods: This qualitative study involved 18 adult participants (8 women and 10 men). Participants engaged in two short-term ABP sessions (approximately 50 minutes per session) over 2 weeks, using an ABP metaverse system prototype. Semistructured in-depth interviews were conducted with both the participants and therapists before and after the ABP sessions. The interviews were conducted via an online platform, with each interview lasting approximately 30 minutes. The key topics included the sense of intimacy, communication effectiveness of avatar expressions, emotions toward one’s avatar, concentration during sessions, and perceived important aspects of the ABP. Data were analyzed using thematic analysis. Results: The analysis revealed 3 main themes with 8 subthemes: (1) reduction of psychological barriers through avatar use (subthemes: anonymity, ease of access, self-objectification, and potential for self-disclosure); (2) importance of the avatar–self-connection in therapeutic relationship formation (subthemes: avatar self-relevance and avatar–self-connection fostering intimacy and trust); and (3) importance of nonverbal communication (subthemes: significance of nonverbal expressions and formation of empathy and trust through nonverbal expressions). Participants reported enhanced comfort and self-disclosure owing to the anonymity provided by avatars, while emphasizing the importance of avatar customization and the role of nonverbal cues in facilitating communication and building rapport. Conclusions: This pilot study provides valuable insights into the short-term ABP user experience and therapeutic relationship formation. Our findings suggest that ABP has the potential to reduce barriers to therapy through anonymity, ease of access, and potential for self-disclosure, while allowing for meaningful nonverbal communication. The avatar–self-connection emerged as a crucial factor in the effectiveness of ABP, highlighting the importance of avatar customization in enhancing user engagement and therapeutic outcomes. Future research and development in ABP should focus on improving avatar customization options, enhancing the fidelity of nonverbal cues, and investigating the long-term effectiveness of ABP compared with traditional face-to-face therapy. Trial Registration: CRIS KCT0009695; https://tinyurl.com/2a48s7dh %R 10.2196/66158 %U https://humanfactors.jmir.org/2025/1/e66158 %U https://doi.org/10.2196/66158 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64097 %T Barriers and Facilitators to User Engagement and Moderation for Web-Based Peer Support Among Young People: Qualitative Study Using the Behavior Change Wheel Framework %A Ananya,Ananya %A Tuuli,Janina %A Perowne,Rachel %A Gutman,Leslie Morrison %+ Department of Clinical, Educational and Health Psychology, Faculty of Brain Sciences, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 8059 0939, l.gutman@ucl.ac.uk %K internet %K moderation %K engagement %K youth %K teenager %K adolescent %K peer support %K web-based group %K user engagement %K support group %K barrier %K facilitator %K Theoretical Domains Framework %K Behavior Change Wheel %K qualitative %K interview %K behavior change technique %K thematic analysis %D 2025 %7 5.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Peer support groups or web-based chats for young people offer anonymous peer support in judgment-free spaces, where users may share their thoughts and feelings with others who may have experienced similar situations. User engagement is crucial for effective web-based peer support; however, levels of engagement vary. While moderation of peer support groups can have a positive impact on the engagement of young people, effective moderation can be challenging to implement. Objective: This study aimed to identify barriers and facilitators to user engagement with, and moderation of, web-based peer support groups among young people aged 16 to 25 years and to provide recommendations for enhancing this service. Methods: Drawing upon the Theoretical Domains Framework (TDF) and the Behavior Change Wheel (BCW), this study conducted qualitative interviews and gathered open-ended questionnaires from service users and moderators of The Mix, the United Kingdom’s leading web-based mental health platform providing peer support groups for young people. Semistructured interviews were conducted with 2 service users and 8 moderators, and open-ended questionnaires were completed by 7 service users. Themes were coded using the Capability, Opportunity, Motivation, and Behavior (COM-B) model and the TDF. The BCW tools were then used to identify relevant behavior change techniques to improve user engagement in, and moderation of, the service. Results: Thematic analysis revealed a total of 20 inductive themes within 10 TDF domains—9 (45%) for engagement and 11 (55%) for moderation. Of these 20 themes, 3 (15%) were facilitators of engagement, 7 (35%) were facilitators of moderation, 4 (20%) were barriers to moderation, and 6 (30%) barriers to engagement. Results suggest that skills, knowledge, beliefs about consequences, intentions, emotions, and the social and physical environment are important factors influencing service users and moderators of group chats. In particular, supporting the improvement of memory, attention, and decision-making skills of those involved; adapting the physical environment to facilitate effective interactions; and reducing negative emotions are suggested to optimize the value and effectiveness of peer support groups for young people’s mental health for both the service users and moderators of these services. Conclusions: The study demonstrates the effectiveness of the BCW approach and the use of the TDF and COM-B model to understand the influences on behavior in a systematic manner, especially for mental health and well-being interventions. The findings can be applied to design structured interventions to change behaviors related to the engagement with, and moderation of, web-based peer support groups and, in turn, improve mental health outcomes for young people. %M 39908551 %R 10.2196/64097 %U https://humanfactors.jmir.org/2025/1/e64097 %U https://doi.org/10.2196/64097 %U http://www.ncbi.nlm.nih.gov/pubmed/39908551 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e63515 %T Evaluation of a Guided Chatbot Intervention for Young People in Jordan: Feasibility Randomized Controlled Trial %A de Graaff,Anne Marijn %A Habashneh,Rand %A Fanatseh,Sarah %A Keyan,Dharani %A Akhtar,Aemal %A Abualhaija,Adnan %A Faroun,Muhannad %A Aqel,Ibrahim Said %A Dardas,Latefa %A Servili,Chiara %A van Ommeren,Mark %A Bryant,Richard %A Carswell,Kenneth %+ Department of Mental Health, Brain Health and Substance Use, World Health Organization, Av. Appia 20, Geneva, 1211, Switzerland, 41 792493513, degraaffa@who.int %K chatbot %K youth %K depression %K anxiety %K feasibility study %K randomized controlled trial %K mental health %K evaluation %K Jordan %K CBT %K psychological treatment %K digital intervention %K health intervention %K mood disorder %K digital health %D 2025 %7 5.2.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression and anxiety are a leading cause of disability worldwide and often start during adolescence and young adulthood. The majority of young people live in low- and middle-income countries where there is a lack of mental health services. The World Health Organization (WHO) developed a guided, nonartificial intelligence chatbot intervention called Scalable Technology for Adolescents and youth to Reduce Stress (STARS) to reduce symptoms of depression and anxiety among young people affected by adversity. Objective: The objective of this study was to evaluate the feasibility of the STARS intervention and study procedures among young people in Jordan. Methods: A 2-arm, single-blind, feasibility randomized controlled trial was conducted among 60 young people aged 18 years to 21 years living in Jordan with self-reported elevated levels of psychological distress. Immediately after baseline, participants were randomized 1:1 into the STARS intervention or enhanced care as usual (ECAU). STARS consisted of 10 lessons in which participants interacted with a chatbot and learned several cognitive behavioral therapy strategies, with optional guidance by a trained e-helper through 5 weekly phone calls. ECAU consisted of a static web page providing basic psychoeducation. Online questionnaires were administered at baseline (week 0) and postassessment (week 8) to assess depression (Hopkins Symptom Checklist-25 [HSCL-25]), anxiety (HSCL-25), functional impairment (WHO Disability Assessment Schedule [WHODAS] 2.0), psychological well-being (WHO-Five Well-Being Index [WHO-5]), and agency (State Hope Scale). Process evaluation interviews with stakeholders were conducted after the postassessment. Results: Participants were recruited in December 2022 and January 2023. Of 700 screening website visits, 160 participants were eligible, and 60 participants (mean age 19.7, SD 1.16 years; 49/60, 82% female) continued to baseline and were randomized into STARS (n=30) or ECAU (n=30). Of those who received STARS, 37% (11/30) completed at least 8 chatbot lessons, and 13% (4/30) completed all 5 support calls. The research protocol functioned well in terms of balanced randomization, high retention at postassessment (48/60, 80%), and good psychometric properties of the online questionnaires. Process evaluation interviews with STARS participants, ECAU participants, e-helpers, and the clinical supervisor indicated the acceptability of the study procedures and the STARS and ECAU conditions and highlighted several aspects that could be improved, including the e-helper support and features of the STARS chatbot. Conclusions: This study demonstrated the feasibility and acceptability of the STARS intervention and research procedures. A fully powered, definitive randomized controlled trial will be conducted to evaluate the effectiveness of STARS. Trial Registration: ISRCTN ISRCTN19217696; https://doi.org/10.1186/ISRCTN19217696 %M 39908538 %R 10.2196/63515 %U https://mental.jmir.org/2025/1/e63515 %U https://doi.org/10.2196/63515 %U http://www.ncbi.nlm.nih.gov/pubmed/39908538 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e57201 %T Evaluating the Effectiveness of InsightApp for Anxiety, Valued Action, and Psychological Resilience: Longitudinal Randomized Controlled Trial %A Amo,Victoria %A Lieder,Falk %+ Max Planck Institute for Intelligent Systems, Max-Planck-Ring 8, Tübingen, 72076, Germany, 49 15730645508, victoria.amo@tuebingen.mpg.de %K ecological momentary intervention %K serious game %K mindfulness-based intervention %K acceptance and commitment therapy %K cognitive behavioral therapy %K metacognition %K stress %K anxiety %K mobile phone %D 2025 %7 4.2.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety disorders are among the most prevalent mental disorders, and stress plays a significant role in their development. Ecological momentary interventions (EMIs) hold great potential to help people manage stress and anxiety by training emotion regulation and coping skills in real-life settings. InsightApp is a gamified EMI and research tool that incorporates elements from evidence-based therapeutic approaches. It is designed to strengthen people’s metacognitive skills for coping with challenging real-life situations and embracing anxiety and other emotions. Objective: This randomized controlled trial aims to examine the effectiveness of InsightApp in (1) improving individuals’ metacognitive strategies for coping with stress and anxiety and (2) promoting value-congruent action. It also evaluates how long these effects are retained. This experiment advances our understanding of the role of metacognition in emotional and behavioral reactivity to stress. Methods: We conducted a randomized controlled trial with 228 participants (completion rate: n=197, 86.4%; mean age 38, SD 11.50 years; age range 20-80 years; female: n=101, 52.6%; and White: n=175, 91.1%), who were randomly assigned to either the treatment or the active placebo control group. During the 1-week intervention phase, the treatment group engaged with InsightApp, while participants in the control group interacted with a placebo version of the app that delivered executive function training. We assessed the differences between the 2 groups in posttest and follow-up assessments of mental health and well-being while controlling for preexisting differences. Moreover, we used a multilevel model to analyze the longitudinal data, focusing on the within-participant causal effects of the intervention on emotional and behavioral reactivity to daily stressors. Specifically, we measured daily anxiety, struggle with anxiety, and value-congruent action. Results: The intervention delivered by InsightApp yielded mixed results. On one hand, we found no significant posttest scores on mental health and well-being measures directly after the intervention or 7 days later (all P>.22). In contrast, when confronted with real-life stress, the treatment group experienced a 15% lower increase in anxiety (1-tailed t test, t197=–2.4; P=.009) and a 12% lower increase in the struggle with anxiety (t197=–1.87; P=.031) than the control group. Furthermore, individuals in the treatment group demonstrated a 7% higher tendency to align their actions with their values compared to the control group (t197=3.23; P=.002). After the intervention period, InsightApp’s positive effects on the struggle with anxiety in reaction to stress were sustained, and increased to an 18% lower reactivity to stress (t197=–2.84; P=.002). Conclusions: As our study yielded mixed results, further studies are needed to obtain an accurate and reliable understanding of the effectiveness of InsightApp. Overall, our findings tentatively suggest that guiding people to apply adaptive metacognitive strategies for coping with real-life stress daily with a gamified EMI is a promising approach that deserves further evaluation. Trial Registration: OSF Registries osf.io/k3b5d; https://osf.io/k3b5d %M 39904504 %R 10.2196/57201 %U https://mental.jmir.org/2025/1/e57201 %U https://doi.org/10.2196/57201 %U http://www.ncbi.nlm.nih.gov/pubmed/39904504 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63139 %T Effectiveness of Cognitive Behavioral Therapy Provided Through a Web Application for Subthreshold Depression, Subthreshold Insomnia, and Subthreshold Panic: Open-Labeled 6-Arm Randomized Clinical Trial Pilot Study %A Taguchi,Kayoko %A Miyoshi,Mirai %A Seki,Yoichi %A Baba,Shiori %A Shimizu,Eiji %+ Research Center for Child Mental Development, Chiba University, chuo-ku, Inohana 1-8-1, Chiba, 260-8670, Japan, 81 43 226 2027, k.taguchi@chiba-u.jp %K minimally important change %K nonguided cognitive behavioral therapy %K subthreshold depression %K subthreshold insomnia %K subthreshold panic %K cognitive behavioral therapy %K CBT %K psychiatric disease %K primary care %K interventions %K depression %K anxiety %K insomnia %K psychological therapy %D 2025 %7 3.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: A common definition of “subthreshold” is that the diagnostic threshold is not met but the individuals are not asymptomatic. Some symptoms are present, causing significant difficulty in functioning and negatively impacting quality of life. Despite the attention given to subthreshold symptoms and the interventions for subthreshold symptoms being efficient in preventing the transition to psychiatric disease in primary care, reports on specific interventions are insufficient. Objective: This study aimed to verify the effectiveness of internet-delivered cognitive behavioral therapy (ICBT) for subthreshold depression (SD), subthreshold insomnia (SI), and subthreshold panic (SP). Additionally, this study aimed to explore the minimally important change (MIC) of each subthreshold group’s effectiveness outcome. Methods: Participants aged 18-70 years from internet research monitors were categorized into SD, SI, and SP groups based on screening assessment. They were randomly assigned to intervention or control groups within each subthreshold symptom. The intervention groups worked on 4 weeks of nonguided ICBT (“Mentre”), while the control groups worked on a sham app. The primary outcome was the score change from screening (T1) to 4-week follow-up (T4) using the Center for Epidemiologic Studies Depression Scale (CESD) in the SD group, the Pittsburgh Sleep Quality Index (PSQI) in the SI group, and the Panic and Agoraphobia Scale (PAS) in the SP group. Secondary outcomes were score changes in the Generalized Anxiety Disorder-7 (GAD-7) scale, the Patient Health Questionnaire 9 (PHQ-9), the CESD, the PSQI, and the PAS, except the primary outcome in each group. Secondary outcomes were analyzed using complete-case analysis and repeated-measures ANOVA. Additionally, the MIC in the primary endpoint for each group was also calculated as an exploratory outcome. Results: The SD, SP, and SI groups contained 846, 597, and 1106 participants, respectively. In the SD group, the difference in the CESD score change from baseline to follow-up between the intervention and control groups was significant (difference=0.52, 95% CI 1.29-4.66, P<.001). In the SI group, the difference in the PSQI score change was also significant (difference=0.53, 95% CI 0.11-0.94, P=.01). However, in the SP group, the difference in the PAS score change was not significant (difference=0.07, 95% CI –2.00 to 2.15, P=.94). Conclusions: Our ICBT program Mentre contributes to the improvement of SI and SD. This suggests that nonguided ICBT may be effective in preventing SI and SD from progressing to the full threshold. However, appropriate definitions of subthreshold symptoms are necessary. In particular, it is difficult to define SP, and further research that considers the specific factors of each subthreshold symptom is necessary to accumulate evidence. Trial Registration: University Hospital Medical Information Network (UMIN) UMIN000051280; https://tinyurl.com/2wyahhe3 %M 39899369 %R 10.2196/63139 %U https://formative.jmir.org/2025/1/e63139 %U https://doi.org/10.2196/63139 %U http://www.ncbi.nlm.nih.gov/pubmed/39899369 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e59653 %T Effectiveness of a Web-Based Self-Guided Intervention (MINDxYOU) for Reducing Stress and Promoting Mental Health Among Health Professionals: Results From a Stepped-Wedge Cluster Randomized Trial %A López-del-Hoyo,Yolanda %A Fernández-Martínez,Selene %A Perez-Aranda,Adrian %A Monreal-Bartolomé,Alicia %A Barceló-Soler,Alberto %A Camarero-Grados,Loreto %A Armas-Landaeta,Carilene %A Guzmán-Parra,José %A Carbonell,Vera %A Campos,Daniel %A Chen,Xinyuan %A García-Campayo,Javier %+ Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Carrer de la Fortuna, s/n, Bellaterra, Barcelona, 08193, Spain, 34 935 81 18 55, adrian.peara@gmail.com %K eHealth %K health professionals %K stress %K mental health %K stress reduction %K web-based intervention %K stepped-wedge design %K randomized controlled trial %D 2025 %7 3.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The high levels of sustained stress that health professionals often experience are a significant risk factor for developing mental health problems, such as anxiety, depression, and somatic symptoms, that not only affect their well-being but also have major social and organizational consequences. Different interventions, including those based on third-wave psychotherapy principles (ie, mindfulness, compassion, and acceptance), have proven to be effective in reducing stress in this population. Among them, those delivered on the web constitute a promising alternative with notable advantages in accessibility and flexibility, but some adherence inconveniences may limit their efficacy. Objective: This study aimed to evaluate the effectiveness of the MINDxYOU program, a web-based self-guided intervention based on third-wave psychotherapy principles, to reduce perceived stress and promote mental health in a sample of health professionals. Methods: In a stepped-wedge cluster randomized design, 357 health professionals from health centers in Aragon and Málaga, Spain, were recruited. They were divided into 6 clusters—3 per region—and randomly assigned to 1 of the 3 sequences, each starting with a control phase and then transitioning to the intervention phase (the MINDxYOU program) after 8, 16, or 24 weeks. This self-guided, web-based program, designed to be completed over 8 weeks, included weekly contact (via WhatsApp, call, or email) from the research team to promote adherence. Participants were assessed on the web every 8 weeks for 5 assessments. Perceived stress was the study’s primary outcome, with additional measures of clinical factors (anxiety, depression, and somatization) and process variables (resilience, mindfulness, compassion, and acceptance). Results: The program was initiated by 229 participants, 112 (48.9%) of whom were completers (ie, completed at least 3 of the 4 modules). Perceived stress demonstrated a significant reduction both when considering the entire sample (β=–1.08, SE 0.51; P=.03) and the sample of completers (β=–1.84, SE 0.62; P=.003). The proportion of participants reflecting “low stress” increased after the treatment (n=90, 46.6% vs n=100, 28.8% at baseline). Intracluster analysis revealed that pre- versus postintervention moderate effects were present in 2 clusters (Cohen d=0.46 and 0.62), and these were maintained in subsequent assessments. The linear mixed-effects models also showed that depression, anxiety, and somatization, as well as resilience, self-compassion, and some mindfulness facets, experienced significant improvements (P<.05) when comparing the intervention and control phases. Conclusions: The MINDxYOU program was effective in reducing perceived stress and promoting mental health, as well as increasing resilience, mindfulness facets, and self-compassion. These effects suggest that participants experienced a tangible improvement that could potentially enhance their well-being. Adherence to the intervention was moderate, while program use was notable compared to similar interventions. Finding ways to promote adherence to the intervention would contribute to increasing the effectiveness of this program. Trial Registration: ClinicalTrials.gov NCT05436717; https://clinicaltrials.gov/study/NCT05436717 International Registered Report Identifier (IRRID): RR2-10.1186/s12912-022-01089-5 %M 39899345 %R 10.2196/59653 %U https://www.jmir.org/2025/1/e59653 %U https://doi.org/10.2196/59653 %U http://www.ncbi.nlm.nih.gov/pubmed/39899345 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e66045 %T Exploring the Users’ Perspective of the Nationwide Self-Exclusion Service for Gambling Disorder, “Spelpaus”: Qualitative Interview Study %A Tjernberg,Johanna %A Helgesson,Sara %A Håkansson,Anders %A Hansson,Helena %+ Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Psychiatry, Baravägen 1, Lund, 221 00, Sweden, 46 703135677, anders_c.hakansson@med.lu.se %K gambling disorder %K gambling addiction %K behavioral addiction %K harm reduction %K self-exclusion %K voluntary self-exclusion %K Spelpaus %K lived experience %K human factors %K usability %K qualitative study %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Problem gambling and gambling disorder cause severe social, psychiatric, and financial consequences, and voluntary self-exclusion is a common harm reduction tool used by individuals with gambling problems. Objective: The aim of this study was to explore users’ experience of a novel nationwide, multioperator gambling self-exclusion service, “Spelpaus,” in Sweden and to inform stakeholders and policy makers in order to improve harm reduction tools against gambling problems. Methods: Semistructured interviews were conducted with 15 individuals who reported self-perceived gambling problems and who had experience of having used the self-exclusion service Spelpaus in Sweden. Interviews were transcribed and analyzed through qualitative content analysis. Results: We identified 3 categories and 8 subcategories. The categories were (1) reasons for the decision to self-exclude, (2) positive experiences, and (3) suggestions for improvement. The subcategories identified a number of reasons for self-exclusion, such as financial reasons and family reasons, and positive experiences described as a relief from gambling; in addition, important suggestions for improvement were cited, such as a more gradual return to gambling post–self-exclusion, better ways to address loopholes in the system, and transfer from self-exclusion to treatment. Conclusions: Voluntary self-exclusion from gambling, using a nationwide multioperator service, remains an appreciated harm-reducing tool. However, transfer from self-exclusion to treatment should be facilitated by policy making, and loopholes allowing for breaching of the self-exclusion need to be counteracted. %M 39888656 %R 10.2196/66045 %U https://humanfactors.jmir.org/2025/1/e66045 %U https://doi.org/10.2196/66045 %U http://www.ncbi.nlm.nih.gov/pubmed/39888656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58164 %T Investigating the Efficacy of the Web-Based Common Elements Toolbox (COMET) Single-Session Interventions in Improving UK University Student Well-Being: Randomized Controlled Trial %A Lambert,Jeffrey %A Loades,Maria %A Marshall,Noah %A Higson-Sweeney,Nina %A Chan,Stella %A Mahmud,Arif %A Pile,Victoria %A Maity,Ananya %A Adam,Helena %A Sung,Beatrice %A Luximon,Melanie %A MacLennan,Keren %A Berry,Clio %A Chadwick,Paul %+ Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 1225 385249, m.e.loades@bath.ac.uk %K Common Elements Toolbox %K mental well-being %K online interventions %K single-session interventions %K university students %D 2025 %7 31.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health problems in university students are associated with many negative outcomes, yet there is a gap between need and timely access to help. Single-session interventions (SSIs) are designed to be scalable and accessible, delivering core evidence-based intervention components within a one-off encounter. Objective: COMET (Common Elements Toolbox) is an online self-help SSI that includes behavioral activation, cognitive restructuring, gratitude, and self-compassion. COMET has previously been evaluated in India, Kenya, and the United States with promising results. This study tests the acceptability, appropriateness, perceived utility, and efficacy of COMET among UK university students during the peripandemic period. Methods: We conducted a randomized controlled trial evaluating the efficacy of COMET compared with a control group, with 2- and 4-week follow-ups. Outcome variables were subjective well-being, depression severity, anxiety severity, positive affect, negative affect, and perceived stress. We also measured intervention satisfaction immediately after completion of COMET. All UK university students with access to the internet were eligible to participate and were informed of the study online. The data were analyzed using linear mixed models and reported in accordance with the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile Health Applications and Online Telehealth) checklist. Results: Of the 831 people screened, 468 participants were randomized to a condition, 407 completed the postintervention survey, 147 returned the 2-week follow-up survey, 118 returned the 4-week follow-up survey, and 89 returned both. Of the 239 randomized, 212 completed COMET. Significant between-group differences in favor of the COMET intervention were observed at 2-week follow-ups for subjective well-being (Warwick-Edinburgh Mental Well-Being Scale; mean difference [MD] 1.39, 95% CI 0.19-2.61; P=.03), depression severity (9-item Patient Health Questionnaire; MD –1.31, 95% CI –2.51 to –0.12; P=.03), and perceived stress (4-item Perceived Stress Scale; MD –1.33, 95% CI –2.10 to –0.57; P<.001). Overall, participants were satisfied with COMET, with the majority endorsing the intervention and its modules as acceptable, appropriate, and exhibiting high utility. The self-compassion module was most often reported as the participants’ favorite module and the behavioral activation module was their least favorite. Qualitative analysis revealed that participants found COMET generally accessible, but too long, and experienced immediate and long-term beneficial effects. Conclusions: This study demonstrated high engagement with the COMET intervention, along with preliminary short-term efficacy. Almost all participants completed the intervention, but study attrition was high. Participant feedback indicated a high level of overall satisfaction with the intervention, with perceived accessibility, immediate benefits, and potential long-term impact being notable findings. These findings support the potential value of COMET as a mental health intervention and highlight important areas for further improvement. Trial Registration: ClinicalTrials.gov NCT05718141; https://clinicaltrials.gov/ct2/show/NCT05718141 %M 39888663 %R 10.2196/58164 %U https://www.jmir.org/2025/1/e58164 %U https://doi.org/10.2196/58164 %U http://www.ncbi.nlm.nih.gov/pubmed/39888663 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64745 %T Increasing Access to Mental Health Supports for 18- to 25-Year-Old Indigenous Youth With the JoyPop Mobile Mental Health App: Study Protocol for a Randomized Controlled Trial %A MacIsaac,Angela %A Neufeld,Teagan %A Malik,Ishaq %A Toombs,Elaine %A Olthuis,Janine V %A Schmidt,Fred %A Dunning,Crystal %A Stasiuk,Kristine %A Bobinski,Tina %A Ohinmaa,Arto %A Stewart,Sherry H %A Newton,Amanda S %A Mushquash,Aislin R %+ Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B5E1, Canada, 1 8073438010 ext 8771, aislin.mushquash@lakeheadu.ca %K mental health %K youth %K Indigenous %K First Nations %K eHealth %K mHealth %K JoyPop %K protocol %K mobile mental health app %K mobile app %K Canada %K mobile health %K emotion regulation %D 2025 %7 30.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Transitional-aged youth have a high burden of mental health difficulties in Canada, with Indigenous youth, in particular, experiencing additional circumstances that challenge their well-being. Mobile health (mHealth) approaches hold promise for supporting individuals in areas with less access to services such as Northern Ontario. Objective: The primary objective of this study is to evaluate the effectiveness of the JoyPop app in increasing emotion regulation skills for Indigenous transitional-aged youth (aged 18-25 years) on a waitlist for mental health services when compared with usual practice (UP). The secondary objectives are to (1) evaluate the impact of the app on general mental health symptoms and treatment readiness and (2) evaluate whether using the app is associated with a reduction in the use (and therefore cost) of other services while one is waiting for mental health services. Methods: The study is a pragmatic, parallel-arm randomized controlled superiority trial design spanning a 4-week period. All participants will receive UP, which involves waitlist monitoring practices at the study site, which includes regular check-in phone calls to obtain any updates regarding functioning. Participants will be allocated to the intervention (JoyPop+UP) or control (UP) condition in a 1:1 ratio using stratified block randomization. Participants will complete self-report measures of emotion regulation (primary outcome), mental health, treatment readiness, and service use during 3 assessments (baseline, second [after 2 weeks], and third [after 4 weeks]). Descriptive statistics pertaining to baseline variables and app usage will be reported. Linear mixed modeling will be used to analyze change in outcomes over time as a function of condition assignment, while a cost-consequence analysis will be used to evaluate the association between app use and service use. Results: Recruitment began September 1, 2023, and is ongoing. In total, 2 participants have completed the study. Conclusions: This study will assess whether the JoyPop app is effective for Indigenous transitional-aged youth on a waitlist for mental health services. Positive findings may support the integration of the app into mental health services as a waitlist management tool. Trial Registration: ClinicalTrials.gov NCT05991154; https://clinicaltrials.gov/study/NCT05991154 International Registered Report Identifier (IRRID): DERR1-10.2196/64745 %M 39883939 %R 10.2196/64745 %U https://www.researchprotocols.org/2025/1/e64745 %U https://doi.org/10.2196/64745 %U http://www.ncbi.nlm.nih.gov/pubmed/39883939 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54216 %T Self-Guided Smartphone App (Vimbo) for the Reduction of Symptoms of Depression and Anxiety in South African Adults: Pilot Quantitative Single-Arm Study %A Steyn,Sherrie %A Slabbert,Meggan %+ Vimbo Health SA (Pty) Ltd, 20 Riverclub Mews, 7 Sycamore Avenue, Riverclub, Sandton, 2191, South Africa, 27 63 861 6780, sherrie@vimbohealth.com %K treatment gap %K mental health %K health %K depression %K anxiety %K South Africa %K CBT %K cognitive behavioral therapy %K app-based intervention %K mobile health %K mental health app %K smartphone %K mobile phone %D 2025 %7 30.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Barriers to mental health assessment and intervention have been well documented within South Africa, in both urban and rural settings. Internationally, evidence has emerged for the effectiveness of technology and, specifically, app-based mental health tools and interventions to help overcome some of these barriers. However, research on digital interventions specific to the South African context and mental health is limited. Objective: This pilot study investigated the feasibility of using an app (Vimbo) to treat symptoms of anxiety and depression in South African adults recruited from a community sample. The Vimbo app is a self-guided, cognitive behavioral therapy–based digital intervention for common mental health difficulties developed for the South African context. Methods: This pilot study used a naturalistic, single-arm design testing the Vimbo app over 12 weeks, from October 2020 to February 2021. Participants were recruited through the South African Depression and Anxiety Group and social media advertisements online. A 2-week retention period was used to allow for a minimum of 2 datasets. App usage and engagement metrics were extracted directly from the back end of the app. Based on the model, researchers expected many users to discontinue usage when their symptom levels entered a healthy range. Pre-post review of symptom levels was used to reflect on clinical recovery status at discontinuation after the retention period. Results: A total of 218 applicants met study eligibility criteria and were invited to download the Vimbo app. Of these, 52% (114/218) of the participants registered with the app, who indicated multiple variances of depression and anxiety symptoms ranging in severity from mild to severe. Two participants users withdrew from the study. Moreover, 69% (77/112) of users were retained, including 8 who had technical issues with their treatment. When comparing broad uptake across all interested participants, chi-square analysis indicated significantly reduced uptake in participants identifying as “unemployed but seeking employment” (χ24=10.47; N=251; P=.03). When considering app usage for the entire cohort (n=69, excluding participants with technical issues), there was a mean of 72.87 (SD 71.425) total module pages read, a mean of 30% (SD 29.473%) of prescribed content completed, and a mean of 19.93 (SD 27.517) times engaging with tools and skills. Conclusions: Our findings support the case for continued exploration of app-based interventions for treating depression and anxiety in South Africa. Developing strategies to increase access and improve intervention uptake may prove essential to helping mobile health interventions make as significant an impact as possible. Future research should include a randomized controlled trial with a larger sample to further assess the efficacy of app-based interventions in treating mental health difficulties in South Africa. %M 39883938 %R 10.2196/54216 %U https://formative.jmir.org/2025/1/e54216 %U https://doi.org/10.2196/54216 %U http://www.ncbi.nlm.nih.gov/pubmed/39883938 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55308 %T Investigating Smartphone-Based Sensing Features for Depression Severity Prediction: Observation Study %A Terhorst,Yannik %A Messner,Eva-Maria %A Opoku Asare,Kennedy %A Montag,Christian %A Kannen,Christopher %A Baumeister,Harald %+ Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Str. 16, Ulm, 89081, Germany, 49 8921805057, yannik.terhorst@psy.lmu.de %K smart sensing %K digital phenotyping %K depression %K observation study %K smartphone %K mHealth %K mobile health %K app %K mental health %K symptoms %K assessments %D 2025 %7 30.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Unobtrusively collected objective sensor data from everyday devices like smartphones provide a novel paradigm to infer mental health symptoms. This process, called smart sensing, allows a fine-grained assessment of various features (eg, time spent at home based on the GPS sensor). Based on its prevalence and impact, depression is a promising target for smart sensing. However, currently, it is unclear which sensor-based features should be used in depression severity prediction and if they hold an incremental benefit over established fine-grained assessments like the ecological momentary assessment (EMA). Objective: The aim of this study was to investigate various features based on the smartphone screen, app usage, and call sensor alongside EMA to infer depression severity. Bivariate, cluster-wise, and cluster-combined analyses were conducted to determine the incremental benefit of smart sensing features compared to each other and EMA in parsimonious regression models for depression severity. Methods: In this exploratory observational study, participants were recruited from the general population. Participants needed to be 18 years of age, provide written informed consent, and own an Android-based smartphone. Sensor data and EMA were collected via the INSIGHTS app. Depression severity was assessed using the 8-item Patient Health Questionnaire. Missing data were handled by multiple imputations. Correlation analyses were conducted for bivariate associations; stepwise linear regression analyses were used to find the best prediction models for depression severity. Models were compared by adjusted R2. All analyses were pooled across the imputed datasets according to Rubin’s rule. Results: A total of 107 participants were included in the study. Ages ranged from 18 to 56 (mean 22.81, SD 7.32) years, and 78% of the participants identified as female. Depression severity was subclinical on average (mean 5.82, SD 4.44; Patient Health Questionnaire score ≥10: 18.7%). Small to medium correlations were found for depression severity and EMA (eg, valence: r=–0.55, 95% CI –0.67 to –0.41), and there were small correlations with sensing features (eg, screen duration: r=0.37, 95% CI 0.20 to 0.53). EMA features could explain 35.28% (95% CI 20.73% to 49.64%) of variance and sensing features (adjusted R2=20.45%, 95% CI 7.81% to 35.59%). The best regression model contained EMA and sensing features (R2=45.15%, 95% CI 30.39% to 58.53%). Conclusions: Our findings underline the potential of smart sensing and EMA to infer depression severity as isolated paradigms and when combined. Although these could become important parts of clinical decision support systems for depression diagnostics and treatment in the future, confirmatory studies are needed before they can be applied to routine care. Furthermore, privacy, ethical, and acceptance issues need to be addressed. %M 39883512 %R 10.2196/55308 %U https://www.jmir.org/2025/1/e55308 %U https://doi.org/10.2196/55308 %U http://www.ncbi.nlm.nih.gov/pubmed/39883512 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67814 %T Experiences of Peer Mentoring Sexual and Gender Minority Emerging Adults Who Are at Risk for Suicide: Mixed Methods Study %A Tran,Jennifer T %A Webster,Jessica %A Wolfe,James R %A Ben Nathan,Jennifer %A Mayinja,Lindiwe %A Kautz,Marin %A Oquendo,Maria A %A Brown,Gregory K %A Mandell,David %A Mowery,Danielle %A Bauermeister,José A %A Brown,Lily A %+ Department of Family and Community Health, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 2158983616, jtgtran@nursing.upenn.edu %K suicide prevention %K peer mentorship %K LGBTQIA health %K mental health %D 2025 %7 29.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and Gender Diverse Youth (SGDY) are at increased risk for suicide due to unique experiences including discrimination, family or friend rejection, and low positive affect. Peer mentors (PMs) may offer a unique opportunity for intervention but are underutilized for suicide prevention among SGDY. Objective: Little is known about the training needed for PMs when working with SGDY at risk for suicide. We developed an intervention, Supporting Transitions to Adulthood and Reducing Suicide (STARS), to improve suicide prevention among SGDY and increase social support, coping, and positive effects. PMs were trained by a licensed clinical therapist and provided a manual. PMs meet virtually for 6 weeks, providing social support, strategies to diminish the impact of discrimination, connection to safe spaces, and reinforcement of intentions to use Safety Plans with mentees. Methods: To understand PMs’ experiences in their role, including distress, fidelity to the manual, and perceptions of feasibility and acceptability of STARS and mentees’ Safety Plan, we collected survey data from mentees and PMs as well as in-depth interviews with PMs after the completion of the intervention. Results: As of September 2024, all peer mentees (N=64) have completed the study and all PMs have finished providing sessions for peer mentees. PMs (n=5) reported overall high comfort (8.52) and low distress (1.93) during sessions. All 5 PMs had high fidelity (>90%) to the PM intervention training. All 5 PMs reported high feasibility (17.50), acceptability (20), and appropriateness (20) of the STARS intervention. Mentees (n=27) reported high confidence ratings (3.54) in speaking with their PMs. Conclusions: Peer mentorship for SGDY who are at risk for suicide was feasible and acceptable by PMs and mentees alike. PMs reported that they felt comfortable and confident during the sessions. Mentees also reported confidence in working with their PMs. Future research should explore the optimal strategies to support PMs and mentees as they engage in suicide prevention work as well as incorporate feedback from the PMs in this study to ensure optimal outcomes. Trial Registration: ClinicalTrials.gov NCT05018143; https://clinicaltrials.gov/study/NCT05018143 International Registered Report Identifier (IRRID): RR2-10.2196/48177 %M 39879591 %R 10.2196/67814 %U https://formative.jmir.org/2025/1/e67814 %U https://doi.org/10.2196/67814 %U http://www.ncbi.nlm.nih.gov/pubmed/39879591 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e65222 %T Testing the Feasibility, Acceptability, and Potential Efficacy of an Innovative Digital Mental Health Care Delivery Model Designed to Increase Access to Care: Open Trial of the Digital Clinic %A Macrynikola,Natalia %A Chen,Kelly %A Lane,Erlend %A Nguyen,Nic %A Pinto,Jennifer %A Yen,Shirley %A Torous,John %+ Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States, 1 617 667 4735, jtorous@bidmc.harvard.edu %K digital interventions %K transdiagnostic treatment %K evidence-based treatment %K digital navigator %K access to care %K mobile phone %D 2025 %7 29.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health concerns have become increasingly prevalent; however, care remains inaccessible to many. While digital mental health interventions offer a promising solution, self-help and even coached apps have not fully addressed the challenge. There is now a growing interest in hybrid, or blended, care approaches that use apps as tools to augment, rather than to entirely guide, care. The Digital Clinic is one such model, designed to increase access to high-quality mental health services. Objective: To assess the feasibility, acceptability, and potential efficacy of the Digital Clinic model, this study aims to conduct a nonrandomized open trial with participants experiencing depression, anxiety, or both, at various levels of clinical severity. Methods: Clinicians were trained in conducting brief transdiagnostic evidence-based treatment augmented by a mental health app (mindLAMP); digital navigators were trained in supporting participants’ app engagement and digital literacy while also sharing app data with both patients and clinicians. Feasibility and acceptability of this 8-week program were assessed against a range of benchmarks. Potential efficacy was assessed by calculating pre-post change in symptoms of depression (Patient Health Questionnaire-9; PHQ-9), anxiety (7-item Generalized Anxiety Disorder; GAD-7), and comorbid depression and anxiety (Patient Health Questionnaire Anxiety and Depression Scale; PHQ-ADS), as well as rates of clinically meaningful improvement and remission. Secondary outcomes included change in functional impairment, self-efficacy in managing emotions, and flourishing. Results: Of the 258 enrolled participants, 215 (83.3%) completed the 8-week program. Most were White (n=151, 70.2%) and identified as cisgender women (n=136, 63.3%), with a mean age of 41 (SD 14) years. Feasibility and acceptability were good to excellent across a range of domains. The program demonstrated potential efficacy: the average PHQ-9 score was moderate to moderately severe at baseline (mean 13.39, SD 4.53) and decreased to subclinical (mean 7.79, SD 4.61) by the end of the intervention (t126=12.50, P<.001, Cohen d=1.11). Similarly, the average GAD-7 score decreased from moderate at baseline (mean 12.93, SD 3.67) to subclinical (mean 7.35, SD 4.19) by the end of the intervention (t113=13, P<.001, Cohen d=1.22). Participation in the program was also associated with high rates of clinically significant improvement and remission. Conclusions: Results suggest that the Digital Clinic model is feasible, acceptable, and potentially efficacious, warranting a future randomized controlled trial to establish the efficacy of this innovative model of care. %M 39879612 %R 10.2196/65222 %U https://mental.jmir.org/2025/1/e65222 %U https://doi.org/10.2196/65222 %U http://www.ncbi.nlm.nih.gov/pubmed/39879612 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e62782 %T Role of Tailored Timing and Frequency Prompts on the Efficacy of an Internet-Delivered Stress Recovery Intervention for Health Care Workers: Randomized Controlled Trial %A Nomeikaite,Auguste %A Gelezelyte,Odeta %A Böttche,Maria %A Andersson,Gerhard %A Kazlauskas,Evaldas %+ Center for Psychotraumatology, Institute of Psychology, Vilnius University, Room 203, 29 MK Čiurlionio St, Vilnius, LT-03100, Lithuania, 370 52667615, auguste.nomeikaite@fsf.vu.lt %K internet interventions %K mental health %K stress %K health care workers %K short message service %K cognitive behavioral therapy %K internet-delivered cognitive behavioral therapy %K psychotherapy %K randomized %K controlled trial %K engagement %K SMSl worker %K usage %K occupational health %K provider %K prompt %K message %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Prompts offer a promising strategy to promote client engagement in internet-delivered cognitive behavioral therapy (ICBT). However, if the prompts do not meet the needs of clients, they can potentially be more obtrusive rather than helpful. Objective: The aim of this study was to test if prompts tailored based on timing and frequency, aligned with preintervention goal setting, can increase usage and the efficacy of a therapist-supported ICBT stress recovery intervention for health care workers. Methods: The 2-arm randomized controlled trial included 87 health care workers (99% female, aged 19-68 years: mean 39.61, SD 11.49): 43 in the standard intervention group and 44 in the tailored prompts group. The primary outcome measure was the Recovery Experiences Questionnaire, and the secondary outcomes were the Perceived Stress Scale-4, the Patient Health Questionnaire-4, and the World Health Organization-5 Well-Being Index. The self-report data were collected before the intervention (September 2022), postintervention (October 2022), and 6-month follow-up (May 2023). Results: The results showed that tailored prompts, although appreciated by the majority (39/40, 98%), did not improve intervention usage indicators, such as the number of logins (t85=–0.91; P=.36), modules opened (t83.57=–1.47; P=.15), modules completed (t85=–0.71; P=.48), exercises completed (t85=–1.05; P=.30), or the time spent using the program (χ22=1.1; P=.57). Similarly, tailored prompts did not increase the effects of the intervention in terms of stress recovery skills (Cohen d ranging from 0.31 to 0.85), perceived stress (d=–0.08; –0.70), depression (d=–0.11; –0.38), anxiety (d=–0.32; –0.64), or psychological well-being (d=0.26; 0.46). In addition, the standard intervention group showed greater long-term stress recovery effects than the group using the internet-delivered intervention supplemented by tailored prompts (β=–0.24, P=.03). Conclusions: Although the study confirmed the efficacy of the program, the merits of tailored prompts in ICBT for stress recovery were not supported. Future research is needed to test the effects of the stress recovery intervention supplemented by goal setting and tailored prompts. Trial Registration: ClinicalTrials.gov NCT05553210; https://clinicaltrials.gov/study/NCT05553210 %M 39874572 %R 10.2196/62782 %U https://mental.jmir.org/2025/1/e62782 %U https://doi.org/10.2196/62782 %U http://www.ncbi.nlm.nih.gov/pubmed/39874572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e47927 %T Implementing Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety in Adults: Systematic Review %A Duffy,Daniel %A Richards,Derek %A Hisler,Garrett %A Timulak,Ladislav %+ Amwell Science, Amwell, 75th State St., 26th Floor, Boston, MA, 02109, United States, 1 617 204 3500, Daniel.Duffy@amwell.com %K mixed methods systematic review %K internet-delivered cognitive behavioral therapy %K iCBT %K implementation science %K implementation research %K depression %K anxiety %D 2025 %7 28.1.2025 %9 Review %J J Med Internet Res %G English %X Background: Scientific implementation findings relevant to the implementation of internet-delivered cognitive behavioral therapy (iCBT) for depression and anxiety in adults remain sparse and scattered across different sources of published information. Identifying evidence-based factors that influence the implementation of iCBT is key to successfully using iCBT in real-world clinical settings. Objective: This systematic review evaluated the following: (1) aspects that research articles postulate as important for the implementation of iCBT and (2) aspects relevant to the day-to-day running of iCBT services. A mixed methods systematic review using a convergent synthesis design was conducted to bring together evidence across this sparse literature consisting of divergent scientific article types to investigate the implementation of iCBT for depression and anxiety in adults. Methods: We searched the PsycINFO, PsycArticles, MEDLINE, CINAHL Complete, and Embase databases for any published peer-reviewed scientific articles that report on the implementation of iCBT for depression or anxiety disorders in adults. A total of 40 articles spanning the case study, commentary, meta-analysis, mixed methods study, pilot randomized controlled trial, randomized controlled trial, qualitative study, quantitative study, review, and systematic review article types were identified as eligible for this mixed methods review. Data were analyzed qualitatively using the descriptive-interpretive approach. Results: The first domain highlighted the impact of therapist and patient attitudes when implementing iCBT, the superiority of guided iCBT over unguided iCBT, its noninferiority to equivalent face-to-face treatments, and its utility outside of the original target of mild-to-moderate depression and anxiety. In total, 3 subdomains were identified under the second domain: (1) the management of iCBT in the workplace, detailing the importance of managing the iCBT service, related staff, and their motivations for using it; (2) the practice of iCBT in the workplace, describing the therapeutic aspects of iCBT provision, such as the provision of support, the background of supporters, and screening procedures; and (3) contextual considerations, detailing the impact of governmental legislation on therapy conducted over the internet, the lack of an iCBT workforce as a limiting factor, and the cost estimates associated with iCBT provision. Conclusions: Broadly, the findings describe several aspects that should be taken into account when researchers or practitioners implement iCBT as part of their work. However, the findings should be interpreted with caution, as the articles reviewed spanned many article types, and few of the included studies were directly focused on evaluating the implementation of iCBT. While findings provide insight into important factors to consider during iCBT implementation, these findings and their limitations highlight the need for more implementation-specific research in this area. %M 39874577 %R 10.2196/47927 %U https://www.jmir.org/2025/1/e47927 %U https://doi.org/10.2196/47927 %U http://www.ncbi.nlm.nih.gov/pubmed/39874577 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59414 %T A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan %A Saleem,Maham %A Zafar,Shamsa %A Klein,Thomas %A Koesters,Markus %A Bashir,Adnan %A Fuhr,Daniela C %A Sikander,Siham %A Zeeb,Hajo %+ Leibniz Institute for Prevention Research and Epidemiology – BIPS, Achterstraße 30, Bremen, 28359, Germany, 49 421 218 ext 56760, saleem@leibniz-bips.de %K digital mental health %K digital technology %K digital intervention %K Problem Management Plus %K lay health worker programme %K common mental health disorders %K low- and middle-income countries %K co-production %D 2025 %7 28.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health remains among the top 10 leading causes of disease burden globally, and there is a significant treatment gap due to limited resources, stigma, limited accessibility, and low perceived need for treatment. Problem Management Plus, a World Health Organization–endorsed brief psychological intervention for mental health disorders, has been shown to be effective and cost-effective in various countries globally but faces implementation challenges, such as quality control in training, supervision, and delivery. While digital technologies to foster mental health care have the potential to close treatment gaps and address the issues of quality control, their development requires context-specific, interdisciplinary, and participatory approaches to enhance impact and acceptance. Objective: We aimed to co-produce Technology-Assisted Problem Management Plus (TA-PM+) for "lady health workers" (LHWs; this is the terminology used by the Lady Health Worker Programme for lay health workers) to efficiently deliver sessions to women with symptoms of common mental health disorders within the community settings of Pakistan and conducted usability testing in community settings. Methods: A 3-stage framework was used for co-producing and prototyping the intervention. Stage 1 (evidence review and stakeholder consultation) included 3 focus group discussions with 32 LHWs and 7 in-depth interviews with key stakeholders working in the health system or at the health policy level. Thematic analyses using the Capability, Opportunity, and Motivation for Behavioral Change (COM-B) model were conducted. Stage 2 included over eight online workshops, and a multidisciplinary intervention development group co-produced TA-PM+. Stage 3 (prototyping) involved 2 usability testing rounds. In round 1 conducted in laboratory settings, 6 LHWs participated in role plays and completed the 15-item mHealth Usability App Questionnaire (MUAQ) (score range 0-7). In round 2 conducted in community settings, trained LHWs delivered the intervention to 6 participants screened for depression and anxiety. Data were collected using the MUAQ completed by LHWs and the Patient Satisfaction Questionnaire (PSQ) (score range 0-46) completed by participants. Results: Qualitative analysis indicated that a lack of digital skills among LHWs, high workload, resource scarcity for digitization (specifically internet bandwidth in the community), and need for comprehensive training were barriers for TA-PM+ implementation in the community through LHWs. Training, professional support, user guidance, an easy and automated interface, offline functionalities, incentives, and strong credibility among communities were perceived to enhance the capability, opportunity, and motivation of LHWs to implement TA-PM+. TA-PM+ was co-produced with features like an automated interface, a personal dashboard, guidance videos, and a connected supervisory panel. The mean MUAQ score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2. The mean PSQ score for TA-PM+ was 40 in round 2. Conclusions: Co-production of TA-PM+ for LHWs balanced context and evidence. The 3-stage iterative development approach resulted in high usability and acceptability of TA-PM+ for LHWs and participants. %M 39874072 %R 10.2196/59414 %U https://formative.jmir.org/2025/1/e59414 %U https://doi.org/10.2196/59414 %U http://www.ncbi.nlm.nih.gov/pubmed/39874072 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e67478 %T Exploring the Psychological and Physiological Insights Through Digital Phenotyping by Analyzing the Discrepancies Between Subjective Insomnia Severity and Activity-Based Objective Sleep Measures: Observational Cohort Study %A Yeom,Ji Won %A Kim,Hyungju %A Pack,Seung Pil %A Lee,Heon-Jeong %A Cheong,Taesu %A Cho,Chul-Hyun %+ , Department of Psychiatry, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 029205505, david0203@gmail.com %K insomnia %K wearable devices %K sleep quality %K subjective assessment %K digital phenotyping %K psychological factors %K mobile phone %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Insomnia is a prevalent sleep disorder affecting millions worldwide, with significant impacts on daily functioning and quality of life. While traditionally assessed through subjective measures such as the Insomnia Severity Index (ISI), the advent of wearable technology has enabled continuous, objective sleep monitoring in natural environments. However, the relationship between subjective insomnia severity and objective sleep parameters remains unclear. Objective: This study aims to (1) explore the relationship between subjective insomnia severity, as measured by ISI scores, and activity-based objective sleep parameters obtained through wearable devices; (2) determine whether subjective perceptions of insomnia align with objective measures of sleep; and (3) identify key psychological and physiological factors contributing to the severity of subjective insomnia complaints. Methods: A total of 250 participants, including both individuals with and without insomnia aged 19-70 years, were recruited from March 2023 to November 2023. Participants were grouped based on ISI scores: no insomnia, mild, moderate, and severe insomnia. Data collection involved subjective assessments through self-reported questionnaires and objective measurements using wearable devices (Fitbit Inspire 3) that monitored sleep parameters, physical activity, and heart rate. The participants also used a smartphone app for ecological momentary assessment, recording daily alcohol consumption, caffeine intake, exercise, and stress. Statistical analyses were used to compare groups on subjective and objective measures. Results: Results indicated no significant differences in general sleep structure (eg, total sleep time, rapid eye movement sleep time, and light sleep time) among the insomnia groups (mild, moderate, and severe) as classified by ISI scores (all P>.05). Interestingly, the no insomnia group had longer total awake times and lower sleep quality compared with the insomnia groups. Among the insomnia groups, no significant differences were observed regarding sleep structure (all P>.05), suggesting similar sleep patterns regardless of subjective insomnia severity. There were significant differences among the insomnia groups in stress levels, dysfunctional beliefs about sleep, and symptoms of restless leg syndrome (all P≤.001), with higher severity associated with higher scores in these factors. Contrary to expectations, no significant differences were observed in caffeine intake (P=.42) and alcohol consumption (P=.07) between the groups. Conclusions: The findings demonstrate a discrepancy between subjective perceptions of insomnia severity and activity-based objective sleep parameters, suggesting that factors beyond sleep duration and quality may contribute to subjective sleep complaints. Psychological factors, such as stress, dysfunctional sleep beliefs, and symptoms of restless legs syndrome, appear to play significant roles in the perception of insomnia severity. These results highlight the importance of considering both subjective and objective assessments in the evaluation and treatment of insomnia and suggest potential avenues for personalized treatment strategies that address both psychological and physiological aspects of sleep disturbances. Trial Registration: Clinical Research Information Service KCT0009175; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=26133 %M 39869900 %R 10.2196/67478 %U https://mental.jmir.org/2025/1/e67478 %U https://doi.org/10.2196/67478 %U http://www.ncbi.nlm.nih.gov/pubmed/39869900 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e64959 %T Establishment and Maintenance of a Digital Therapeutic Alliance in People Living With Negative Symptoms of Schizophrenia: Two Exploratory Single-Arm Studies %A Snipes,Cassandra %A Dorner‑Ciossek,Cornelia %A Hare,Brendan D %A Besedina,Olya %A Campellone,Tim %A Petrova,Mariya %A Lakhan,Shaheen E %A Pratap,Abhishek %+ Boehringer Ingelheim International GmbH, Binger Straße 173, Ingelheim am Rhein, 55216, Germany, 49 (7351) 54 97758, cornelia.dorner-ciossek@boehringer-ingelheim.com %K therapeutic alliance %K digital working alliance %K experiential negative symptoms %K schizophrenia %K digital therapeutics %K digital literacy %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Evidence-based digital therapeutics represent a new treatment modality in mental health, potentially providing cost-efficient, accessible means of augmenting existing treatments for chronic mental illnesses. CT-155/BI 3972080 is a prescription digital therapeutic under development as an adjunct to standard of care treatments for patients 18 years of age and older with experiential negative symptoms (ENS) of schizophrenia. Individual components of CT-155/BI 3972080 are designed based on the underlying principles of face-to-face treatment. A positive therapeutic alliance between patients and health care providers is linked with improved clinical outcomes in mental health. Likewise, establishing a similar therapeutic alliance with a digital therapeutic (ie, digital working alliance [DWA]) may be important for engagement and treatment effectiveness of this modality. Objective: This study aimed to investigate the establishment and maintenance of a DWA between a beta version of CT-155/BI 3972080 (CT-155 beta) and adults with ENS of schizophrenia. Methods: Two multicenter, exploratory, single-arm studies (study 1: CT-155-C-001 and study 2: CT-155-C-002) enrolled adults with schizophrenia and ENS receiving stable antipsychotic medication (≥12 weeks). Participants had access to CT-155 beta and were presented with daily in-app activities during a 3-week orientation phase that included lessons designed to facilitate building of a DWA. In study 2, the 3-week orientation phase was followed by an abbreviated active 4-week phase. Digital literacy at baseline was evaluated using the Mobile Device Proficiency Questionnaire (MDPQ). The mobile Agnew Relationship Measure (mARM) was used to assess DWA establishment after 3 weeks in both studies, and after 7 weeks in study 2 to assess DWA maintenance. Participant safety, digital literacy, and correlations between negative symptom severity and DWA were assessed in both studies. Results: Of the enrolled participants, 94% (46/49) and 86% (43/50) completed studies 1 and 2, respectively. Most were male (study 1: 71%, 35/49; study 2: 80%, 40/50). The baseline digital literacy assessed through MDPQ score was comparable in both studies (study 1: mean 30.56, SD 8.06; study 2: mean 28.69, SD 8.31) indicating proficiency in mobile device use. After 3 weeks, mARM scores (study 1: mean 5.16, SD 0.8; study 2: mean 5.36, SD 1.06) indicated that a positive DWA was established in both studies. In study 2, the positive DWA established at week 3 was maintained at week 7 (mARM: mean 5.48, SD 0.97). There were no adverse events (AEs) in study 1, and 3 nonserious and nontreatment-related AEs in study 2. Conclusions: A positive DWA was established between participants and CT-155 beta within 3 weeks. The second 7-week study showed maintenance of the DWA to the end of the study. Results support the establishment and maintenance of a DWA between adults with ENS of schizophrenia and a beta version of CT-155/BI 3972080, a prescription digital therapeutic under development to target these symptoms. Trial Registration: Clinicaltrials.gov NCT05486312; https://clinicaltrials.gov/study/NCT05486312 %M 39869902 %R 10.2196/64959 %U https://mental.jmir.org/2025/1/e64959 %U https://doi.org/10.2196/64959 %U http://www.ncbi.nlm.nih.gov/pubmed/39869902 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66715 %T Effectiveness of Video Teletherapy in Treating Obsessive-Compulsive Disorder in Children and Adolescents With Exposure and Response Prevention: Retrospective Longitudinal Observational Study %A Feusner,Jamie D %A Farrell,Nicholas R %A Nunez,Mia %A Lume,Nicholas %A MacDonald,Catherine W %A McGrath,Patrick B %A Trusky,Larry %A Smith,Stephen %A Rhode,Andreas %+ NOCD, Inc, 225 N Michigan Ave Suite 1430, Chicago, IL, 60601, United States, jamie@nocdhelp.com %K digital behavioral health %K youth %K cognitive-behavioral therapy %K exposure and response prevention %K CBT %K ERP %K OCD %K psychiatry %K clinical trial %K psychology %K video therapy %K teletherapy %K e-therapy %K e-counseling %K cyber-counseling %K adolescents %K adolescence %K obsessive-compulsive disorder %K retrospective study %K longitudinal study %K observational study %K ERP therapy %D 2025 %7 27.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: An effective primary treatment for obsessive-compulsive disorder (OCD) in children and adolescents as well as adults is exposure and response prevention (ERP), a form of intervention in the context of cognitive-behavioral therapy. Despite strong evidence supporting the efficacy and effectiveness of ERP from studies in research and real-world settings, its clinical use remains limited. This underuse is often attributed to access barriers such as the scarcity of properly trained therapists, geographical constraints, and costs. Some of these barriers may be addressed with virtual behavioral health, providing ERP for OCD through video teletherapy and supplemented by app-based therapeutic tools and messaging support between sessions. Studies of teletherapy ERP in adults with OCD have shown benefits in research and real-world settings in both small and large samples. However, studies of teletherapy ERP in children and adolescents thus far have been in small samples and limited to research rather than real-world settings. Objective: This study reports on the real-world effectiveness of teletherapy ERP for OCD in the largest sample (N=2173) of child and adolescent patients to date. Methods: Children and adolescents with OCD were treated with live, face-to-face video teletherapy sessions, with parent or caregiver involvement, using ERP. Assessments were conducted at baseline, after 7-11 weeks, and after 13-17 weeks. Additionally, longitudinal assessments of OCD symptoms were performed at weeks 18-30, 31-42, and 43-54. We analyzed longitudinal outcomes of OCD symptoms, depression, anxiety, and stress using linear mixed models. Results: Treatment resulted in a median 38.46% (IQR 12.50%-64.00%) decrease in OCD symptoms at 13-17 weeks, and 53.4% of youth met full response criteria at this point. Improvements were observed in all categories of starting symptom severity: mild (median 40.3%, IQR 8.5%-79.8%), moderate (median 38.4%, IQR 13.3%-63.6%), and severe (median 34.1%, IQR 6.6%-58.5%). In addition, there were significant reductions in the severity of depression, anxiety, and stress symptoms. The median amount of therapist involvement was 13 (IQR 10.0-16.0) appointments and 11.5 (IQR 9.0-15.0) hours. Further, symptom improvements were maintained or improved upon in the longitudinal assessment periods of weeks 18-30, 31-42, and 43-54. Conclusions: These results show that remote ERP treatment, assisted by technology, can effectively improve both core OCD and related depression, anxiety, and stress symptoms in children and adolescents with OCD in a real-world setting. Notable outcomes were achieved in a relatively small amount of therapist time, demonstrating its efficiency. Demonstrating the usefulness of a delivery format that overcomes several traditional barriers to treatment, these findings have implications for widespread dissemination of accessible, evidence-based care for children and adolescents with OCD. %M 39869894 %R 10.2196/66715 %U https://www.jmir.org/2025/1/e66715 %U https://doi.org/10.2196/66715 %U http://www.ncbi.nlm.nih.gov/pubmed/39869894 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e67785 %T Effectiveness of Digital Mental Health Interventions in the Workplace: Umbrella Review of Systematic Reviews %A Cameron,Gillian %A Mulvenna,Maurice %A Ennis,Edel %A O'Neill,Siobhan %A Bond,Raymond %A Cameron,David %A Bunting,Alex %+ School of Computing, Ulster University, 2-24 York Street, Belfast, BT15 1AP, United Kingdom, 44 7753 430736, cameron-g2@ulster.ac.uk %K digital interventions for mental health %K workplace wellbeing %K stress %K anxiety %K depression %K burnout %K CBT %K umbrella review %K digital mental health %K evaluation %K psychological %K databases %K Pubmed %K Web of Science %K Medline %K Cochrane Library %K PRISMA %D 2025 %7 24.1.2025 %9 Review %J JMIR Ment Health %G English %X Background: There is potential for digital mental health interventions to provide affordable, efficient, and scalable support to individuals. Digital interventions, including cognitive behavioral therapy, stress management, and mindfulness programs, have shown promise when applied in workplace settings. Objective: The aim of this study is to conduct an umbrella review of systematic reviews in order to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. Methods: A systematic search was conducted to identify systematic reviews relating to digital interventions for the workplace, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis). The review protocol was registered in the Open Science Framework. The following databases were searched: PubMed, Web of Science, MEDLINE, PsycINFO, and Cochrane Library. Data were extracted using a predefined extraction table. To assess the methodological quality of a study, the AMSTAR-2 tool was used to critically appraise systematic reviews of health care interventions. Results: The literature search resulted in 11,875 records, which was reduced to 14 full-text systematic literature reviews with the use of Covidence to remove duplicates and screen titles and abstracts. The 14 included reviews were published between 2014 and 2023, comprising 9 systematic reviews and 5 systematic reviews and meta-analyses. AMSTAR-2 was used to complete a quality assessment of the reviews, and the results were critically low for 7 literature reviews and low for the other 7 literature reviews. The most common types of digital intervention studied were cognitive behavioral therapy, mindfulness/meditation, and stress management followed by other self-help interventions. Effectiveness of digital interventions was found for many mental health symptoms and conditions in employee populations, such as stress, anxiety, depression, burnout, and psychological well-being. Factors such as type of technology, guidance, recruitment, tailoring, and demographics were found to impact effectiveness. Conclusions: This umbrella review aimed to critically evaluate, synthesize, and summarize evidence of various digital mental health interventions available within a workplace setting. Despite the low quality of the reviews, best practice guidelines can be derived from factors that impact the effectiveness of digital interventions in the workplace. Trial Registration: OSF Registries osf.io/rc6ds; https://doi.org/10.17605/OSF.IO/RC6DS %M 39854722 %R 10.2196/67785 %U https://mental.jmir.org/2025/1/e67785 %U https://doi.org/10.2196/67785 %U http://www.ncbi.nlm.nih.gov/pubmed/39854722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63197 %T Digital Mindfulness Training for Burnout Reduction in Physicians: Clinician-Driven Approach %A Antico,Lia %A Brewer,Judson %+ Brown University, Department of Behavioral and Social Sciences, 121 S Main St, Providence, RI, 02903, United States, 1 401 328 0763, lia_antico@brown.edu %K burnout %K anxiety %K empathy fatigue %K physician %K mindfulness %K digital therapeutics %K app %K smartphone %K podcast %K compassion %K health care provider %K training %K physician burnout %K cynicism %K efficacy %K treatment %K meditation %K chronic %K workplace stress %K digital health %K mHealth %K mobile phone %D 2025 %7 24.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Physician burnout is widespread in health care systems, with harmful consequences on physicians, patients, and health care organizations. Mindfulness training (MT) has proven effective in reducing burnout; however, its time-consuming requirements often pose challenges for physicians who are already struggling with their busy schedules. Objective: This study aimed to design a short and pragmatic digital MT program with input from clinicians specifically to address burnout and to test its efficacy in physicians. Methods: Two separate nonrandomized pilot studies were conducted. In the first study, 27 physicians received the digital MT in a podcast format, while in the second study, 29 physicians and nurse practitioners accessed the same training through a free app-based platform. The main outcome measure was cynicism, one dimension of burnout. The secondary outcome measures were emotional exhaustion (the second dimension of burnout), anxiety, depression, intolerance of uncertainty, empathy (personal distress, perspective taking, and empathic concern subscales), self-compassion, and mindfulness (nonreactivity and nonjudgment subscales). In the second study, worry, sleep disturbances, and difficulties in emotion regulation were also measured. Changes in outcomes were assessed using self-report questionnaires administered before and after the treatment and 1 month later as follow-up. Results: Both studies showed that MT decreased cynicism (posttreatment: 33% reduction; P≤.04; r≥0.41 and follow-up: 33% reduction; P≤.04; r≥0.45), while improvements in emotional exhaustion were observed solely in the first study (25% reduction, P=.02, r=.50 at posttreatment; 25% reduction, P=.008, r=.62 at follow-up). There were also significant reductions in anxiety (P≤.01, r≥0.49 at posttreatment; P≤.01, r≥0.54 at follow-up), intolerance of uncertainty (P≤.03, r≥.57 at posttreatment; P<.001, r≥0.66 at follow-up), and personal distress (P=.03, r=0.43 at posttreatment; P=.03, r=0.46 at follow-up), while increases in self-compassion (P≤.02, r≥0.50 at posttreatment; P≤.006, r≥0.59 at follow-up) and mindfulness (nonreactivity: P≤.001, r≥0.69 at posttreatment; P≤.004, r≥0.58 at follow-up; nonjudgment: P≤.009, r≥0.50 at posttreatment; P≤.03, r≥0.60 at follow-up). In addition, the second study reported significant decreases in worry (P=.04, r=0.40 at posttreatment; P=.006, r=0.58 at follow-up), sleep disturbances (P=.04, r=0.42 at posttreatment; P=.01, r=0.53 at follow-up), and difficulties in emotion regulation (P=.005, r=0.54 at posttreatment; P<.001, r=0.70 at follow-up). However, no changes were observed over time for depression or perspective taking and empathic concern. Finally, both studies revealed significant positive correlations between burnout and anxiety (cynicism: r≥0.38; P≤.04; emotional exhaustion: r≥0.58; P≤.001). Conclusions: To our knowledge, this research is the first where clinicians were involved in designing an intervention targeting burnout. These findings suggest that this digital MT serves as a viable and effective tool for alleviating burnout and anxiety among physicians. Trial Registration: ClinicalTrials.gov NCT06145425; https://clinicaltrials.gov/study/NCT06145425 %M 39854701 %R 10.2196/63197 %U https://formative.jmir.org/2025/1/e63197 %U https://doi.org/10.2196/63197 %U http://www.ncbi.nlm.nih.gov/pubmed/39854701 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e58183 %T Medical Students’ Acceptance of Tailored e–Mental Health Apps to Foster Their Mental Health: Cross-Sectional Study %A Grüneberg,Catharina %A Bäuerle,Alexander %A Karunakaran,Sophia %A Darici,Dogus %A Dörrie,Nora %A Teufel,Martin %A Benson,Sven %A Robitzsch,Anita %K eHealth %K medical education %K medical students %K tailored interventions %K UTAUT %K intention to use %K e–mental health apps %K app %K foster %K cross-sectional study %K mental health problems %K physician %K well-being %K mobile apps %K acceptance %K assessment %K mental health apps %D 2025 %7 24.1.2025 %9 %J JMIR Med Educ %G English %X Background: Despite the high prevalence of mental health problems among medical students and physicians, help-seeking remains low. Digital mental health approaches offer beneficial opportunities to increase well-being, for example, via mobile apps. Objective: This study aimed to assess the acceptance, and its underlying predictors, of tailored e–mental health apps among medical students by focusing on stress management and the promotion of personal skills. Methods: From November 2022 to July 2023, a cross-sectional study was conducted with 245 medical students at the University of Duisburg-Essen, Germany. Sociodemographic, mental health, and eHealth-related data were assessed. The Unified Theory of Acceptance and Use of Technology (UTAUT) was applied. Differences in acceptance were examined and a multiple hierarchical regression analysis was conducted. Results: The general acceptance of tailored e–mental health apps among medical students was high (mean 3.72, SD 0.92). Students with a job besides medical school reported higher acceptance (t107.3=–2.16; P=.03; Padj=.027; Cohen d=4.13) as well as students with higher loads of anxiety symptoms (t92.4=2.36; P=.02; Padj=.03; Cohen d=0.35). The t values were estimated using a 2-tailed t test. Regression analysis revealed that acceptance was significantly predicted by anxiety symptoms (β=.11; P=.045), depressive symptoms (β=–.11; P=.05), internet anxiety (β=–.12; P=.01), digital overload (β=.1; P=.03), and the 3 UTAUT core predictors—performance expectancy (β=.24; P<.001), effort expectancy (β=.26; P<.001), and social influence (β=.43; P<.001). Conclusions: The high acceptance of e–mental health apps among medical students and its predictors lay a valuable basis for the development and implementation of tailored e–mental health apps within medical education to foster their mental health. More research using validated measures is needed to replicate our findings and to further investigate medical students’ specific needs and demands regarding the framework of tailored e–mental health apps. %R 10.2196/58183 %U https://mededu.jmir.org/2025/1/e58183 %U https://doi.org/10.2196/58183 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55932 %T Exploring Web-Based Support for Suicidal Ideation in the Scottish Population: Usability Study %A McClelland,Heather %A O'Connor,Rory C %A Gibson,Laura %A MacIntyre,Donald J %+ School of Health and Wellbeing, University of Glasgow, 90 Byres Road, Clarice Pears Building, Glasgow, G12 8TB, United Kingdom, 44 141 330 3299, heather.mcclelland@glasgow.ac.uk %K suicide prevention %K Scotland %K suicidal thoughts %K digital intervention %K internet %K self-help %K crisis intervention %D 2025 %7 24.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is a global health concern. In the United Kingdom, Scotland has the highest suicide rate. Lived experience and suicide prevention stakeholders in Scotland have identified a key gap in suicide prevention activities: the lack of 24-hour peer-driven web-based support for people who are suicidal. Objective: This usability study aimed to evaluate the feasibility, acceptability, utility, and reach of a suicide prevention website (Surviving Suicidal Thoughts) specifically designed to support residents in Scotland who are experiencing suicidal thoughts themselves or suspect or know someone who is experiencing suicidal thoughts. Intended support was delivered through the provision of personal testimony videos of individuals with lived experience. Methods: A peer-driven website was developed specifically to support residents of Scotland experiencing suicidal thoughts. The website included resources (eg, videos from lived experience and written guidance about how to respond to someone who may be experiencing suicidal thoughts) to help reduce distress, normalize experiences, and challenge distressing thoughts. The website was promoted via leading web-based social media channels and Google Ads. Evaluation of the website was based on website engagement, marketing strategy, and direct web user feedback via a cross-sectional survey. Results: Data were collected for 41 weeks (June 2022 to February 2023) spanning the launch of the website and the conclusion of the second marketing campaign. On average, the website received 99.9 visitors per day. A total of 56% (n=14,439) of visitors were female, ages ranged from younger than 18 years to older than 70 years (commonly between 25 and 34 years) and originated from all regions of Scotland. According to Google Search terms of Scottish residents, of the individuals indicated to be experiencing suicidal thoughts but not looking for help, 5.3% (n=920) engaged with the website compared to 10.5% (n=2898) who were indicated to be looking for help for themselves. Based on participant responses to the evaluation survey (n=101), the website was associated with a significant reduction in suicidal thoughts (P=.03). Reasons for visiting the website varied. Marketing data implied that people were more likely to engage with advertisements, which they felt were more personal, and visitors to the website were more likely to engage with videos, which corresponded to their age. Conclusions: A peer-led website may help residents of Scotland who are experiencing suicidal thoughts. Web-based interventions may have considerable reach in Scotland both in terms of age and geographic area. Engagement with the website was similar to other self-help websites for suicidal ideation; however, more nuanced methods of analyzing website engagement for help-seeking behavior are recommended. Future work would benefit from exploring the effectiveness of this website based on a larger participant sample with website modifications guided by the principles of social learning theory. %M 39854713 %R 10.2196/55932 %U https://formative.jmir.org/2025/1/e55932 %U https://doi.org/10.2196/55932 %U http://www.ncbi.nlm.nih.gov/pubmed/39854713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68031 %T Improving Mental Health and Well-Being Through the Paradym App: Quantitative Study of Real-World Data %A Metaxa,Athina Marina %A Liverpool,Shaun %A Eisenstadt,Mia %A Pollard,John %A Carlsson,Courtney %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Rd, Oxford, OX2 6GG, United Kingdom, 30 6930228210, athina.metaxa@hmc.ox.ac.uk %K well-being %K awareness %K mental health %K formative %K mobile phone %K well-being %K apps %K quantitative evaluation %K real-world data %K emotional well-being %K pre-post %K single arm %K quantitative data %D 2025 %7 23.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: With growing evidence suggesting that levels of emotional well-being have been decreasing globally over the past few years, demand for easily accessible, convenient, and affordable well-being and mental health support has increased. Although mental health apps designed to tackle this demand by targeting diagnosed conditions have been shown to be beneficial, less research has focused on apps aiming to improve emotional well-being. There is also a dearth of research on well-being apps structured around users’ lived experiences and emotional patterns and a lack of integration of real-world evidence of app usage. Thus, the potential benefits of these apps need to be evaluated using robust real-world data. Objective: This study aimed to explore usage patterns and preliminary outcomes related to mental health and well-being among users of an app (Paradym; Paradym Ltd) designed to promote emotional well-being and positive mental health. Methods: This is a pre-post, single-arm evaluation of real-world data provided by users of the Paradym app. Data were provided as part of optional built-in self-assessments that users completed to test their levels of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), life satisfaction (Satisfaction With Life Scale), and overall well-being (World Health Organization-5 Well-Being Index) when they first started using the app and at regular intervals following initial usage. Usage patterns, including the number of assessments completed and the length of time between assessments, were recorded. Data were analyzed using within-subjects t tests, and Cohen d estimates were used to measure effect sizes. Results: A total of 3237 app users completed at least 1 self-assessment, and 787 users completed a follow-up assessment. The sample was diverse, with 2000 users (61.8%) being located outside of the United States. At baseline, many users reported experiencing strong feelings of burnout (677/1627, 41.6%), strong insecurities (73/211, 34.6%), and low levels of thriving (140/260, 53.8%). Users also experienced symptoms of depression (mean 9.85, SD 5.55) and anxiety (mean 14.27, SD 6.77) and reported low levels of life satisfaction (mean 12.14, SD 7.42) and general well-being (mean 9.88, SD 5.51). On average, users had been using the app for 74 days when they completed a follow-up assessment. Following app usage, small but significant improvements were reported across all outcomes of interest, with anxiety and depression scores improving by 1.20 and 1.26 points on average, respectively, and life satisfaction and well-being scores improving by 0.71 and 0.97 points, respectively. Conclusions: This real-world data analysis and evaluation provided positive preliminary evidence for the Paradym app’s effectiveness in improving mental health and well-being, supporting its use as a scalable intervention for emotional well-being, with potential applications across diverse populations and settings, and encourages the use of built-in assessments in mental health app research. %M 39848610 %R 10.2196/68031 %U https://formative.jmir.org/2025/1/e68031 %U https://doi.org/10.2196/68031 %U http://www.ncbi.nlm.nih.gov/pubmed/39848610 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64483 %T Identifying the Minimal Clinically Important Difference in Emotion Regulation Among Youth Using the JoyPop App: Survey Study %A Charlton,Jaidyn %A Malik,Ishaq %A Ashley,Angela M %A Newton,Amanda %A Toombs,Elaine %A Schmidt,Fred %A Olthuis,Janine V %A Stasiuk,Kristine %A Bobinski,Tina %A Mushquash,Aislin %+ Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON, Canada, 1 8073438010 ext 8771, aislin.mushquash@lakeheadu.ca %K mHealth %K mobile health %K app %K psychometrics %K emotion regulation %K Indigenous mental health %K Indigenous youth %K mental health interventions %K resilience %K clinical psychology %K adolescent mental health %K mental health %K JoyPop %K pediatrics %K mobile phone %D 2025 %7 23.1.2025 %9 Short Paper %J JMIR Form Res %G English %X Background: The minimal clinically important difference (MCID) is an important threshold to consider when evaluating the meaningfulness of improvement following an intervention. The JoyPop app is an evidence-based smartphone app designed to improve resilience and emotion regulation. Information is needed regarding the JoyPop app’s MCID among culturally diverse youth. Objective: This study aims to calculate the MCID for youth using the JoyPop app and to explore how the MCID may differ for a subset of Indigenous youth. Methods: Youth (N=36; aged 12-18 years) were recruited to use the JoyPop app for up to 4 weeks as part of a larger pilot evaluation. Results were based on measures completed after 2 weeks of app use. The MCID was calculated using emotion regulation change scores (Difficulties in Emotion Regulation–Short Form [DERS-SF]) and subjective ratings on the Global Rating of Change Scale (GRCS). This MCID calculation was completed for youth overall and separately for Indigenous youth only. Results: A significant correlation between GRCS scores and change scores on the DERS-SF supported face validity (r=–0.37; P=.04). The MCID in emotion regulation following the use of the JoyPop app for youth overall was 2.80 on the DERS-SF. The MCID for Indigenous youth was 4.29 on the DERS-SF. In addition, most youth reported improved emotion regulation after using the JoyPop app. Conclusions: These MCID findings provide a meaningful threshold for improvement in emotion regulation for the JoyPop app. They provide potential effect sizes and can aid in sample size estimations for future research with the JoyPop app or e-mental health technologies in general. The difference between overall youth and Indigenous youth MCID values also highlights the importance of patient-oriented ratings of symptom improvement as well as cultural considerations when conducting intervention research and monitoring new interventions in clinical practice. %M 39847426 %R 10.2196/64483 %U https://formative.jmir.org/2025/1/e64483 %U https://doi.org/10.2196/64483 %U http://www.ncbi.nlm.nih.gov/pubmed/39847426 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60868 %T Use of Go-Beyond as a Self-Directed Internet-Based Program Supporting Veterans’ Transition to Civilian Life: Preliminary Usability Study %A Alichniewicz,Karolina Katarzyna %A Hampton,Sarah %A Romaniuk,Madeline %A Bennett,Darcy %A Guindalini,Camila %+ Greenslopes Private Hospital, Gallipoli Medical Research, Newdegate Street, Greenslopes, Brisbane, QLD 4120, Australia, 61 7 33947613, alichniewiczkarolina@gallipoliresearch.org.au %K military transition %K web-based interventions %K military-civilian adjustment %K Go-Beyond %K internet-based program %K civilian %K military service %K veteran %K premilitary life %K mental health issues %K physical injuries %K adoption %K quantitative analysis %K survey %K family %K support %K digital technology %K user engagement %K effectiveness %K assessment %D 2025 %7 23.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition from military service to civilian life presents a variety of challenges for veterans, influenced by individual factors such as premilitary life, length of service, and deployment history. Mental health issues, physical injuries, difficulties in relationships, and identity loss compound the reintegration process. To address these challenges, various face-to-face and internet-based programs are available yet underused. This paper presents the preliminary evaluation of “Go-Beyond, Navigating Life Beyond Service,” an internet-based psychoeducational program for veterans. Objective: The study aims to identify the reach, adoption, and engagement with the program and to generate future recommendations to enhance its overall impact. Methods: This study exclusively used data that were automatically and routinely collected from the start of the Go-Beyond program’s launch on May 24, 2021, until May 7, 2023. When accessing the Go-Beyond website, veterans were asked to complete the Military-Civilian Adjustment and Reintegration Measure (M-CARM) questionnaire, which produces a unique M-CARM profile of results specifying potential areas of need on the 5 domains of the measure. Users were then automatically allocated to Go-Beyond modules that aligned with their M-CARM profile. Additionally, quantitative and qualitative data were collected from a survey on aesthetics, interactivity, user journey, and user experience, which was optional for users to complete at the end of each module. Results: Results show a conversion rate of 28.5% (273/959) from the M-CARM survey to the Go-Beyond program. This rate is notably higher compared with similar internet-based self-help programs, such as VetChange (1033/22,087, 4.7%) and resources for gambling behavior (5652/8083, 14%), but lower than the MoodGYM program (82,159/194,840, 42.2%). However, these comparisons should be interpreted with caution due to the limited availability of published conversion rates and varying definitions of uptake and adoption across studies. Additionally, individuals were 1.64 (95% CI 1.17-2.28) more likely to enroll when they express a need in Purpose and Connection, and they were 1.50 (95% CI 1.06-2.18) times more likely to enroll when they express the need Beliefs About Civilians, compared with those without these needs. The overall completion rate for the program was 31% (85/273) and modules’ individual completion rates varied from 8.4% (17/203) to 20% (41/206). Feedback survey revealed high overall user satisfaction with Go-Beyond, emphasizing its engaging content and user-friendly modules. Notably, 94% (88/94) of survey respondents indicated they would recommend the program to other veterans, family, or friends. Conclusions: The Go-Beyond program may offer promising support for veterans transitioning to civilian life through digital technology. Our study reveals insights on user engagement and adoption, emphasizing the need for ongoing evaluation to further address the diverse needs of military personnel. Future research should explore predictors of engagement, the addition of peer or facilitator support, and the use of outcome measures for effectiveness assessment. %M 39847427 %R 10.2196/60868 %U https://formative.jmir.org/2025/1/e60868 %U https://doi.org/10.2196/60868 %U http://www.ncbi.nlm.nih.gov/pubmed/39847427 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e57405 %T Integrating Videoconferencing Therapist Guidance Into Stepped Care Internet-Delivered Cognitive Behavioral Therapy for Child and Adolescent Anxiety: Noninferiority Randomized Controlled Trial %A March,Sonja %A Spence,Susan H %A Myers,Larry %A Ford,Martelle %A Smith,Genevieve %A Donovan,Caroline L %+ Centre for Health Research & School of Psychology and Wellbeing, University of Southern Queensland Education City, 37 Sinnathamby Blvd, Springfield Central, 4300, Australia, 61 7 3470 4434, sonja.march@unisq.edu.au %K internet-delivered cognitive behavioral therapy %K ICBT %K anxiety %K child %K adolescent %K stepped care %K videoconferencing %D 2025 %7 22.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Self-guided internet-delivered cognitive behavioral therapy (ICBT) achieves greater reach than ICBT delivered with therapist guidance, but demonstrates poorer engagement and fewer clinical benefits. Alternative models of care are required that promote engagement and are effective, accessible, and scalable. Objective: This randomized trial evaluated whether a stepped care approach to ICBT using therapist guidance via videoconferencing for the step-up component (ICBT-SC[VC]) is noninferior to ICBT with full therapist delivery by videoconferencing (ICBT-TG[VC]) for child and adolescent anxiety. Methods: Participants included 137 Australian children and adolescents aged 7 to 17 years (male: n=61, 44.5%) with a primary anxiety disorder who were recruited from participants presenting to the BRAVE Online website. This noninferiority randomized trial compared ICBT-SC[VC] to an ICBT-TG[VC] program, with assessments conducted at baseline, 12 weeks, and 9 months after treatment commencement. All ICBT-TG[VC] participants received therapist guidance (videoconferencing) after each session for all 10 sessions. All ICBT-SC[VC] participants completed the first 5 sessions online without therapist guidance. If they demonstrated response to treatment after 5 sessions (defined as reductions in anxiety symptoms to the nonclinical range), they continued sessions without therapist guidance. If they did not respond, participants were stepped up to receive supplemental therapist guidance (videoconferencing) for the remaining sessions. The measures included a clinical diagnostic interview (Anxiety Disorders Interview Schedule) with clinician-rated severity rating as the primary outcome and parent- and child-reported web-based surveys assessing anxiety and anxiety-related interference (secondary outcomes). Results: Although there were no substantial differences between the treatment conditions on primary and most secondary outcome measures, the noninferiority of ICBT-SC[VC] compared to ICBT-TG[VC] could not be determined. Significant clinical benefits were evident for participants in both treatments, although this was significantly higher for the ICBT-TG[VC] participants. Of the 89 participants (38 in ICBT-SC[VC] and 51 in ICBT-TG[VC]) who remained in the study, 26 (68%) in ICBT-SC[VC] and 45 (88%) in ICBT-TG[VC] were free of their primary anxiety diagnosis by the 9-month follow-up. For the intention-to-treat sample (N=137), 41% (27/66) ICBT-SC[VC], and 69% (49/71) ICBT-TG[VC] participants were free of their primary anxiety diagnosis. Therapy compliance was lower for the ICBT-SC[VC] participants (mean 7.39, SD 3.44 sessions) than for the ICBT-TG[VC] participants (mean 8.73, SD 3.08 sessions), although treatment satisfaction was moderate to high in both conditions. Conclusions: This study provided further support for the benefits of low-intensity ICBT for children and adolescents with a primary anxiety disorder and highlighted the excellent treatment outcomes that can be achieved through therapist-guided ICBT delivered via videoconferencing. Although noninferiority of the stepped care adaptive approach could not be determined, it was acceptable to families, produced good outcomes, and could assist in increasing access to evidence-based care. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12618001418268; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001418268 %M 39841993 %R 10.2196/57405 %U https://mental.jmir.org/2025/1/e57405 %U https://doi.org/10.2196/57405 %U http://www.ncbi.nlm.nih.gov/pubmed/39841993 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e66925 %T Impact of a Virtual Reality Intervention on Stigma, Empathy, and Attitudes Toward Patients With Psychotic Disorders Among Mental Health Care Professionals: Randomized Controlled Trial %A Tay,Jing Ling %A Qu,Yuanrong %A Lim,Lucas %A Puthran,Rohan %A Tan,Chye Lee Robert %A Rajendran,Rajkirren %A Wei,Ker Chiah %A Xie,Huiting %A Sim,Kang %+ West Region, Institute of Mental Health, 10 Buangkok View Buangkok Green Medical Park, Singapore, 539747, Singapore, 65 6389 2000, tay.jing.ling@aic.sg %K virtual reality %K social distance %K stigma %K empathy %K mental health %K schizophrenia %K psychosis %K psychotic disorder %K mental disorder %K healthcare professional %K VR %K randomized controlled trial %K RCT %K user satisfaction %D 2025 %7 21.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Previous studies have found that psychotic disorders are among the most stigmatized mental disorders. Of note, virtual reality (VR) interventions have been associated with improvements in attitudes and empathy and reduced stigma toward individuals with psychotic disorders, especially among undergraduates, but this has not been examined among mental health care professionals. Objective: We aimed to evaluate the effectiveness of a newly developed VR intervention for mental health care professionals to improve attitudes and empathy and reduce stigma toward people with psychotic disorders. Methods: We conducted a randomized controlled trial and recruited eligible mental health care professionals from a tertiary mental health care institution. Both arms (VR intervention and VR control groups) were evaluated at baseline, postintervention, and 1-month follow up. The evaluation included outcomes related to attitudes (modified attitudes toward people with schizophrenia scale), stigma (social distance scale, personal stigma scale), and empathy (empathetic concern subscale of the Interpersonal Reactivity Index). The experience with the VR intervention was assessed using a user satisfaction questionnaire, and qualitative feedback was gathered. Results: Overall, 180 mental health care professionals participated and completed the study. Both groups showed improvements in attitude, social distance, and stigma scores but not the empathy score following the intervention. The VR intervention group had better user satisfaction than the VR control group. In addition, certain outcome measures were positively associated with specific factors including female gender, higher education level, certain job roles, years of work, and presence of loved ones with a mental disorder. Conclusions: Both the intervention and control VR groups of mental health care professionals showed improvements in attitudes, stigma, and social distance toward people with psychotic disorders. Future longitudinal studies may want to evaluate the impact of VR on caregivers and the public on these same and other outcome measures to reduce stigma and improve empathy toward individuals with psychotic disorders. Trial Registration: clinicaltrials.gov NCT05982548; https://clinicaltrials.gov/study/NCT05982548 %M 39836956 %R 10.2196/66925 %U https://mental.jmir.org/2025/1/e66925 %U https://doi.org/10.2196/66925 %U http://www.ncbi.nlm.nih.gov/pubmed/39836956 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e70439 %T Responsible Design, Integration, and Use of Generative AI in Mental Health %A Asman,Oren %A Torous,John %A Tal,Amir %K responsible AI in medicine %K AI ethics %K digital mental health ethics %K artificial intelligence %K large language model %K model alignment %D 2025 %7 20.1.2025 %9 %J JMIR Ment Health %G English %X Generative artificial intelligence (GenAI) shows potential for personalized care, psychoeducation, and even crisis prediction in mental health, yet responsible use requires ethical consideration and deliberation and perhaps even governance. This is the first published theme issue focused on responsible GenAI in mental health. It brings together evidence and insights on GenAI’s capabilities, such as emotion recognition, therapy-session summarization, and risk assessment, while highlighting the sensitive nature of mental health data and the need for rigorous validation. Contributors discuss how bias, alignment with human values, transparency, and empathy must be carefully addressed to ensure ethically grounded, artificial intelligence–assisted care. By proposing conceptual frameworks; best practices; and regulatory approaches, including ethics of care and the preservation of socially important humanistic elements, this theme issue underscores that GenAI can complement, rather than replace, the vital role of human empathy in clinical settings. To achieve this, an ongoing collaboration between researchers, clinicians, policy makers, and technologists is essential. %R 10.2196/70439 %U https://mental.jmir.org/2025/1/e70439 %U https://doi.org/10.2196/70439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60286 %T Psychological and Behavioral Insights From Social Media Users: Natural Language Processing–Based Quantitative Study on Mental Well-Being %A Yang,Xingwei %A Li,Guang %+ Information Technology Management, Ted Rogers School of Management, Toronto Metropolitan University, 55 Dundas St W, Toronto, ON, M5G 2C3, Canada, 1 416 979 5044, nancy.yang@torontomu.ca %K social media %K natural language processing %K social interaction %K decision support system %K depression detection %D 2025 %7 20.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression significantly impacts an individual’s thoughts, emotions, behaviors, and moods; this prevalent mental health condition affects millions globally. Traditional approaches to detecting and treating depression rely on questionnaires and personal interviews, which can be time consuming and potentially inefficient. As social media has permanently shifted the pattern of our daily communications, social media postings can offer new perspectives in understanding mental illness in individuals because they provide an unbiased exploration of their language use and behavioral patterns. Objective: This study aimed to develop and evaluate a methodological language framework that integrates psychological patterns, contextual information, and social interactions using natural language processing and machine learning techniques. The goal was to enhance intelligent decision-making for detecting depression at the user level. Methods: We extracted language patterns via natural language processing approaches that facilitate understanding contextual and psychological factors, such as affective patterns and personality traits linked with depression. Then, we extracted social interaction influence features. The resultant social interaction influence that users have within their online social group is derived based on users’ emotions, psychological states, and context of communication extracted from status updates and the social network structure. We empirically evaluated the effectiveness of our framework by applying machine learning models to detect depression, reporting accuracy, recall, precision, and F1-score using social media status updates from 1047 users along with their associated depression diagnosis questionnaire scores. These datasets also include user postings, network connections, and personality responses. Results: The proposed framework demonstrates accurate and effective detection of depression, improving performance compared to traditional baselines with an average improvement of 6% in accuracy and 10% in F1-score. It also shows competitive performance relative to state-of-the-art models. The inclusion of social interaction features demonstrates strong performance. By using all influence features (affective influence features, contextual influence features, and personality influence features), the model achieved an accuracy of 77% and a precision of 80%. Using affective features and affective influence features also showed strong performance, achieving 81% precision and an F1-score of 79%. Conclusions: The developed framework offers practical applications, such as accelerating hospital diagnoses, improving prediction accuracy, facilitating timely referrals, and providing actionable insights for early interventions in mental health treatment plans. %M 39832365 %R 10.2196/60286 %U https://formative.jmir.org/2025/1/e60286 %U https://doi.org/10.2196/60286 %U http://www.ncbi.nlm.nih.gov/pubmed/39832365 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e65246 %T Barriers and Facilitators of User Engagement With Digital Mental Health Interventions for People With Psychosis or Bipolar Disorder: Systematic Review and Best-Fit Framework Synthesis %A Eisner,Emily %A Faulkner,Sophie %A Allan,Stephanie %A Ball,Hannah %A Di Basilio,Daniela %A Nicholas,Jennifer %A Priyam,Aansha %A Wilson,Paul %A Zhang,Xiaolong %A Bucci,Sandra %+ Division of Psychology and Mental Health, University of Manchester, Jean McFarlane Building, Manchester, M13 9PL, United Kingdom, 44 1613066000, emily.eisner@manchester.ac.uk %K psychosis %K bipolar %K schizophrenia %K smartphone %K digital %K wearable %K mobile phone %K PRISMA %D 2025 %7 20.1.2025 %9 Review %J JMIR Ment Health %G English %X Background: Digital mental health interventions (DMHIs) to monitor and improve the health of people with psychosis or bipolar disorder show promise; however, user engagement is variable, and integrated clinical use is low. Objective: This prospectively registered systematic review examined barriers and facilitators of clinician and patient engagement with DMHIs, to inform implementation within real-world settings. Methods: A systematic search of 7 databases identified empirical studies reporting qualitative or quantitative data about factors affecting staff or patient engagement with DMHIs aiming to monitor or improve the mental or physical health of people with psychosis or bipolar disorder. The Consolidated Framework for Implementation Research was used to synthesize data on barriers and facilitators, following a best-fit framework synthesis approach. Results: The review included 175 papers (150 studies; 11,446 participants) describing randomized controlled trials; surveys; qualitative interviews; and usability, cohort, and case studies. Samples included people with schizophrenia spectrum psychosis (98/150, 65.3% of studies), bipolar disorder (62/150, 41.3% of studies), and clinicians (26/150, 17.3% of studies). Key facilitators were a strong recognition of DMHIs’ relative advantages, a clear link between intervention focus and specific patient needs, a simple, low-effort digital interface, human-supported delivery, and device provision where needed. Although staff thought patients would lose, damage, or sell devices, reviewed studies found only 11% device loss. Barriers included intervention complexity, perceived risks, user motivation, discomfort with self-reflection, digital poverty, symptoms of psychosis, poor compatibility with existing clinical workflows, staff and patient fears that DMHIs would replace traditional face-to-face care, infrastructure limitations, and limited financial support for delivery. Conclusions: Identified barriers and facilitators highlight key considerations for DMHI development and implementation. As to broader implications, sustainable business models are needed to ensure that evidence-based DMHIs are maintained and deployed. Trial Registration: PROSPERO CRD42021282871; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=282871 %M 39832352 %R 10.2196/65246 %U https://mental.jmir.org/2025/1/e65246 %U https://doi.org/10.2196/65246 %U http://www.ncbi.nlm.nih.gov/pubmed/39832352 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e59611 %T Integration of Conventional and Virtual Reality Approaches in Augmented Reality for Theory-Based Psychoeducational Intervention Design for Chronic Low Back Pain: Scoping Review %A Conen,Robin %A Mueller,Steffen %A Tibubos,Ana Nanette %+ Department of Nursing Science, Diagnostics in Healthcare and eHealth, Trier University, Max-Planck-Straße 6, Trier, 54296, Germany, 49 651 201 1904, conen@uni-trier.de %K augmented reality %K virtual reality %K chronic low back pain %K education %K pain management %K intervention %D 2025 %7 20.1.2025 %9 Review %J Interact J Med Res %G English %X Background: Psychoeducation positively influences the psychological components of chronic low back pain (CLBP) in conventional treatments. The digitalization of health care has led to the discussion of virtual reality (VR) interventions. However, CLBP treatments in VR have some limitations due to full immersion. In comparison, augmented reality (AR) supplements the real world with virtual elements involving one’s own body sensory perception and can combine conventional and VR approaches. Objective: The aim of this study was to review the state of research on the treatment of CLBP through psychoeducation, including immersive technologies, and to formulate suggestions for psychoeducation in AR for CLBP. Methods: A scoping review following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was performed in August 2024 by using Livivo ZB MED, PubMed, Web of Science, American Psychological Association PsycINFO (PsycArticle), and PsyArXiv Preprints databases. A qualitative content analysis of the included studies was conducted based on 4 deductively extracted categories. Results: We included 12 studies published between 2019 and 2024 referring to conventional and VR-based psychoeducation for CLBP treatment, but no study referred to AR. In these studies, educational programs were combined with physiotherapy, encompassing content on pain biology, psychological education, coping strategies, and relaxation techniques. The key outcomes were pain intensity, kinesiophobia, pain catastrophizing, degree of disability, quality of life, well-being, self-efficacy, depression, attrition rate, and user experience. Passive, active, and gamified strategies were used to promote intrinsic motivation from a psychological point of view. Regarding user experience from a software development perspective, user friendliness, operational support, and application challenges were recommended. Conclusions: For the development of a framework for an AR-based psychoeducational intervention for CLBP, the combination of theories of acceptance and use of technologies with insights from health psychological behavior change theories appears to be of great importance. An example of a theory-based design of a psychoeducation intervention in AR for CLBP is proposed and discussed. %M 39832362 %R 10.2196/59611 %U https://www.i-jmr.org/2025/1/e59611 %U https://doi.org/10.2196/59611 %U http://www.ncbi.nlm.nih.gov/pubmed/39832362 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 10 %N %P e64267 %T Exploring the Needs and Preferences of Users and Parents to Design a Mobile App to Deliver Mental Health Peer Support to Adolescents With Type 1 Diabetes: Qualitative Study %A Yakubu,Titilola I %A Jhajj,Poonamdeep %A Pawer,Samantha %A West,Nicholas C %A Amed,Shazhan %A Tang,Tricia S %A Görges,Matthias %+ Research Institute, BC Children’s Hospital, Rm V3-324, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 6048752000 ext 5616, mgoerges@bcchr.ca %K peer support %K type 1 diabetes %K digital interventions %K diabetes distress %K depression %K mental health %K focus groups %K disease management %K adolescent %K parent %K mobile app %K mHealth %K type 1 %K diabetes %K qualitative study %K physical health %K psychological %K emotional health %K mental health support %K thematic analysis %K data collection %K mobile health %D 2025 %7 20.1.2025 %9 Original Paper %J JMIR Diabetes %G English %X Background: Beyond physical health, managing type 1 diabetes (T1D) also encompasses a psychological component, including diabetes distress, that is, the worries, fears, and frustrations associated with meeting self-care demands over the lifetime. While digital health solutions have been increasingly used to address emotional health in diabetes, these technologies may not uniformly meet the unique concerns and technological savvy across all age groups. Objective: This study aimed to explore the mental health needs of adolescents with T1D, determine their preferred modalities for app-based mental health support, and identify desirable design features for peer-delivered mental health support modeled on an app designed for adults with T1D. Methods: A semistructured qualitative focus group study was conducted with adolescents with T1D and parents of adolescents with T1D. Data were collected through pre–focus group surveys, including sociodemographic background, diabetes status, health care experiences, and focus group sessions, including their opinions on peer support and technology. A thematic analysis following an inductive and iterative process was performed to develop themes and subthemes from the collected information. Results: Focus group participants included 10 adolescents (mean 16, SD 1 years; 8/10, 80% female; who had been living with diabetes for an average of 9, SD 5 years) and 10 parents (mean age 51, SD 7 years; 9/10, 90% female). Four core themes emerged: (1) experience: navigating adolescence with T1D, (2) empowerment: support systems that enabled better management of their T1D, (3) obstacles: societal barriers that affect adolescents’ T1D management, and (4) innovation: adolescent-driven preferences for digital peer support platforms. Conclusions: App-based peer support offers a promising avenue for addressing the mental health needs of adolescents with T1D. Understanding the unique support needs of these adolescents and using this information to suggest design considerations for a mental health peer support app is an important step toward addressing their complex emotional and social challenges. %M 39832366 %R 10.2196/64267 %U https://diabetes.jmir.org/2025/1/e64267 %U https://doi.org/10.2196/64267 %U http://www.ncbi.nlm.nih.gov/pubmed/39832366 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e56945 %T Codeveloping an Online Resource for People Bereaved by Suicide: Mixed Methods User-Centered Study %A Leaune,Edouard %A Bislimi,Kushtrim %A Lau-Taï,Pauline %A Rouzé,Héloïse %A Chalancon,Benoit %A Lestienne,Laurène %A Grandgenevre,Pierre %A Morgiève,Margot %A Laplace,Nathalie %A Vaiva,Guillaume %A Haesebaert,Julie %A Poulet,Emmanuel %+ Le Vinatier - Lyon Metropole Academic Hospital Center, 95, Boulevard Pinel, Bron, 69500, France, 33 0674111823, edouard.leaune@ch-le-vinatier.fr %K suicide bereavement %K social media %K mixed methods %K participatory %K user-centered %K mobile phone %K online resource %K suicide %K risk %K suicidal behaviors %K mental health %K impairments %K adaptive online resource %K Information System Research %K France %D 2025 %7 20.1.2025 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although suicide bereavement is highly distressing and is associated with an increased risk of suicidal behaviors and mental and physical health impairments, those bereaved by suicide encounter difficulties accessing support. Digital resources offer new forms of support for bereaved people. However, digital resources dedicated to those bereaved by suicide are still limited. Objective: This paper aimed to develop and implement an evidence-based, innovative, and adaptive online resource for people bereaved by suicide, based on their needs and expectations. Methods: We performed a mixed methods, participatory, user-centered study seeking to build resources from the perspectives of people bereaved by suicide and professionals or volunteers working in the field of postvention. We used the Information System Research framework, which uses a three-stage research cycle, including (1) the relevance cycle, (2) the design cycle, and (3) the rigor cycle, and the Design Science Research framework. Results: A total of 478 people participated in the study, including 451 people bereaved by suicide, 8 members of charities, and 19 mental health professionals working in the field of postvention. The development stage of the resource lasted 18 months, from October 2021 to March 2023. A total of 9 focus groups, 1 online survey, 30 usability tests, and 30 semistructured interviews were performed. A website for people bereaved by suicide named “espoir-suicide” was developed that includes (1) evidence-based information on suicide prevention and bereavement, (2) testimonies of people bereaved by suicide, (3) a delayed chat to ask questions on suicide and bereavement to a specialized team of mental health professionals, and (4) an interactive nationwide resource directory. The mean system usability score was 90.3 out of 100 for 30 participants, with 93% (n=28) of them having a rating above 80. Since the implementation of espoir-suicide in March 2023, a total of 19,400 connections have been recorded, 117 local resources have been registered nationwide, and 73 questions have been posted in the chat. Conclusions: The use of a mixed methods, participatory, user-centered design allowed us to implement an evidence-based, innovative, and functional website for people bereaved by suicide that was highly relevant for fulfilling the needs and expectations of French people bereaved by suicide. International Registered Report Identifier (IRRID): RR2-10.3389/fpsyt.2021.770154 %M 39832356 %R 10.2196/56945 %U https://mental.jmir.org/2025/1/e56945 %U https://doi.org/10.2196/56945 %U http://www.ncbi.nlm.nih.gov/pubmed/39832356 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 2 %N %P e49923 %T Immersive Virtual Reality for Health Promotion and Primary Prevention in Psychology: Scoping Review %A Bonneterre,Solenne %A Zerhouni,Oulmann %A Boffo,Marilisa %K virtual reality %K health psychology %K prevention psychology %K health promotion %D 2025 %7 20.1.2025 %9 %J JMIR XR Spatial Comput %G English %X Background: Virtual reality (VR) has emerged as a promising tool in health promotion and prevention psychology. Its ability to create immersive, engaging, and standardized environments offers unique opportunities for interventions and assessments. However, the scope of VR applications in this field remains unclear. Objective: This scoping review aims to identify and map the applications of VR in health promotion and prevention psychology, focusing on its uses, outcomes, and challenges. Methods: A systematic search was conducted across 3 electronic databases (PubMed, PsycINFO, and Scopus) for studies published between 2010 and 2024. Eligibility criteria included empirical studies using immersive VR for health promotion and prevention, while studies using nonimmersive VR, lacking health-related applications, or focusing on clinical interventions were excluded. The review followed PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews) guidelines, and 4295 records were initially identified, with 51 studies included after screening. Data were synthesized qualitatively to identify key applications, limitations, and emerging trends. Results: VR was primarily used in three areas: (1) delivering interventions (eg, pilot testing, skills training), (2) exploring fundamental research questions, and (3) assessing outcomes such as behavioral or psychological responses. Although VR demonstrated potential for enhancing user engagement and replicating ecological scenarios, its effectiveness compared to nonimmersive methods varied. Most studies were pilot or feasibility studies with small, nonrepresentative samples, short follow-up periods, and limited methodological standardization. Conclusions: VR offers a versatile and promising tool for health promotion and prevention but its applications are still in the early stages. The evidence is limited by methodological weaknesses and variability in outcomes. Future research should prioritize replication, longitudinal designs, and standardized methodologies to strengthen the evidence base and expand the applicability of VR interventions. %R 10.2196/49923 %U https://xr.jmir.org/2025/1/e49923 %U https://doi.org/10.2196/49923 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65434 %T Explainable Predictive Model for Suicidal Ideation During COVID-19: Social Media Discourse Study %A Bouktif,Salah %A Khanday,Akib Mohi Ud Din %A Ouni,Ali %+ Department of Computer Science and Software Engineering, College of Information Technology, United Arab Emirates University, Sheikh Khalifa Bin Zayed, Asharij, Al Ain, Abu Dhabi, 1551, United Arab Emirates, 971 507605406, salahb@uaeu.ac.ae %K COVID-19 %K suicide %K social networking sites %K deep learning %K explainable artificial intelligence %K suicidal ideation %K artificial intelligence %K AI %K social media %K predictive model %K mental health %K pandemic %K natural language processing %K NLP %K suicidal thought %K deep neural network approach %D 2025 %7 17.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Studying the impact of COVID-19 on mental health is both compelling and imperative for the health care system’s preparedness development. Discovering how pandemic conditions and governmental strategies and measures have impacted mental health is a challenging task. Mental health issues, such as depression and suicidal tendency, are traditionally explored through psychological battery tests and clinical procedures. To address the stigma associated with mental illness, social media is used to examine language patterns in posts related to suicide. This strategy enhances the comprehension and interpretation of suicidal ideation. Despite easy expression via social media, suicidal thoughts remain sensitive and complex to comprehend and detect. Suicidal ideation captures the new suicidal statements used during the COVID-19 pandemic that represents a different context of expressions. Objective: In this study, our aim was to detect suicidal ideation by mining textual content extracted from social media by leveraging state-of-the-art natural language processing (NLP) techniques. Methods: The work was divided into 2 major phases, one to classify suicidal ideation posts and the other to extract factors that cause suicidal ideation. We proposed a hybrid deep learning–based neural network approach (Bidirectional Encoder Representations from Transformers [BERT]+convolutional neural network [CNN]+long short-term memory [LSTM]) to classify suicidal and nonsuicidal posts. Two state-of-the-art deep learning approaches (CNN and LSTM) were combined based on features (terms) selected from term frequency–inverse document frequency (TF-IDF), Word2vec, and BERT. Explainable artificial intelligence (XAI) was used to extract key factors that contribute to suicidal ideation in order to provide a reliable and sustainable solution. Results: Of 348,110 records, 3154 (0.9%) were selected, resulting in 1338 (42.4%) suicidal and 1816 (57.6%) nonsuicidal instances. The CNN+LSTM+BERT model achieved superior performance, with a precision of 94%, a recall of 95%, an F1-score of 94%, and an accuracy of 93.65%. Conclusions: Considering the dynamic nature of suicidal behavior posts, we proposed a fused architecture that captures both localized and generalized contextual information that is important for understanding the language patterns and predict the evolution of suicidal ideation over time. According to Local Interpretable Model-Agnostic Explanations (LIME) and Shapley Additive Explanations (SHAP) XAI algorithms, there was a drift in the features during and before COVID-19. Due to the COVID-19 pandemic, new features have been added, which leads to suicidal tendencies. In the future, strategies need to be developed to combat this deadly disease. %M 39823631 %R 10.2196/65434 %U https://www.jmir.org/2025/1/e65434 %U https://doi.org/10.2196/65434 %U http://www.ncbi.nlm.nih.gov/pubmed/39823631 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56601 %T Development and Evaluation of a Mindfulness-Based Mobile Intervention for Perinatal Mental Health: Randomized Controlled Trial %A Park,Sehwan %A Cho,Hee Young %A Park,Jin Young %A Chung,Kyungmi %A Jhung,Kyungun %+ Department of Psychiatry, Catholic Kwandong University International St. Mary’s Hospital, Catholic Kwandong University College of Medicine, 25, Simgok-ro 100 Beon-gil, Incheon, 22711, Republic of Korea, 82 1090563807, kyungun12@gmail.com %K anxiety %K perinatal mental health %K depression %K mobile health care %K mindfulness %K mobile phone %D 2025 %7 17.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Perinatal mental health problems, such as anxiety, stress, and depression, warrant particularly close monitoring and intervention, but they are often unaddressed in both obstetric and psychiatric clinics, with limited accessibility and treatment resources. Mobile health interventions may provide an effective and more accessible solution for addressing perinatal mental health. Development and evaluation of a mobile mental health intervention specifically for pregnant women are warranted. Objective: This study aimed to evaluate the effectiveness of a 4-week, self-administered mobile mindfulness intervention in reducing anxiety, depression, and stress, and improving emotional well-being, maternal-fetal attachment, and mindfulness skills in a general population of pregnant women. Methods: Pregnant women were recruited and randomized to an intervention or a wait-list control group. The intervention group participated in a self-administered 4-week smartphone-based mindfulness program. Anxiety, depression, and stress were assessed as primary outcomes at baseline and postintervention. Secondary outcomes were mental health well-being, maternal-fetal attachment, and skills of mindfulness. The usability of the mobile intervention was also evaluated. Results: A total of 133 pregnant women were randomly assigned to the intervention (n=66) or the control group (n=67). The overall dropout rate was 30% (39/133). Anxiety scores of the intervention group significantly decreased from baseline to postintervention (P=.03, Wilcoxon Signed-Rank test), whereas no significant changes were observed in the control group. Depression and stress scores showed no significant changes. Emotional well-being significantly improved in the intervention group (P=.01). Improvements were observed in maternal-fetal attachment, particularly in attributing characteristics to the fetus (P=.003) and in differentiating the self from the fetus (P=.006). Mindfulness awareness also showed significant improvement (P=.008). Significant between-group effects were identified for mindfulness awareness (P=.006) and attributing characteristics to the fetus (P=.002). After applying the false discovery rate corrections, within-group improvements in emotional well-being, maternal-fetal attachment, and mindfulness awareness remained significant, while between-group differences for emotional well-being and differentiation were not significant. Conclusions: A mobile mindfulness program effectively reduced anxiety and improved emotional well-being, maternal-fetal attachment, and mindfulness awareness in the general population of pregnant women. Mobile interventions may offer a cost-effective and feasible method for promoting perinatal mental health. Trial Registration: Clinical Research Information Service KCT0007166; https://tinyurl.com/458vfc4r %M 39823585 %R 10.2196/56601 %U https://www.jmir.org/2025/1/e56601 %U https://doi.org/10.2196/56601 %U http://www.ncbi.nlm.nih.gov/pubmed/39823585 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57614 %T A Mobile Health Intervention to Support Collaborative Decision-Making in Mental Health Care: Development and Usability %A Romm,Kristin Lie %A Skoge,Mari %A Barrett,Elizabeth Ann %A Berentzen,Lars-Christian %A Bergsager,Dagfinn %A Fugelli,Pål %A Bjella,Thomas %A Gardsjord,Erlend Strand %A Kling,Kristine %A Kruse,Sindre Hembre %A Kværner,Kari Jorunn %A Melle,Ingrid %A Mork,Erlend %A Ihler,Henrik Myhre %A Rognli,Eline Borger %A Simonsen,Carmen %A Værnes,Tor Gunnar %A Aminoff,Sofie Ragnhild %+ Early Intervention in Psychosis Advisory Unit for South-East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Sognsvannsveien 21, Oslo, 0372, Norway, 47 91 50 27 70, k.l.romm@medisin.uio.no %K eHealth %K shared decision-making %K user involvement %K user-centered design %K mental disorder %K mobile technology %K illness course %K recovery %K mobile apps %K mHealth %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Shared decision-making between clinicians and service users is crucial in mental health care. One significant barrier to achieving this goal is the lack of user-centered services. Integrating digital tools into mental health services holds promise for addressing some of these challenges. However, the implementation of digital tools, such as mobile apps, remains limited, and attrition rates for mental health apps are typically high. Design thinking can support the development of tools tailored to the needs of service users and clinicians. Objective: This study aims to develop and beta test a digital tool designed for individuals with severe mental disorders or substance use disorders to facilitate shared decision-making on treatment goals and strategies within mental health services. Methods: We used a user-centered design approach to develop iTandem, an app facilitating collaborative treatment between service users and clinicians. Through qualitative interviews and workshops, we engaged 6 service users with severe mental disorders or substance use disorders, 6 clinicians, and 1 relative to identify and design relevant app modules. A beta test of iTandem was conducted to refine the app and plan for a pilot trial in a clinical setting. After 6 weeks of app use, 5 clinicians and 4 service users were interviewed to provide feedback on the concept, implementation, and technical issues. Safety and ethical considerations were thoroughly discussed and addressed. Results: To avoid overload for the service users, we applied a pragmatic take on module content and size. Thus, iTandem includes the following 8 modules, primarily based on the needs of service users and clinicians: Sleep (sleep diary), Medication (intake and side effects), Recovery (measures, including well-being and personal recovery, and exercises, including good things and personal strengths), Mood (mood diary and report of daily feelings), Psychosis (level of positive symptoms and their consequences and level of negative symptoms), Activity (goal setting and progress), Substance use (weekly use, potential triggers or strategies used to abstain), and Feedback on therapy (of individual sessions and overall rating of the past week). For the beta testing, service users and clinicians collaborated in choosing 2-3 modules in iTandem to work with during treatment sessions. The testing showed that the app was well received by service users, and that facilitation for implementation is crucial. Conclusions: iTandem and similar apps have the potential to enhance treatment outcomes by facilitating shared decision-making and tailoring treatment to the needs of service users. However, successful implementation requires thorough testing, iterative development, and evaluations of both utility and treatment effects. There is a critical need to focus on how technology integrates into clinical settings—from development to implementation—and to conduct further research on early health technology assessments to guide these processes. %M 39823632 %R 10.2196/57614 %U https://formative.jmir.org/2025/1/e57614 %U https://doi.org/10.2196/57614 %U http://www.ncbi.nlm.nih.gov/pubmed/39823632 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 11 %N %P e54154 %T Benefits of Remote-Based Mindfulness on Physical Symptom Outcomes in Cancer Survivors: Systematic Review and Meta-Analysis %A Komariah,Maria %A Maulana,Sidik %A Amirah,Shakira %A Platini,Hesti %A Rahayuwati,Laili %A Yusuf,Ah %A Firdaus,Mohd Khairul Zul Hasymi %K cancer %K physical symptoms %K mindfulness %K remote-based intervention %K quality of life %D 2025 %7 16.1.2025 %9 %J JMIR Cancer %G English %X Background: Many cancer survivors experience a wide range of symptoms closely linked to psychological problems, highlighting the need for psychological treatment, one of the most popular being mindfulness. The use of the internet has greatly increased in the last decade, and has encouraged the use of remote-based interventions to help people living with cancer access treatment remotely via devices. Objective: The primary aim of this study was to explore the efficacy of internet-based mindfulness interventions on the physical symptoms of people living with cancer, where physical symptoms are defined as distressing somatic experiences (eg fatigue, insomnia, and pain) regardless of the underlying cause. The secondary aim was to investigate interventions for the quality of life (QoL). Methods: This study followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. Relevant articles were systematically searched using electronic databases, namely Scopus, Medline through PubMed, Cumulated Index in Nursing and Allied Health Literature (CINAHL) through EBSCOhost, and Cochrane Central Database. Randomized controlled and pilot trials involving adults and/or older adults with cancer and using remote-based mindfulness interventions compared to usual care were included. The quality of the trials included in this study was assessed using the revised Cochrane risk of bias, version 2.0. This study estimated the standardized mean difference (SMD) and mean difference (MD) with 95% CI. The I2 test was used to identify potential causes of heterogeneity. Publication bias was assessed using contour-enhanced funnel plots and the Egger linear regression test to reveal a small study effect. Results: The initial search yielded 1985 records, of which 13 studies were ultimately included. After treatment, remote-based mindfulness significantly reduced fatigue (SMD −0.94; 95% CI: −1.56 to −0.33; P=.002), sleep disturbance (SMD −0.36; 95% CI: −0.60 to −0.12; P=.004), and improved physical function (SMD .25; 95% CI: 0.09 to 0.41; P=.002) compared to that observed before treatment. However, compared with usual care, remote-based mindfulness showed a statistically significant reduction only in sleep disturbance (SMD: −0.37; 95% CI: −0.58 to −0.16; P=.0006) after treatment. Moreover, remote-based mindfulness was not statistically significant in reducing pain both within and between groups. Conclusions: Remote-based mindfulness shows promise in reducing sleep disturbances; however, its impact on fatigue, pain, and physical function may be limited. %R 10.2196/54154 %U https://cancer.jmir.org/2025/1/e54154 %U https://doi.org/10.2196/54154 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e51022 %T Determinants of Dropout From a Virtual Agent–Based App for Insomnia Management in a Self-Selected Sample of Users With Insomnia Symptoms: Longitudinal Study %A Sanchez Ortuño,María Montserrat %A Pecune,Florian %A Coelho,Julien %A Micoulaud-Franchi,Jean Arthur %A Salles,Nathalie %A Auriacombe,Marc %A Serre,Fuschia %A Levavasseur,Yannick %A De Sevin,Etienne %A Sagaspe,Patricia %A Philip,Pierre %K insomnia %K digital behavioral therapy %K mobile health %K dropout %K virtual agent–based app %K virtual agent %K user %K digital intervention %K smartphone %K mental health %K implementation %K cognitive behavioral therapy %K CBT %D 2025 %7 15.1.2025 %9 %J JMIR Ment Health %G English %X Background: Fully automated digital interventions delivered via smartphone apps have proven efficacious for a wide variety of mental health outcomes. An important aspect is that they are accessible at a low cost, thereby increasing their potential public impact and reducing disparities. However, a major challenge to their successful implementation is the phenomenon of users dropping out early. Objective: The purpose of this study was to pinpoint the factors influencing early dropout in a sample of self-selected users of a virtual agent (VA)–based behavioral intervention for managing insomnia, named KANOPEE, which is freely available in France. Methods: From January 2021 to December 2022, of the 9657 individuals, aged 18 years or older, who downloaded and completed the KANOPEE screening interview and had either subclinical or clinical insomnia symptoms, 4295 (44.5%) dropped out (ie, did not return to the app to continue filling in subsequent assessments). The primary outcome was a binary variable: having dropped out after completing the screening assessment (early dropout) or having completed all the treatment phases (n=551). Multivariable logistic regression analysis was used to identify predictors of dropout among a set of sociodemographic, clinical, and sleep diary variables, and users’ perceptions of the treatment program, collected during the screening interview. Results: The users’ mean age was 47.95 (SD 15.21) years. Of those who dropped out early and those who completed the treatment, 65.1% (3153/4846) were women and 34.9% (1693/4846) were men. Younger age (adjusted odds ratio [AOR] 0.98, 95% CI 0.97‐0.99), lower education level (compared to middle school; high school: AOR 0.56, 95% CI 0.35‐0.90; bachelor’s degree: AOR 0.35, 95% CI 0.23‐0.52; master’s degree or higher: AOR 0.35, 95% CI 0.22‐0.55), poorer nocturnal sleep (sleep efficiency: AOR 0.64, 95% CI 0.42‐0.96; number of nocturnal awakenings: AOR 1.13, 95% CI 1.04‐1.23), and more severe depression symptoms (AOR 1.12, 95% CI 1.04‐1.21) were significant predictors of dropping out. When measures of perceptions of the app were included in the model, perceived benevolence and credibility of the VA decreased the odds of dropout (AOR 0.91, 95% CI 0.85‐0.97). Conclusions: As in traditional face-to-face cognitive behavioral therapy for insomnia, the presence of significant depression symptoms plays an important role in treatment dropout. This variable represents an important target to address to increase early engagement with fully automated insomnia management programs. Furthermore, our results support the contention that a VA can provide relevant user stimulation that will eventually pay out in terms of user engagement. Trial Registration: ClinicalTrials.gov NCT05074901; https://clinicaltrials.gov/study/NCT05074901?a=1 %R 10.2196/51022 %U https://mental.jmir.org/2025/1/e51022 %U https://doi.org/10.2196/51022 %0 Journal Article %@ 2817-092X %I JMIR Publications %V 4 %N %P e64182 %T Transforming Perceptions: Exploring the Multifaceted Potential of Generative AI for People With Cognitive Disabilities %A Hadar Souval,Dorit %A Haber,Yuval %A Tal,Amir %A Simon,Tomer %A Elyoseph,Tal %A Elyoseph,Zohar %K generative artificial intelligence %K cognitive disability %K social participation %K AI ethics %K assistive technology %K cognitive disorder %K societal barriers %K social inclusion %K disability study %K social mirror %K cognitive partner %K empowerment %K user involvement %K GenAI %K artificial intelligence %K neurotechnology %K neuroinformatics %K digital health %K health informatics %K neuroscience %K mental health %K computer science %K machine learning %D 2025 %7 15.1.2025 %9 %J JMIR Neurotech %G English %X Background: The emergence of generative artificial intelligence (GenAI) presents unprecedented opportunities to redefine conceptions of personhood and cognitive disability, potentially enhancing the inclusion and participation of individuals with cognitive disabilities in society. Objective: We aim to explore the transformative potential of GenAI in reshaping perceptions of cognitive disability, dismantling societal barriers, and promoting social participation for individuals with cognitive disabilities. Methods: This study is a critical review of current literature in disability studies, artificial intelligence (AI) ethics, and computer science, integrating insights from disability theories and the philosophy of technology. The analysis focused on 2 key aspects: GenAI as a social mirror reflecting societal values and biases, and GenAI as a cognitive partner for individuals with cognitive disabilities. Results: This paper proposes a theoretical framework for understanding the impact of GenAI on perceptions of cognitive disability. It introduces the concepts of GenAI as a “social mirror” that reflects and potentially amplifies societal biases and as a “cognitive copilot” providing personalized assistance in daily tasks, social interactions, and environmental navigation. This paper also presents a novel protocol for developing AI systems tailored to the needs of individuals with cognitive disabilities, emphasizing user involvement, ethical considerations, and the need to address both the opportunities and challenges posed by GenAI. Conclusions: Although GenAI has great potential for promoting the inclusion and empowerment of individuals with cognitive disabilities, realizing this potential requires a change in societal attitudes and development practices. This paper calls for interdisciplinary collaboration and close partnership with the disability community in the development and implementation of GenAI technologies. Realizing the potential of GenAI for promoting the inclusion and empowerment of individuals with cognitive disabilities requires a multifaceted approach. This involves a shift in societal attitudes, inclusive AI development practices that prioritize the needs and perspectives of the disability community, and ongoing interdisciplinary collaboration. This paper emphasizes the importance of proceeding with caution, recognizing the ethical complexities and potential risks alongside the transformative possibilities of GenAI technology. %R 10.2196/64182 %U https://neuro.jmir.org/2025/1/e64182 %U https://doi.org/10.2196/64182 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59154 %T Considering Comorbidities and Individual Differences in Testing a Gaming Behavioral Activation App for Perinatal Depression and Anxiety: Open Trial Pilot Intervention Study %A Hamlett,Gabriella E %A Schrader,Chloe %A Ferguson,Craig %A Kobylski,Lauren A %A Picard,Rosalind %A Locascio,Joseph J %A McNally,Richard J %A Cohen,Lee S %A Vanderkruik,Rachel %K perinatal anxiety %K perinatal depression %K behavioral activation %K digital mental health %K mobile phone %D 2025 %7 14.1.2025 %9 %J JMIR Form Res %G English %X Background: There is increasing interest in the development of scalable digital mental health interventions for perinatal populations to increase accessibility. Mobile behavioral activation (BA) is efficacious for the treatment of perinatal depression; however, the effect of comorbid anxiety and depression (CAD) on symptom trajectories remains underexplored. This is important given that at least 10% of women in the perinatal period experience CAD. Objective: We assessed whether there were differences in symptom trajectories in pregnant participants with CAD as compared to those with depression only (ie, major depressive disorder [MDD]) during intervention with a BA mobile gaming app. Methods: Pregnant adults with either CAD (n=10) or MDD (n=7) used a BA app for 10 weeks and completed biweekly symptom severity questionnaires for depression and anxiety. We assessed whether baseline diagnoses were associated with differential symptom trajectories across the study with mixed effects longitudinal models. Results: When controlling for baseline symptoms, results revealed a significant interaction between baseline diagnosis and the quadratic component of study week on anxiety (β=.18, SE 0.07; t62=2.61; P=.01), revealing a tendency for anxiety in the CAD group to increase initially and then decrease at an accelerated rate, whereas MDD symptoms were relatively stable across time. There was a significant effect of linear time on depression (β=−.39, SE 0.11; t68=−3.51; P=.001), showing that depression declined steadily across time for both groups. There was a significant effect of baseline diagnosis on depression (β=−8.53, SE 3.93; t13=−2.17; P=.05), suggesting that those with MDD had higher follow-up depression compared to those with CAD when holding other predictors constant. Conclusions: The app was beneficial in reducing depression symptoms in perinatal individuals with different comorbidity profiles. With respect to anxiety symptom trajectories, however, there was more variability. The app may be especially effective for the treatment of anxiety symptoms among individuals with CAD, as it encourages in-the-moment ecologically relevant exposure to anxiety-provoking stimuli. Despite no significant group difference in baseline anxiety symptoms, the MDD group did not have a significant reduction in their anxiety symptoms across the study period, and some individuals had an increase in anxiety. Findings may point to opportunities for the augmentation of BA gaming apps for those with MDD to more effectively target anxiety symptoms. Overall, findings suggest there may be value in considering comorbidities and individual variations in participants when developing scalable mobile interventions for perinatal populations. %R 10.2196/59154 %U https://formative.jmir.org/2025/1/e59154 %U https://doi.org/10.2196/59154 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66181 %T Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study %A Vonderlin,Ruben %A Boritz,Tali %A Claus,Carola %A Senyüz,Büsra %A Mahalingam,Saskia %A Tennenhouse,Rachel %A Lis,Stefanie %A Schmahl,Christian %A Margraf,Jürgen %A Teismann,Tobias %A Kleindienst,Nikolaus %A McMain,Shelley %A Bohus,Martin %+ Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 621 1703 4445, ruben.vonderlin@zi-mannheim.de %K dialectical behavior therapy %K borderline personality disorder %K online psychotherapy %K virtual psychotherapy %K telehealth %K personality disorders %K mental %K psychotherapy %K online %K internet %K telemedicine %K psychiatry %K psychiatric %K acceptance %D 2025 %7 14.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation. Objective: This study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD). Methods: A total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists’ and patients’ perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples. Results: Analyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format. Conclusions: Telehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered. Trial Registration: German Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824 %M 39808784 %R 10.2196/66181 %U https://formative.jmir.org/2025/1/e66181 %U https://doi.org/10.2196/66181 %U http://www.ncbi.nlm.nih.gov/pubmed/39808784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60292 %T The Impact of Linguistic Signals on Cognitive Change in Support Seekers in Online Mental Health Communities: Text Analysis and Empirical Study %A Li,Min %A Gu,Dongxiao %A Li,Rui %A Gu,Yadi %A Liu,Hu %A Su,Kaixiang %A Wang,Xiaoyu %A Zhang,Gongrang %+ School of Management, Hefei University of Technology, 193 Tunxi Road, Hefei, 230009, China, 86 13866167367, gudongxiao@hfut.edu.cn %K mental health %K online communities %K cognitive change %K signaling theory %K text analysis %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: In online mental health communities, the interactions among members can significantly reduce their psychological distress and enhance their mental well-being. The overall quality of support from others varies due to differences in people’s capacities to help others. This results in some support seekers’ needs being met, while others remain unresolved. Objective: This study aimed to examine which characteristics of the comments posted to provide support can make support seekers feel better (ie, result in cognitive change). Methods: We used signaling theory to model the factors affecting cognitive change and used consulting strategies from the offline, face-to-face psychological counseling process to construct 6 characteristics: intimacy, emotional polarity, the use of first-person words, the use of future-tense words, specificity, and language style. Through text mining and natural language processing (NLP) technology, we identified linguistic features in online text and conducted an empirical analysis using 12,868 online mental health support reply data items from Zhihu to verify the effectiveness of those features. Results: The findings showed that support comments are more likely to alter support seekers’ cognitive processes if those comments have lower intimacy (βintimacy=–1.706, P<.001), higher positive emotional polarity (βemotional_polarity=.890, P<.001), lower specificity (βspecificity=–.018, P<.001), more first-person words (βfirst-person=.120, P<.001), more future- and present-tense words (βfuture-words=.301, P<.001), and fewer function words (βlinguistic_style=–.838, P<.001). The result is consistent with psychotherapists’ psychotherapeutic strategy in offline counseling scenarios. Conclusions: Our research contributes to both theory and practice by proposing a model to reveal the factors that make support seekers feel better. The findings have significance for support providers. Additionally, our study offers pointers for managing and designing online communities for mental health. %M 39808783 %R 10.2196/60292 %U https://www.jmir.org/2025/1/e60292 %U https://doi.org/10.2196/60292 %U http://www.ncbi.nlm.nih.gov/pubmed/39808783 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65589 %T Therapeutic Potential of Social Chatbots in Alleviating Loneliness and Social Anxiety: Quasi-Experimental Mixed Methods Study %A Kim,Myungsung %A Lee,Seonmi %A Kim,Sieun %A Heo,Jeong-in %A Lee,Sangil %A Shin,Yu-Bin %A Cho,Chul-Hyun %A Jung,Dooyoung %+ Department of Psychiatry, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 029205505, david0203@gmail.com %K artificial intelligence %K AI %K social chatbot %K loneliness %K social anxiety %K exploratory research %K mixed methods study %D 2025 %7 14.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) social chatbots represent a major advancement in merging technology with mental health, offering benefits through natural and emotional communication. Unlike task-oriented chatbots, social chatbots build relationships and provide social support, which can positively impact mental health outcomes like loneliness and social anxiety. However, the specific effects and mechanisms through which these chatbots influence mental health remain underexplored. Objective: This study explores the mental health potential of AI social chatbots, focusing on their impact on loneliness and social anxiety among university students. The study seeks to (i) assess the impact of engaging with an AI social chatbot in South Korea, "Luda Lee," on these mental health outcomes over a 4-week period and (ii) analyze user experiences to identify perceived strengths and weaknesses, as well as the applicability of social chatbots in therapeutic contexts. Methods: A single-group pre-post study was conducted with university students who interacted with the chatbot for 4 weeks. Measures included loneliness, social anxiety, and mood-related symptoms such as depression, assessed at baseline, week 2, and week 4. Quantitative measures were analyzed using analysis of variance and stepwise linear regression to identify the factors affecting change. Thematic analysis was used to analyze user experiences and assess the perceived benefits and challenges of chatbots. Results: A total of 176 participants (88 males, average age=22.6 (SD 2.92)) took part in the study. Baseline measures indicated slightly elevated levels of loneliness (UCLA Loneliness Scale, mean 27.97, SD (11.07)) and social anxiety (Liebowitz Social Anxiety Scale, mean 25.3, SD (14.19)) compared to typical university students. Significant reductions were observed as loneliness decreasing by week 2 (t175=2.55, P=.02) and social anxiety decreasing by week 4 (t175=2.67, P=.01). Stepwise linear regression identified baseline loneliness (β=0.78, 95% CI 0.67 to 0.89), self-disclosure (β=–0.65, 95% CI –1.07 to –0.23) and resilience (β=0.07, 95% CI 0.01 to 0.13) as significant predictors of week 4 loneliness (R2=0.64). Baseline social anxiety (β=0.92, 95% CI 0.81 to 1.03) significantly predicted week 4 anxiety (R2=0.65). These findings indicate higher baseline loneliness, lower self-disclosure to the chatbot, and higher resilience significantly predicted higher loneliness at week 4. Additionally, higher baseline social anxiety significantly predicted higher social anxiety at week 4. Qualitative analysis highlighted the chatbot's empathy and support as features for reliability, though issues such as inconsistent responses and excessive enthusiasm occasionally disrupted user immersion. Conclusions: Social chatbots may have the potential to mitigate feelings of loneliness and social anxiety, indicating their possible utility as complementary resources in mental health interventions. User insights emphasize the importance of empathy, accessibility, and structured conversations in achieving therapeutic goals. Trial Registration: Clinical Research Information Service (CRIS) KCT0009288; https://tinyurl.com/hxrznt3t %M 39808786 %R 10.2196/65589 %U https://www.jmir.org/2025/1/e65589 %U https://doi.org/10.2196/65589 %U http://www.ncbi.nlm.nih.gov/pubmed/39808786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59540 %T Effectiveness of a Videoconference-Based Cognitive Behavioral Therapy Program for Patients with Schizophrenia: Pilot Randomized Controlled Trial %A Katsushima,Masayuki %A Nakamura,Hideki %A Shiko,Yuki %A Hanaoka,Hideki %A Shimizu,Eiji %+ Department of Rehabilitation, Faculty of Health Care and Medical Sports, Teikyo Heisei University, 4-1 UruidoMinami, Ichihara, 290-0193, Japan, 81 436 74 6915, m.katsushima@thu.ac.jp %K schizophrenia %K randomized controlled trial %K cognitive behavioral therapy %K videoconference %K remote therapy %D 2025 %7 14.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy for psychosis (CBTp) is not sufficiently widespread in clinical practice, although evidence has been presented. Objective: The purpose of this study was to explore whether one-on-one videoconference-based CBTp (vCBTp) is more effective than usual care (UC) alone for improving psychiatric symptoms in patients with schizophrenia attending outpatient clinics. Methods: In this exploratory randomized controlled trial, patients with schizophrenia and schizoaffective disorders who were still taking medication in an outpatient clinic were randomly assigned to either the vCBTp plus UC group (n=12) or the UC group (n=12). The vCBTp program was conducted once a week, with each session lasting for 50 minutes, for a total of 7 sessions conducted in real-time and in a one-on-one format remotely using a loaned tablet computer (iPad). The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score, which measures the difference in the mean change from baseline (week 0) to posttest (week 8). Results: The study included 24 participants. There were no significant differences between the 2 groups at baseline. With regard to significant differences between the 2 groups in terms of the primary outcome, the mean change in the PANSS total score from baseline to week 8 in the vCBTp plus UC group was –9.5 (95% CI –12.09 to –6.91) and the mean change in the UC alone group was 6.9 (95% CI 1.54-12.30). The difference between the 2 groups was significant (P<.001). In addition, significant improvements were observed in the subscales of positive (P<.001) and negative (P=.004) symptoms and general psychopathology (P<.001). Significant differences were also observed in the secondary outcomes of the General Anxiety Disorder-7 (GAD-7; P=.04) and EQ-5D-5L (P=.005). There were no dropouts and no serious adverse events in this study. Conclusions: A total of 7 remote vCBTp sessions conducted in the vCBTp plus UC group could be safely administered to patients with schizophrenia. They were also observed to be effective for psychiatric symptoms, general anxiety, and quality of life. However, because of the observed worsening of scores in the UC group, caution is required in interpreting significant differences between the 2 groups. This approach is expected to improve accessibility to CBTp for outpatients with schizophrenia and social anxiety regarding transportation use and financial and physical burdens related to transportation, and to contribute to promoting CBTp acceptability by compensating for the shortage of implementers. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000043396; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000049544 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069734 %M 39610049 %R 10.2196/59540 %U https://formative.jmir.org/2025/1/e59540 %U https://doi.org/10.2196/59540 %U http://www.ncbi.nlm.nih.gov/pubmed/39610049 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e53850 %T A Mobile App–Based Gratitude Intervention’s Effect on Mental Well-Being in University Students: Randomized Controlled Trial %A Fuller,Chloë %A Marin-Dragu,Silvia %A Iyer,Ravishankar Subramani %A Meier,Sandra Melanie %K gratitude intervention %K smartphone app %K gratitude exercises %K psychological well-being %K mobile phone %D 2025 %7 14.1.2025 %9 %J JMIR Mhealth Uhealth %G English %X Background: Gratitude interventions are used to cultivate a sense of gratitude for life and others. There have been mixed results of the efficacy of gratitude interventions’ effect on psychological well-being with a variety of populations and methodologies. Objectives: The objective of our study was to test the effectiveness of a gratitude intervention smartphone app on university students’ psychological well-being. Methods: We used a randomized experimental design to test our objective. Participants were recruited undergraduate students from a web-based university study recruitment system. Participants completed 90 web-based survey questions on their emotional well-being and personality traits at the beginning and end of the 3-week research period. Their depression, anxiety, and stress levels were measured with the Depression, Anxiety, and Stress Scale (DASS-21). After the baseline survey, participants were randomly assigned to either the control or the intervention. Participants in the intervention group used both a fully automated mobile sensing app and a gratitude intervention mobile iOS smartphone app designed for youth users and based on previous gratitude interventions and exercises. The gratitude intervention app prompted users to complete daily gratitude exercises on the app including a gratitude journal, a gratitude photo book, an imagine exercise, a speech exercise, and meditation. Participants in the control group used only the mobile sensing app, which passively collected smartphone sensory data on mobility, screen time, sleep, and social interactions. Results: A total of 120 participants met the inclusion criteria, and 27 were lost to follow-up for a total of 41 participants in the intervention group and 52 in the control group providing complete data. Based on clinical cutoffs from the baseline assessment, 56 out of 120 participants were identified as being in a subsample with at least moderate baseline symptomatology. Participants in the subsample with at least moderate baseline symptomatology reported significantly lower symptoms of depression, anxiety, and stress postintervention (Cohen d=−0.68; P=.04) but not in the full sample with low baseline symptomatology (Cohen d=0.16; P=.46). The number of times the app was accessed was not correlated with changes in either the subsample (r=0.01; P=.98) or the full sample (r=−0.04; P=.79). Conclusions: University students experiencing moderate to severe distress can benefit from a gratitude intervention smartphone app to improve symptoms of depression, anxiety, and stress. The number of times the gratitude intervention app was used is not related to well-being outcomes. Clinicians could look at incorporating gratitude apps with other mental health treatments or for those waitlisted as a cost-effective and minimally guided option for university students experiencing psychological distress. Trial Registration: Clinicaltrials.gov NCT06621745; http://clinicaltrials.gov/ct2/show/NCT06621745 %R 10.2196/53850 %U https://mhealth.jmir.org/2025/1/e53850 %U https://doi.org/10.2196/53850 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64218 %T Community-Based 4-Level Intervention Targeting Depression and Suicidal Behavior in Europe: Protocol for an Implementation Project %A Schnitzspahn,Katharina %A Abdulla,Kahar %A Arensman,Ella %A Van Audenhove,Chantal %A Mere,Rainer %A Pérez Sola,Victor %A Sisask,Merike %A Székely,András %A Toczyski,Piotr %A Hegerl,Ulrich %+ European Alliance Against Depression e.V., Heinrich-Hoffmann-Str. 10, Leipzig, 60528, Germany, 49 069630180928, katharina.schnitzspahn@eaad.net %K depression %K suicide %K mental health %K European Alliance Against Depression %K EAAD %K 4-level community-based intervention %K iFightDepression %K cognitive behavioral therapy %K mHealth %D 2025 %7 10.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: The community-based, 4-level intervention of the European Alliance Against Depression (EAAD) is simultaneously addressing depression and suicidal behavior. Intervention activities target primary care health professionals (level 1), the general public (level 2), community facilitators (level 3), and patients and their relatives (level 4). Activities comprise the digital iFightDepression tool, a guided self-management tool based on cognitive behavioral therapy. Objective: This study aimed to present the European Union–cofunded EAAD-Best study protocol, aiming at the implementation, dissemination, and evaluation of the 4-level intervention and the iFightDepression tool in several countries across Europe. Methods: The 4-level intervention has been implemented for the first time in Bulgaria, Estonia, Greece, and Poland. In 3 countries that have already implemented the 4-level intervention (Hungary, Ireland, and Spain), activities have been extended to new regions. In addition, the nationwide uptake of the iFightDepression tool by patients with depression has been promoted in all mentioned countries and Italy. Results: To evaluate the implementation of the 4-level intervention and the iFightDepression tool, data related to the process, output, and outcome were collected between 2022 and 2024. Data processing and analyses started in 2023. Analyses are expected to be completed in 2024. Results are expected to be published in 2025. Conclusions: This paper informs researchers, practitioners, and stakeholders on how to implement best practices in mental health promotion and evaluate their effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/64218 %M 39793023 %R 10.2196/64218 %U https://www.researchprotocols.org/2025/1/e64218 %U https://doi.org/10.2196/64218 %U http://www.ncbi.nlm.nih.gov/pubmed/39793023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67627 %T Trends in Mental Health Outcomes of College Students Amid the Pandemic (Roadmap mHealth App): Longitudinal Observational Study %A Jayaraj,Gautham %A Cao,Xiao %A Horwitz,Adam %A Rozwadowski,Michelle %A Shea,Skyla %A Hanauer,Shira N %A Hanauer,David A %A Tewari,Muneesh %A Shedden,Kerby %A Choi,Sung Won %+ Department of Pediatrics, Medical School, University of Michigan, 1200 E Hospital Dr, Medical Professional Building D4115, Ann Arbor, MI, 48109, United States, 1 734 615 5707, sungchoi@med.umich.edu %K mHealth %K college %K student %K mental health %K positive psychology %K flourishing %K COVID-19 %K wellbeing %K mobile phone %K SARS-CoV-2 %K coronavirus %K pandemic %K COVID %K app %K digital health %K smartphone %K eHealth %K telehealth %K telemedicine %K longitudinal %K higher education %K depression %K anxiety %K loneliness %D 2025 %7 9.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The mental health crisis among college students intensified amid the COVID-19 pandemic, suggesting an urgent need for innovative solutions to support them. Previous efforts to address mental health concerns have been constrained, often due to the underuse or shortage of services. Mobile health (mHealth) technology holds significant potential for providing resilience-building support and enhancing access to mental health care. Objective: This study aimed to examine the trends in mental health and well-being outcomes over 3 years among college students, with an exploratory aim to assess the potential impact of the Roadmap mHealth app on these outcomes. Methods: A fully automated longitudinal observational study was conducted remotely from a large public academic institution in the Midwestern United States, evaluating mental health and well-being outcomes among college students using the Roadmap mHealth app over 3 fall semesters from 2020 to 2022. The study enrolled 2164 college students in Year I, with 1128 and 1033 students returning in Years II and III, respectively. Participants completed various self-reported measures, including the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for anxiety, and additional metrics for coping, flourishing, and loneliness. Results: The findings indicated an evolving trajectory in students’ mental health. In Year I, depression and anxiety levels were higher compared with levels reported between 2014 and 2019, remaining stable into Year II. However, significant decreases were noted by Year III for both depression (Year I mean 7.78, SD 5.65 vs Year III mean 6.21, SD 4.68; t108=–2.90; P=.01) and anxiety (Year I mean 6.61, SD 4.91 vs Year III mean 5.62, SD 4.58; t116=–2.02; P=.046). Problem-focused coping decreased initially from Year I (mean 2.46, SD 0.58) to Year II (mean 2.36, SD 0.60; t1073=–5.87; P<.001), then increased by Year III (mean 2.40, SD 0.63; t706=2.26; P=.02). Emotion-focused (Year I mean 2.33, SD 0.41 vs Year III mean 2.22, SD 0.47; t994=–7.47; P<.001) and avoidant coping (Year I mean 1.76, SD 0.37 vs Year III mean 1.65, SD 0.38; t997=–8.53; P=.02) consistently decreased. Loneliness significantly decreased from Year I (mean 5.79, SD 1.74) to Year III (mean 5.17, SD 1.78; t1013=–10.74; P<.001), accompanied by an increase in flourishing from Year I (mean 63.78, SD 14.76) to Year III (mean 66.98, SD 15.06; t994=7.22; P<.001). Analysis of app usage indicated that the positive piggy bank and gratitude journal were the favored activities. Greater engagement with the app was positively correlated with enhanced flourishing, even after adjusting for demographic and sociobehavioral factors (β=.04, SE .016; t3974=2.17; P=.03). Conclusions: In this study, students’ mental health and well-being improved, with notable reductions in depression, anxiety, and loneliness, associated with an increase in flourishing. The app did not appear to worsen students’ mental health. Based on the usage pattern, it is possible the app enhanced positive psychology-based practices. Future research should explore the efficacy of mHealth interventions through randomized controlled trials to further understand their impact on college students’ mental health outcomes. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): RR2-10.2196/29561 %M 39787592 %R 10.2196/67627 %U https://www.jmir.org/2025/1/e67627 %U https://doi.org/10.2196/67627 %U http://www.ncbi.nlm.nih.gov/pubmed/39787592 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e59124 %T Effectiveness of a Virtual Reality Serious Video Game (The Secret Trail of Moon) for Emotional Regulation in Children With Attention-Deficit/Hyperactivity Disorder: Randomized Clinical Trial %A Martin-Moratinos,Marina %A Bella-Fernández,Marcos %A Rodrigo-Yanguas,María %A González-Tardón,Carlos %A Li,Chao %A Wang,Ping %A Royuela,Ana %A Lopez-Garcia,Pilar %A Blasco-Fontecilla,Hilario %+ Health Sciences and School of Doctoral Programs, International University of La Rioja, Avda de la Paz, 137, Logroño, 26006, Spain, 34 910149575, hilariomanuel.blasco@unir.net %K attention-deficit/hyperactivity disorder %K ADHD %K emotional regulation %K serious video games %K virtual reality %K cognitive training %K music %K chess %D 2025 %7 8.1.2025 %9 Original Paper %J JMIR Serious Games %G English %X Background: Difficulties in emotional regulation are often observed in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Innovative complementary treatments, such as video games and virtual reality, have become increasingly appealing to patients. The Secret Trail of Moon (MOON) is a serious video game developed by a multidisciplinary team featuring cognitive training exercises. In this second randomized clinical trial, we evaluated the impact of a 20-session treatment with MOON on emotional regulation, as measured by the Strengths and Difficulties Questionnaire. Objective: We hypothesize that patients with ADHD using MOON will show improvements in (1) emotional regulation, (2) core ADHD symptoms, (3) cognitive functioning, and (4) academic performance, compared to a control group; additionally, we anticipate that (5) changing the platform (from face-to-face using virtual reality to the web) will not affect emotional regulation scores; and (6) the video game will not cause any clinically significant side effects. Methods: This was a prospective, unicentric, randomized, unblinded, pre- and postintervention study with block-randomized sequence masking. Participants included individuals aged between 7 and 18 years who had a clinical diagnosis of ADHD and were receiving pharmacological treatment. They were randomized into 2 groups using an electronic case report form: the MOON group, receiving standard pharmacological treatment plus personalized cognitive training via a serious video game, and the control group, receiving standard pharmacological treatment. We provided both the groups with psychoeducational support on ADHD. Analysis was conducted using the Student 2-tailed t test and 2-factor ANOVA. An independent monitor supervised the study. Results: A total of 76 patients with ADHD participated in the trial, with an equal randomization (MOON: n=38, 50% and control: n=38, 50%) and a total dropout rate of 7. The primary hypothesis, a 3- or 4-point reduction in the global Strengths and Difficulties Questionnaire score, was not met. However, significant improvements were observed in material organization (P=.03), working memory (P=.04), and inhibition (P=.05), particularly among patients more engaged with the MOON treatment. Conclusions: Serious video games, when integrated into a multimodal treatment plan, can enhance outcomes for symptoms associated with ADHD. Trial Registration: ClinicalTrials.gov NCT06006871; https://clinicaltrials.gov/study/NCT06006871 International Registered Report Identifier (IRRID): RR2-10.2196/53191 %M 39773848 %R 10.2196/59124 %U https://games.jmir.org/2025/1/e59124 %U https://doi.org/10.2196/59124 %U http://www.ncbi.nlm.nih.gov/pubmed/39773848 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58563 %T Trajectories of Change, Illness Understanding, and Parental Worries in Children and Adolescents Undergoing Internet-Delivered Cognitive-Behavioral Therapy for Functional Abdominal Pain Disorders: Protocol for a Single-Case Design and Explorative Pilot Study %A Skovslund Nielsen,Eva %A Kallesøe,Karen %A Bennedsen Gehrt,Tine %A Bjerre-Nielsen,Ellen %A Lalouni,Maria %A Frostholm,Lisbeth %A Bonnert,Marianne %A Rask,Charlotte Ulrikka %+ Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 172,, Aarhus N, 8200, Denmark, 45 23882426, eniels@rm.dk %K functional abdominal pain disorders %K abdominal pain %K internet-based intervention %K cognitive behavioral therapy %K interoception %K attentional bias %K parental distress %K single case study %K children %K adolescents %K youth %K study protocol %K quality of life %K treatment %K medication %K psychological treatment %K psychology %D 2025 %7 7.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Functional abdominal pain disorders (FAPDs) are common in young people and are characterized by persistent or recurrent abdominal symptoms without apparent structural or biochemical abnormalities. FAPDs are associated with diminished quality of life, school absence, increased health care use, and comorbid anxiety and depression. Exposure-based internet-delivered cognitive behavioral therapy (ICBT) has demonstrated efficacy in alleviating abdominal symptoms and improving quality of life. However, a deeper understanding of effect mechanisms and identification of possible additional treatment targets could refine treatment. Objective: This protocol paper aims to describe a study focusing on children and adolescents undergoing ICBT for FAPDs, aiming to further investigate the underlying mechanisms of effect. Methods: Children (8-12 years), adolescents (13-17 years) with FAPDs, and their respective parents will be included for 10 weeks for ICBT. First, detailed trajectories of effect are examined through a randomized single-case design study involving 6 children and 6 adolescents (substudy 1). Following this, an open-ended explorative pilot study with 30 children and 30 adolescents explores potential illness-related cognitive biases and interoceptive accuracy before and after treatment (substudy 2). Finally, spanning across these 2 substudies, including all parents from substudies 1 and 2, we will assess parental distress and illness worries before and after treatment, and how these factors impact the treatment adherence and outcomes of the child or adolescent (substudy 3). Results: Recruitment of participants began in June 2022 and is finalized for substudy 1 and ongoing for substudies 2 and 3. Recruitment is expected to be completed by January 2025, with final data collection during April 2025. Conclusions: The findings have the potential to contribute to the ongoing improvement of specialized psychological treatment for FAPDs in young people. Trial Registration: ClinicalTrials.gov NCT05237882; https://clinicaltrials.gov/study/NCT05237882; ClinicalTrials.gov NCT05486585; https://clinicaltrials.gov/study/NCT05486585; OSF Registries osf.io/c49k7; https://osf.io/c49k7 International Registered Report Identifier (IRRID): DERR1-10.2196/58563 %M 39773759 %R 10.2196/58563 %U https://www.researchprotocols.org/2025/1/e58563 %U https://doi.org/10.2196/58563 %U http://www.ncbi.nlm.nih.gov/pubmed/39773759 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58650 %T Co-Design of an Escape Room for e-Mental Health Training of Mental Health Care Professionals: Research Through Design Study %A Bierbooms,Joyce J P A %A Sluis-Thiescheffer,Wouter R J W %A Feijt,Milou Anne %A Bongers,Inge M B %+ Tilburg University, PO box 90153, Tilburg, 5000 LE, Netherlands, 31 13 466 31 39, j.j.p.a.bierbooms@tilburguniversity.edu %K serious gaming %K mental health care professionals %K e-mental health %K skill enhancement %K training %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Many efforts to increase the uptake of e-mental health (eMH) have failed due to a lack of knowledge and skills, particularly among professionals. To train health care professionals in technology, serious gaming concepts such as educational escape rooms are increasingly used, which could also possibly be used in mental health care. However, such serious-game concepts are scarcely available for eMH training for mental health care professionals. Objective: This study aims to co-design an escape room for training mental health care professionals’ eMH skills and test the escape room’s usability by exploring their experiences with this concept as a training method. Methods: This project used a research through design approach with 3 design stages. In the first stage, the purpose, expectations, and storylines for the escape room were formulated in 2 co-design sessions with mental health care professionals, game designers, innovation staff, and researchers. In the second stage, the results were translated into the first escape room, which was tested in 3 sessions, including one web version of the escape room. In the third stage, the escape room was tested with mental health care professionals outside the co-design team. First, 2 test sessions took place, followed by 3 field study sessions. In the field study sessions, a questionnaire was used in combination with focus groups to assess the usability of the escape room for eMH training in practice. Results: An escape room prototype was iteratively developed and tested by the co-design team, which delivered multiple suggestions for adaptations that were assimilated in each next version of the prototype. The field study showed that the escape room creates a positive mindset toward eMH. The suitability of the escape room to explore the possibilities of eMH was rated 4.7 out of 5 by the professionals who participated in the field study. In addition, it was found to be fun and educational at the same time, scoring 4.7 (SD 0.68) on a 5-point scale. Attention should be paid to the game’s complexity, credibility, and flexibility. This is important for the usefulness of the escape room in clinical practice, which was rated an average of 3.8 (SD 0.77) on a 5-point scale. Finally, implementation challenges should be addressed, including organizational policy and stimulation of eMH training. Conclusions: We can conclude that the perceived usability of an escape room for training mental health care professionals in eMH skills is promising. However, it requires additional effort to transfer the learnings into mental health care professionals’ clinical practice. A straightforward implementation plan and testing the effectiveness of an escape room on skill enhancement in mental health care professionals are essential next steps to reach sustainable goals. %M 39773391 %R 10.2196/58650 %U https://formative.jmir.org/2025/1/e58650 %U https://doi.org/10.2196/58650 %U http://www.ncbi.nlm.nih.gov/pubmed/39773391 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57624 %T The Trifecta of Industry, Academic, and Health System Partnership to Improve Mental Health Care Through Smartphone-Based Remote Patient Monitoring: Development and Usability Study %A Epperson,C Neill %A Davis,Rachel %A Dempsey,Allison %A Haller,Heinrich C %A Kupfer,David J %A Love,Tiffany %A Villarreal,Pamela M %A Matthews,Mark %A Moore,Susan L %A Muller,Kimberly %A Schneck,Christopher D %A Scott,Jessica L %A Zane,Richard D %A Frank,Ellen %+ Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus, 1890 N Revere Ct, Suite 4003, Mail Stop F546, Aurora, CO, 80045, United States, 1 303 724 4940, neill.epperson@cuanschutz.edu %K digital health %K mobile intervention %K telepsychiatry %K artificial intelligence %K psychiatry %K mental health %K depression %K mood %K bipolar %K monitor %K diagnostic tool %K diagnosis %K electronic health record %K EHR %K alert %K notification %K prediction %K mHealth %K mobile health %K smartphone %K passive %K self-reported %K patient generated %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health treatment is hindered by the limited number of mental health care providers and the infrequency of care. Digital mental health technology can help supplement treatment by remotely monitoring patient symptoms and predicting mental health crises in between clinical visits. However, the feasibility of digital mental health technologies has not yet been sufficiently explored. Rhythms, from the company Health Rhythms, is a smartphone platform that uses passively acquired smartphone data with artificial intelligence and predictive analytics to alert patients and providers to an emerging mental health crisis. Objective: The objective of this study was to test the feasibility and acceptability of Rhythms among patients attending an academic psychiatric outpatient clinic. Methods: Our group embedded Rhythms into the electronic health record of a large health system. Patients with a diagnosis of major depressive disorder, bipolar disorder, or other mood disorder were contacted online and enrolled for a 6-week trial of Rhythms. Participants provided data by completing electronic surveys as well as by active and passive use of Rhythms. Emergent and urgent alerts were monitored and managed according to passively collected data and patient self-ratings. A purposively sampled group of participants also participated in qualitative interviews about their experience with Rhythms at the end of the study. Results: Of the 104 participants, 89 (85.6%) completed 6 weeks of monitoring. The majority of the participants were women (72/104, 69.2%), White (84/104, 80.8%), and non-Hispanic (100/104, 96.2%) and had a diagnosis of major depressive disorder (71/104, 68.3%). Two emergent alerts and 19 urgent alerts were received and managed according to protocol over 16 weeks. More than two-thirds (63/87, 72%) of those participating continued to use Rhythms after study completion. Comments from participants indicated appreciation for greater self-awareness and provider connection, while providers reported that Rhythms provided a more nuanced understanding of patient experience between clinical visits. Conclusions: Rhythms is a user-friendly, electronic health record–adaptable, smartphone-based tool that provides patients and providers with a greater understanding of patient mental health status. Integration of Rhythms into health systems has the potential to facilitate mental health care and improve the experience of both patients and providers. %M 39773396 %R 10.2196/57624 %U https://formative.jmir.org/2025/1/e57624 %U https://doi.org/10.2196/57624 %U http://www.ncbi.nlm.nih.gov/pubmed/39773396 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e65912 %T Enhancing Access to Mental Health Services for Antepartum and Postpartum Women Through Telemental Health Services at Wellbeing Centers in Selected Health Facilities in Bangladesh: Implementation Research %A Hossain,Aniqa Tasnim %A Rahman,Md Hafizur %A Manna,Ridwana Maher %A Akter,Ema %A Islam,SM Hasibul %A Hossain,Md Alamgir %A Ara,Tasnu %A Usmani,Nasimul Ghani %A Chandra,Pradip %A Khan,Maruf Ahmed %A Rahman,SM Mustafizur %A Ahmed,Helal Uddin %A Mozumder,Muhammad Kamruzzaman %A Juthi,Jesmin Mahmuda %A Shahrin,Fatema %A Shams,Sadia Afrose %A Afroze,Fahmida %A Banu,Mukta Jahan %A Ameen,Shafiqul %A Jabeen,Sabrina %A Ahmed,Anisuddin %A Amin,Mohammad Robed %A Arifeen,Shams El %A Shomik,Mohammad Sohel %A Rahman,Ahmed Ehsanur %+ International Centre for Diarrhoeal Disease Research, Bangladesh, 68 Shaheed Tajuddin Ahmed Sarani, Dhaka, 1212, Bangladesh, 880 1716543128, aniqa.hossain@icddrb.org %K Wellbeing Centers %K antepartum %K postpartum %K depression %K anxiety %K implementation %D 2025 %7 3.1.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Globally, 10% of pregnant women and 13% of postpartum women experience mental disorders. In Bangladesh, nearly 50% of mothers face common mental disorders, but mental health services and trained professionals to serve their needs are scarce. To address this, the government of Bangladesh’s Non-Communicable Disease Control program initiated “Wellbeing Centers,” telemental health services in selected public hospitals. Objective: This study examines implementation outcomes, including adoption, accessibility, acceptability, feasibility, usefulness, need, experience, perception, and expectations of the Wellbeing Centers, with a focus on antepartum and postpartum women. Methods: Between January 2023 and August 2024, we interviewed 911 antepartum and postpartum women receiving mental health services and 168 health care providers at 6 Wellbeing Centers in 4 districts in Bangladesh. Data collection involved both quantitative and qualitative methods. Implementation outcomes were measured following the World Health Organization’s implementation research framework. Depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 questionnaires. Descriptive statistics and adjusted odds ratios (aORs) with 95% CIs were used to evaluate the implementation outcomes. Qualitative information was obtained through in-depth interviews and key-informant interviews. Results: Almost all health care providers (165/168, 98.2%) reported that the Wellbeing Centers were feasible to implement in their health facilities; however, about half (84/168, 50%) felt that trained staff to operate them were insufficient. Almost all women agreed that the Wellbeing Centers were acceptable (906/911, 99.8%), useful (909/911, 99.8%), and enhanced access to mental health care (906/911, 99.5%). Patients visiting district-level hospitals had higher odds of access (aOR 1.5, 95% CI 1.1-2.0) to Wellbeing Centers. Moreover, 77.4% (705/911) of women experienced depression symptoms, and 76.7% (699/911) experienced anxiety symptoms. About 51.8% (472/911) experienced tiredness or lack of energy, 50.9% (464/911) felt nervous, anxious, or on edge, 57.2% (521/911) felt worried, and 3.8% (35/911) had suicidal ideation almost every day. Patients visiting district hospitals had higher odds (aOR 2.6, 95% CI 1.8-3.78) of depression and anxiety symptoms compared to the patients visiting subdistrict-level hospitals. Decreasing trends in Patient Health Questionnaire-9 scores (from mean 14.4, SD 0.47 to mean 12.9, SD 0.47) and Generalized Anxiety Disorder-7 scores (from mean 13.3, SD 0.49 to mean 12.5, SD 0.48) between 2 counseling sessions indicated improved mental health in the antepartum and postpartum women. The Wellbeing Centers’ services were appreciated for their privacy and being free and accessible. However, stigma, postpartum illness, and long waiting times prevented some women from using these services. Conclusions: To our knowledge, this is the first implementation research assessing telemental health in public health facilities involving trained psychologists and psychiatrists. Our study highlighted the increased accessibility, feasibility, acceptability, and utility of Wellbeing Centers for antepartum and postpartum women in Bangladesh, supporting their scale-up in similar settings. %M 39753209 %R 10.2196/65912 %U https://pediatrics.jmir.org/2025/1/e65912 %U https://doi.org/10.2196/65912 %U http://www.ncbi.nlm.nih.gov/pubmed/39753209 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e52083 %T The Association Between Internet Addiction and the Risk of Suicide Attempts in Chinese Adolescents Aged 11-17 Years: Prospective Cohort Study %A Li,Sihong %A Jin,Xingyue %A Song,Lintong %A Fan,Tianqing %A Shen,Yanmei %A Zhou,Jiansong %+ Department of Psychiatry, National Clinical Research Center for Mental Disorders, and National Center for Mental Disorders, The Second Xiangya Hospital of Central South University, No.139, Renmin Road Central Changsha-Hunan-China, Changsha, 410011, China, 86 15116269263, ymshen@csu.edu.cn %K adolescents %K pathological internet use %K internet addiction %K suicide attempts %K risk factors %K cohort study %D 2025 %7 3.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a critical public health issue in adolescents worldwide. Internet addiction may play a role in the increased rate of suicide attempts in this population. However, few studies have explored the relationship between pathological internet use and suicide attempts among adolescents. Objective: This study aimed to conduct a prospective cohort study to examine whether higher severity of pathological internet use was associated with an increased risk of suicide attempts among Chinese adolescents. Methods: A total of 782 adolescents were recruited from a middle school from November 2020 to December 2020 and followed up for 6 months. An online self-reported questionnaire was used to collect the participants’ demographic data and assess their mental health. The Depression, Anxiety, and Stress Scale–21 items (DASS-21) was used to evaluate depression, anxiety, and stress. The Chen Internet Addiction Scale–Revised (CIAS-R) was used to assess the symptoms and severity of pathological internet use. χ2 test and ANOVA were used for intergroup comparison, and logistic regression analysis was used to examine the relationship between the severity of pathological internet use and suicide attempts. We also used a restricted cubic splines model to investigate the pattern of the association. Results: The participants had an average age of 12.59 (SD 0.64) years, with the majority being of Han ethnicity (743/782, 95.01%) and more than half being male (426/782, 54.48%). Most participants had no previous history of depression (541/782, 69.18%), anxiety (415/782, 53.07%), or stress (618/782, 79.03%). The rate of newly reported suicide attempts was 4.6% (36/782). A significant positive association was observed between internet addiction and suicide attempts (odds ratio 3.88, 95% CI 1.70-8.82), which remained significant after adjusting for age, sex, ethnicity, anxiety, depression, and stress (odds ratio 2.65, 95% CI 1.07-6.55). In addition, this association exhibited a linear pattern in the restricted cubic spline regression model. Conclusions: This study suggested that internet addiction, rather than internet overuse, was associated with a higher likelihood of suicide attempts, which highlighted the importance of addressing internet addiction symptoms among Chinese adolescents for suicide prevention. %M 39752720 %R 10.2196/52083 %U https://www.jmir.org/2025/1/e52083 %U https://doi.org/10.2196/52083 %U http://www.ncbi.nlm.nih.gov/pubmed/39752720 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e63538 %T Development and Evaluation of a Mental Health Chatbot Using ChatGPT 4.0: Mixed Methods User Experience Study With Korean Users %A Kang,Boyoung %A Hong,Munpyo %+ Sungkyunkwan University, 25-2, Sungkyunkwan-Ro, Jongno-gu, Seoul, 03063, Republic of Korea, 82 027401770, bykang2015@gmail.com %K mental health chatbot %K Dr. CareSam %K HoMemeTown %K ChatGPT 4.0 %K large language model %K LLM %K cross-lingual %K pilot testing %K cultural sensitivity %K localization %K Korean students %D 2025 %7 3.1.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: Mental health chatbots have emerged as a promising tool for providing accessible and convenient support to individuals in need. Building on our previous research on digital interventions for loneliness and depression among Korean college students, this study addresses the limitations identified and explores more advanced artificial intelligence–driven solutions. Objective: This study aimed to develop and evaluate the performance of HoMemeTown Dr. CareSam, an advanced cross-lingual chatbot using ChatGPT 4.0 (OpenAI) to provide seamless support in both English and Korean contexts. The chatbot was designed to address the need for more personalized and culturally sensitive mental health support identified in our previous work while providing an accessible and user-friendly interface for Korean young adults. Methods: We conducted a mixed methods pilot study with 20 Korean young adults aged 18 to 27 (mean 23.3, SD 1.96) years. The HoMemeTown Dr CareSam chatbot was developed using the GPT application programming interface, incorporating features such as a gratitude journal and risk detection. User satisfaction and chatbot performance were evaluated using quantitative surveys and qualitative feedback, with triangulation used to ensure the validity and robustness of findings through cross-verification of data sources. Comparative analyses were conducted with other large language models chatbots and existing digital therapy tools (Woebot [Woebot Health Inc] and Happify [Twill Inc]). Results: Users generally expressed positive views towards the chatbot, with positivity and support receiving the highest score on a 10-point scale (mean 9.0, SD 1.2), followed by empathy (mean 8.7, SD 1.6) and active listening (mean 8.0, SD 1.8). However, areas for improvement were noted in professionalism (mean 7.0, SD 2.0), complexity of content (mean 7.4, SD 2.0), and personalization (mean 7.4, SD 2.4). The chatbot demonstrated statistically significant performance differences compared with other large language models chatbots (F=3.27; P=.047), with more pronounced differences compared with Woebot and Happify (F=12.94; P<.001). Qualitative feedback highlighted the chatbot’s strengths in providing empathetic responses and a user-friendly interface, while areas for improvement included response speed and the naturalness of Korean language responses. Conclusions: The HoMemeTown Dr CareSam chatbot shows potential as a cross-lingual mental health support tool, achieving high user satisfaction and demonstrating comparative advantages over existing digital interventions. However, the study’s limited sample size and short-term nature necessitate further research. Future studies should include larger-scale clinical trials, enhanced risk detection features, and integration with existing health care systems to fully realize its potential in supporting mental well-being across different linguistic and cultural contexts. %M 39752663 %R 10.2196/63538 %U https://medinform.jmir.org/2025/1/e63538 %U https://doi.org/10.2196/63538 %U http://www.ncbi.nlm.nih.gov/pubmed/39752663 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e49844 %T The Virtual Client Experience Survey for Mental Health and Addictions: Revalidation of a Survey to Measure Client and Family Experiences of Virtual Care %A Crawford,Allison %A Kirvan,Anne %A Sanches,Marcos %A Gambin,Amanda %A Canso,Denise %A Serhal,Eva %+ Centre for Addiction and Mental Health, 60 White Squirrel Way, Office 223, Toronto, ON, M6J1H4, Canada, 1 416 535 8501, allison.crawford@utoronto.ca %K virtual care %K digital health %K mental health %K client satisfaction %K health care quality %K Virtual Client Experience Survey %K telehealth %K telemedicine %K eHealth %D 2025 %7 3.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The onset of the COVID-19 pandemic precipitated a rapid shift to virtual care in health care settings, inclusive of mental health care. Understanding clients’ perspectives on virtual mental health care quality will be critical to informing future policies and practices. Objective: This study aimed to outline the process of redesigning and validating the Virtual Client Experience Survey (VCES), which can be used to evaluate client and family experiences of virtual care, specifically virtual mental health and addiction care. Methods: The VCES was adapted from a previously validated telepsychiatry survey. All items were reviewed and updated, with particular attention to the need to ensure relevance across mental health care sectors and settings. The survey was then revalidated using the 6 domains of health care quality of the Institute of Medicine (IOM) as a guiding framework. These 6 domains include being safe, effective, patient-centered, efficient, timely, and equitable. The VCES was piloted with a convenience sample of clients and family members accessing outpatient care at the Centre for Addiction and Mental Health (CAMH) in Toronto, Ontario, through video or telephone. A confirmatory factor analysis (CFA) was conducted in MPlus and used to test the factorial structures of the VCES, with minor respecification of the model based on modification indices, factor loadings, reliability, and item-total correlation. The respecifications were checked for alignment with the construct definitions and item interpretation. The reliability of the constructs was estimated by the Cronbach α coefficient. Results: The survey was completed 181 times. The construct reliability was generally high. Timely was the only subscale with an α lower than 0.7; all others were above 0.8. In all cases, the corrected item-total correlation was higher than 0.3. For the CFA, the model was adjusted after multiple imputations with 20 datasets. The mean chi-square value was 437.5, with df=199 (P<.001). The mean root mean square error of approximation (RMSEA) was 0.08 (SD 0.002), the mean confirmatory fit index (CFI) was 0.987 (SD 0.001), the mean Tucker-Lewis Index (TLI) was 0.985 (SD 0.001), and the mean standardized root mean square residual (SRMR) was 0.04 (SD 0.001). Conclusions: This study describes the validation of the VCES to evaluate client and family experiences of virtual mental health and addictions care. Given the widespread uptake of virtual care, this survey has broad applicability across settings that provide mental health and addiction care. The VCES can be used to guide targeted quality improvement initiatives across health care quality domains. By effectively addressing challenges as they emerge, it is anticipated that we will continue to move toward hybrid modalities of practice that leverage the strengths and benefits of telephone, video, and in-person care to effectively respond to unique client and family needs and circumstances. %M 39752192 %R 10.2196/49844 %U https://www.jmir.org/2025/1/e49844 %U https://doi.org/10.2196/49844 %U http://www.ncbi.nlm.nih.gov/pubmed/39752192 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 12 %N %P e57795 %T User Experiences of and Preferences for Self-Guided Digital Interventions for the Treatment of Mild to Moderate Eating Disorders: Systematic Review and Metasynthesis %A Cheung,Lauryn Gar-Mun %A Thomas,Pamela Carien %A Brvar,Eva %A Rowe,Sarah %+ Division of Psychiatry, University College London, Maple House, 149 Tottenham Ct Rd, London, W1T 7NF, United Kingdom, 44 020 7679 2000, s.rowe@ucl.ac.uk %K eating disorders %K anorexia %K bulimia %K binge eating %K other specified feeding or eating disorder %K OSFED %K intervention %K digital intervention %K self-help %K systematic review %D 2025 %7 3.1.2025 %9 Review %J JMIR Ment Health %G English %X Background: Digital interventions typically involve using smartphones or PCs to access online or downloadable self-help and may offer a more accessible and convenient option than face-to-face interventions for some people with mild to moderate eating disorders. They have been shown to substantially reduce eating disorder symptoms, but treatment dropout rates are higher than for face-to-face interventions. We need to understand user experiences and preferences for digital interventions to support the design and development of user-centered digital interventions that are engaging and meet users’ needs. Objective: This study aims to understand user experiences and user preferences for digital interventions that aim to reduce mild to moderate eating disorder symptoms in adults. Methods: We conducted a metasynthesis of qualitative studies. We searched 6 databases for published and unpublished literature from 2013 to 2024. We searched for studies conducted in naturalistic or outpatient settings, using primarily unguided digital self-help interventions designed to reduce eating disorder symptoms in adults with mild to moderate eating disorders. We conducted a thematic synthesis using line-by-line coding of the results and findings from each study to generate themes. Results: A total of 8 studies were included after screening 3695 search results. Overall, 7 metathemes were identified. The identified metathemes included the appeal of digital interventions, role of digital interventions in treatment, value of support in treatment, communication at the right level, importance of engagement, shaping knowledge to improve eating disorder behaviors, and design of the digital intervention. Users had positive experiences with digital interventions and perceived them as helpful for self-reflection and mindfulness. Users found digital interventions to be convenient and flexible and that they fit with their lifestyle. Overall, users noticed reduced eating disorder thoughts and behaviors. However, digital interventions were not generally perceived as a sufficient treatment that could replace traditional face-to-face treatment. Users have individual needs, so an ideal intervention would offer personalized content and functions. Conclusions: Users found digital interventions for eating disorders practical and effective but stressed the need for interventions to address the full range of symptoms, severity, and individual needs. Future digital interventions should be cocreated with users and offer more personalization. Further research is needed to determine the appropriate balance of professional and peer support and whether these interventions should serve as the first step in the stepped care model. Trial Registration: PROSPERO CRD42023426932; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=426932 %M 39752210 %R 10.2196/57795 %U https://mental.jmir.org/2025/1/e57795 %U https://doi.org/10.2196/57795 %U http://www.ncbi.nlm.nih.gov/pubmed/39752210 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e59489 %T The Impact of Parental Support on Adherence to Therapist-Assisted Internet-Delivered Acceptance and Commitment Therapy in Primary Care for Adolescents With Anxiety: Naturalistic 12-Month Follow-Up Study %A Larsson,Anna %A Weineland,Sandra %A Nissling,Linnea %A Lilja,Josefine L %+ Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, FoU primär och nära vård Södra Älvsborg, Sven Eriksonsplatsen 4, Borås, 503 38, Sweden, 46 104359410, anna.caroline.larsson@vgregion.se %K adolescents %K parental support %K anxiety %K depression %K primary care %K mental health %K ACT %K acceptance and commitment therapy %K iACT %K internet-delivered acceptance and commitment therapy %D 2025 %7 3.1.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Mental health problems among adolescents are increasing, and internet-delivered acceptance and commitment therapy (iACT) constitutes a possible way to improve access to care while reducing costs. Nevertheless, few studies have investigated iACT for adolescents in regular primary care nor the role of parental support. Objective: This is an exploratory evaluation investigating iACT, with or without parental support, for adolescents. The aims were to examine treatment adherence, symptoms of anxiety and depression, psychological flexibility, and overall functioning. Methods: Adolescents with anxiety were recruited within the regular primary care patient flow during the implementation phase of therapist-assisted iACT for adolescents. Assessment and inclusion were executed face-to-face. Due to organizational reasons, the assignment of treatment methods could not be randomized. Adherence was investigated by measuring the number of completed modules. Outcome measures were collected by self-assessment questionnaires including the Revised Children’s Anxiety and Depression Scale and Avoidance and Fusion Questionnaire for Youth, as well as interviews using the Children’s Global Assessment Scale. The analysis was performed as an exploratory evaluation using descriptive data for treatment adherence and nonparametric within-group analysis with the Wilcoxon signed rank test for related samples and treatment outcomes. This evaluation is naturalistic, and the results are preliminary and of a hypothesis-generating character and should be handled with caution. Results: The iACT group without parental support (n=9) exhibited a gradual dropout throughout the treatment period (n=5), whereas the iACT group with parental support (n=15) exhibited the lowest number of dropouts from treatment before completion (n=2), of which all occurred during the second half of treatment. The within-group, per-protocol analyses for the Revised Children’s Anxiety and Depression Scale indicated reduced symptoms of anxiety and depression at the 12-month follow-up (z score: –2.94; P=.003; r=–0.6). The within-group, per-protocol analyses for the Avoidance and Fusion Questionnaire for Youth indicated increased psychological flexibility at the 12-month follow-up (z score: –2.54; P=.01; r=0.55). Nevertheless, no differences in overall functioning measured by the Children’s Global Assessment Scale were found. Conclusions: The results indicate that parental support might play a role in treatment adherence in iACT for adolescents with anxiety. Moreover, the outcome measures suggest that iACT for adolescents in primary care could constitute an effective treatment for both anxiety and depression, as indicated by the symptom reduction and increased psychological flexibility, maintained at the 12-month follow-up. Nevertheless, due to a small and gender-biased sample size with a large proportion of dropouts and missing data, a nonrandomized assignment of intervention, and an analysis limited to within group, this study should be considered an explorative evaluation rather than an outcome study. %M 39752209 %R 10.2196/59489 %U https://pediatrics.jmir.org/2025/1/e59489 %U https://doi.org/10.2196/59489 %U http://www.ncbi.nlm.nih.gov/pubmed/39752209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62995 %T Supplemental Intervention for Alcohol Use Disorder Treatment Patients With a Co-Occurring Anxiety Disorder: Technical Development and Functional Testing of an Autonomous Digital Program %A Rinehart,Linda Marie %A Anker,Justin %A Unruh,Amanda %A Degeneffe,Nikki %A Thuras,Paul %A Norden,Amie %A Hartnett,Lilly %A Kushner,Matt %K alcohol use disorder %K anxiety disorder %K comorbidity %K digital intervention %K psychological treatments %K addiction %K community-based practice %K therapy %K stress %K depression %K therapist-delivered therapies %D 2024 %7 31.12.2024 %9 %J JMIR Form Res %G English %X Background: Anxiety disorders are common in alcohol use disorder (AUD) treatment patients. Such co-occurring conditions (“comorbidity”) have negative prognostic implications for AUD treatment outcomes, yet they commonly go unaddressed in standard AUD care. Over a decade ago, we developed and validated a cognitive behavioral therapy intervention to supplement standard AUD care that, when delivered by trained therapists, improves outcomes in comorbid patients. However, this validated intervention, like many others in addiction care, has not been taken up in community-based AUD treatment programs. This phenomenon—empirically validated treatments that fail to be widely adopted in community care—has been termed the “research-to-practice gap.” Researchers have suggested that the availability of fully autonomous digital equivalents of validated therapist-delivered therapies could reduce some barriers underlying the research-to-practice gap, especially by eliminating the need for costly and intensive therapist training and supervision. Objective: With this in mind, we obtained a Program Development Grant (R34) to conduct formative work in the development of a fully autonomous digital version of our previously validated therapist-delivered intervention for AUD treatment patients with a comorbid anxiety disorder. Methods: In the first phase of the project, we developed the digital intervention. This process included: (1) identifying appropriate collaborators and vendors; (2) consultation with an e-learning expert to develop a storyboard and accompanying graphics and narrative; (3) video production and editing; and (4) interactive programming. The second phase of the project was functional testing of the newly developed digital intervention conducted in 52 residential AUD treatment patients with a comorbid anxiety disorder. Patients underwent the 3 one-hour segments of the newly developed intervention and completed user surveys, knowledge quizzes, and behavioral competence tests. Results: While the development of the digital intervention was successful, the timeline was approximately double that projected (1 vs 2 years) due to false starts and inefficiencies that we describe, including lessons learned. Functional testing of the newly developed digital intervention showed that, on average, patients rated the user experience in the upper (favorable) 20% of the response scales. Knowledge quizzes and behavioral demonstrations showed that over 80% of participants gained functional mastery of the key skills and information taught in the program. Conclusions: Functional testing results in this study justify a randomized controlled trial of the digital intervention’s efficacy, which is currently ongoing. In sharing the details of our challenges and solutions in developing the digital intervention, we hope to inform others developing digital tools. The extent to which the availability of empirically validated, fully autonomous digital interventions achieves their potential to reduce the research-to-practice gap remains an open but important empirical question. The present work stands as a necessary first step toward that end. %R 10.2196/62995 %U https://formative.jmir.org/2024/1/e62995 %U https://doi.org/10.2196/62995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64081 %T Effects of Large Language Model–Based Offerings on the Well-Being of Students: Qualitative Study %A Selim,Rania %A Basu,Arunima %A Anto,Ailin %A Foscht,Thomas %A Eisingerich,Andreas Benedikt %+ Faculty of Medicine, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2AZ, United Kingdom, 44 020 7589 5111, rania.selim18@imperial.ac.uk %K large language models %K ChatGPT %K functional support %K escapism %K fantasy fulfillment %K angst %K despair %K anxiety %K deskilling %K pessimism about the future %D 2024 %7 27.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, the adoption of large language model (LLM) applications, such as ChatGPT, has seen a significant surge, particularly among students. These artificial intelligence–driven tools offer unprecedented access to information and conversational assistance, which is reshaping the way students engage with academic content and manage the learning process. Despite the growing prevalence of LLMs and reliance on these technologies, there remains a notable gap in qualitative in-depth research examining the emotional and psychological effects of LLMs on users’ mental well-being. Objective: In order to address these emerging and critical issues, this study explores the role of LLM-based offerings, such as ChatGPT, in students’ lives, namely, how postgraduate students use such offerings and how they make students feel, and examines the impact on students’ well-being. Methods: To address the aims of this study, we employed an exploratory approach, using in-depth, semistructured, qualitative, face-to-face interviews with 23 users (13 female and 10 male users; mean age 23 years, SD 1.55 years) of ChatGPT-4o, who were also university students at the time (inclusion criteria). Interviewees were invited to reflect upon how they use ChatGPT, how it makes them feel, and how it may influence their lives. Results: The current findings from the exploratory qualitative interviews showed that users appreciate the functional support (8/23, 35%), escapism (8/23, 35%), and fantasy fulfillment (7/23, 30%) they receive from LLM-based offerings, such as ChatGPT, but at the same time, such usage is seen as a “double-edged sword,” with respondents indicating anxiety (8/23, 35%), dependence (11/23, 48%), concerns about deskilling (12/23, 52%), and angst or pessimism about the future (11/23, 48%). Conclusions: This study employed exploratory in-depth interviews to examine how the usage of LLM-based offerings, such as ChatGPT, makes users feel and assess the effects of using LLM-based offerings on mental well-being. The findings of this study show that students used ChatGPT to make their lives easier and felt a sense of cognitive escapism and even fantasy fulfillment, but this came at the cost of feeling anxious and pessimistic about the future. %M 39729617 %R 10.2196/64081 %U https://formative.jmir.org/2024/1/e64081 %U https://doi.org/10.2196/64081 %U http://www.ncbi.nlm.nih.gov/pubmed/39729617 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e58452 %T Game-Based Promotion of Assertiveness to Mitigate the Effects of Bullying in High School Students: Development and Evaluation Study %A Lepe-Salazar,Francisco %A Mejía-Romero,Fernando %A Benicio-Rodríguez,Dámaso %A Hernández-Reyes,Aylin %A Nakajima,Tatsuo %A Salgado-Torres,Sarita %+ Ludolab, Nigromante 89, Centro, Colima, 28030, Mexico, 52 3121100163, flepe@ludolab.org %K serious games %K bullying %K assertiveness %K multiple composite scenarios %K scenario %K cognitive behavioral therapy %K gaming %K design %K development %K bully %K assertive %K feasibility %D 2024 %7 24.12.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: For years, Mexico has reported the highest global incidence of school bullying, with approximately 19% of students going through some form of hostile peer interactions. Despite numerous interventions, these harmful conducts remain deeply entrenched in educational environments. Objective: To address this issue, we developed Bernstein, a serious game that promotes assertiveness—an essential protective factor that reduces the negative effects of bullying. Methods: Bernstein was designed using multiple composite scenarios, a methodology grounded in cognitive behavioral therapy. To evaluate the game’s effectiveness, we conducted an exploratory trial using the Rathus Assertiveness Schedule to assess assertiveness levels before and after the intervention. Participants were high school students who met the inclusion criteria of being open to playing a serious game (with no prior gaming experience required) and having access to a computer with internet connectivity for remote participation. A total of 100 students (65 boys and 35 girls) enrolled in the intervention; however, only 46 participants in the treatment group and 46 in the control group completed the study, resulting in a dropout rate of 8% (8/100). A paired 1-tailed t test was used to compare pre- and postintervention scores within each group, and a one-way ANOVA was conducted to compare the average score improvements between the 2 groups. Results: The treatment group showed a pretest mean Rathus Assertiveness Schedule score of –2.78 (SD 25.93) and a posttest mean of 1.69 (SD 29.48), with a paired 1-tailed t test yielding a P value of .01. The control group had a pretest mean of 2.07 (SD 25.69) and a posttest mean of –2.39 (SD 32.98), with a paired 1-tailed t test yielding a P value of .04. The one-way ANOVA (between groups) yielded a P value of .006, indicating a statistically significant difference, favoring Bernstein over the alternative protocol. Participant feedback highlighted the game’s engaging narrative and character design, although usability issues, such as navigation challenges, were noted as areas for improvement. Conclusions: The results suggest that Bernstein is a promising tool for promoting assertiveness in high school students, providing a potential strategy for addressing bullying-related issues. The study underscores the value of integrating Bernstein into educational programs, offering students a safe and interactive environment to develop resilience. As an exploratory trial, this study faced limitations affecting the generalizability of findings, including the remote format’s impact on facilitator guidance and a relatively small sample size. Further trials with larger, more diverse groups are recommended to validate these early results and enhance Bernstein’s scalability as part of a comprehensive antibullying strategy. %M 39718822 %R 10.2196/58452 %U https://games.jmir.org/2024/1/e58452 %U https://doi.org/10.2196/58452 %U http://www.ncbi.nlm.nih.gov/pubmed/39718822 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e60003 %T Balancing Between Privacy and Utility for Affect Recognition Using Multitask Learning in Differential Privacy–Added Federated Learning Settings: Quantitative Study %A Benouis,Mohamed %A Andre,Elisabeth %A Can,Yekta Said %K privacy preservation %K multitask learning %K federated learning %K privacy %K physiological signals %K affective computing %K wearable sensors %K sensitive data %K empathetic sensors %K data privacy %K digital mental health %K wearables %K ethics %K emotional well-being %D 2024 %7 23.12.2024 %9 %J JMIR Ment Health %G English %X Background: The rise of wearable sensors marks a significant development in the era of affective computing. Their popularity is continuously increasing, and they have the potential to improve our understanding of human stress. A fundamental aspect within this domain is the ability to recognize perceived stress through these unobtrusive devices. Objective: This study aims to enhance the performance of emotion recognition using multitask learning (MTL), a technique extensively explored across various machine learning tasks, including affective computing. By leveraging the shared information among related tasks, we seek to augment the accuracy of emotion recognition while confronting the privacy threats inherent in the physiological data captured by these sensors. Methods: To address the privacy concerns associated with the sensitive data collected by wearable sensors, we proposed a novel framework that integrates differential privacy and federated learning approaches with MTL. This framework was designed to efficiently identify mental stress while preserving private identity information. Through this approach, we aimed to enhance the performance of emotion recognition tasks while preserving user privacy. Results: Comprehensive evaluations of our framework were conducted using 2 prominent public datasets. The results demonstrate a significant improvement in emotion recognition accuracy, achieving a rate of 90%. Furthermore, our approach effectively mitigates privacy risks, as evidenced by limiting reidentification accuracies to 47%. Conclusions: This study presents a promising approach to advancing emotion recognition capabilities while addressing privacy concerns in the context of empathetic sensors. By integrating MTL with differential privacy and federated learning, we have demonstrated the potential to achieve high levels of accuracy in emotion recognition while ensuring the protection of user privacy. This research contributes to the ongoing efforts to use affective computing in a privacy-aware and ethical manner. %R 10.2196/60003 %U https://mental.jmir.org/2024/1/e60003 %U https://doi.org/10.2196/60003 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55924 %T Characteristics and Outcomes of mHealth Interventions in Psychosis: Systematic Mapping Review %A Loh,Pei Yi %A Martinengo,Laura %A Heaukulani,Creighton %A Tan,Xin Yang %A Hng,Moses %A Cheah,Yong Yin %A Morris,Robert J T %A Tudor Car,Lorainne %A Lee,Jimmy %+ Institute of Mental Health, 10 Buangkok View, Singapore, 539747​, Singapore, 65 63892000, jimmy_lee@imh.com.sg %K mHealth %K digital health %K mobile applications %K psychosis %K schizophrenia %K schizophrenia spectrum %K psychotic disorders %K mapping review %D 2024 %7 23.12.2024 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) interventions have gained popularity in augmenting psychiatric care for adults with psychosis. Interest has grown in leveraging mHealth to empower individuals living with severe mental illness and extend continuity of care beyond the hospital to the community. However, reported outcomes have been mixed, likely attributed in part to the intervention and adopted outcomes, which affected between-study comparisons. Objective: This study aimed to critically review outcome measures used to evaluate mHealth interventions for adults with psychosis in relation to the characteristics of mHealth interventions. Methods: A systematic mapping review was conducted. We searched PubMed, CINAHL, Embase, PsycINFO, and Cochrane Libraries from 1973 to the present. Selection criteria included randomized controlled studies of mHealth interventions in adults diagnosed with schizophrenia spectrum disorders. Reviewers worked in pairs to screen and extract data from included studies independently using a standardized form; disagreements were resolved by consensus with an independent reviewer. We report our findings in line with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: A total of 1703 citations were screened; 29 publications reporting on 23 studies were included in this review. mHealth interventions for psychosis span a wide range, with psychological therapy being the most-deployed intervention (12/23, 52%), followed by psychoeducation (8/23, 35%) and active self-monitoring (8/23, 35%). Several mHealth interventions for psychosis targeted multiple pillars of biopsychosocial well-being (10/23, 43%); the bulk of interventions (16/23, 70%) incorporated features promoting users’ self-management. The majority of mHealth interventions were delivered through applications (14/23, 61%) as the main medium and smartphones (17/23, 74%) as the main channel of delivery. Interventions were primarily administered in the outpatient and community settings (16/23, 70%); many were also blended with in-person sessions (11/23, 48%) or guided remotely (6/23, 26%) by persons, including health care providers or trained peer supporters. The severity of psychosis-related symptoms (21/23, 91%) was the most prevalent outcome, of which positive symptoms (13/23, 57%), mood and anxiety (10/23, 43%), and overall psychopathology severity (9/23, 39%) were most commonly measured. Patient-centric outcomes, including well-being (17/23, 74%)—particularly quality of life (10/23, 43%)—and user experience (15/23, 65%), including feasibility (7/23, 30%), acceptability (7/23, 30%), and engagement (7/23, 26%). Notably, outcome choices remained diverse despite stratification by type of mHealth intervention. Conclusions: mHealth interventions for psychosis encompass a wide range of modalities and use outcome measures that probe various social and behavioral determinants of health. These should be considered complex interventions, and a holistic evaluation approach combining clinical and patient-centric outcomes is recommended. %M 39714907 %R 10.2196/55924 %U https://www.jmir.org/2024/1/e55924 %U https://doi.org/10.2196/55924 %U http://www.ncbi.nlm.nih.gov/pubmed/39714907 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63399 %T Examining Caregiver Practices During Adolescent Outpatient Alcohol Use and Co-Occurring Mental Health Treatment: Protocol for a Dyadic Ecological Momentary Assessment Study %A Meisel,Samuel N %A Hogue,Aaron %A Kelly,John F %A McQuaid,Elizabeth %A Miranda Jr,Robert %+ Department of Psychological and Brain Sciences, Boston University, 900 Commonwealth Avenue, Boston, MA, 02215, United States, 1 6173539610, smeisel@bu.edu %K adolescent %K caregiver %K ecological momentary assessment %K alcohol %K co-occurring disorders treatment %K treatment %K older adult %K aging %K alcohol use %K mental health %K assessment %K protocol %K alcohol use disorder %K drinking %K substance use %K data collection %D 2024 %7 20.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Caregiver-involved treatments for adolescents with alcohol use disorder and co-occurring disorders (AUD+CODs) are associated with the best treatment outcomes. Understanding what caregiving practices during treatment improve core adolescent treatment targets may facilitate the refinement and scalability of caregiver-involved interventions. Caregiving is dynamic, varying by context, affect, and adolescent behavior. Caregiver-involved treatments seek to change momentary interactions between caregivers and their adolescents. Accordingly, this protocol outlines a dyadic ecological momentary assessment (EMA) study to examine caregiving practices during AUD+CODs treatment and their associations with adolescent core treatment targets (eg, alcohol craving and use, motivation to reduce or stop drinking, and internalizing and externalizing symptoms). Objective: This paper aims to describe the methods for examining momentary caregiving practices and adolescent core treatment targets during adolescent outpatient AUD+CODs treatment. Methods: We will recruit 75 caregiver-adolescent dyads from outpatient mental health clinics providing AUD+CODs treatment. Eligible families will have an adolescent who (1) is aged between 13 and 18 years; (2) meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnostic criteria for AUD; (3) is enrolled in outpatient treatment at the time of recruitment; and (4) has a legal guardian willing to participate in the study. Caregivers and adolescents will complete an eligibility screening, followed by a baseline assessment during or as close as possible to the second week of treatment. During the baseline assessment, caregivers and adolescents will receive formal training in EMA procedures. Next, caregivers and adolescents will complete a 15-week EMA burst design consisting of three 21-day EMA periods with 3-week breaks between periods. Throughout the study, participants will also complete weekly reports regarding the skills learned or practiced during therapy. The three overarching aims to the proposed study are as follows: (1) examine momentary caregiving practices (eg, support, monitoring, substance use communication quality) and their associations with core treatment targets, (2) examine how these associations change throughout treatment, and (3) examine whether a caregiver report of learning or practicing parenting- or family-focused behaviors in treatment sessions is associated with changes in the use of caregiving practices in daily life. Results: The proposed study was informed by a pilot study assessing the feasibility and acceptability of dyadic EMA during adolescent AUD+COD treatment. Some benchmarks were met during this study (eg, ≥80% caregiver retention rate), although most benchmarks were not (eg, adolescent [772/1622, 47.6%] and caregiver [1331/1881, 70.76%] random prompt compliance was below the ≥80% target). Data collection is anticipated to begin in December of 2024. The proposed study is designed to be completed over 3 years. Conclusions: Examining momentary caregiving practices using EMA has important implications for refining and scaling caregiver-involved interventions for AUD+CODs so that families who would benefit from caregiver-involved treatments can have access to them. International Registered Report Identifier (IRRID): PRR1-10.2196/63399 %M 39705699 %R 10.2196/63399 %U https://www.researchprotocols.org/2024/1/e63399 %U https://doi.org/10.2196/63399 %U http://www.ncbi.nlm.nih.gov/pubmed/39705699 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e51567 %T Early Attrition Prediction for Web-Based Interpretation Bias Modification to Reduce Anxious Thinking: A Machine Learning Study %A Baee,Sonia %A Eberle,Jeremy W %A Baglione,Anna N %A Spears,Tyler %A Lewis,Elijah %A Wang,Hongning %A Funk,Daniel H %A Teachman,Bethany %A E Barnes,Laura %+ Department of Systems and Information Engineering, University of Virginia, 151 Engineer’s Way, Charlottesville, VA, 22904, United States, 1 434 924 1723, lb3dp@virginia.edu %K digital mental health intervention %K attrition prediction %K user engagement %K cognitive bias modification %K CBM-I %K dropout rate %K personalization %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital mental health is a promising paradigm for individualized, patient-driven health care. For example, cognitive bias modification programs that target interpretation biases (cognitive bias modification for interpretation [CBM-I]) can provide practice thinking about ambiguous situations in less threatening ways on the web without requiring a therapist. However, digital mental health interventions, including CBM-I, are often plagued with lack of sustained engagement and high attrition rates. New attrition detection and mitigation strategies are needed to improve these interventions. Objective: This paper aims to identify participants at a high risk of dropout during the early stages of 3 web-based trials of multisession CBM-I and to investigate which self-reported and passively detected feature sets computed from the participants interacting with the intervention and assessments were most informative in making this prediction. Methods: The participants analyzed in this paper were community adults with traits such as anxiety or negative thinking about the future (Study 1: n=252, Study 2: n=326, Study 3: n=699) who had been assigned to CBM-I conditions in 3 efficacy-effectiveness trials on our team’s public research website. To identify participants at a high risk of dropout, we created 4 unique feature sets: self-reported baseline user characteristics (eg, demographics), self-reported user context and reactions to the program (eg, state affect), self-reported user clinical functioning (eg, mental health symptoms), and passively detected user behavior on the website (eg, time spent on a web page of CBM-I training exercises, time of day during which the exercises were completed, latency of completing the assessments, and type of device used). Then, we investigated the feature sets as potential predictors of which participants were at high risk of not starting the second training session of a given program using well-known machine learning algorithms. Results: The extreme gradient boosting algorithm performed the best and identified participants at high risk with macro–F1-scores of .832 (Study 1 with 146 features), .770 (Study 2 with 87 features), and .917 (Study 3 with 127 features). Features involving passive detection of user behavior contributed the most to the prediction relative to other features. The mean Gini importance scores for the passive features were as follows: .033 (95% CI .019-.047) in Study 1; .029 (95% CI .023-.035) in Study 2; and .045 (95% CI .039-.051) in Study 3. However, using all features extracted from a given study led to the best predictive performance. Conclusions: These results suggest that using passive indicators of user behavior, alongside self-reported measures, can improve the accuracy of prediction of participants at a high risk of dropout early during multisession CBM-I programs. Furthermore, our analyses highlight the challenge of generalizability in digital health intervention studies and the need for more personalized attrition prevention strategies. %M 39705068 %R 10.2196/51567 %U https://mental.jmir.org/2024/1/e51567 %U https://doi.org/10.2196/51567 %U http://www.ncbi.nlm.nih.gov/pubmed/39705068 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59372 %T A Digital Mental Health Solution to Improve Social, Emotional, and Learning Skills for Youth: Protocol for an Efficacy and Usability Study %A Taylor,Kayla V %A Garchitorena,Laurent %A Scaramutti-Gladfelter,Carolina %A Wyrick,Mykayla %A Grill,Katherine B %A Seixas,Azizi A %+ Department of Informatics and Health Data Science, University of Miami Miller School of Medicine, 1120 NW 14th Street, Miami, FL, 33136, United States, 1 3052438256, lgg82@miami.edu %K mental health %K digital health %K mHealth %K usability %K pilot study %K United States %K mental health crisis %K Science Technology Engineering Math and Social and Emotional Learning %K STEMSEL %K efficacy %K well-being %K barriers %K facilitators %K resources %K youth %K adolescents %K teenagers %K students %K feasibility %K adoption %K evidence-based %K intervention %K anxiety %K depression %K Neolth %K digital app %D 2024 %7 19.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has exposed a devastating youth mental health crisis in the United States, characterized by an all-time high prevalence of youth mental illness. This crisis is exacerbated by limited access to mental health services and the reduction of mental health support in schools. Mobile health platforms offer a promising avenue for delivering tailored and on-demand mental health care. Objective: To address the lack of youth mental health services, we created the Science Technology Engineering Math and Social and Emotional Learning (STEMSEL) study. Our aim was to investigate the efficacy of a digital mental health intervention, Neolth, in enhancing social and emotional well-being, reducing academic stress, and increasing mental health literacy and life skills among adolescents. Methods: The STEMSEL study will involve the implementation and evaluation of Neolth across 4 distinct phases. In phase 1, a comprehensive needs assessment will be conducted across 3 diverse schools, each using a range of teaching methods, including in-person, digital, and hybrid modalities. Following this, in phase 2, school administrators and teachers undergo intensive training sessions on Neolth’s functionalities and intervention processes as well as understand barriers and facilitators of implementing a digital mental health program at their respective schools. Phase 3 involves recruiting middle and high school students aged 11-18 years from the participating schools, with parental consent and student assent obtained, to access Neolth. Students will then be prompted to complete an intake questionnaire, enabling the customization of available modules to address their specific needs. Finally, phase 4 will include a year-long pre- and posttest pilot study to rigorously evaluate the usability and effectiveness of Neolth in addressing the mental health concerns of students across the selected schools. Results: Phase 1 was successfully completed in August 2022, revealing significant deficits in mental health resources within the participating schools. The needs assessment identified critical gaps in available mental health support services. We are currently recruiting a diverse group of middle and high school students to participate in the study. The study’s completion is scheduled for 2024, with data expected to provide insights into the real-world use of Neolth among the adolescent population. It is designed to deliver findings regarding the intervention’s efficacy in addressing the mental health needs of students. Conclusions: The STEMSEL study plays a crucial role in assessing the feasibility and adoption of digital mental health interventions within the school-aged youth population in the United States. The findings generated from this study have the potential to dismantle obstacles to accessing mental health assistance and broaden the availability of care through evidence-based strategies. International Registered Report Identifier (IRRID): DERR1-10.2196/59372 %M 39701588 %R 10.2196/59372 %U https://www.researchprotocols.org/2024/1/e59372 %U https://doi.org/10.2196/59372 %U http://www.ncbi.nlm.nih.gov/pubmed/39701588 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e59381 %T A Narrative-Gamified Mental Health App (Kuamsha) for Adolescents in Uganda: Mixed Methods Feasibility and Acceptability Study %A R Pozuelo,Julia %A Nabulumba,Christine %A Sikoti,Doreen %A Davis,Meghan %A Gumikiriza-Onoria,Joy Louise %A Kinyanda,Eugene %A Moffett,Bianca %A van Heerden,Alastair %A O'Mahen,Heather A %A Craske,Michelle %A , %A Sulaiman,Munshi %A Stein,Alan %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Headington, Oxford, OX3 7JX, United Kingdom, 44 01865618200, julia_ruizpozuelo@hms.harvard.edu %K adolescents %K mental health %K Uganda %K gamified app %K digital interventions %K mobile phone %K user-centered design %K low- and middle-income countries %D 2024 %7 19.12.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Many adolescents in Uganda are affected by common mental disorders, but only a few affordable treatment options are available. Digital mental health interventions offer promising opportunities to reduce these large treatment gaps, but interventions specifically tailored for Ugandan adolescents are limited. Objective: This study aimed to determine the feasibility and acceptability of the Kuamsha program, an intervention delivered through a gamified app with low-intensity telephonic guidance, as a way to promote mental health among adolescents from the general population in Uganda. Methods: A 3-month pre-post single-arm trial was conducted with adolescents aged between 15 and 19 years living in Wakiso District, Central Uganda. The intervention was coproduced with adolescents from the study site to ensure that it was culturally acceptable. The feasibility and acceptability of the intervention were evaluated using an explanatory sequential mixed methods approach. Feasibility was assessed by collecting data on trial retention rates and treatment adherence rates. Acceptability was assessed through a questionnaire and in-depth interviews with participants following the conclusion of the intervention period. As a secondary objective, we explored the changes in participants’ mental health before and after the intervention. Results: A total of 31 adolescents were recruited for the study. Results from the study showed high levels of feasibility and acceptability. Trial retention rates exceeded 90%, and treatment adherence was ≥80%. These results, evaluated against our predefined trial progression criteria, indicate a successful feasibility study, with all criteria exceeding the thresholds necessary to progress to a larger trial. App engagement metrics, such as time spent on the app and modules completed, exceeded existing literature benchmarks, and many adolescents continued to use the app after the intervention. In-depth interviews and questionnaire responses revealed high acceptability levels. Depressive symptoms trended toward reduction (mean difference: 1.41, 95% CI –0.60 to 3.42, Cohen d=0.30), although this was not statistically significant (P=.16). Supporting this trend, we also observed a reduction in the proportion of participants with moderate depressive symptoms from 32% (10/31) to 17% (5/29) after the intervention, but this change was also not significant (P=.10). Conclusions: This study presents evidence to support the Kuamsha program as a feasible and acceptable digital mental health program for adolescents in Uganda. A fully powered randomized controlled trial is needed to assess its effectiveness in improving adolescents’ mental health. %M 39700489 %R 10.2196/59381 %U https://games.jmir.org/2024/1/e59381 %U https://doi.org/10.2196/59381 %U http://www.ncbi.nlm.nih.gov/pubmed/39700489 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55450 %T Service Attributes and Acceptability of Digital and Nondigital Depression Management Methods Among Individuals With Depressive Symptoms: Survey Study %A Auyeung,Larry %A Mak,Winnie W S %A Tsang,Ella Zoe %+ Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong SAR, China (Hong Kong), 852 31906792, larryauyeung@link.cuhk.edu.hk %K eHealth %K acceptability %K user preference %K diffusion of innovation %K mental health services %D 2024 %7 19.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Academic research on digital mental health tends to focus on its efficacy and effectiveness, with much less attention paid to user preferences and experiences in real-world settings. Objective: This study aims to analyze service characteristics that service users value and compare the extent to which various digital and nondigital mental health treatments and management methods fulfill users’ expectations. Methods: A total of 114 people with at least moderate levels of depressive symptoms (as measured by Patient Health Questionnaire–9 score ≥10) completed a web-based questionnaire measuring their awareness and adoption of digital mental health services and their valuation of 15 psychological service attributes, including effectiveness, credibility, waiting time, and more. They were also assessed on their expectations toward seven common mental health treatments and management methods, including (1) face-to-face psychological intervention, (2) medication, (3) guided internet-based psychological intervention, (4) face-to-face counseling service, (5) self-guided mental health apps for depression, (6) self-help bibliotherapy, and (7) psychological intervention via videoconferencing. Results: A Friedman test with a Dunn posttest showed the average importance rank of “effectiveness” was significantly higher than all other measured attributes. “Privacy,” “credibility,” and “cost” were ranked as equally important. Participants rated face-to-face psychological intervention the most effective management method, while other digital management methods were perceived as less effective. Medication was perceived as the least appealing method, while other methods were deemed equally appealing. Face-to-face psychological intervention, medication, and counseling were considered less satisfactory due to their higher costs and longer waiting times when compared to digital services. Repeated measures ANOVA showed some forms of management method were more likely to be adopted, including guided internet-based psychological intervention, psychological intervention via videoconferencing, face-to-face psychological intervention, and face-to-face counseling services provided by a counselor as compared to self-guided mobile apps, self-help bibliotherapy, and medication. Conclusions: The study highlights the importance of considering multiple service attributes beyond effectiveness in depression management methods, despite effectiveness being regarded as the most crucial factor using the rank method. Compared to nondigital services, digital services were identified as having specific strengths as perceived by users. Future dissemination and promotion efforts may focus on debunking myths of guided internet-based psychological intervention as a less effective option and promoting the particular service strengths of digital services. %M 39699956 %R 10.2196/55450 %U https://formative.jmir.org/2024/1/e55450 %U https://doi.org/10.2196/55450 %U http://www.ncbi.nlm.nih.gov/pubmed/39699956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60879 %T A Digital Approach for Addressing Suicidal Ideation and Behaviors in Youth Mental Health Services: Observational Study %A Chong,Min K %A Hickie,Ian B %A Ottavio,Antonia %A Rogers,David %A Dimitropoulos,Gina %A LaMonica,Haley M %A Borgnolo,Luke J %A McKenna,Sarah %A Scott,Elizabeth M %A Iorfino,Frank %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 (02) 9114 2199, min.chong@sydney.edu.au %K mental health service %K youth mental health %K suicide management %K clinical decision support %K primary care %K personalization %K suicide %K suicidal %K youth %K mental health %K mental health care %K suicide prevention %K digital technology %K online assessment %K clinician %K digital health %K health informatics %K clinical information %D 2024 %7 18.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Long wait times for mental health treatments may cause delays in early detection and management of suicidal ideation and behaviors, which are crucial for effective mental health care and suicide prevention. The use of digital technology is a potential solution for prompt identification of youth with high suicidality. Objective: The primary aim of this study was to evaluate the use of a digital suicidality notification system designed to detect and respond to suicidal needs in youth mental health services. Second, the study aimed to characterize young people at different levels of suicidal ideation and behaviors. Methods: Young people aged between 16 and 25 years completed multidimensional assessments using a digital platform, collecting demographic, clinical, social, functional, and suicidality information. When the suicidality score exceeded a predetermined threshold, established based on clinical expertise and service policies, a rule-based algorithm configured within the platform immediately generated an alert for treating clinicians. Subsequent clinical actions and response times were analyzed. Results: A total of 2021 individuals participated, of whom 266 (11%) triggered one or more high suicidal ideation and behaviors notification. Of the 292 notifications generated, 76% (222/292) were resolved, with a median response time of 1.9 (range 0-50.8) days. Clinical actions initiated to address suicidality included creating safety plans (60%, 134/222), conducting safety checks (18%, 39/222), psychological therapy (8%, 17/222), transfer to another service (3%, 8/222), and scheduling of new appointments (2%, 4/222). Young people with high levels of suicidality were more likely to present with more severe and comorbid symptoms, including low engagement in work or education, heterogenous psychopathology, substance misuse, and recurrent illness. Conclusions: The digital suicidality notification system facilitated prompt clinical actions by alerting clinicians to high levels of suicidal ideation and behaviors detected among youth. Further, the multidimensional assessment revealed complex and comorbid symptoms exhibited in youth with high suicidality. By expediting and personalizing care for those displaying elevated suicidality, the digital notification system can play a pivotal role in preventing rapid symptom progression and its detrimental impacts on young people’s mental health. %M 39693140 %R 10.2196/60879 %U https://www.jmir.org/2024/1/e60879 %U https://doi.org/10.2196/60879 %U http://www.ncbi.nlm.nih.gov/pubmed/39693140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59093 %T Effectiveness of an Internet-Based Acceptance and Commitment Therapy Intervention for Reducing Psychological Distress in Health Care Professionals: Randomized Controlled Trial %A Zhang,Lin %A Huang,Shuang %A Liu,Sha %A Huang,Yuanxiu %A Chen,Shan %A Hu,Jinsong %A Xu,Mingzhong %+ Changsha Municipal Center for Disease Control and Prevention, 509 Wanjiali North Road, Changsha, 410004, China, 86 13873184830, cscdcbm@126.com %K acceptance and commitment therapy %K internet-based intervention %K stress %K anxiety %K depression %K burnout %K health care professionals %K randomized controlled trial %D 2024 %7 18.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychological distress is prevalent among health care professionals and can lead to poor-quality patient care. Internet-based acceptance and commitment therapy (iACT) is a promising intervention for improving mental health due to its low cost and easy access. However, there is limited evidence of its effectiveness in reducing health care professionals’ psychological distress. Objective: This study aims to examine the effects of iACT on psychological distress (stress, anxiety, and depression) among health care professionals in China. Methods: From October 2022 to February 2023, a total of 108 health care professionals were recruited via WeChat and randomized into a 6-week iACT intervention program with therapist support (n=54) or waitlist control group (n=54). The intervention included 21 self-guided sessions combining teaching videos, mindfulness practices, and journal writing, followed by 7 live conferences to share experiences and discuss questions, all conducted via WeChat. Primary outcomes (stress, anxiety, and depression) and secondary outcomes (burnout and psychological flexibility) were collected using the Sojump platform, the most popular web-based survey platform in China. Generalized estimating equations were used to compare the outcomes between groups and assess the effects of group, time, and group-by-time interaction. Subgroup and sensitive analyses were performed to test the robustness of our findings across various groups. Results: Among the 108 health care professionals, 68 (63%) completed the follow-up assessment at week 10, including 35 (64.8%) in the iACT group and 33 (61.1%) in the waitlist control group. Of the 54 participants in the iACT group, all attended at least 2 sessions, and 25 attended all 28 sessions. On average, participants attended 20 (71%) sessions. The iACT group showed significant improvement in the Depression Anxiety and Stress Scales-21 total score (d=0.82, 95% CI 0.39-1.26), and the effects were sustained for 4 weeks after the intervention (d=1.08, 95% CI 0.57-1.59). Compared to the control group, the iACT group showed significantly lower scores in burnout at week 6 (d=1.42, 95% CI 0.95-1.89) and week 10 (d=1.52, 95% CI 0.98-2.06). The iACT group showed significantly higher psychological flexibility at week 6 (d=1.23, 95% CI 0.77-1.69) and week 10 (d=1.15, 95% CI 0.64-1.66). Conclusions: The iACT effectively decreased health care professionals’ psychological distress and burnout and improved their psychological flexibility. Our findings provide implications and guidance for the development and broad implementation of iACT in health care settings to improve the mental health of health care professionals. Trial Registration: Chinese Clinical Trial Register ChiCTR2400093584; https://tinyurl.com/38werwsk %M 39693127 %R 10.2196/59093 %U https://www.jmir.org/2024/1/e59093 %U https://doi.org/10.2196/59093 %U http://www.ncbi.nlm.nih.gov/pubmed/39693127 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e59053 %T Use of Serious Games in Interventions of Executive Functions in Neurodiverse Children: Systematic Review %A Rodríguez Timaná,Luis Carlos %A Castillo García,Javier Ferney %A Bastos Filho,Teodiano %A Ocampo González,Alvaro Alexander %A Hincapié Monsalve,Nazly Rocio %A Valencia Jimenez,Nicolas Jacobo %+ Faculty of Engineering, Universidad Santiago de Cali, Calle 5 # 62-00 - Pampalinda, Santiago de Cali, 763022, Colombia, 57 3234664283, luis.rodriguez11@usc.edu.co %K executive functions %K neurodiversity %K serious games %K cognitive training %K therapeutic interventions %D 2024 %7 18.12.2024 %9 Review %J JMIR Serious Games %G English %X Background: Serious games (SG) have emerged as promising tools for cognitive training and therapeutic interventions, especially for enhancing executive functions. These games have demonstrated the potential to support individuals with diverse health conditions, including neurodevelopmental and cognitive disorders, through engaging and interactive experiences. However, a comprehensive understanding of the effectiveness of SG in enhancing executive functions is needed. Objective: This systematic review aims to assess the impact of serious games on executive functions (EF), focusing on attention, working memory, cognitive flexibility, and inhibitory control. In addition, it explores the integration of SG into educational and therapeutic settings for individuals with cognitive and neurodevelopmental conditions. Only open access articles published from 2019 to the search date were included to capture the most recent advancements in the field. Methods: A comprehensive search was conducted on June 20, 2024, across Scopus, Web of Science, and PubMed databases. Due to limited direct results linking SG and neurodiversity, separate searches were performed to analyze the relationship between SG and EF, as well as SG and neurodiverse populations. Two independent reviewers assessed the quality and risk of bias of the included studies using the Risk of Bias 2 tool for randomized studies and the Risk of Bias in Non-Randomized Studies of Interventions tool for nonrandomized studies. Results: The review identified 16 studies that met the inclusion criteria. Of these, 15 addressed the use of SG for improving EF in neurodiverse populations, such as children with attention-deficit/hyperactivity disorder, autism spectrum disorder, and down syndrome. These studies demonstrated significant improvements in various EF domains, including attention, working memory, and cognitive flexibility. However, there was notable heterogeneity in sample sizes, participant ages, and game types. Three studies specifically focused on individuals with down syndrome, showing promising results in improving cognitive functions. Conclusions: SG hold considerable potential as therapeutic tools for enhancing EF across neurodiverse populations. They have shown positive effects in improving cognitive skills and promoting inclusion in both educational and therapeutic settings. However, further research is required to optimize game design, assess long-term outcomes, and address the variability in study quality. The exclusive inclusion of open access studies may have limited the scope of the review, and future research should incorporate a broader range of studies to provide a more comprehensive understanding of SG’s impact on neurodiversity. Trial Registration: PROSPERO CRD42024563231; https://tinyurl.com/ycxdymyb %M 39693133 %R 10.2196/59053 %U https://games.jmir.org/2024/1/e59053 %U https://doi.org/10.2196/59053 %U http://www.ncbi.nlm.nih.gov/pubmed/39693133 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63760 %T Open-World Games’ Affordance of Cognitive Escapism, Relaxation, and Mental Well-Being Among Postgraduate Students: Mixed Methods Study %A Anto,Ailin %A Basu,Arunima %A Selim,Rania %A Foscht,Thomas %A Eisingerich,Andreas Benedikt %+ Faculty of Medicine, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2AZ, United Kingdom, 44 020 7589 5111, ailin.anto18@imperial.ac.uk %K open-world games %K cognitive escapism %K relaxation %K mental well-being %K students %K video games %K stress %K freedom to explore %D 2024 %7 17.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Open-world games, characterized by their expansive and interactive environments, may offer unique cognitive escapism opportunities, potentially leading to relaxation and enhanced well-being. These games, such as “The Legend of Zelda: Breath of the Wild” and “The Legend of Zelda: Tears of the Kingdom,” allow players to experience a sense of freedom and autonomy, which can reduce stress and improve mental health. While previous research has examined the general impact of video games on mental well-being, specific studies on the effects of open-world games among postgraduate students are limited. Objective: This study aims to investigate the relationships between cognitive escapism provided by open-world games and their effects on relaxation and well-being. The goal was to understand how the immersive nature of these games contributes to stress reduction and overall mental health improvement among postgraduate students. Methods: A mixed methods approach was used, which involved in-depth exploratory qualitative interviews and a survey of 609 players of popular open-world games. Quantitative data were collected using standardized questionnaires to measure open-world games’ affordance of cognitive escapism, relaxation, and well-being. Qualitative data were obtained through 32 in-depth interviews that explored players’ experiences and perceptions of cognitive escapism, relaxation, and mental well-being. Results: Qualitative data (n=32; n=15, 47% female; n=16, 50% male; n=1, 3% preferred not to disclose gender; mean age 23.19, SD 2.19 y) revealed that cognitive escapism through immersive game worlds allowed players to temporarily disconnect from real-world stressors, resulting in enhanced mood and psychological well-being. Players indicated that the nonlinear gameplay and freedom to explore interactive environments provided a sense of relaxation and mental rejuvenation. Quantitative analysis (N=609) showed a substantial mediating role of relaxation in the relationship between cognitive escapism offered by open-world games and well-being. Specifically, cognitive escapism had a significant positive effect on players’ relaxation (β=.15; SE 0.04; P<.001; 95% CI 0.0695-0.2331), which in turn had a significant and positive effect on players’ well-being scores (β=.12; SE 0.04; P=.002; 95% CI 0.0445-0.2032). Conclusions: The study demonstrates that open-world games offer substantial benefits for cognitive escapism, significantly improving relaxation and well-being among postgraduate students. The immersive and autonomous nature of these games is crucial in reducing stress and enhancing mental health. Future research may investigate the long-term effects of regular engagement with open-world games and explore their potential therapeutic applications for managing stress and anxiety. %M 39689301 %R 10.2196/63760 %U https://www.jmir.org/2024/1/e63760 %U https://doi.org/10.2196/63760 %U http://www.ncbi.nlm.nih.gov/pubmed/39689301 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e63316 %T Efficacy of the mHealth App Intellect in Improving Subclinical Obsessive-Compulsive Disorder in University Students: Randomized Controlled Trial With a 4-Week Follow-Up %A Lee Yoon Li,Madeline %A Lee Si Min,Stephanie %A Sündermann,Oliver %+ National University of Singapore, 9 Arts Link, #13-02, Singapore, 117570, Singapore, 65 80435120 ext 5120, psymos@nus.edu.sg %K mobile health app %K self-guided interventions %K obsessive-compulsive disorder %K cognitive behavioral therapy %K maladaptive perfectionism %K randomized controlled trial %K behavioral %K efficacy %K mHealth app %K university students %K Singapore %K symptoms %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obsessive-compulsive disorder (OCD) is the third most prevalent mental health disorder in Singapore, with a high degree of burden and large treatment gaps. Self-guided programs on mobile apps are accessible and affordable interventions, with the potential to address subclinical OCD before symptoms escalate. Objective: This randomized controlled trial aimed to examine the efficacy of a self-guided OCD program on the mobile health (mHealth) app Intellect in improving subclinical OCD and maladaptive perfectionism (MP) as a potential moderator of this predicted relationship. Methods: University students (N=225) were randomly assigned to an 8-day, self-guided app program on OCD (intervention group) or cooperation (active control). Self-reported measures were obtained at baseline, after the program, and at a 4-week follow-up. The primary outcome measure was OCD symptom severity (Obsessive Compulsive Inventory–Revised [OCI-R]). Baseline MP was assessed as a potential moderator. Depression, anxiety, and stress (Depression Anxiety and Stress Scales-21) were controlled for during statistical analyses. Results: The final sample included 192 participants. The intervention group reported significantly lower OCI-R scores compared with the active control group after the intervention (partial eta-squared [ηp2]=0.031; P=.02) and at 4-week follow-up (ηp2=0.021; P=.044). A significant, weak positive correlation was found between MP and OCI-R levels at baseline (r=0.28; P<.001). MP was not found to moderate the relationship between condition and OCI-R scores at postintervention (P=.70) and at 4-week follow-up (P=.88). Conclusions: This study provides evidence that the self-guided OCD program on the Intellect app is effective in reducing subclinical OCD among university students in Singapore. Future studies should include longer follow-up durations and study MP as a moderator in a broader spectrum of OCD symptom severity. Trial Registration: ClinicalTrials.gov NCT06202677; https://clinicaltrials.gov/study/NCT06202677 %M 39680884 %R 10.2196/63316 %U https://mhealth.jmir.org/2024/1/e63316 %U https://doi.org/10.2196/63316 %U http://www.ncbi.nlm.nih.gov/pubmed/39680884 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 5 %N %P e65506 %T Effect of a Web-Based Heartfulness Program on the Mental Well-Being, Biomarkers, and Gene Expression Profile of Health Care Students: Randomized Controlled Trial %A Thimmapuram,Jayaram %A Patel,Kamlesh D %A Bhatt,Deepti %A Chauhan,Ajay %A Madhusudhan,Divya %A Bhatt,Kashyap K %A Deshpande,Snehal %A Budhbhatti,Urvi %A Joshi,Chaitanya %+ WellSpan Health, 1001 S George St, York, PA, 17403, United States, 1 7174956027, jthimmapuram@wellspan.org %K heartfulness %K meditation %K stress %K anxiety %K depression %K interleukins %K gene expression %K dehydroepiandrosterone %K DHEA %K gene %K mental health %K meditation %K randomized study %K web-based program %K mental well-being %K well-being %K mental %K health care students %K student %K mRNA %K messenger ribonucleic acid %K youth %K young adults %K web-based %K biomarker %K RNA %K bioinformatics %K randomized %K statistical analysis %K nursing %K physiotherapy %K pharmacy %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: Health care students often experience high levels of stress, anxiety, and mental health issues, making it crucial to address these challenges. Variations in stress levels may be associated with changes in dehydroepiandrosterone sulfate (DHEA-S) and interleukin-6 (IL-6) levels and gene expression. Meditative practices have demonstrated effectiveness in reducing stress and improving mental well-being. Objective: This study aims to assess the effects of Heartfulness meditation on mental well-being, DHEA-S, IL-6, and gene expression profile. Methods: The 78 enrolled participants were randomly assigned to the Heartfulness meditation (n=42, 54%) and control (n=36, 46%) groups. The participants completed the Perceived Stress Scale (PSS) and Depression Anxiety Stress Scale (DASS-21) at baseline and after week 12. Gene expression with messenger RNA sequencing and DHEA-S and IL-6 levels were also measured at baseline and the completion of the 12 weeks. Statistical analysis included descriptive statistics, paired t test, and 1-way ANOVA with Bonferroni correction. Results: The Heartfulness group exhibited a significant 17.35% reduction in PSS score (from mean 19.71, SD 5.09 to mean 16.29, SD 4.83; P<.001) compared to a nonsignificant 6% reduction in the control group (P=.31). DASS-21 scores decreased significantly by 27.14% in the Heartfulness group (from mean 21.15, SD 9.56 to mean 15.41, SD 7.87; P<.001) while it increased nonsignificantly by 17% in the control group (P=.04). For the DASS-21 subcomponents—the Heartfulness group showed a statistically significant 28.53% reduction in anxiety (P=.006) and 27.38% reduction in stress (P=.002) versus an insignificant 22% increase in anxiety (P=.02) and 6% increase in stress (P=.47) in the control group. Further, DHEA-S levels showed a significant 20.27% increase in the Heartfulness group (from mean 251.71, SD 80.98 to mean 302.74, SD 123.56; P=.002) compared to an insignificant 9% increase in the control group (from mean 285.33, SD 112.14 to mean 309.90, SD 136.90; P=.10). IL-6 levels showed a statistically significant difference in both the groups (from mean 4.93, SD 1.35 to mean 3.67, SD 1.0; 28.6%; P<.001 [Heartfulness group] and from mean 4.52, SD 1.40 to mean 2.72, SD 1.74; 40%; P<.001 [control group]). Notably, group comparison at 12 weeks revealed a significant difference in perceived stress, DASS-21 and its subcomponents, and IL-6 (all P<.05/4). The gene expression profile with messenger RNA sequencing identified 875 upregulated genes and 1539 downregulated genes in the Heartfulness group compared to baseline, and there were 292 upregulated genes and 1180 downregulated genes in the Heartfulness group compared to the control group after the intervention. Conclusions: Heartfulness practice was associated with decreased depression, anxiety, and stress scores and improved health measures in DHEA-S and IL-6 levels. The gene expression data point toward possible mechanisms of alleviation of symptoms of stress, anxiety and depression. Trial Registration: ISRCTN Registry ISRCTN82860715; https://doi.org/10.1186/ISRCTN82860715 %M 39680432 %R 10.2196/65506 %U https://bioinform.jmir.org/2024/1/e65506 %U https://doi.org/10.2196/65506 %U http://www.ncbi.nlm.nih.gov/pubmed/39680432 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46860 %T Participant Adherence and Contact Behavior in a Guided Internet Intervention for Depressive Symptoms: Exploratory Study %A Bur,Oliver Thomas %A Berger,Thomas %K internet intervention %K depression %K guidance %K contact behavior %K messages %K adherence %K online %K intervention %K digital health %K therapy %K participant %D 2024 %7 16.12.2024 %9 %J JMIR Form Res %G English %X Background: The number of studies on internet-based guided self-help has rapidly increased during the last 2 decades. Guided self-help comprises 2 components: a self-help program that patients work through and usually weekly guidance from therapists who support patients using the self-management program. Little is known about participants' behavior patterns while interacting with therapists and their use of self-help programs in relation to intervention outcomes. Objective: This exploratory study aimed to investigate whether the number of messages sent to the therapist (ie, contact behavior) is an indicator of the outcome, that is, a reduction in depressive symptoms. Furthermore, we investigated whether adherence was associated with outcome. Most importantly, we investigated whether different combinations of adherence and contact behavior were associated with outcome. Methods: Drawing on a completer sample (n=113) from a randomized full factorial trial, participants were categorized into 4 groups. The groups were based on median splits of 2 variables, that is, the number of messages sent to therapists (low: groups 1 and 2; high: groups 3 and 4) and adherence (low: groups 1 and 3; high: groups 2 and 4). The 4 groups were compared in terms of change in depressive symptoms (measured with the Patient Health Questionnaire-9) from pre- to posttreatment and pretreatment to follow-up, respectively. Results: On average, participants sent 4.5 (SD 3.7) messages to their therapist and completed 18.2 (SD 5.2) pages of the program in 6.39 (SD 5.39) hours. Overall, analyses revealed no main effect for participants’ messages (H1=0.18, P=.67) but a significant main effect for adherence on changes in depressive symptoms from pre- to posttreatment (H1=5.10, P=.02). The combined consideration of adherence and messages sent to the therapist revealed group differences from pre- to posttreatment (H3=8.26, P=.04). Group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=–2.84, P=.002). Furthermore, there were group differences from pretreatment to follow-up (H3=8.90, P=.03). Again, group 3 showed a significantly smaller improvement in symptoms compared with group 4 (Z=–2.62, P=.004) and group 2 (Z=–2.47, P=.007). All other group comparisons did not yield significant differences. Conclusion: This exploratory study suggests that participants characterized by low adherence and frequent messaging do not improve their symptoms as much as other participants. These participants might require more personalized support beyond the scope of guided internet interventions. The paper underscores the importance of considering individual differences in contact behavior when tailoring interventions. The results should be interpreted with caution and further investigated in future studies. Trial Registration: ClinicalTrials.gov NCT04318236; https://www.clinicaltrials.gov/study/NCT04318236 %R 10.2196/46860 %U https://formative.jmir.org/2024/1/e46860 %U https://doi.org/10.2196/46860 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e59785 %T Integrating Patient-Generated Digital Data Into Mental Health Therapy: Mixed Methods Analysis of User Experience %A Southwick,Lauren %A Sharma,Meghana %A Rai,Sunny %A Beidas,Rinad S %A Mandell,David S %A Asch,David A %A Curtis,Brenda %A Guntuku,Sharath Chandra %A Merchant,Raina M %K digital data %K social media %K psychotherapy %K latent Dirichlet allocation %K LDA %K mobile phone %D 2024 %7 16.12.2024 %9 %J JMIR Ment Health %G English %X Background: Therapists and their patients increasingly discuss digital data from social media, smartphone sensors, and other online engagements within the context of psychotherapy. Objective: We examined patients’ and mental health therapists’ experiences and perceptions following a randomized controlled trial in which they both received regular summaries of patients’ digital data (eg, dashboard) to review and discuss in session. The dashboard included data that patients consented to share from their social media posts, phone usage, and online searches. Methods: Following the randomized controlled trial, patient (n=56) and therapist (n=44) participants completed a debriefing survey after their study completion (from December 2021 to January 2022). Participants were asked about their experience receiving a digital data dashboard in psychotherapy via closed- and open-ended questions. We calculated descriptive statistics for closed-ended questions and conducted qualitative coding via NVivo (version 10; Lumivero) and natural language processing using the machine learning tool latent Dirichlet allocation to analyze open-ended questions. Results: Of 100 participants, nearly half (n=48, 49%) described their experience with the dashboard as “positive,” while the other half noted a “neutral” experience. Responses to the open-ended questions resulted in three thematic areas (nine subcategories): (1) dashboard experience (positive, neutral or negative, and comfortable); (2) perception of the dashboard’s impact on enhancing therapy (accountability, increased awareness over time, and objectivity); and (3) dashboard refinements (additional sources, tailored content, and privacy). Conclusions: Patients reported that receiving their digital data helped them stay “accountable,” while therapists indicated that the dashboard helped “tailor treatment plans.” Patient and therapist surveys provided important feedback on their experience regularly discussing dashboards in psychotherapy. Trial Registration: ClinicalTrials.gov NCT04011540; https://clinicaltrials.gov/study/NCT04011540 %R 10.2196/59785 %U https://mental.jmir.org/2024/1/e59785 %U https://doi.org/10.2196/59785 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55856 %T Screening for Depression and Anxiety Using a Nonverbal Working Memory Task in a Sample of Older Brazilians: Observational Study of Preliminary Artificial Intelligence Model Transferability %A Georgescu,Alexandra Livia %A Cummins,Nicholas %A Molimpakis,Emilia %A Giacomazzi,Eduardo %A Rodrigues Marczyk,Joana %A Goria,Stefano %K depression %K anxiety %K Brazil %K machine learning %K n-back %K working memory %K artificial intelligence %K gerontology %K older adults %K mental health %K AI %K transferability %K detection %K screening %K questionnaire %K longitudinal study %D 2024 %7 12.12.2024 %9 %J JMIR Form Res %G English %X Background: Anxiety and depression represent prevalent yet frequently undetected mental health concerns within the older population. The challenge of identifying these conditions presents an opportunity for artificial intelligence (AI)–driven, remotely available, tools capable of screening and monitoring mental health. A critical criterion for such tools is their cultural adaptability to ensure effectiveness across diverse populations. Objective: This study aims to illustrate the preliminary transferability of two established AI models designed to detect high depression and anxiety symptom scores. The models were initially trained on data from a nonverbal working memory game (1- and 2-back tasks) in a dataset by thymia, a company that develops AI solutions for mental health and well-being assessments, encompassing over 6000 participants from the United Kingdom, United States, Mexico, Spain, and Indonesia. We seek to validate the models’ performance by applying it to a new dataset comprising older Brazilian adults, thereby exploring its transferability and generalizability across different demographics and cultures. Methods: A total of 69 Brazilian participants aged 51-92 years old were recruited with the help of Laços Saúde, a company specializing in nurse-led, holistic home care. Participants received a link to the thymia dashboard every Monday and Thursday for 6 months. The dashboard had a set of activities assigned to them that would take 10-15 minutes to complete, which included a 5-minute game with two levels of the n-back tasks. Two Random Forest models trained on thymia data to classify depression and anxiety based on thresholds defined by scores of the Patient Health Questionnaire (8 items) (PHQ-8) ≥10 and those of the Generalized Anxiety Disorder Assessment (7 items) (GAD-7) ≥10, respectively, were subsequently tested on the Laços Saúde patient cohort. Results: The depression classification model exhibited robust performance, achieving an area under the receiver operating characteristic curve (AUC) of 0.78, a specificity of 0.69, and a sensitivity of 0.72. The anxiety classification model showed an initial AUC of 0.63, with a specificity of 0.58 and a sensitivity of 0.64. This performance surpassed a benchmark model using only age and gender, which had AUCs of 0.47 for PHQ-8 and 0.53 for GAD-7. After recomputing the AUC scores on a cross-sectional subset of the data (the first n-back game session), we found AUCs of 0.79 for PHQ-8 and 0.76 for GAD-7. Conclusions: This study successfully demonstrates the preliminary transferability of two AI models trained on a nonverbal working memory task, one for depression and the other for anxiety classification, to a novel sample of older Brazilian adults. Future research could seek to replicate these findings in larger samples and other cultural contexts. Trial Registration: ISRCTN Registry ISRCTN90727704; https://www.isrctn.com/ISRCTN90727704 %R 10.2196/55856 %U https://formative.jmir.org/2024/1/e55856 %U https://doi.org/10.2196/55856 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56567 %T Expanding a Health Technology Solution to Address Therapist Challenges in Implementing Homework With Adult Clients: Mixed Methods Study %A Bunnell,Brian E %A Schuler,Kaitlyn R %A Ivanova,Julia %A Flynn,Lea %A Barrera,Janelle F %A Niazi,Jasmine %A Turner,Dylan %A Welch,Brandon M %+ Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 E Fletcher Ave, Tampa, FL, 33613-4706, United States, 1 8139748607, bbunnell@usf.edu %K mental health %K mental illness %K mental disease %K mental disorder %K homework %K homework challenge %K therapy %K therapist %K barriers %K adult client %K adult %K technology-based solution %K health technology %K digital health %K digital technology %K digital intervention %K mobile phone %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Homework is implemented with variable effectiveness in real-world therapy settings, indicating a need for innovative solutions to homework challenges. We developed Adhere.ly, a user-friendly, Health Insurance Portability and Accountability Act–compliant web-based platform to help therapists implement homework with youth clients and their caregivers. The initial version had limited functionality, was designed for youth clients and their caregivers, and required expanding available features and exercises to suit adult clients. Objective: The purpose of this study was to better understand barriers and potential solutions to homework implementation experienced by therapists seeing adult clients and obtain their input on new features and exercises that would enable Adhere.ly to better meet their needs when working with this population. Methods: This study used an exploratory, sequential mixed methods design that included 13 semistructured focus groups with mental health therapists and clinic leaders and a survey administered to 100 therapists. Analyses were performed using the NVivo qualitative analysis software and SPSS. Results: The findings revealed common barriers, such as clients and therapists being busy, forgetting to complete homework, managing multiple platforms and homework materials, and clients lacking motivation. Adhere.ly was perceived as a potential solution, particularly its user-friendly interface and SMS text-message based reminders. Therapists suggested integrating Adhere.ly with telemedicine and electronic health record platforms and adding more exercises to support manualized therapy protocols and therapy guides. Conclusions: This study highlights the importance of technology-based solutions in addressing barriers to homework implementation in mental health treatment with adult clients. Adhere.ly shows promise in addressing these challenges and has the potential to improve therapy efficiency and homework completion rates. The input from therapists informed the development of Adhere.ly, guiding the expansion of features and exercises to better meet the needs of therapists working with adult clients. %M 39665475 %R 10.2196/56567 %U https://humanfactors.jmir.org/2024/1/e56567 %U https://doi.org/10.2196/56567 %U http://www.ncbi.nlm.nih.gov/pubmed/39665475 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e63078 %T Feasibility and Efficacy of a Novel Mindfulness App Used With Matcha Green Tea in Generally Healthy Adults: Randomized Controlled Trial %A Tanaka-Kanegae,Ryohei %A Yamada,Koji %A Cook,Chad M %A Blonquist,Traci M %A Taggart,Kristen D %A Hamada,Koichiro %+ Saga Nutraceuticals Research Institute, Otsuka Pharmaceutical Co Ltd, 5006-5 Aza Higashiyama, Omagari, Yoshinogari-cho, Kanzaki-gun, Saga, 842-0195, Japan, 81 952521522, tanaka.ryohei@otsuka.jp %K mindfulness %K guided tea meditation %K meditation %K matcha %K green tea %K mobile app %K smartphone %K stress %K mood %K mHealth %K mobile health %K well-being %K wellness %D 2024 %7 10.12.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness practices, such as breathing meditation (BM), reduce stress and enhance mood. One such practice is mindful eating, where a practitioner focuses on the five senses while eating or drinking. A novel set of prototypes has been developed, incorporating principles of mindful eating. These prototypes include matcha green tea and a mobile app that provides audio guidance for meditation during the preparation and consumption of the beverage (hereafter referred to as guided tea meditation [GTM]). Objective: This study assessed the feasibility and efficacy of GTM, evaluating meditation time, frequency, and prototype acceptability over 8 weeks, alongside changes in stress and mood. Additionally, other benefits of GTM were explored. Methods: A comparator group was established in which participants performed traditional BM without an app or audio guide (active control). This unblinded randomized controlled trial involved 100 healthy American volunteers (n=49 GTM, n=51 BM). During the 8-week study period, participants were encouraged to perform either GTM or BM for 10 minutes daily. The meditation activity was self-reported the following day. Only the GTM group assessed the prototype acceptability. The Perceived Stress Scale-10 was used to measure stress levels, while the Two-Dimensional Mood Scale was used to evaluate mood changes. Other meditation benefits were explored using a questionnaire. All questionnaires were presented and completed via an app. An intention-to-treat analysis was performed. Results: No significant between-group differences were found in total meditation time (P=.15) or frequency (P=.36). However, the weekly time and frequency of the GTM group remained above 50 minutes per week and 4 days per week, respectively. Over half of the GTM participants (≥28/49, ≥57%) accepted the prototype. The GTM group exhibited significant stress reductions at weeks 4 and 8 (both P<.001), similar to the BM group. Improvements in mood metrics were observed after a single GTM session on days 1 and 56, similar to the BM group. Moreover, increases in premeditation scores for relaxed and calm from day 1 to day 56 were significantly higher for the GTM group (P=.04 and .048, respectively). The majority of participants (≥25/49, ≥51%) assigned to GTM experienced positive changes in happiness, time management, quality of life, relationships, sleep, and work performance as they continued meditating. However, no significant between-group differences were found in these exploratory outcomes (P>.08). Conclusions: We believe that GTM exhibits good feasibility. Meanwhile, GTM reduced stress, improved mood, and let the practitioners feel other benefits, similar to BM. Long-term practitioners of GTM may even feel more relaxed and calmer in the state of premeditation than those who practice BM. Trial Registration: ClinicalTrials.gov NCT05832645; https://clinicaltrials.gov/study/NCT05832645 %M 39657179 %R 10.2196/63078 %U https://mhealth.jmir.org/2024/1/e63078 %U https://doi.org/10.2196/63078 %U http://www.ncbi.nlm.nih.gov/pubmed/39657179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55712 %T Ecological Momentary Assessment of Mental Health Problems Among University Students: Data Quality Evaluation Study %A Portillo-Van Diest,Ana %A Mortier,Philippe %A Ballester,Laura %A Amigo,Franco %A Carrasco,Paula %A Falcó,Raquel %A Gili,Margalida %A Kiekens,Glenn %A H Machancoses,Francisco %A Piqueras,Jose A %A Rebagliato,Marisa %A Roca,Miquel %A Rodríguez-Jiménez,Tíscar %A Alonso,Jordi %A Vilagut,Gemma %+ Hospital del Mar Research Institute, Carrer Doctor Aiguader, 88, Barcelona, 08023, Spain, 34 93 316 07 60, pmortier@researchmar.net %K experience sampling method %K ecological momentary assessment %K mental health %K university students %K participation %K compliance %K reliability %K sensitivity analysis %K mobile phone %D 2024 %7 10.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of ecological momentary assessment (EMA) designs has been on the rise in mental health epidemiology. However, there is a lack of knowledge of the determinants of participation in and compliance with EMA studies, reliability of measures, and underreporting of methodological details and data quality indicators. Objective: This study aims to evaluate the quality of EMA data in a large sample of university students by estimating participation rate and mean compliance, identifying predictors of individual-level participation and compliance, evaluating between- and within-person reliability of measures of negative and positive affect, and identifying potential careless responding. Methods: A total of 1259 university students were invited to participate in a 15-day EMA study on mental health problems. Logistic and Poisson regressions were used to investigate the associations between sociodemographic factors, lifetime adverse experiences, stressful events in the previous 12 months, and mental disorder screens and EMA participation and compliance. Multilevel reliability and intraclass correlation coefficients were obtained for positive and negative affect measures. Careless responders were identified based on low compliance or individual reliability coefficients. Results: Of those invited, 62.1% (782/1259) participated in the EMA study, with a mean compliance of 76.9% (SD 27.7%). Participation was higher among female individuals (odds ratio [OR] 1.41, 95% CI 1.06-1.87) and lower among those aged ≥30 years (OR 0.20, 95% CI 0.08-0.43 vs those aged 18-21 years) and those who had experienced the death of a friend or family member in the previous 12 months (OR 0.73, 95% CI 0.57-0.94) or had a suicide attempt in the previous 12 months (OR 0.26, 95% CI 0.10-0.64). Compliance was particularly low among those exposed to sexual abuse before the age of 18 years (exponential of β=0.87) or to sexual assault or rape in the previous year (exponential of β=0.80) and among those with 12-month positive alcohol use disorder screens (exponential of β=0.89). Between-person reliability of negative and positive affect was strong (RkRn>0.97), whereas within-person reliability was fair to moderate (Rcn>0.43). Of all answered assessments, 0.86% (291/33,626) were flagged as careless responses because the response time per item was <1 second or the participants gave the same response to all items. Of the participants, 17.5% (137/782) could be considered careless responders due to low compliance (<25/56, 45%) or very low to null individual reliability (raw Cronbach α<0.11) for either negative or positive affect. Conclusions: Data quality assessments should be carried out in EMA studies in a standardized manner to provide robust conclusions to advance the field. Future EMA research should implement strategies to mitigate nonresponse bias as well as conduct sensitivity analyses to assess possible exclusion of careless responders. %M 39657180 %R 10.2196/55712 %U https://www.jmir.org/2024/1/e55712 %U https://doi.org/10.2196/55712 %U http://www.ncbi.nlm.nih.gov/pubmed/39657180 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56205 %T mHealth Apps in German Outpatient Mental Health Care: Protocol for a Mixed Methods Approach %A Höfer,Klemens %A Plescher,Felix %A Schlierenkamp,Sarah %A Solar,Stefanie %A Neusser,Silke %A Schneider,Udo %A Best,Dieter %A Wasem,Jürgen %A Abels,Carina %A Bußmann,Anna %+ Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Straße 9, Essen, 45127, Germany, 49 2011834037, klemens.hoefer@medman.uni-due.de %K mental health care %K mHealth %K digital health applications %K Digitale Gesundheitsanwendungen %K mental disorders %K health care research %K applications %K app %K mental health %K outpatient %K digital health %K adults %K Germany %K mobile health apps %K treatment %D 2024 %7 10.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental disorders are complex diseases that affect 28% (about 17.8 million people) of the adult population in Germany annually. Since 2020, certain mobile health (mHealth) apps, so-called digital health applications (DiGA), are reimbursable in the German statutory health insurance system. A total of 27 of the 56 currently available DiGA are approved for the treatment of mental and behavioral diseases. An indicator of existing problems hindering the use of DiGA is the rather hesitant prescribing behavior. Objective: This project aims to develop health policy recommendations for the optimal integration of DiGA into outpatient psychotherapeutic care. The project is funded by the Innovation Fund of the Joint Federal Committee (grant 01VSF22029). The current status quo of the use of DiGA will be analyzed. Furthermore, concepts for the integration of mHealth apps, as well as their transfer into the care process will be investigated. In addition, barriers will be identified, and existing expectations of different perspectives captured. Methods: The project will be based on a mixed methods approach. A scoping review and a qualitative analysis of focus groups and expert interviews will be carried out. Additionally, an analysis of claims data of the statutory health insurance will be conducted. This will be followed by a written survey of insured persons and health care providers. Finally, health policy recommendations will be derived in cooperation with stakeholders. Results: The scoping reviews and qualitative analyses have been completed, and the quantitative surveys are currently being carried out. The target number of responses in the survey of insured persons has already been achieved. Furthermore, the analysis claims data of the statutory health insurance is currently being conducted. Conclusions: There is a need for research on how DiGA can be optimally integrated into the care process of patients with mental disorders as evidence regarding the topic is limited and prescribing behavior low. Although the potential of DiGA in mental health care has not yet fully unfolded, Germany serves as a model for other countries regarding reimbursable mHealth apps. This project aims to explore the potentials of DiGA and to describe the organizational, institutional, and procedural steps necessary for them to best support mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/56205 %M 39657173 %R 10.2196/56205 %U https://www.researchprotocols.org/2024/1/e56205 %U https://doi.org/10.2196/56205 %U http://www.ncbi.nlm.nih.gov/pubmed/39657173 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e56959 %T Brief Video-Delivered Intervention to Reduce Anxiety and Improve Functioning in Older Veterans: Pilot Randomized Controlled Trial %A Gould,Christine E %A Carlson,Chalise %A Wetherell,Julie L %A Goldstein,Mary K %A Anker,Lauren %A Beaudreau,Sherry A %+ Geriatric Research, Education and Clinical Center, VA Palo Alto Health Care System, 3801 Miranda Ave, Palo Alto, CA, 94304, United States, 1 650 493 5000 ext 68899, Christine.Gould@va.gov %K guided self-management %K internet %K progressive relaxation %K technology %K anxiety %K telehealth %K veterans %K older adults %D 2024 %7 9.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Older veterans with anxiety disorders encounter multiple barriers to receiving mental health services, including transportation difficulties, physical limitations, and limited access to providers trained to work with older persons. To address both accessibility and the shortage of available providers, evidence-based treatments that can be delivered via guided self-management modalities are a potential solution. Objective: This study aims to determine the feasibility and acceptability of a randomized controlled trial of 2 guided self-management interventions. This study compared the treatment effects of these 2 interventions (relaxation and health psychoeducation) on anxiety symptom severity and functioning in older veterans with anxiety disorders. Our exploratory aims examined factors related to home practices and treatment engagement and perceptions of the practices. Methods: Participants were randomized to one of two video-delivered interventions: (1) Breathing, Relaxation, and Education for Anxiety Treatment in the Home Environment (BREATHE)—breathing and progressive relaxation or (2) Healthy Living for Reduced Anxiety—psychoeducation about lifestyle changes. Telephone coaching calls were conducted weekly. Measures of anxiety, depression, and functioning were obtained at baseline, week 4 (end of treatment), week 8, and week 12. Participants completed a semistructured interview at week 12. Analyses included descriptive statistics to summarize measures of intervention engagement; mixed-effects models to characterize symptom change, and qualitative analyses. Results: Overall, 56 participants (n=48, 86% men; n=23, 41% from ethnic or racial minority groups; mean age 71.36, SD 6.19 y) were randomized. No difference in retention between study arms was found. The Healthy Living group (29/56, 52%) completed significantly more lessons (mean 3.68, SD 0.86) than the BREATHE group (27/56, 48%; mean 2.85, SD 1.43; t53=2.60; P=.01) but did not differ in completion of coaching calls. In the BREATHE group, greater baseline anxiety scores (r=–0.41; P=.03) and greater severity of medical comorbidity (r=–0.50; P=.009) were associated with fewer completed practices. There was no effect of intervention on change in total anxiety scores or functioning. For specific anxiety subtypes, Healthy Living produced a greater decline in somatic anxiety compared with BREATHE. Qualitative analyses found barriers to practicing, including difficulty setting time aside to practice, forgetting, or having other activities that interfered with BREATHE practices. Some participants described adapting their practice routine to fit their daily lives; some also used relaxation skills in everyday situations. Conclusions: These findings suggest that a larger randomized controlled trial of guided self-management approaches to treating late-life anxiety is feasible; however, BREATHE was not effective in reducing anxiety compared with Healthy Living. Possible contributing factors may have been the reliance on a single technique. Progressive relaxation was reported to be enjoyable for most participants, but maintaining home practices was challenging. Those with milder anxiety severity and fewer health problems were better able to adhere to practices. Trial Registration: ClinicalTrials.gov NCT02400723; https://clinicaltrials.gov/study/NCT02400723 %M 39652863 %R 10.2196/56959 %U https://aging.jmir.org/2024/1/e56959 %U https://doi.org/10.2196/56959 %U http://www.ncbi.nlm.nih.gov/pubmed/39652863 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55635 %T Dynamic Bidirectional Associations Between Global Positioning System Mobility and Ecological Momentary Assessment of Mood Symptoms in Mood Disorders: Prospective Cohort Study %A Lee,Ting-Yi %A Chen,Ching-Hsuan %A Chen,I-Ming %A Chen,Hsi-Chung %A Liu,Chih-Min %A Wu,Shu-I %A Hsiao,Chuhsing Kate %A Kuo,Po-Hsiu %+ Department of Public Health and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 521, No 17, Xuzhou Road, Taipei, 10055, Taiwan, 886 2 33668015, phkuo@ntu.edu.tw %K ecological momentary assessment %K digital phenotyping %K GPS mobility %K bipolar disorder %K major depressive disorder %K GPS %K global positioning system %K mood disorders %K assessment %K depression %K anxiety %K digital phenotype %K smartphone app %K technology %K behavioral changes %K patient %K monitoring %D 2024 %7 6.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Although significant research has explored the digital phenotype in mood disorders, the time-lagged and bidirectional relationship between mood and global positioning system (GPS) mobility remains relatively unexplored. Leveraging the widespread use of smartphones, we examined correlations between mood and behavioral changes, which could inform future scalable interventions and personalized mental health monitoring. Objective: This study aims to investigate the bidirectional time lag relationships between passive GPS data and active ecological momentary assessment (EMA) data collected via smartphone app technology. Methods: Between March 2020 and May 2022, we recruited 45 participants (mean age 42.3 years, SD 12.1 years) who were followed up for 6 months: 35 individuals diagnosed with mood disorders referred by psychiatrists and 10 healthy control participants. This resulted in a total of 5248 person-days of data. Over 6 months, we collected 2 types of smartphone data: passive data on movement patterns with nearly 100,000 GPS data points per individual and active data through EMA capturing daily mood levels, including fatigue, irritability, depressed, and manic mood. Our study is limited to Android users due to operating system constraints. Results: Our findings revealed a significant negative correlation between normalized entropy (r=–0.353; P=.04) and weekly depressed mood as well as between location variance (r=–0.364; P=.03) and depressed mood. In participants with mood disorders, we observed bidirectional time-lagged associations. Specifically, changes in homestay were positively associated with fatigue (β=0.256; P=.03), depressed mood (β=0.235; P=.01), and irritability (β=0.149; P=.03). A decrease in location variance was significantly associated with higher depressed mood the following day (β=–0.015; P=.009). Conversely, an increase in depressed mood was significantly associated with reduced location variance the next day (β=–0.869; P<.001). These findings suggest a dynamic interplay between mood symptoms and mobility patterns. Conclusions: This study demonstrates the potential of utilizing active EMA data to assess mood levels and passive GPS data to analyze mobility behaviors, with implications for managing disease progression in patients. Monitoring location variance and homestay can provide valuable insights into this process. The daily use of smartphones has proven to be a convenient method for monitoring patients’ conditions. Interventions should prioritize promoting physical movement while discouraging prolonged periods of staying at home. %M 39642364 %R 10.2196/55635 %U https://www.jmir.org/2024/1/e55635 %U https://doi.org/10.2196/55635 %U http://www.ncbi.nlm.nih.gov/pubmed/39642364 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56407 %T Text Messaging to Extend School-Based Suicide Prevention: Pilot Randomized Controlled Trial %A Pisani,Anthony R %A Wyman,Peter A %A Cero,Ian %A Kelberman,Caroline %A Gurditta,Kunali %A Judd,Emily %A Schmeelk-Cone,Karen %A Mohr,David %A Goldston,David %A Ertefaie,Ashkan %+ Department of Psychiatry, University of Rochester Medical Center, University of Rochester, 301 Crittenden Blvd, Rochester, NY, 14627, United States, 1 585 507 7177, anthony_pisani@urmc.rochester.edu %K suicide prevention %K text messaging %K self-violence %K self-harm %K suicidal behavior %K randomized controlled trial %K adolescent %K teenager %K student %K school %K United States %K Text4Strength %K help-seeking attitude %K coping %K awareness %K depression %K mood disorder %K mental health %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is the third-leading cause of death among US adolescents aged 10-19 years, and about 10% attempt suicide each year. School-based universal prevention may reduce youth suicidal behavior. Sources of Strength uses a peer leader network diffusion model to promote healthy norms across a school population. A key challenge within schoolwide programs is reaching a large and diverse array of students, especially those less engaged with their peers. Motivated by this challenge, we developed and field-tested Text4Strength—a program of automated text messages targeting help-seeking attitudes and norms, social coping resources, and emotion regulation skills. Objective: This study conducted a pilot randomized controlled trial of Text4Strength in 1 high school as an extension of an ongoing schoolwide program (Sources of Strength), to test its impact on targets that have the potential to reduce suicidal behavior. Methods: Students at an upstate New York high school (N=223) received 1-2 text messages per week for 9 weeks, targeting strategies for coping with difficult feelings and experiences through clarifying emotions and focusing on positive affect concepts, awareness, and strengthening of youth-adult relationships; and positive help-seeking norms, skills, and resources. Surveys were administered at baseline, immediately post intervention and 3 months after texting ended. We measured proximal intervention targets (methods of coping during stressful events, ability to make sense of their own emotions, feelings of powerlessness during emotion management and recovery, relations with trusted adults at school, and help-seeking behaviors), symptoms and suicide ideation, and student replies to messages. Results: No significant effects were observed for any outcome at either follow-up time point. Results showed that if there is a true (but undetected) intervention effect, it is small. Students with fewer friend nominations did not interact any more or less with the text messages. Exploratory moderation analyses observed no interaction between the intervention condition and the number of friends or baseline suicide ideation at any time point. Conclusions: In contrast to a promising previous field test, these results suggest that Text4Strength is unlikely to have impacted the outcomes of interest and that undetected moderate or large effects can be ruled out with high confidence. Although motivated by the need to reach more isolated students, students with fewer friends did not engage more or show a greater effect than other participants. This study was conducted in a single high school that was already implementing Sources of Strength, so the bar for showing a distinct effect from texting alone was high. Many further channels for reaching youth through private messaging remain unexplored. Alternative delivery systems should be investigated, such as embedding messaging in gaming chat systems and other media. More sophisticated systems drawing on chatbots may also achieve better outcomes. Trial Registration: ClinicalTrials.gov NCT03145363; https://clinicaltrials.gov/study/NCT03145363 %M 39642360 %R 10.2196/56407 %U https://mental.jmir.org/2024/1/e56407 %U https://doi.org/10.2196/56407 %U http://www.ncbi.nlm.nih.gov/pubmed/39642360 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55478 %T Neurological Evidence of Diverse Self-Help Breathing Training With Virtual Reality and Biofeedback Assistance: Extensive Exploration Study of Electroencephalography Markers %A Ng,Hei-Yin Hydra %A Wu,Changwei W %A Hsu,Hao-Che %A Huang,Chih-Mao %A Hsu,Ai-Ling %A Chao,Yi-Ping %A Jung,Tzyy-Ping %A Chuang,Chun-Hsiang %+ Research Center for Education and Mind Sciences, College of Education, National Tsing Hua University, Rm. 1515, 5/F, Administration Building, National Tsing Hua University, No. 521, Nanda Rd., Hsinchu, 300193, Taiwan, 886 35715131 ext 78608, cch.chuang@gmail.com %K biofeedback %K virtual reality %K breathing training %K EEG %K electroencephalography %K effective connectivity %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent advancements in virtual reality (VR) and biofeedback (BF) technologies have opened new avenues for breathing training. Breathing training has been suggested as an effective means for mental disorders, but it is difficult to master the technique at the beginning. VR-BF technologies address the problem of breathing, and visualizing breathing may facilitate the learning of breathing training. This study explores the integration of VR and BF to enhance user engagement in self-help breathing training, which is a multifaceted approach encompassing mindful breathing, guided breathing, and breath counting techniques. Objective: We identified 3 common breathing training techniques in previous studies, namely mindful breathing, guided breathing, and breath counting. Despite the availability of diverse breathing training methods, their varying effectiveness and underlying neurological mechanisms remain insufficiently understood. We investigated using electroencephalography (EEG) indices across multiple breathing training modalities to address this gap. Methods: Our automated VR-based breathing training environment incorporated real-time EEG, heart rate, and breath signal BF. We examined 4 distinct breathing training conditions (resting, mindful breathing, guided breathing, and breath counting) in a cross-sectional experiment involving 51 healthy young adults, who were recruited through online forum advertisements and billboard posters. In an experimental session, participants practiced resting state and each breathing training technique for 6 minutes. We then compared the neurological differences across the 4 conditions in terms of EEG band power and EEG effective connectivity outflow and inflow with repeated measures ANOVA and paired t tests. Results: The analyses included the data of 51 participants. Notably, EEG band power across the theta, alpha, low-beta, high-beta, and gamma bands varied significantly over the entire scalp (t ≥1.96, P values <.05). Outflow analysis identified condition-specific variations in the delta, alpha, and gamma bands (P values <.05), while inflow analysis revealed significant differences across all frequency bands (P values <.05). Connectivity flow analysis highlighted the predominant influence of the right frontal, central, and parietal brain regions in the neurological mechanisms underlying the breathing training techniques. Conclusions: This study provides neurological evidence supporting the effectiveness of self-help breathing training through the combined use of VR and BF technologies. Our findings suggest the involvement of internal-external attention focus and the dorsal attention network in different breathing training conditions. There is a huge potential for the use of breathing training with VR-BF techniques in terms of clinical settings, the new living style since COVID-19, and the commercial value of introducing VR-BF breathing training into consumer-level digital products. Furthermore, we propose avenues for future research with an emphasis on the exploration of applications and the gamification potential in combined VR and BF breathing training. Trial Registration: ClinicalTrials.gov NCT06656741; https://clinicaltrials.gov/study/NCT06656741 %M 39642375 %R 10.2196/55478 %U https://formative.jmir.org/2024/1/e55478 %U https://doi.org/10.2196/55478 %U http://www.ncbi.nlm.nih.gov/pubmed/39642375 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53280 %T The Use of a Digital Well-Being App (Stay Strong App) With Indigenous People in Prison: Randomized Controlled Trial %A Perdacher,Elke %A Kavanagh,David %A Sheffield,Jeanie %A Dale,Penny %A Heffernan,Edward %+ Queensland Forensic Mental Health Service, Level 5, 270 Roma Street, Brisbane, Queensland, 4000, Australia, 61 7 3837 5820, elke.perdacher@health.qld.gov.au %K First Nations %K Indigenous %K digital mental health %K e-mental health %K mental health %K social and emotional well-being %K SEWB %K prisoner %K prison %D 2024 %7 6.12.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Indigenous Australians in custody experience much greater rates of poor mental health and well-being than those of the general community, and these problems are not adequately addressed. Digital mental health strategies offer innovative opportunities to address the problems, but little is known about their feasibility in or impact on this population. Objective: This study aims to conduct a pilot trial evaluating the impact of adding the Stay Strong app to mental health and well-being services for Indigenous women and men in custody. The trial compared immediate and 3-month delayed use of the app by the health service, assessing its effects on well-being, empowerment, and psychological distress at 3 and 6 months after the baseline. Methods: Indigenous participants were recruited from 3 high-security Australian prisons from January 2017 to September 2019. The outcome measures assessed well-being (Warwick-Edinburgh Mental Wellbeing Scale), empowerment (Growth and Empowerment Measure [GEM]—giving total, 14-item Emotional Empowerment Scale, and 12 Scenarios scores), and psychological distress (Kessler Psychological Distress Scale). Intention-to-treat effects on these outcomes were analyzed using linear mixed models. Results: Substantial challenges in obtaining ethical and institutional approval for the trial were encountered, as were difficulties in timely recruitment and retention due to staff shortages and the release of participants from prison before follow-up assessments and an inability to follow up with participants after release. A total of 132 prisoners (age: mean 33, SD 8 y) were randomized into either an immediate (n=82) or a delayed treatment (n=52) group. However, only 56 (42.4%) could be assessed at 3 months and 37 (28%) at 6 months, raising questions concerning the representativeness of the results. Linear improvements over time were seen in all outcomes (GEM total: Cohen d=0.99; GEM 14-item Emotional Empowerment Scale: Cohen d=0.94; GEM 12 Scenarios: Cohen d=0.87; Warwick-Edinburgh Mental Wellbeing Scale: Cohen d=0.76; Kessler Psychological Distress Scale: Cohen d=0.49), but no differential effects for group or the addition of the Stay Strong app were found. Conclusions: We believe this to be Australia’s first evaluation of a digital mental health app in prison and the first among Indigenous people in custody. While the study demonstrated that the use of a well-being app within a prison was feasible, staff shortages led to delayed recruitment and a consequent low retention, and significant beneficial effects of the app’s use within a forensic mental health service were not seen. Additional staff resources and a longer intervention may be needed to allow a demonstration of satisfactory retention and impact in future research. Trial Registration: ANZCTR ACTRN12624001261505; https://www.anzctr.org.au/ACTRN12624001261505.aspx %M 39642362 %R 10.2196/53280 %U https://mental.jmir.org/2024/1/e53280 %U https://doi.org/10.2196/53280 %U http://www.ncbi.nlm.nih.gov/pubmed/39642362 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45640 %T Examining the Use of Virtual Reality to Support Mindfulness Skills Practice in Mood and Anxiety Disorders: Mixed Methods Study %A Blackmore,Rebecca %A Giles,Claudia %A Tremain,Hailey %A Kelly,Ryan %A Foley,Fiona %A Fletcher,Kathryn %A Nedeljkovic,Maja %A Wadley,Greg %A Seabrook,Elizabeth %A Thomas,Neil %+ Centre for Mental Health and Brain Sciences, Swinburne University of Technology, John Street, Hawthorn, VIC, 3122, Australia, 61 392148444, neilthomas@swin.edu.au %K virtual reality %K mindfulness %K mood disorders %K anxiety disorders %K depression %K bipolar disorder %D 2024 %7 6.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual reality (VR) has been proposed as a technology to support mindfulness practice through promoting increased engagement and presence. The proposed benefits of this technology have been largely unexamined with clinical populations. Further research is required to understand its clinical potential and utility in improving and managing mental health symptoms. Objective: This study aims to investigate the proximal impacts of a single, brief, VR-supported mindfulness practice for individuals with a mood or anxiety disorder and to understand user experiences, which may affect the acceptability and efficacy of VR mindfulness for this population. Methods: This mixed methods study recruited 28 participants with a primary diagnosis of major depressive disorder, bipolar disorder, or anxiety disorder. Participants completed a mindfulness practice wearing a VR headset that was presenting an omnidirectional video of a forest scene, which was overlaid with a guided audio voiceover. Before and after the practice, measures were completed assessing state mindfulness (Toronto Mindfulness Scale), affect (Positive and Negative Affect Schedule), and anxiety (State-Trait Anxiety Inventory Y-1; n=27). Semistructured interviews were then held inquiring about the user experience and were analyzed using thematic analysis (n=24). Results: After completing the VR-supported mindfulness practice, both measures of state mindfulness on the Toronto Mindfulness Scale, mean curiosity and decentering, increased significantly (Cohen d=1.3 and 1.51, respectively; P<.001). Negative affect on the Positive and Negative Affect Schedule (Cohen d=0.62; P=.003) and State-Trait Anxiety Inventory Y-1 state anxiety (Cohen d=0.84; P<.001) significantly reduced. There was no significant change in positive affect (Cohen d=0.29; P=.08). Qualitative analysis of interviews identified 14 themes across 5 primary theme categories. The results suggested that being mindful during the use of the app was experienced as relatively effortless because of the visual and immersive elements. It was also experienced as convenient and safe, including when compared with prior traditional experiences of mindfulness. Participants also identified the uses for VR-supported mindfulness in managing emotions and symptoms of mental illness. Conclusions: The results provide preliminary evidence that VR-supported mindfulness can improve emotional states and manage mental health symptoms for those with mood or anxiety disorders. It offers some potential clinical applications for those with mood or anxiety disorders for exploration within future research. %M 39641990 %R 10.2196/45640 %U https://www.jmir.org/2024/1/e45640 %U https://doi.org/10.2196/45640 %U http://www.ncbi.nlm.nih.gov/pubmed/39641990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53829 %T An Automated Conversational Agent Self-Help Program: Randomized Controlled Trial %A Foran,Heather M %A Kubb,Christian %A Mueller,Janina %A Poff,Spencer %A Ung,Megan %A Li,Margaret %A Smith,Eric Michael %A Akinyemi,Akinniyi %A Kambadur,Melanie %A Waller,Franziska %A Graf,Mario %A Boureau,Y-Lan %+ Department of Health Psychology, University of Klagenfurt, Universitaetstrasse 65067, Klagenfurt, 9020, Austria, 43 46327001641, Heather.Foran@aau.at %K well-being %K chatbot %K randomized controlled trial %K prevention %K flourishing %D 2024 %7 6.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Health promotion and growth-based interventions can effectively improve individual well-being; however, significant gaps in access and utilization still exist. Objective: This study aims to develop and test the effectiveness and implementation of a new, widely targeted conversational agent prevention program (Zenny) designed to enhance well-being. Methods: A total of 1345 individuals in the United States were recruited online and randomly assigned to either (1) a self-help program intervention delivered via an automated conversational agent on WhatsApp or (2) an active control group that had access to evidence-based wellness resources available online. The primary outcomes were well-being (measured using the 5-item World Health Organization Well-being Scale), psychosocial flourishing (assessed with the Flourishing Scale), and positive psychological health (evaluated with the Mental Health Continuum-Short Form). Outcome measures were collected at baseline and again 1 month postassessment. All analyses were conducted using an intention-to-treat approach. Results: Both groups showed significant improvements in well-being (self-help program intervention group effect size: Cohen d=0.26, P<.001; active control group effect size: d=0.24, P<.001), psychosocial flourishing (intervention: d=0.19, P<.001; active control: d=0.18, P<.001), and positive psychological health (intervention: d=0.17, P=.001; active control: d=0.24, P<.001) at postassessment. However, there were no significant differences in effectiveness between the 2 groups (P ranged from .56 to .92). As hypothesized a priori, a greater number of days spent actively engaging with the conversational agent was associated with larger improvements in well-being at postassessment among participants in the intervention group (β=.109, P=.04). Conclusions: The findings from this study suggest that the free conversational agent wellness self-help program was as effective as evidence-based web resources. Further research should explore strategies to increase participant engagement over time, as only a portion of participants were actively involved, and higher engagement was linked to greater improvements in well-being. Long-term follow-up studies are also necessary to assess whether these effects remain stable over time. Trial Registration: ClinicalTrials.gov NCT06208566; https://clinicaltrials.gov/ct2/show/NCT06208566; OSF Registries osf.io/ahe2r; https://doi.org/10.17605/osf.io/ahe2r %M 39641985 %R 10.2196/53829 %U https://www.jmir.org/2024/1/e53829 %U https://doi.org/10.2196/53829 %U http://www.ncbi.nlm.nih.gov/pubmed/39641985 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49927 %T Machine Learning–Based Suicide Risk Prediction Model for Suicidal Trajectory on Social Media Following Suicidal Mentions: Independent Algorithm Validation %A Kaminsky,Zachary %A McQuaid,Robyn J %A Hellemans,Kim GC %A Patterson,Zachary R %A Saad,Mysa %A Gabrys,Robert L %A Kendzerska,Tetyana %A Abizaid,Alfonso %A Robillard,Rebecca %+ University of Ottawa Institute of Mental Health Research at The Royal, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada, 1 6137226521 ext 7003, Zachary.Kaminsky@theroyal.ca %K suicide %K prediction %K social media %K machine learning %K suicide risk model %K validation %K prediction %K natural language processing %K suicide risk %K Twitter %K suicidal ideation %K suicidal mention %D 2024 %7 5.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous efforts to apply machine learning–based natural language processing to longitudinally collected social media data have shown promise in predicting suicide risk. Objective: Our primary objective was to externally validate our previous machine learning algorithm, the Suicide Artificial Intelligence Prediction Heuristic (SAIPH), against external survey data in 2 independent cohorts. A second objective was to evaluate the efficacy of SAIPH as an indicator of changing suicidal ideation (SI) over time. The tertiary objective was to use SAIPH to evaluate factors important for improving or worsening suicidal trajectory on social media following suicidal mention. Methods: Twitter (subsequently rebranded as X) timeline data from a student survey cohort and COVID-19 survey cohort were scored using SAIPH and compared to SI questions on the Beck Depression Inventory and the Self-Report version of the Quick Inventory of Depressive Symptomatology in 159 and 307 individuals, respectively. SAIPH was used to evaluate changing SI trajectory following suicidal mentions in 2 cohorts collected using the Twitter application programming interface. Results: An interaction of the mean SAIPH score derived from 12 days of Twitter data before survey completion and the average number of posts per day was associated with quantitative SI metrics in each cohort (student survey cohort interaction β=.038, SD 0.014; F4,94=3.3, P=.01; and COVID-19 survey cohort interaction β=.0035, SD 0.0016; F4,493=2.9, P=.03). The slope of average daily SAIPH scores was associated with the change in SI scores within longitudinally followed individuals when evaluating periods of 2 weeks or less (ρ=0.27, P=.04). Using SAIPH as an indicator of changing SI, we evaluated SI trajectory in 2 cohorts with suicidal mentions, which identified that those with responses within 72 hours exhibit a significant negative association of the SAIPH score with time in the 3 weeks following suicidal mention (ρ=–0.52, P=.02). Conclusions: Taken together, our results not only validate the association of SAIPH with perceived stress, SI, and changing SI over time but also generate novel methods to evaluate the effects of social media interactions on changing suicidal trajectory. %M 39637380 %R 10.2196/49927 %U https://www.jmir.org/2024/1/e49927 %U https://doi.org/10.2196/49927 %U http://www.ncbi.nlm.nih.gov/pubmed/39637380 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54619 %T Remotely Delivered Video Interaction Guidance for Families of Children With an Intellectual Disability Referred to Specialist Mental Health Services: Protocol for a Feasibility Randomized Controlled Trial %A Kohn,Charmaine %A Turner,Lauren %A Yang,Zhixing %A Absoud,Michael %A Casbard,Angela %A Gomes,Manuel %A Grant,Gemma %A Hassiotis,Angela %A Kennedy,Eilis %A Levitt,Sophie %A McNamara,Rachel %A Randell,Elizabeth %A Totsika,Vasiliki %+ University College London, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, 44 0207 679 2000, v.totsika@ucl.ac.uk %K learning disability %K intellectual disability %K ID %K child mental health %K challenging behavior %K family therapy %K parent-child relations %K parenting %D 2024 %7 5.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Children with an intellectual disability (ID) are 3-4 times more likely to present with behaviors that challenge and mental health problems than typically developing children. Parenting and the quality of parent-child relationships are risk factors for these families. The COVID-19 pandemic further exacerbated difficulties, leading to an increase in child mental health problems and behaviors that challenge, a deterioration in parental mental health, and further strain on family relationships. Remote family interventions could be an effective solution for both families and specialist mental health services. Video interaction guidance (VIG) has shown promise for improving child mental health. However, it is unclear whether it is widely acceptable to families and feasible to implement across specialist child mental health services. Objective: This randomized controlled trial aims to evaluate the feasibility of delivering VIG as a remote intervention for parents of children aged 6-12 years with ID who have been referred to specialist mental health services. Methods: The study will be undertaken across 5-7 National Health Service specialist mental health services in England, involving 50 participants randomly allocated on a 1:1 basis to either the intervention group (receiving remote VIG) or the treatment-as-usual (TAU) group. The intervention group will engage in 3-5 cycles of VIG delivered remotely over 12 weeks. The primary feasibility outcomes include the recruitment rate, retention at 6-month follow-up, and VIG cycle completion rate. The secondary outcomes will assess the acceptability of VIG and the feasibility of remote implementation, including fidelity to the intervention protocol. Data will be gathered through online surveys and telephone interviews at baseline, 3 months, and 6 months. Feasibility outcomes will be summarized using descriptive statistics, while thematic analysis will be applied to qualitative data from semistructured interviews with participants, VIG practitioners, and service managers. An embedded process evaluation will explore barriers and facilitators to engagement with VIG, and a parallel health economics evaluation will assess the feasibility of capturing service use data and intervention costs. Results: The trial was open to recruitment between December 2022 and March 2024. The first results should be available in 2025. Conclusions: The study is the first randomized evaluation of VIG as offered to parents of children with ID who have been referred to specialist mental health settings. The outcomes from this feasibility trial will inform the decision to proceed with a definitive trial, using a traffic light system to evaluate recruitment, retention, and VIG completion rates alongside qualitative insights and economic evaluations. Trial Registration: ISRCTN Registry ISRCTN13171328; http://www.isrctn.com/ISRCTN13171328 International Registered Report Identifier (IRRID): DERR1-10.2196/54619 %M 39636678 %R 10.2196/54619 %U https://www.researchprotocols.org/2024/1/e54619 %U https://doi.org/10.2196/54619 %U http://www.ncbi.nlm.nih.gov/pubmed/39636678 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50664 %T Effectiveness of an Internet-Based Self-Help Acceptance and Commitment Therapy Program on Medical Students’ Mental Well-Being: Follow-Up Randomized Controlled Trial %A Wang,Difan %A Lin,Bingyan %A Zhang,Shuangxi %A Xu,Wei %A Liu,Xinying %+ Faculty of Psychology, Beijing Normal University, 19 Xinjiekouwai Street Haidian District, Beijing, 100875, China, 86 010 66939114, livingxw@163.com %K internet-delivered self-help acceptance and commitment therapy %K depression %K anxiety %K stress %K psychological inflexibility %K obsessive-compulsive symptoms %K medical students %K iACT 2.0 program %D 2024 %7 4.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychological distress is a growing problem among medical students worldwide. This highlights the need for psychological interventions to focus on mental health and improve well-being in this population. Objective: This study developed an internet-based, self-help, acceptance and commitment therapy program (iACT 2.0), aiming to examine its effectiveness in reducing depression, anxiety, stress, psychological inflexibility (PI), and obsessive-compulsive symptoms (OCSs) among medical students. Methods: A total of 520 Chinese postgraduate medical students were randomly assigned to either an iACT 2.0 intervention group (n=260; six online lessons, once every 5 days) or a control condition (n=260; without intervention). Participants completed questionnaires including the 21-item Depression Anxiety Stress Scale, the revised Obsessive-Compulsive Inventory, and the Multidimensional Psychological Flexibility Inventory at the preintervention (T1), postintervention (T2), and 1-month follow-up time points (T3). No therapist support was provided during the 1-month iACT 2.0 intervention period. Data were collected via an online platform and analyzed using repeated-measures ANOVA. Results: Participants in the intervention group demonstrated a significant decrease in depression, anxiety, stress, PI, and OCSs compared to the control group after the intervention (F=22.9-672.04, all P<.001). Specifically, the intervention group showed significant reductions in all measured outcomes from the preintervention to postintervention time point and at the 1-month follow-up (all P<.001). In contrast, no significant changes were observed in the control group over the same period (all P>.05). The groups did not differ significantly at baseline (all P>.05). Significant differences were noted at both the postintervention and follow-up time points (all P<.001). Conclusions: This study demonstrated that the newly developed iACT 2.0 was effective in reducing depression, anxiety, stress, PI, and OCSs. Notably, the positive effects of the intervention persisted at the 1-month follow-up. This program can offer a useful addition to existing mental illness treatment and lead to improvements in clinical and psychotherapy planning while simultaneously reducing the burden on traditional counseling and services. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300070725; https://tinyurl.com/2h75wx8n %M 39631061 %R 10.2196/50664 %U https://www.jmir.org/2024/1/e50664 %U https://doi.org/10.2196/50664 %U http://www.ncbi.nlm.nih.gov/pubmed/39631061 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60461 %T Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study %A Golsong,Konstanze %A Kaufmann,Luisa %A Baldofski,Sabrina %A Kohls,Elisabeth %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, University of Leipzig Medical Center, Haus 13, Semmelweisstraße 10, Leipzig, Germany, 49 341 9724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K mental health %K eHealth %K app %K health care %K app-based support %K psychiatric symptoms %K mobile phone %K COVID-19 %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Methods: Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment–like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). Results: In total, 57 patients participated in the study, and the data of 38 (67%) were analyzed; 17 (30%) dropped out. Satisfaction with the app was high, with 53% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47%) of the completers trying relaxation modules and 71% (27/38) regularly responding to the ecological momentary assessment–like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58% (22/38) felt “definitely” or “rather” encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=–0.36; P=.03). Conclusions: App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic. %M 39630503 %R 10.2196/60461 %U https://formative.jmir.org/2024/1/e60461 %U https://doi.org/10.2196/60461 %U http://www.ncbi.nlm.nih.gov/pubmed/39630503 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e66430 %T Psychedelic Art and Implications for Mental Health: Randomized Pilot Study %A Peng,Mary L %A Monin,Joan %A Ovchinnikova,Polina %A Levi,Amanda %A McCall,Terika %+ Department of Orthopedics and Sports Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 (617) 355 6021, marypeng@hms.harvard.edu %K digital art %K mental health %K psychedelic art %K well-being %K pilot trial %K digital health tool %K art therapy %D 2024 %7 3.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychedelic art (PA) emerged in the 1960s during the psychedelic era; then characterized by visuals induced by the ingestion of psychedelic drugs, it is now an art form known for its vibrant colors, distorted forms, and intricate patterns. Building upon the existing research on art viewing as an effective means to improving physiological and psychological well-being, viewing PA is postulated to evoke positive emotions and provide a meditative experience, contributing to improved mental well-being. Objective: This study aims to investigate how digitally rendered PA influences viewers’ perceived emotional, mental, and physical states compared to imagery of natural scenery, offering insights into potential applications in mental health care and well-being. Methods: Overall, 102 participants age 18 to 35 years were randomly assigned to either the experimental group viewing 300 seconds of PA imagery (50/102, 49%) or the control group viewing 300 seconds of scenic imagery (52/102, 51%), after which every participant completed a survey that gathered qualitative data on the perceived impact of viewing their given imagery on their physical, mental, and emotional states through open-ended questions. Thematic analysis was conducted to identify the patterns of experiences reported by the participants. Results: Qualitative analysis unveiled a greater intensity and diversity of emotional, mental, and physical impacts induced by PA compared to natural scenery, including the sense of relaxation and peace, anxiety and stress alleviation, joy, thrill and sense of euphoria, sensations of awe and wonder, hypnotizing effect, holistic meditative effect, provocation of creative thoughts, induced hyperawareness of bodily states, and transitions from induced overstimulation or anxious thoughts to feelings of calmness. Conclusions: The preliminary findings of this study suggest that PA is a rich and complex form of visual art that has the potential to facilitate healing and promote well-being and mental health. PA presents promising avenues for integration into mental health care, therapeutic practices, digital health, health care environment, and medical research. %M 39626224 %R 10.2196/66430 %U https://formative.jmir.org/2024/1/e66430 %U https://doi.org/10.2196/66430 %U http://www.ncbi.nlm.nih.gov/pubmed/39626224 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56874 %T Predicting and Monitoring Symptoms in Patients Diagnosed With Depression Using Smartphone Data: Observational Study %A Ikäheimonen,Arsi %A Luong,Nguyen %A Baryshnikov,Ilya %A Darst,Richard %A Heikkilä,Roope %A Holmen,Joel %A Martikkala,Annasofia %A Riihimäki,Kirsi %A Saleva,Outi %A Isometsä,Erkki %A Aledavood,Talayeh %+ Department of Computer Science, Aalto University, Konemiehentie 2, Espoo, 02150, Finland, 358 449750110, arsi.ikaheimonen@aalto.fi %K data analysis %K digital phenotyping %K digital behavioral data %K depression symptoms %K depression monitoring %K mHealth %K mobile health %K smartphone %K mobile phone %D 2024 %7 3.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical diagnostic assessments and the outcome monitoring of patients with depression rely predominantly on interviews by professionals and the use of self-report questionnaires. The ubiquity of smartphones and other personal consumer devices has prompted research into the potential of data collected via these devices to serve as digital behavioral markers for indicating the presence and monitoring of the outcome of depression. Objective: This paper explores the potential of using behavioral data collected with smartphones to detect and monitor depression symptoms in patients diagnosed with depression. Specifically, it investigates whether this data can accurately classify the presence of depression, as well as monitor the changes in depressive states over time. Methods: In a prospective cohort study, we collected smartphone behavioral data for up to 1 year. The study consists of observations from 164 participants, including healthy controls (n=31) and patients diagnosed with various depressive disorders: major depressive disorder (MDD; n=85), MDD with comorbid borderline personality disorder (n=27), and major depressive episodes with bipolar disorder (n=21). Data were labeled based on depression severity using 9-item Patient Health Questionnaire (PHQ-9) scores. We performed statistical analysis and used supervised machine learning on the data to classify the severity of depression and observe changes in the depression state over time. Results: Our correlation analysis revealed 32 behavioral markers associated with the changes in depressive state. Our analysis classified patients who are depressed with an accuracy of 82% (95% CI 80%-84%) and change in the presence of depression with an accuracy of 75% (95% CI 72%-76%). Notably, the most important smartphone features for classifying depression states were screen-off events, battery charge levels, communication patterns, app usage, and location data. Similarly, for predicting changes in depression state, the most important features were related to location, battery level, screen, and accelerometer data patterns. Conclusions: The use of smartphone digital behavioral markers to supplement clinical evaluations may aid in detecting the presence and changes in severity of symptoms of depression, particularly if combined with intermittent use of self-report of symptoms. %M 39626241 %R 10.2196/56874 %U https://www.jmir.org/2024/1/e56874 %U https://doi.org/10.2196/56874 %U http://www.ncbi.nlm.nih.gov/pubmed/39626241 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60610 %T Opportunities for Telemedicine to Improve Parents’ Well-Being During the Neonatal Care Journey: Scoping Review %A Wagenaar,Josephine %A Mah,Crystal %A Bodell,Fredrik %A Reiss,Irwin %A Kleinsmann,Maaike %A Obermann-Borst,Sylvia %A Taal,H Rob %K telemedicine %K telehealth %K neonatal care %K parental well-being %K family-centered care %K pediatrics %K neonates %K newborns %K parents %K neonatal intensive care unit %K NICU %D 2024 %7 2.12.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Neonatal intensive care unit admissions of newborns are emotional and stressful for parents, influencing their mental and physical well-being and resulting in high rates of psychological morbidities. Significant research has been undertaken to understand and quantify the burden of a newborn’s medical journey on parents’ well-being. Simultaneously, an increase has been observed in the development and implementation of telemedicine interventions, defined as the remote delivery of health care. Telemedicine is used as an overarching term for different technological interventions grouped as real-time audio-visual communication, remote patient monitoring, and asynchronous communication. Various telemedicine interventions have been proposed and developed but scarcely with the primary goal of improving parental well-being during their newborn’s medical journey. Objective: This study aims to identify telemedicine interventions with the potential to improve parents’ well-being and to present the methods used to measure their experience. Methods: A scoping review was conducted, including empirical studies evaluating telemedicine in neonatal care that either measured parental well-being or included parents in the evaluation. Abstract and title screening, full-text screening, and data extraction were performed by three researchers. Two researchers were needed to reach decisions on both the inclusion and extraction of articles. Results: The review included 50 out of 737 screened articles. Telemedicine interventions focused mainly on daily visits at the neonatal intensive care unit and discharge preparedness for parents. Surveys were the primary tool used for outcome measurement (36/50, 72%). Aspects of parents’ well-being were evaluated in 62% (31/50) of studies. Telemedicine interventions developed to provide education and support showed a potential to improve self-efficacy and discharge preparedness and decrease anxiety and stress when they included a real-time telemedicine component. Conclusions: This scoping review identified specific telemedicine interventions, such as real-time audio-visual communication and eHealth apps, that have the potential to improve parental well-being by enhancing self-efficacy and discharge preparedness, and reducing anxiety and stress. However, more insights are needed to understand how these interventions affect well-being. Parents should be included in future research in both the development and evaluation stages. It is important to not only measure parents’ perceptions but also focus on the impact of a telemedicine intervention on their well-being. %R 10.2196/60610 %U https://pediatrics.jmir.org/2024/1/e60610 %U https://doi.org/10.2196/60610 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51470 %T Intention to Seek Mental Health Services During the 2022 Shanghai COVID-19 City-Wide Lockdown: Web-Based Cross-Sectional Study %A Luo,Lingzi %A Li,Gen %A Tang,Weiming %A Wu,Dan %A Hall,Brian %+ New York University Shanghai, Center for Global Health Equity, N812 567 West Yangsi Road, Shanghai, 200124, China, 86 62899837, bhall41@gmail.com %K COVID-19 %K mental health services %K intention %K mobile %K digital %K lockdowns %K depression %K anxiety %K help-seeking %K regression %K applications %K mHealth %K WeChat %K pandemic %K social isolation %K mental health %K intent %K outbreak %K SARS-CoV-2 %K survey %K usage %K service %D 2024 %7 2.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The implementation of COVID-19 lockdown measures had immediate and delayed psychological effects. From March 27, 2022, to June 1, 2022, the Shanghai government enforced a city-wide lockdown that affected 25 million residents. During this period, mental health services were predominantly provided through digital platforms. However, limited knowledge exists regarding the general population’s intention to use mental health services during this time. Objective: This study aimed to assess the intention of Shanghai residents to use mental health services during the 2022 Shanghai lockdown and identify factors associated with the intention to use mobile mental health services. Methods: An online survey was distributed from April 29 to June 1, 2022, using a purposive sampling approach across 16 districts in Shanghai. Eligible participants were adults over 18 years of age who were physically present in Shanghai during the lockdown. Multivariable logistic regression was used to estimate the associations between demographic factors, lockdown-related stressors and experiences, physical and mental health status, and study outcomes–mobile mental health service use intention (mobile applications and WeChat Mini Programs [Tencent Holdings Limited]). Results: The analytical sample comprised 3230 respondents, among whom 29.7% (weighted percentage; n=1030) screened positive for depression or anxiety based on the 9-item Patient Health Questionnaire or the 7-item Generalized Anxiety Disorder Scale. Less than one-fourth of the respondents (24.4%, n=914) expressed an intention to use any form of mental health services, with mobile mental health service being the most considered option (19.3%, n=728). Only 10.9% (n=440) used digital mental health services during the lockdown. Factors associated with increased odds of mobile mental health service use intention included being female, being employed, being a permanent resident, experiencing COVID-19–related stressors (such as loss of income, food insecurity, and potentially traumatic experiences), and having social and financial support. Individuals with moderate or severe anxiety, as well as those with comorbid anxiety and depression, demonstrated a higher intention to use mobile mental health services. However, individuals with depression alone did not exhibit a significantly higher intention compared with those without common mental disorders. Conclusions: Despite a high prevalence of common mental disorders among Shanghai residents, less than one-fourth of the study respondents expressed an intention to use any form of mental health services during the lockdown. Mobile apps or WeChat Mini Programs were the most considered mental health service formats. The study provided insights for developing more person-centered mobile mental health services to meet the diverse needs of different populations. %M 39622023 %R 10.2196/51470 %U https://formative.jmir.org/2024/1/e51470 %U https://doi.org/10.2196/51470 %U http://www.ncbi.nlm.nih.gov/pubmed/39622023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54941 %T Digital Interventions for Symptoms of Borderline Personality Disorder: Systematic Review and Meta-Analysis %A Lindsay,Julia A B %A McGowan,Niall M %A Henning,Thomas %A Harriss,Eli %A Saunders,Kate E A %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Oxford, OX3 7JX, United Kingdom, 44 01865613196, julia.lindsay@psych.ox.ac.uk %K borderline personality disorder %K BPD %K digital intervention %K digital health %K digital therapeutics %K persuasive system design %K systematic review %K meta-analysis %K suicidal ideation %K paranoia %K single symptom %K mental health %K behavior change %K treatment %K effectiveness %K symptom %K suicide %K mobile phone %D 2024 %7 29.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Borderline personality disorder (BPD) is a mental health condition with insufficient care availability worldwide. Digital mental health interventions could reduce this treatment gap. Persuasive system design (PSD) is a conceptual framework outlining elements of digital interventions that support behavior change. Objective: This systematic review aims to characterize digital interventions targeting BPD symptoms, assess treatment efficacy, and identify its association with intervention features, including PSD elements. Methods: A systematic review of automated digital interventions targeting symptoms of BPD was conducted. Eligible studies recruited participants aged ≥18 years, based on a diagnosis of BPD or one of its common comorbidities, or as healthy volunteers. OVID Embase, OVID MEDLINE, OVID PsycINFO, and the Cochrane Central Register for Controlled Trials were searched on July 19, 2022, and February 28, 2023. Intervention characteristics were tabulated. A meta-analysis of randomized controlled trials (RCTs) determined treatment effects separately for each core symptom of BPD using Hedges g. Associations between the treatment effect and intervention features, including PSD elements, were assessed by subgroup analysis (Cochran Q test). Risk of bias was assessed using the Cochrane Risk of Bias 2 tool for RCTs and the National Institutes of Health Quality Assessment Tool for pre-post studies. Results: A total of 40 (0.47%) publications out of 8520 met the inclusion criteria of this review, representing 6611 participants. Studies comprised examinations of 38 unique interventions, of which 32 (84%) were RCTs. Synthesis found that included interventions had the following transdiagnostic treatment targets: severity of BPD symptoms (4/38, 11%), suicidal ideation (17/38, 45%), paranoia (5/38, 13%), nonsuicidal self-injury (5/38, 13%), emotion regulation (4/38, 11%), and anger (3/38, 8%). Common therapeutic approaches were based on dialectical behavioral therapy (8/38, 21%), cognitive behavioral therapy (6/38, 16%), or both (5/38, 13%). Meta-analysis found significant effects of digital intervention for both symptoms of paranoia (Hedges g=–0.52, 95% CI –0.86 to –0.18; P=.01) and suicidal ideation (Hedges g=–0.13, 95% CI –0.25 to –0.01; P=.03) but not overall BPD symptom severity (Hedges g=–0.17, 95% CI –0.42 to 0.10; P=.72). Subgroup analysis of suicidal ideation interventions found that evidence-based treatments such as cognitive behavioral therapy and dialectical behavior therapy were significantly more effective than alternative modalities (Cochran Q=4.87; P=.03). The degree of human support was not associated with the treatment effect. Interventions targeting suicidal ideation that used reminders, offered self-monitoring, and encouraged users to rehearse behaviors were associated with a greater reduction in ideation severity. Conclusions: Evidence suggests that digital interventions may reduce the symptoms of suicidal ideation and paranoia and that the design of digital interventions may impact the efficacy of treatments targeting suicidal ideation. These results support the use of transdiagnostic digital interventions for paranoia and suicidal ideation. Trial Registration: PROSPERO CRD42022358270; https://tinyurl.com/3mz7uc7k %R 10.2196/54941 %U https://www.jmir.org/2024/1/e54941 %U https://doi.org/10.2196/54941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e65477 %T Therapy Mode Preference Scale: Preliminary Validation Methodological Design %A Cerrito,Brianna %A Xiao,Jamie %A Fialk,Amanda %A Buono,Frank D %K virtual teletherapy %K young adult mental health treatment %K in-person therapy %K virtual mental health care %K telehealth %K mental health treatment %K virtual care %K therapeutic %K virtual therapy %K in-person treatment %K exploratory factor analysis %K hierarchical linear regression %K standardized tool %K herapeutic impact %D 2024 %7 29.11.2024 %9 %J JMIR Form Res %G English %X Background: The use of tele–mental health care increased rapidly in 2020 as a critical response to the COVID-19 pandemic, serving as an effective contact-free alternative to treatment. Today, tele–mental health care remains a viable option for individuals with geographic and physical barriers to treatment. However, there are several potential therapeutic disadvantages to tele–mental health care (ie, missing nonverbal signals, handling crises, confidentiality, weakened social connection in group therapy) that should be evaluated. While published literature has explored client satisfaction within teletherapy and the effect of using technology for tele–mental health care demands, there is a need for published surveys that evaluate the therapeutic experience in teletherapy and in-person mediums of care. Objective: The authors of this study sought to develop and validate a survey that could evaluate the comparative impact of teletherapy and in-person care from a therapeutic perspective across key factors (ie, therapeutic alliance, engagement, rapport, and confidentiality). Methods: Participants were clients who experienced both tele–mental health care and in-person therapy at an intensive outpatient mental health treatment program for young adults from April 2020 through June 2022. Generated items on the survey were formulated based on input from experts in the field and existing validated scales. All individuals completed the survey on the internet, following informed consent (n=89). An exploratory factor analysis was conducted to understand factor structure, and Cronbach α was used to determine internal consistency. Incremental validity was demonstrated through a hierarchical linear regression. Results: The exploratory factor analysis revealed a 14-item, 3-factor structure. All 14 items correlated at a minimum of 0.30 with at least one other item. Kaiser-Meyer-Olkin measure of sampling adequacy was 0.75 and Bartlett’s test of sphericity was significant (χ291=528.41, P<.001). In total, 3 factors accounted for 61% of the variance, and the preliminary Cronbach α (α=0.71) indicates a satisfactory level of internal consistency. The Zoom Exhaustion and Fatigue Scale (ZEF) and Client Satisfaction Questionnaire (CSQ; −0.29) were significantly correlated, as well as the ZEF and Therapy Mode Preference Scale (TMPS; −0.31), and CSQ and TMPS (0.50; P<.001). Hierarchical linear regression revealed that the CSQ significantly accounted for additional variance in the TMPS (P<.001). With the ZEF entered into the model, no further variance was accounted for (P=.06). Conclusions: Continual research is warranted to expand the current findings by validating this standardized tool for assessing the therapeutic impact of teletherapy versus in-person care in a generalizable population. %R 10.2196/65477 %U https://formative.jmir.org/2024/1/e65477 %U https://doi.org/10.2196/65477 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55736 %T Biomarkers of Response to Internet-Based Psychological Interventions: Systematic Review %A Gotti,Giulia %A Gabelli,Chiara %A Russotto,Sophia %A Madeddu,Fabio %A Courtet,Philippe %A Lopez-Castroman,Jorge %A Zeppegno,Patrizia %A Gramaglia,Carla Maria %A Calati,Raffaella %+ Department of Psychology, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, U6 Building, Room 3129, Milan, 20126, Italy, 39 3477752087, raffaella.calati@unimib.it %K biomarker %K cognitive behavioral therapy %K internet-based intervention %K systematic review %K psychological intervention %K mental health intervention %K meta analysis %K psychiatric %K blood glucose %K mindfulness %K stress management %K immune response %K smoking %K cortisol %D 2024 %7 29.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Internet-based psychological interventions provide accessible care to a wide range of users, overcoming some obstacles—such as distance, costs, and safety—that might discourage seeking help for mental issues. It is well known that psychological treatments and programs affect the body, as well as the mind, producing physiological changes that ought to be considered when assessing the efficacy of the intervention. However, the literature investigating changes in biomarkers specifically after internet-based psychological and mental health interventions has not yet extensively inquired into this topic. Objective: This systematic review aims to provide a synthesis of literature examining the effects of internet-based psychological interventions—targeting both clinical (mental and physical) and nonclinical conditions—on biomarkers. A secondary aim was to evaluate whether the biomarkers’ variations were related to a complementary modification of the psychological or physical symptoms or to a general improvement of the participants’ well-being. Methods: This review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) statement. A literature search was performed through 3 databases (PubMed, PsycINFO, and Scopus). Studies examining changes in biomarkers before and after internet-based psychological interventions or programs targeting both clinical and nonclinical samples were included, with no exclusion criteria concerning mental or physical conditions. Results: A total of 24 studies fulfilled the inclusion criteria. These studies involved individuals with psychiatric or psychological problems (n=6, 25%), those with organic or medical diseases (n=10, 42%), and nonclinical populations (n=8, 33%). Concerning psychiatric or psychological problems, cognitive behavioral therapy (CBT) and CBT-informed interventions showed partial effectiveness in decreasing glycated hemoglobin blood glucose level (n=1) and chemokines (n=1) and in increasing connectivity between the default-mode network and the premotor or dorsolateral prefrontal cortex (n=1). Among individuals with organic or medical diseases, studies reported a significant change in cardiac or cardiovascular (n=3), inflammatory (n=2), cortisol (n=2), glycated hemoglobin (n=2), and immune response (n=1) biomarkers after CBT and CBT-informed interventions, and mindfulness and stress management interventions. Lastly, mindfulness, CBT and CBT-informed interventions, and music therapy succeeded in modifying immune response (n=2), cortisol (n=1), α amylase (n=1), posterior cingulate cortex reactivity to smoking cues (n=1), and carbon monoxide (n=1) levels in nonclinical populations. In some of the included studies (n=5), the psychological intervention or program also produced an improvement of the mental or physical condition of the participants or of their general well-being, alongside significant variations in biomarkers; CBT and CBT-informed interventions proved effective in reducing both psychological (n=2) and physical symptoms (n=2), while a mindfulness program successfully lowered cigarette consumption in a nonclinical sample (n=1). Conclusions: Although further evidence is required, we hope to raise awareness on the potential impact of internet-based interventions on biomarkers related to mental and physical health. %M 39612489 %R 10.2196/55736 %U https://www.jmir.org/2024/1/e55736 %U https://doi.org/10.2196/55736 %U http://www.ncbi.nlm.nih.gov/pubmed/39612489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57205 %T Messenger App–Based Information Provision for Promoting Social Participation to Enhance Well-Being Among Community-Dwelling Adults: Randomized Controlled Trial %A Nakagomi,Atsushi %A Abe,Noriyuki %A Chen,Yu-Ru %A Ide,Kazushige %A Kobayashi,Shuhei %A Hanazato,Masamichi %A Kondo,Katsunori %+ Center for Preventive Medical Sciences, Chiba University, 1-33 Yayoicho, Inage Ward, Chiba, 263-8522, Japan, 81 43 251 1111, anakagomi0211@gmail.com %K messenger app %K event information %K happiness %K social participation %K messenger %K app %K well-being %K adults %K aging %K randomized controlled trial %K RCT %K information technology %K social activity %K Japan %K urban community %K health information %K control group %K multivariable regression %K life satisfaction %K digital intervention %K community-dwelling %D 2024 %7 29.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Engaging in social activities, interacting with peers, and participating in community events may promote health and well-being. Recently, interventions leveraging information and communications technology have emerged as potent tools for promoting social connections and well-being. Particularly, messenger apps have become an integral part of our daily lives, facilitating communication, information dissemination, and social interaction. However, there remains a gap in the literature regarding the utilization of widely adopted messenger apps for this purpose. Objective: This study aimed to evaluate the impact of messenger app–based information provision aimed at promoting social participation on the enhancement of subjective well-being among Japanese community-dwelling adults. Methods: A 2-arm, parallel-group randomized controlled trial was conducted from October 2022 to January 2023 in the Kashiwa-no-ha campus area, Japan—an urban community with active local events. A total of 358 community-dwelling adults who use messenger apps daily were recruited for the study. Of these, 235 (65.6%) participants completed the follow-up survey. Participants were randomly assigned to either the intervention group, receiving the health benefits of social participation and information about local events or spots via a messenger app, or the control group, receiving general health information. The primary outcome was subjective happiness after the intervention, measured on an 11-point scale ranging from 0 (Unhappy) to 10 (Happy). Secondary outcomes included life satisfaction, meaning of life, purpose in life, and participation in local events. The outcomes were analyzed with t tests (2-tailed) and multivariable regression based on the intention-to-treat method. Results: After the intervention, the intervention group reported a mean happiness score of 7.7 (SD 1.7), while the control group reported a score of 7.5 (SD 2.0), with no statistically significant difference (P=.40). Multivariable linear regression analysis adjusted for baseline outcome values and covariates showed that the coefficient of the intervention for life satisfaction was 0.30 (95% CI –0.07 to 0.68; P=.12), while that for meaning of life was 0.33 (95% CI –0.03 to 0.70; P=.07). There was no significant difference in event participation rates between the 2 groups during the study period (P=.22). However, 82.2% (102/124) of the intervention group acknowledged the utility of the event information provided. Conclusions: Messenger app–based information provision did not yield a significant increase in subjective happiness, while there was a positive but not significant trend in life satisfaction. The findings underscore the need for more intensive intervention in future studies to harness the potential of digital interventions. Trial Registration: UMIN Clinical Trials Registry UMIN000049047; https://tinyurl.com/2zzrrae8 %M 39612209 %R 10.2196/57205 %U https://www.jmir.org/2024/1/e57205 %U https://doi.org/10.2196/57205 %U http://www.ncbi.nlm.nih.gov/pubmed/39612209 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56598 %T High-Frequency Cognitive Control Training for Depression: Case Report %A Vander Zwalmen,Yannick %A Hoorelbeke,Kristof %A Demeester,David %A Koster,Ernst H W %+ Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium, 32 92649107, y.vander.zwalmen@ugent.be %K cognitive control training %K CCT %K cognitive function %K depression %K recurrence %K relapse %K prevention %K case report %K working memory %K memory training %K task performance %K digital health %D 2024 %7 29.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive control training (CCT) has gained attention in recent years as a preventative intervention in the context of major depressive disorder. To date, uncertainty exists around the working mechanisms of CCT and how its effects unfold overtime. Objective: This study aimed to examine cognitive and affective transfer effects following an unusually high number of training sessions. Methods: This case report presents data of a participant completing a large amount of training sessions (n=55) over the course of 1 year in 2 training phases: 10 initial sessions, followed by 45 additional sessions. Reliable change indices were calculated for several self-report questionnaires, measuring cognitive and affective functioning. Results: Cognitive task performance suggests improved cognitive functioning after training (accuracy scores increased from 43/181, 24% at baseline to 110/181, 61% shortly after training), which was maintained at follow-up (accuracy scores around 50%). Reliable change indices suggest a decrease in depressive symptoms (Beck Depression Inventory-II score decreased from 23 at baseline to 3 following initial training). Similarly, burnout symptoms following CCT showed a similar decrease. Maladaptive emotion regulation strategies displayed high variability, decreasing after periods of training but increasing when no training was performed. However, no changes in repetitive negative thinking were observed. Thematic analysis from an in-depth interview focusing on CCT adherence and user experience pointed to the importance of independency and accessibility of CCT in perceived agency, as well as the need for clear feedback mechanisms following training. Conclusions: Training task performance indicates further increases in performance beyond typical amounts of training sessions (10-20 sessions), hinting that more sessions could be beneficial for continued improvement in cognitive functioning. In line with previous research, CCT decreased depressive symptomatology. However, its effects on emotion regulation remain unclear. Further mechanistic studies into the temporal unfolding of CCT effects are necessary to investigate potential working mechanisms. Trial Registration: ClinicalTrials.gov NCT05166798; https://clinicaltrials.gov/study/NCT05166798 %M 39612206 %R 10.2196/56598 %U https://formative.jmir.org/2024/1/e56598 %U https://doi.org/10.2196/56598 %U http://www.ncbi.nlm.nih.gov/pubmed/39612206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e63262 %T Moving Toward Meaningful Evaluations of Monitoring in e-Mental Health Based on the Case of a Web-Based Grief Service for Older Mourners: Mixed Methods Study %A Brandl,Lena %A Jansen-Kosterink,Stephanie %A Brodbeck,Jeannette %A Jacinto,Sofia %A Mooser,Bettina %A Heylen,Dirk %K e-mental health %K digital mental health service %K mental health %K digital health %K internet intervention %K monitoring mental health %K monitor %K e-coach %K coaching %K grieve %K mourn %K old %K affective states %K artificial intelligence %K predictive %K repeatedly measured predictors in regression %K fuzzy cognitive map %K algorithm %K AI %D 2024 %7 28.11.2024 %9 %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) tools hold much promise for mental health care by increasing the scalability and accessibility of care. However, current development and evaluation practices of AI tools limit their meaningfulness for health care contexts and therefore also the practical usefulness of such tools for professionals and clients alike. Objective: The aim of this study is to demonstrate the evaluation of an AI monitoring tool that detects the need for more intensive care in a web-based grief intervention for older mourners who have lost their spouse, with the goal of moving toward meaningful evaluation of AI tools in e-mental health. Method: We leveraged the insights from three evaluation approaches: (1) the F1-score evaluated the tool’s capacity to classify user monitoring parameters as either in need of more intensive support or recommendable to continue using the web-based grief intervention as is; (2) we used linear regression to assess the predictive value of users’ monitoring parameters for clinical changes in grief, depression, and loneliness over the course of a 10-week intervention; and (3) we collected qualitative experience data from e-coaches (N=4) who incorporated the monitoring in their weekly email guidance during the 10-week intervention. Results: Based on n=174 binary recommendation decisions, the F1-score of the monitoring tool was 0.91. Due to minimal change in depression and loneliness scores after the 10-week intervention, only 1 linear regression was conducted. The difference score in grief before and after the intervention was included as a dependent variable. Participants’ (N=21) mean score on the self-report monitoring and the estimated slope of individually fitted growth curves and its standard error (ie, participants’ response pattern to the monitoring questions) were used as predictors. Only the mean monitoring score exhibited predictive value for the observed change in grief (R2=1.19, SE 0.33; t16=3.58, P=.002). The e-coaches appreciated the monitoring tool as an opportunity to confirm their initial impression about intervention participants, personalize their email guidance, and detect when participants’ mental health deteriorated during the intervention. Conclusions: The monitoring tool evaluated in this paper identified a need for more intensive support reasonably well in a nonclinical sample of older mourners, had some predictive value for the change in grief symptoms during a 10-week intervention, and was appreciated as an additional source of mental health information by e-coaches who supported mourners during the intervention. Each evaluation approach in this paper came with its own set of limitations, including (1) skewed class distributions in prediction tasks based on real-life health data and (2) choosing meaningful statistical analyses based on clinical trial designs that are not targeted at evaluating AI tools. However, combining multiple evaluation methods facilitates drawing meaningful conclusions about the clinical value of AI monitoring tools for their intended mental health context. %R 10.2196/63262 %U https://formative.jmir.org/2024/1/e63262 %U https://doi.org/10.2196/63262 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64380 %T Public Perception on Artificial Intelligence–Driven Mental Health Interventions: Survey Research %A Varghese,Mahima Anna %A Sharma,Poonam %A Patwardhan,Maitreyee %+ Department of Social Science and Language, Vellore Institute of Technology, Vellore Campus, Tiruvalam Road, Vellore, 632014, India, 91 9702872251, poonam.sharma@vit.ac.in %K public perception %K artificial intelligence %K AI %K AI-driven %K human-driven %K mental health inteventions %K mental health stigma %K trust in AI %K public perception %K digital health %K India %K mobile phone %D 2024 %7 28.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) has become increasingly important in health care, generating both curiosity and concern. With a doctor-patient ratio of 1:834 in India, AI has the potential to alleviate a significant health care burden. Public perception plays a crucial role in shaping attitudes that can facilitate the adoption of new technologies. Similarly, the acceptance of AI-driven mental health interventions is crucial in determining their effectiveness and widespread adoption. Therefore, it is essential to study public perceptions and usage of existing AI-driven mental health interventions by exploring user experiences and opinions on their future applicability, particularly in comparison to traditional, human-based interventions. Objective: This study aims to explore the use, perception, and acceptance of AI-driven mental health interventions in comparison to traditional, human-based interventions. Methods: A total of 466 adult participants from India voluntarily completed a 30-item web-based survey on the use and perception of AI-based mental health interventions between November and December 2023. Results: Of the 466 respondents, only 163 (35%) had ever consulted a mental health professional. Additionally, 305 (65.5%) reported very low knowledge of AI-driven interventions. In terms of trust, 247 (53%) expressed a moderate level of Trust in AI-Driven Mental Health Interventions, while only 24 (5.2%) reported a high level of trust. By contrast, 114 (24.5%) reported high trust and 309 (66.3%) reported moderate Trust in Human-Based Mental Health Interventions; 242 (51.9%) participants reported a high level of stigma associated with using human-based interventions, compared with only 50 (10.7%) who expressed concerns about stigma related to AI-driven interventions. Additionally, 162 (34.8%) expressed a positive outlook toward the future use and social acceptance of AI-based interventions. The majority of respondents indicated that AI could be a useful option for providing general mental health tips and conducting initial assessments. The key benefits of AI highlighted by participants were accessibility, cost-effectiveness, 24/7 availability, and reduced stigma. Major concerns included data privacy, security, the lack of human touch, and the potential for misdiagnosis. Conclusions: There is a general lack of awareness about AI-driven mental health interventions. However, AI shows potential as a viable option for prevention, primary assessment, and ongoing mental health maintenance. Currently, people tend to trust traditional mental health practices more. Stigma remains a significant barrier to accessing traditional mental health services. Currently, the human touch remains an indispensable aspect of human-based mental health care, one that AI cannot replace. However, integrating AI with human mental health professionals is seen as a compelling model. AI is positively perceived in terms of accessibility, availability, and destigmatization. Knowledge and perceived trustworthiness are key factors influencing the acceptance and effectiveness of AI-driven mental health interventions. %M 39607994 %R 10.2196/64380 %U https://formative.jmir.org/2024/1/e64380 %U https://doi.org/10.2196/64380 %U http://www.ncbi.nlm.nih.gov/pubmed/39607994 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49305 %T Internet-Delivered Psychoeducation (SCOPE) for Transition-Aged Autistic Youth: Pragmatic Randomized Controlled Trial %A Backman,Anna %A Roll-Pettersson,Lise %A Mellblom,Are %A Norman-Claesson,Elisabet %A Sundqvist,Emma %A Zander,Eric %A Vigerland,Sarah %A Hirvikoski,Tatja %+ Socialstyrelsen, National Board of Health and Welfare, Rålambsvägen 3, Stockholm, SE 106 30, Sweden, 46 732445857, anna.n.backman@hotmail.com %K autism %K internet based %K young adult %K intervention %K digital communication %K life satisfaction %K codeveloped %K ASD %K autism spectrum disorder %K autistic %K RCT %K randomized controlled trial %K randomized %K psychoeducation %K patient education %D 2024 %7 28.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychoeducation is a recommended first-line intervention for transition-aged autistic youth, but it has not been previously evaluated in an internet-delivered format. SCOPE (Spectrum Computerized Psychoeducation) is an 8-week individual, internet-delivered, therapist-supported psychoeducative intervention. Objective: This study aimed to investigate the effectiveness of SCOPE through a 3-armed randomized controlled trial. The intervention aims to increase participants’ understanding of autism and, in doing so, increase their quality of life (QoL). Methods: SCOPE was codeveloped with clinicians and autistic young adults. It contains 8 autism-related modules, each with (1) text describing the module topic, (2) four video vignettes with recurring characters who describe their lives and perspectives on the module topic, (3) a list of neurotypical characteristics related to the module’s topic, and (4) self-reflection using 3 or 4 questions about the module topic, answered by multiple-choice bullets and voluntary open-ended written comments. Participants were randomized (2:1:1) to SCOPE, an active control (web-based self-study), or treatment as usual (TAU). The primary outcome was participants’ autism knowledge, assessed using the Autism Spectrum Disorder Quiz, and secondary outcomes included acceptance of diagnosis, QoL, and symptoms of mental health problems. All outcomes were assessed at the baseline, postintervention, and 3-month follow-up time points, using mixed-effects models to assess change in outcome measures across time points. Results: Between 2014 and 2020, a total of 141 participants were randomized to 1 of the 3 treatment arms. The SCOPE participants had significantly greater autism knowledge gains at the posttreatment time point compared to TAU participants with a moderate effect size (d=0.47; P=.05); gains were maintained at the 3-month follow-up (d=0.46; P=.05). The self-study participants also had increased knowledge gains compared to TAU participants at the posttreatment time point with a moderate effect size (d=0.60; P=.03) but did not maintain these gains at the 3-month follow-up, and their autism knowledge scores returned to baseline (mean change score: –0.13, 95% CI –1.20 to 0.94; P=.81). In addition, SCOPE participants reported improved QoL at the postintervention (d=0.37, P=.02) and 3-month follow-up time points (d=0.60; P=.001), compared to the combined controls. The gained autism knowledge was not mirrored by changes in symptoms of anxiety or depression. Conclusions: Effective internet-delivered interventions may facilitate first-line service access to individuals who are unable or unwilling to use traditional health care interventions or who live in geographically remote locations. Additionally, an intervention such as SCOPE could impart and sustain the knowledge gained through psychoeducation in transition-aged autistic youth. For future research, qualitative studies could further our understanding of the lived experiences of intervention participation and outcomes after internet-delivered psychoeducation. Trial Registration: ClinicalTrials.gov NCT03665363; https://clinicaltrials.gov/study/NCT03665363 %R 10.2196/49305 %U https://www.jmir.org/2024/1/e49305 %U https://doi.org/10.2196/49305 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58499 %T Avatar Intervention in Virtual Reality for Cannabis Use Disorder in Individuals With Severe Mental Disorders: Results From a 1-Year, Single-Arm Clinical Trial %A Giguere,Sabrina %A Beaudoin,Mélissa %A Dellazizzo,Laura %A Phraxayavong,Kingsada %A Potvin,Stéphane %A Dumais,Alexandre %K cannabis use disorder %K cannabis use %K virtual reality therapy %K virtual reality %K addiction intervention %K relational therapy %K avatar %K digital mental health %D 2024 %7 27.11.2024 %9 %J JMIR Ment Health %G English %X Background: The dual diagnosis of cannabis use disorder (CUD) and severe mental disorder (SMD) results in clinically complex individuals. Cannabis use is known to have negative consequences on psychiatric symptoms, medication compliance, and disease prognosis. Moreover, the effectiveness of currently available psychotherapeutic treatments is limited in this population. In this context, our research team developed avatar intervention, an approach using virtual reality as a therapeutic tool to treat CUD in individuals with SMD. Objective: This pilot clinical trial aimed to evaluate, until the 1-year follow-up, the efficacy of avatar intervention for CUD among 32 participants with a dual diagnosis of SMD and CUD. Methods: Over the course of the 8 intervention sessions, participants were given the opportunity to enter a dialogue in virtual reality with an avatar representing a person with a significant role in their consumption, who was animated in real time by a therapist. The primary outcomes were the quantity of cannabis consumed and the frequency of use. Secondary outcomes included severity of problematic cannabis use, motivation for change, protective strategies for cannabis use, consequences of cannabis use, psychiatric symptoms, and quality of life. Changes in reported outcomes during the assessment periods before the intervention; postintervention; and 3, 6, and 12 months after the end of the intervention were assessed using a linear mixed-effects model. Results: Significant reductions were observed in the quantity of cannabis consumed, and these were maintained until the 12-month follow-up visit (d=0.804; P<.001; confirmed by urine quantification). Frequency of cannabis use showed a small significant reduction at the 3-month follow-up (d=0.384; P=.03). Moreover, improvements were observed in the severity of CUD, cannabis-related negative consequences, the motivation to change cannabis use, and the strategies used to mitigate harms related to cannabis use. Finally, moderate benefits were observed for quality of life and psychiatric symptoms. Conclusions: Overall, this unique intervention shows promising results that seem to be maintained up to 12 months after the end of the intervention. With the aim of overcoming the methodological limitations of a pilot study, a single-blind randomized controlled trial is currently underway to compare the avatar intervention for CUD with a conventional addiction intervention. Trial Registration: ClinicalTrials.gov NCT05726617; https://clinicaltrials.gov/study/NCT05726617 %R 10.2196/58499 %U https://mental.jmir.org/2024/1/e58499 %U https://doi.org/10.2196/58499 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e52294 %T Using Digital Art and Attachment Priming in a Web-Based Serious Game to Reduce Pain and Social Disconnection in Individuals With Chronic Pain and Loneliness: Randomized Controlled Trial %A Peña,Jorge %A Koebner,Ian %A Weisman,William %K pain %K social disconnection %K loneliness %K randomized controlled trial %K art %K museums %K virtual reality %K serious games %K virtual art %K chronic pain and loneliness %K attachment %K priming %K mediation %K intervention %K cyberpsychology %K mental health %D 2024 %7 27.11.2024 %9 %J JMIR Serious Games %G English %X Background: Arts engagement using virtual reality and serious games represent promising nonpharmacological self-management treatment approaches to chronic pain. This study is the first randomized controlled trial to explore the impact of a web-based serious game that simulated a visit to an art museum on pain and social disconnection among individuals living with chronic pain and loneliness. Objective: This study aimed to test the joint and separate effects of exposure to digital art and attachment figure priming on pain and social disconnection among individuals living with chronic pain and loneliness. Methods: This randomized controlled trial used a 2 (digital artwork present and absent) × 2 (secure attachment and avoidant attachment prime) repeated measures factorial web-based experimental design with a hanging control condition. Mediation and moderation analyses examined how feelings about the social world triggered by the artwork and frequency of museum visits impacted the effects of the interventions on pain and social disconnection. Results: The results are based on 308 participants. Mean age of the participants was 42.78 (SD 13.11; range 18-76) years, and 60.2% (n=186) were women. Posttest pain was lower than pretest pain for the artwork present (P=.001) and absent (P=.001) conditions. Similarly, posttest pain was lower than pretest pain for the secure (P=.001) and avoidant (P=.001) attachment priming conditions. Relative to the control group, artwork present (P=.001) and absent (P=.01) conditions had decreased posttest pain. The secure (P=.001) and avoidant (P=.001) attachment priming conditions also had lower posttest pain scores relative to the control group. Moreover, social disconnection decreased from pre- to posttest for both the artwork present (P=.04) and the secure attachment priming (P=.002) conditions. Relative to the control group, posttest social disconnection was lower for the artwork present (P=.02) and secure attachment priming condition (P=.03). The artwork-secure attachment (P=.001) and artwork-avoidant attachment (P=.006) conditions had lower posttest pain scores compared with the control group. Social disconnection decreased from pre- to posttest for the artwork-secure attachment (P=.01) and no artwork-secure attachment (P=.05) conditions. Posttest social disconnection was lower for the artwork-secure attachment condition compared with the control group (P=.04). Positive feelings about the social world triggered by artwork exposure and frequency of museum visits in the last year played a mediating and moderating role in these effects. Positive feelings about the social world were associated with decreased pain (B=−.53) and social disconnection (B=−.25), and these effects operated on individuals exposed to digital artwork at low, medium, and high frequency of physical museum visits. Conclusions: Relative to a control group, visiting a web-based art museum reliably decreased pain and social disconnection among individuals living with chronic pain and loneliness. Engaging with digital artwork that triggers positive feelings about the social world may mitigate the burden of chronic pain. Trial Registration: ClinicalTrials.gov NCT05310747; https://clinicaltrials.gov/study/NCT05310747 %R 10.2196/52294 %U https://games.jmir.org/2024/1/e52294 %U https://doi.org/10.2196/52294 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e63732 %T A Personalized, Transdiagnostic Smartphone App (Mello) Targeting Repetitive Negative Thinking for Depression and Anxiety: Qualitative Analysis of Young People’s Experience %A Valentine,Lee %A Arnold,Chelsea %A Nicholas,Jennifer %A Castagnini,Emily %A Malouf,Jessi %A Alvarez-Jimenez,Mario %A Bell,Imogen H %+ Orygen, 35 Poplar Rd, Melbourne, 3052, Australia, 61 9966 9100, lee.valentine@orygen.org.au %K repetitive negative thinking %K rumination %K anxiety %K depression %K mobile app %K just-in-time adaptive interventions %K youth mental health %K adolescent %K mobile phone %D 2024 %7 27.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing rates of mental health challenges among young people highlight an urgent need for accessible and effective treatment. However, current mental health systems face unprecedented demand, leaving most young people globally with unmet mental health needs. Smartphones present a promising solution to this issue by offering in-the-moment support through innovative just-in-time adaptive interventions, which provide support based on real-time data. Objective: This study explores young people’s experiences with Mello, a just-in-time adaptive intervention that focuses on the transdiagnostic mechanism of repetitive negative thinking (RNT), a significant factor contributing to youth depression and anxiety. Methods: Semistructured qualitative interviews were conducted with 15 participants aged 16 to 25 years, all of whom had previously participated in a pilot randomized controlled trial of Mello. Of the 15 participants, 9 (60%) identified as women, 4 (27%) as men (including 1 transgender man), and 2 (13%) as nonbinary. Interviews focused on participants’ experiences with the Mello app, factors influencing engagement, perceived benefits and limitations, and suggestions for future improvements. Thematic analysis was used to analyze the data. Results: The analysis identified three superordinate themes: Mello as a tool for intentional reflection; doing therapy your own way; and barriers to engagement during low mood, anxiety, and RNT. Theme 1 explored young people’s experiences of how the app facilitated active management of negative thoughts and supported the development of reflective habits, contrasting with their typical strategies of avoidance or resistance. Theme 2 highlighted the value of the app’s self-guided nature, with a particular focus on its flexibility and accessibility, particularly when compared to traditional face-to-face therapy. Finally, theme 3 addressed barriers to engagement, particularly during emotionally difficult times, with participants reporting feeling “stuck” in their negative thoughts. To mitigate these challenges, participants suggested incorporating gamification elements, such as progress-tracking visuals, to enhance motivation and increase engagement with the app. Conclusions: Our findings underscored the value of Mello in promoting intentional engagement and reflection with RNT, consistent with prior research that emphasizes the effectiveness of tailored interventions. Although some users valued the self-guided nature of the application, others encountered difficulties with motivation. Future research should explore strategies to enhance engagement for young people with low mood and motivation, such as co-design methodologies, advanced personalization features, and gamification techniques. %M 39602793 %R 10.2196/63732 %U https://www.jmir.org/2024/1/e63732 %U https://doi.org/10.2196/63732 %U http://www.ncbi.nlm.nih.gov/pubmed/39602793 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e63234 %T Effectiveness of a Novel Web-Based Intervention to Enhance Therapeutic Relationships and Treatment Outcomes in Adult Individual Psychotherapy: Randomized Controlled Trial and Analysis of Predictors of Dropouts %A Stefana,Alberto %A Fusar-Poli,Paolo %A Vieta,Eduard %A Youngstrom,Eric A %+ Department of Brain and Behavioral Sciences, University of Pavia, Via Forlanini 14, Pavia, 27100, Italy, 39 0382987537, alberto.stefana@gmail.com %K therapeutic relationship %K real relationship %K routine outcome monitoring %K measurement-based care %K patient-focused research %K psychotherapy process %K randomized controlled trial %K RCT %K psychotherapy %K assessment %K mental health %K digital mental health %K eHealth %K self monitoring %K outcomes research %K digital health %K health intervention %K therapy %D 2024 %7 27.11.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Routine process and outcome monitoring interventions added to psychotherapy are known to improve treatment outcomes, although they vary in format and effectiveness. Objective: This study aimed to evaluate whether a therapist-independent, internet-based routine process monitoring and feedback system could significantly reduce psychological distress and enhance the quality of the therapeutic relationship compared with a treatment-as-usual control group among individuals already engaged in individual psychotherapy. Methods: We randomized 475 participants into either the intervention group, which received access to an internet-based routine process monitoring and feedback system in addition to psychotherapy, or the control group, which received only psychotherapy. The trial lasted for 10 weeks. Follow-up assessments at 5 weeks and 10 weeks used the Clinical Outcomes in Routine Evaluation-Outcome Measure as the primary outcome, with the Working Alliance Inventory-Short Revised and the Real Relationship Inventory-Client form as secondary outcomes. Results: Per-protocol analyses (n=166) showed that psychological distress decreased in both groups, but there was no significant advantage for the intervention group. The intervention group experienced a decline in the genuineness dimension score of the real relationship, with an effect size of d=–0.27, compared with d=0.01 in the control group. In the intervention group (but not in the control group), dropouts showed significantly lower real relationship levels (P=.002), working alliance quality (P=.051), and emotional disclosure (P=.01) compared with those who completed the study. Additionally, logistic regression revealed distinct predictors of dropout within the control group and intervention group. Conclusions: The findings do not provide conclusive evidence for the efficacy of the new internet-based intervention in enhancing self-monitoring and prompting reflection on patients’ emotional responses to their therapists. However, the intervention appears to influence patients’ perceptions of the genuineness dimension in the therapeutic relationship, warranting further investigation. We hypothesize that this alteration in the genuineness dimension could be attributed to the intervention facilitating a more realistic and accurate perception of the therapeutic relationship among participants. Trial Registration: ClinicalTrials.gov NCT06038747; https://clinicaltrials.gov/study/NCT06038747 International Registered Report Identifier (IRRID): RR2-10.2196/55369 %M 39602203 %R 10.2196/63234 %U https://mental.jmir.org/2024/1/e63234 %U https://doi.org/10.2196/63234 %U http://www.ncbi.nlm.nih.gov/pubmed/39602203 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51978 %T Characterizing Performance on a Suite of English-Language NeuroUX Mobile Cognitive Tests in a US Adult Sample: Ecological Momentary Cognitive Testing Study %A Paolillo,Emily W %A Bomyea,Jessica %A Depp,Colin A %A Henneghan,Ashley M %A Raj,Anunay %A Moore,Raeanne C %+ Department of Psychiatry, University of California San Diego School of Medicine, 9500 Gilman Dr., La Jolla, CA, 92093, United States, 1 619 543 5378, r6moore@health.ucsd.edu %K digital health %K cognition %K cognitive aging %K neuropsychology %K mobile health %K psychometrics %K mobile phone %K Ecological Momentary Assessment %K EMA %K NeuroUX %D 2024 %7 25.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile cognitive testing is growing in popularity, with numerous advantages over traditional cognitive testing; however, the field lacks studies that deeply examine mobile cognitive test data from general adult samples. Objective: This study characterized performance for a suite of 8 mobile cognitive tests from the NeuroUX platform in a sample of US adults across the adult lifespan. Methods: Overall, 393 participants completed 8 NeuroUX cognitive tests and a brief ecological momentary assessment survey once per day on their smartphones for 10 consecutive days; each test was administered 5 times over the testing period. The tests tapped the domains of executive function, processing speed, reaction time, recognition memory, and working memory. Participants also completed a poststudy usability feedback survey. We examined alternate form test-retest reliability; practice effects; and associations between scores (averages and intraindividual variability) and demographics as well as test-taking context (ie, smartphone type, being at home vs not at home, and being alone vs not alone). Results: Our final sample consisted of 393 English-speaking US residents (aged 20-79 y; female: n=198, 50.4%). Of the 367 participants who provided responses about their race and ethnicity, 258 (70.3%) were White. Of the 393 participants, 181 (46.1%) were iOS users, and 212 (53.9%) were Android users. Of 12 test scores derived from the 8 tests, 9 (75%) showed good to excellent test-retest reliability (intraclass correlation coefficients >0.76). Practice effects (ie, improvements in performance) were observed for 4 (33%) of the 12 scores. Older age was associated with worse performance on most of the test scores (9/12, 75%) and greater within-person variability for nearly all reaction time scores (3/4, 75%). Relationships with smartphone type showed better performance among iOS users and those with newer Android software versions compared to those with older software. Being at home (vs not at home) was associated with better performance on tests of processing speed. Being alone (vs not alone) was associated with better performance on tests of recognition and working memory. Poststudy feedback indicated that participants found NeuroUX easy to learn and use, an enjoyable experience, and an app that would be helpful in understanding their thinking skills. Only 4.2% (16/379) endorsed privacy concerns, and 77.3% (293/379) reported that they would be willing to share their results with their health care provider. Older age—but not other demographics—was associated with finding the tests more challenging. Conclusions: In a sample of adults across a wide age range, this study characterized features that are particularly important for the interpretation of remote, repeated mobile cognitive testing performance, including test-retest reliability, practice effects, smartphone type, and test-taking context. These data enhance the understanding and application of mobile cognitive testing, paving the way for improved clinical decision-making, personalized interventions, and advancements in cognitive research. %M 39586088 %R 10.2196/51978 %U https://www.jmir.org/2024/1/e51978 %U https://doi.org/10.2196/51978 %U http://www.ncbi.nlm.nih.gov/pubmed/39586088 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e57225 %T Enhancing Executive Function Skills in Children With Attention-Deficit/Hyperactivity Disorder via Immersive Virtual Reality Interventions: Scoping Review %A Konaç,Asli %A Bini,Maristella %A Fusco,Naomi %A Bourdin-Kreitz,Pierre %K immersive virtual reality %K ADHD %K neurofeedback %K executive functions %K systematic review %K adolescent %K attention-deficit/hyperactivity disorder %K behavioral therapy %K digital health tools %K neurodiversity %K virtual reality %K digital mental health %D 2024 %7 22.11.2024 %9 %J JMIR XR Spatial Comput %G English %X Background: This scoping review investigated immersive virtual reality (IVR) interventions for improving executive function skills of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Objective: This study aimed to identify and closely inspect the characteristics of these interventions and provide a summary of key findings to guide researchers in their future investigations. Methods: A search across Web of Science, Scopus, PubMed, and APA PsycInfo databases was carried out with restrictions of publication date (2000‐2023) and language (English). The inclusion criteria were (1) research articles, excluding protocols, book chapters, reviews, and meta-analyses; (2) usage of IVR, excluding computer-based VR or augmented reality technologies; (3) aim of targeting executive function skills; (4) sample of children and adolescents diagnosed with ADHD (with or without learning disorder comorbidity); and (5) intervention studies (quasi-experimental clinical trials and randomized controlled trials, excluding assessments). Finally, the characteristics of the studies were summarized and inspected. Results: The search yielded 2484 potential records. After a rigorous screening process, 6 articles (5 randomized controlled trials and 1 pilot study) were included. A certain heterogeneity in duration, designs of IVR interventions, and outcome measures were observed. All studies reported overall improvements in the attentional performances of children; however, only a few reported improvements in executive functions. In addition, a tendency toward integration of neurofeedback systems with IVR technologies was observed. Conclusions: Because of the specific objectives and related inclusion and exclusion criteria of this review, only a few interventions could be included and analyzed. Even though there seem to be promising applications of IVR for children and adolescents with ADHD, heterogeneity in intervention characteristics accompanied by observed overall high or serious risk of bias prevented the authors from making generalized conclusions. %R 10.2196/57225 %U https://xr.jmir.org/2024/1/e57225 %U https://doi.org/10.2196/57225 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57415 %T Exploring the Effects of Variety and Amount of Mindfulness Practices on Depression, Anxiety, and Stress Symptoms: Longitudinal Study on a Mental Health–Focused eHealth System for Patients With Breast or Prostate Cancer %A Malandrone,Francesca %A Urru,Sara %A Berchialla,Paola %A Rossini,Pierre Gilbert %A Oliva,Francesco %A Bianchi,Silvia %A Ottaviano,Manuel %A Gonzalez-Martinez,Sergio %A Carli,Vladimir %A Valenza,Gaetano %A Scilingo,Enzo Pasquale %A Carletto,Sara %A Ostacoli,Luca %K depression %K anxiety %K stress %K internet-based %K mental health %K mindfulness %K breast cancer %K prostate cancer %K cancer-related mental distress %K emotional distress %K psychological distress %K mindfulness-based interventions %K MBI %K e-MBI %K dispositional mindfulness %K self-compassion %K mental wellbeing %K mobile phone %D 2024 %7 21.11.2024 %9 %J JMIR Ment Health %G English %X Background: Patients with cancer often face depression and anxiety, and mindfulness-based interventions, including internet-based versions, can effectively reduce these symptoms and improve their quality of life. This study aims to investigate the impact of internet-based mindfulness-based interventions (e-MBIs) on anxiety, depression, and stress symptoms in patients with prostate or breast cancer. Objective: The primary aims are to assess the association between the amount and variety of e-MBI practices and symptom reduction. Second, this study aims to examine how baseline information such as sociodemographic characteristics, dispositional mindfulness (DM), and dispositional self-compassion (DSC) correlate with both app usage and symptom reduction. Methods: Participants included 107 patients with cancer (68 women with breast cancer and 38 men with prostate cancer) enrolled in a hospital setting. They were assigned to the intervention group of the NEVERMIND project, using the e-BMI module via the NEVERMIND app. A longitudinal design involved Pearson correlation analysis to determine the relationship between the amount and duration of e-MBI practices. Linear regression analysis was conducted to gauge the dose-response effect, evaluating the impact of DM and DSC on depression, anxiety, and stress. Negative binomial regression was conudcted to study sociodemographic factors’ influence on the amount of practice in e-MBIs. Results: The participants with more diverse and sustained mindfulness practices experienced significant reductions in depression, anxiety, and stress. A high correlation (0.94) between e-MBI practices and symptom reduction was also highlighted. Male, married, and highly educated patients were more likely to engage in mindfulness. Even if DM and DSC did not impact the amount or variety of practices correlated, they were correlated with symptom reduction, showing that higher levels were associated with significant reductions in depression, anxiety, and stress. Conclusions: While more e-MBI practice is linked to reduced anxiety, depression, and stress, this study emphasizes the crucial role of variety of practice over amount. DM and DSC are key in shaping intervention effectiveness and may act as protectors against psychological distress. Using app log data, our research provides a unique perspective on e-MBI impact, contributing to cancer care understanding and guiding future studies. %R 10.2196/57415 %U https://mental.jmir.org/2024/1/e57415 %U https://doi.org/10.2196/57415 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e64681 %T Mobile App for Improving the Mental Health of Youth in Out-of-Home Care: Development Study Using an Intervention Mapping Approach %A Park,Jinyoung %A Lee,Jungeun %A Noh,Dabok %+ College of Nursing, Eulji University, 553 Sanseong-daero, Sujeong-gu, Seongnam-si, Gyeonggi-do, 13135, Republic of Korea, 82 31 740 7415, daboknoh@eulji.ac.kr %K out-of-home youth %K mental health intervention %K mobile app %K intervention mapping %K youth %K mental health %K mHealth %K mobile health %K app %K interview %K need %K focus group %K emotion %K emotional %K young adult %K independent living %K emotional support %K tool %K emotion regulation %K user %K app usage %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Youth in out-of-home care encounter substantial mental health challenges because of the absence of stable family and social support systems. Their vulnerability is heightened by trauma, neglect, and abuse. They struggle, especially when transitioning to independent living, coping with loneliness, anxiety, and pressure. Objective: This study aimed to develop a mobile app with high accessibility and long-term continuous effects to support independent living and improve mental health among youth in out-of-home care. The approach used was the systematic and step-by-step intervention mapping (IM) framework. Methods: The program was created using the IM framework and had 6 steps. Drawing from data from individual and focus group interviews and literature reviews, we developed a logical model of the problem. We established program outcomes and objectives, defining performance objectives and variable determinants. We identified theoretical and evidence-based methods that influence determinants. The app design integrated these methods into practical applications, allowing for the creation of self-management and emotional support tools. The development process included ongoing discussions between app designers and the research team to ensure that user needs and preferences were addressed. Results: Individual interviews and focus group discussions revealed challenges in managing daily routines and regulating emotions. The program design was based on the transtheoretical model, social cognitive theory, and elaboration likelihood model. Key features included goal setting, structured routines, emotion recognition flashcards, character models demonstrating emotion regulation strategies, verbal persuasion, and self-monitoring tools to support habit formation and emotion regulation. An implementation plan was developed to facilitate the app’s adoption, execution, and maintenance, while an evaluation plan was established, including app usage analytics, user logs, and feedback surveys. A randomized controlled trial will be conducted to assess the app’s impact on mental health outcomes, focusing on reducing anxiety and depressive symptoms, improving emotion regulation, and enhancing daily living skills. Conclusions: The IM framework was beneficial in developing a mobile app to enhance the mental health of youth in out-of-home care. The study produced a program grounded in theory and evidence that caters to the needs of these individuals. Further research should aim to verify the app’s effectiveness in real-world settings and refine it continuously based on user input. %M 39571152 %R 10.2196/64681 %U https://humanfactors.jmir.org/2024/1/e64681 %U https://doi.org/10.2196/64681 %U http://www.ncbi.nlm.nih.gov/pubmed/39571152 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52883 %T Web-Based Intervention Using Self-Compassionate Writing to Induce Positive Mood in Family Caregivers of Older Adults: Quantitative Study %A Wiita,Farah %A Ho,Aileen K %A Weinstein,Netta %+ School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Berkshire, RG6 6AL, United Kingdom, 44 7951506136, f.l.wiita@pgr.reading.ac.uk %K self-compassion %K caregivers %K mindfulness %K intervention %K writing %K experimental %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Caregiver burden can impact the mental health of family caregivers, but self-compassion may help reduce this impact. Brief self-compassion interventions have been shown to be useful but have not been tested in family caregivers of older adults. Objective: This study aimed to test the effects of a brief self-compassion intervention and its components (self-kindness, common humanity, and mindfulness) on mental well-being and mood when reflecting on difficult family caregiving experiences. Methods: British caregivers were recruited through a web-based panel. Three experimental studies manipulated the self-compassion intervention. In study 1 (n=206) and study 2 (n=224), participants wrote about a difficult caregiving experience while focusing on 1 self-compassion component (self-kindness, common humanity, or mindfulness). In study 3 (n=222) participants focused on all components. Self-compassion, serenity, guilt, and sadness were measured. Results: In studies 1 and 2, condition effects showed mindfulness unexpectedly lowered mood. Inconsistent and modest benefits to affect were achieved by engagement in self-kindness and common humanity in study 1 (guilt [lowered]: P=.02 and sadness [lowered]: P=.04; serenity [nonsignificantly raised]: P=.20) and also in study 2 (sadness [nonsignificantly lowered]: P=.23 and guilt [nonsignificantly lowered]: P=.26; serenity [raised]: P=.33); significant benefits for self-compassion and mood were found in study 3 (serenity [raised]: P=.01, kindness [raised]: P=.003, and common humanity [raised]: P≤.001; guilt [lowered]: P<.001 and sadness [lowered]: P≤.001). More intensive efforts should be made to promote self-compassion in caregivers of older adults, with caution advised when relying primarily on mindfulness approaches. Conclusions: Self-compassionate writing may be beneficial for family caregivers, but more intensive interventions are needed. Further research is needed to determine the optimal dosage and content for achieving the greatest effects. %M 39571153 %R 10.2196/52883 %U https://formative.jmir.org/2024/1/e52883 %U https://doi.org/10.2196/52883 %U http://www.ncbi.nlm.nih.gov/pubmed/39571153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57109 %T Engagement and Acceptability of Acceptance and Commitment Therapy in Daily Life in Early Psychosis: Secondary Findings From a Multicenter Randomized Controlled Trial %A van Aubel,Evelyne %A Vaessen,Thomas %A Uyttebroek,Lotte %A Steinhart,Henrietta %A Beijer-Klippel,Annelie %A Batink,Tim %A van Winkel,Ruud %A de Haan,Lieuwe %A van der Gaag,Mark %A van Amelsvoort,Thérèse %A Marcelis,Machteld %A Schirmbeck,Frederike %A Reininghaus,Ulrich %A Myin-Germeys,Inez %+ Center for Contextual Psychiatry, Psychiatry Research Group, Department of Neurosciences, KU Leuven, Herestraat 49, ON5B bus 1029, Leuven, 3000, Belgium, 32 16 37 31 74, lotte.uyttebroek@kuleuven.be %K acceptance and commitment therapy %K ACT %K first episode of psychosis %K FEP %K ultrahigh risk for psychosis %K UHR %K ecological momentary intervention %K EMI %K mobile health %K mHealth %K blended care %K mobile phone %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Acceptance and commitment therapy (ACT) is promising in the treatment of early psychosis. Augmenting face-to-face ACT with mobile health ecological momentary interventions may increase its treatment effects and empower clients to take treatment into their own hands. Objective: This study aimed to investigate and predict treatment engagement with and acceptability of acceptance and commitment therapy in daily life (ACT-DL), a novel ecological momentary intervention for people with an ultrahigh risk state and a first episode of psychosis. Methods: In the multicenter randomized controlled trial, 148 individuals with ultrahigh risk or first-episode psychosis aged 15-65 years were randomized to treatment as usual only (control) or to ACT-DL combined with treatment as usual (experimental), consisting of 8 face-to-face sessions augmented with an ACT-based smartphone app, delivering ACT skills and techniques in daily life. For individuals in the intervention arm, we collected data on treatment engagement with and acceptability of ACT-DL during and after the intervention. Predictors of treatment engagement and acceptability included baseline demographic, clinical, and functional outcomes. Results: Participants who received ACT-DL in addition to treatment as usual (n=71) completed a mean of 6 (SD 3) sessions, with 59% (n=42) of participants completing all sessions. App engagement data (n=58) shows that, on a weekly basis, participants used the app 13 times and were compliant with 6 of 24 (25%) notifications. Distribution plots of debriefing scores (n=46) show that 85%-96% of participants reported usefulness on all acceptability items to at least some extent (scores ≥2; 1=no usefulness) and that 91% (n=42) of participants reported perceived burden by number and length of notifications (scores ≥2; 1=no burden). Multiple linear regression models were fitted to predict treatment engagement and acceptability. Ethnic minority backgrounds predicted lower notification response compliance (B=–4.37; P=.01), yet higher app usefulness (B=1.25; P=.049). Negative (B=–0.26; P=.01) and affective (B=0.14; P=.04) symptom severity predicted lower and higher ACT training usefulness, respectively. Being female (B=–1.03; P=.005) predicted lower usefulness of the ACT metaphor images on the app. Conclusions: Our results corroborate good treatment engagement with and acceptability of ACT-DL in early psychosis. We provide recommendations for future intervention optimization. Trial Registration: OMON NL46439.068.13; https://onderzoekmetmensen.nl/en/trial/24803 %M 39570655 %R 10.2196/57109 %U https://formative.jmir.org/2024/1/e57109 %U https://doi.org/10.2196/57109 %U http://www.ncbi.nlm.nih.gov/pubmed/39570655 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62725 %T Assessing Digital Phenotyping for App Recommendations and Sustained Engagement: Cohort Study %A Dwyer,Bridget %A Flathers,Matthew %A Burns,James %A Mikkelson,Jane %A Perlmutter,Elana %A Chen,Kelly %A Ram,Nanik %A Torous,John %+ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02115, United States, 1 6176676700, jtorous@bidmc.harvard.edu %K engagement %K mental health %K digital phenotype %K pilot study %K phenotyping %K smartphone sensors %K anxiety %K sleep %K fitness %K depression %K qualitative %K app recommendation %K app use %K mobile phone %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Low engagement with mental health apps continues to limit their impact. New approaches to help match patients to the right app may increase engagement by ensuring the app they are using is best suited to their mental health needs. Objective: This study aims to pilot how digital phenotyping, using data from smartphone sensors to infer symptom, behavioral, and functional outcomes, could be used to match people to mental health apps and potentially increase engagement Methods: After 1 week of collecting digital phenotyping data with the mindLAMP app (Beth Israel Deaconess Medical Center), participants were randomly assigned to the digital phenotyping arm, receiving feedback and recommendations based on those data to select 1 of 4 predetermined mental health apps (related to mood, anxiety, sleep, and fitness), or the control arm, selecting the same apps but without any feedback or recommendations. All participants used their selected app for 4 weeks with numerous metrics of engagement recorded, including objective screentime measures, self-reported engagement measures, and Digital Working Alliance Inventory scores. Results: A total of 82 participants enrolled in the study; 17 (21%) dropped out of the digital phenotyping arm and 18 (22%) dropped out from the control arm. Across both groups, few participants chose or were recommended the insomnia or fitness app. The majority (39/47, 83%) used a depression or anxiety app. Engagement as measured by objective screen time and Digital Working Alliance Inventory scores were higher in the digital phenotyping arm. There was no correlation between self-reported and objective metrics of app use. Qualitative results highlighted the importance of habit formation in sustained app use. Conclusions: The results suggest that digital phenotyping app recommendation is feasible and may increase engagement. This approach is generalizable to other apps beyond the 4 apps selected for use in this pilot, and practical for real-world use given that the study was conducted without any compensation or external incentives that may have biased results. Advances in digital phenotyping will likely make this method of app recommendation more personalized and thus of even greater interest. %M 39560976 %R 10.2196/62725 %U https://formative.jmir.org/2024/1/e62725 %U https://doi.org/10.2196/62725 %U http://www.ncbi.nlm.nih.gov/pubmed/39560976 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55562 %T Reducing the Number of Intrusive Memories of Work-Related Traumatic Events in Frontline Health Care Staff During the COVID-19 Pandemic: Case Series %A Kubickova,Veronika %A Steel,Craig %A Moulds,Michelle L %A Kanstrup,Marie %A Beer,Sally %A Darwent,Melanie %A Keating,Liza %A Holmes,Emily A %A Iyadurai,Lalitha %+ Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom, 44 1865226366, craig.steel@hmc.ox.ac.uk %K intrusive memories %K digital intervention %K psychological trauma %K remote delivery %K health care staff %K COVID-19 %K case series %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Frontline health care staff are frequently exposed to traumatic events as part of their work. Although this study commenced before the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many health care staff members report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with posttraumatic stress disorder symptoms in the long term. We need evidence-based interventions that are brief, preventative, nonstigmatizing, suitable for the working lives of frontline health care staff, and effective for repeated trauma exposure. A brief, guided imagery-competing task intervention involving a trauma reminder cue and Tetris gameplay may hold promise in this regard, given evidence that it can prevent and reduce the number of intrusive memories following trauma across various settings. Objective: This case series aims to investigate the impact of a brief imagery-competing task intervention on the number of intrusive memories, general functioning, and symptoms of posttraumatic stress, anxiety, and depression, and examine the feasibility and acceptability of the intervention for UK National Health Service frontline health care staff. The intervention was delivered with guidance from a clinical psychologist. Methods: We recruited 12 clinical staff from the UK National Health Service, specifically from emergency departments, the intensive care unit, and the ambulance service. We evaluated the intervention using an AB single-case experimental design, where the baseline (A) was the monitoring-only phase and the postintervention (B) period was the time after the intervention was first administered. Methods were adapted once the COVID-19 pandemic began. Results: There was a decrease (59%) in the mean number of intrusive memories per day from baseline (mean 1.29, SD 0.94) to postintervention (mean 0.54, SD 0.51). There was a statistically significant reduction in the number of intrusive memories from baseline to postintervention, as shown by an aggregated omnibus analysis with a small effect size (τ-U=–0.38; P<.001). Depression, anxiety, and posttraumatic stress symptoms all significantly reduced from preintervention to postintervention. Participants also reported improvements in functioning based on both quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants. Conclusions: These preliminary findings suggest that this brief therapist-guided imagery-competing task intervention offers a potential approach to mitigating the impact of work-related traumatic events in frontline health care staff, both during a pandemic and beyond. Randomized controlled trials will be an important next step. %M 39556801 %R 10.2196/55562 %U https://humanfactors.jmir.org/2024/1/e55562 %U https://doi.org/10.2196/55562 %U http://www.ncbi.nlm.nih.gov/pubmed/39556801 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59831 %T Patient and Health Care Professional Perspectives About Referral, Self-Reported Use, and Perceived Importance of Digital Mental Health App Attributes in a Diverse Integrated Health System: Cross-Sectional Survey Study %A Miller,Michael J %A Eberhart,Lindsay G %A Heliste,Jennifer L %A Tripuraneni,Bhaskara R %+ Mid-Atlantic Permanente Research Institute (MAPRI), 700 2nd St NE, 5th Floor, Washington, DC, 20002, United States, 1 202 317 0618, Michael.J1.Miller@kp.org %K digital mental health applications %K DMHA %K mobile health %K mHealth %K mobile phone %K smartphone %K user experience %K engagement %K implementation %K Kaiser Permanente %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health applications (DMHAs) are emerging, novel solutions to address gaps in behavioral health care. Accordingly, Kaiser Permanente Mid-Atlantic States (KPMAS) integrated referrals for 6 unique DMHAs into clinical care in 2019. Objective: This study investigated patient and health care professional (HCP) experiences with DMHA referral; DMHA use; and perceived importance of engagement, functionality, design, and information attributes in real-world practice. Methods: Separate cross-sectional surveys were developed and tested for patients and HCPs. Surveys were administered to KPMAS participants through REDCap (Research Electronic Data Capture), and completed between March 2022 and June 2022. Samples included randomly selected patients who were previously referred to at least 1 DMHA between April 2021 and December 2021 and behavioral health and primary care providers who referred DMHAs between December 2019 and December 2021. Results: Of the 119 patients e-mailed a survey link, 58 (48.7%) completed the survey and 44 (37%) confirmed receiving a DMHA referral. The mean age of the sample was 42.21 (SD 14.08) years (29/44, 66%); 73% (32/44) of the respondents were female, 73% (32/44) of the respondents had at least a 4-year college degree, 41% (18/44) of the respondents were Black or African American, and 39% (17/44) of the respondents were White. Moreover, 27% (12/44) of the respondents screened positive for anxiety symptoms, and 23% (10/44) of the respondents screened positive for depression. Overall, 61% (27/44) of the respondents reported DMHA use for ≤6 months since referral, 36% (16/44) reported use within the past 30 days, and 43% (19/44) of the respondents reported that DMHAs were very or extremely helpful for improving mental and emotional health. The most important patient-reported DMHA attributes by domain were being fun and interesting to use (engagement); ease in learning how to use (functionality); visual appeal (design); and having well-written, goal- and topic-relevant content (information). Of the 60 sampled HCPs, 12 (20%) completed the survey. Mean HCP respondent age was 46 (SD 7.75) years, and 92% (11/12) of the respondents were female. Mean number of years since completing training was 14.3 (SD 9.94) years (10/12, 83%). Of the 12 HCPs, 7 (58%) were physicians and 5 (42%) were nonphysicians. The most important HCP-reported DMHA attributes by domain were personalized settings and content (engagement); ease in learning how to use (functionality); arrangement and size of screen content (design); and having well-written, goal- and topic-relevant content (information). HCPs described “typical patients” referred to DMHAs based on perceived need, technical capability, and common medical conditions, and they provided guidance for successful use. Conclusions: Individual patient needs and preferences should match the most appropriate DMHA. With many DMHA choices, decision support systems are essential to assist patients and HCPs with selecting appropriate DMHAs to optimize uptake and sustained use. %M 39546791 %R 10.2196/59831 %U https://formative.jmir.org/2024/1/e59831 %U https://doi.org/10.2196/59831 %U http://www.ncbi.nlm.nih.gov/pubmed/39546791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59225 %T AI for Analyzing Mental Health Disorders Among Social Media Users: Quarter-Century Narrative Review of Progress and Challenges %A Owen,David %A Lynham,Amy J %A Smart,Sophie E %A Pardiñas,Antonio F %A Camacho Collados,Jose %+ School of Computer Science and Informatics, Cardiff University, Abacws, Senghennydd Road, Cardiff, CF24 4AG, United Kingdom, 44 (0)29 2087 4812, owendw1@cardiff.ac.uk %K mental health %K depression %K anxiety %K schizophrenia %K social media %K natural language processing %K narrative review %D 2024 %7 15.11.2024 %9 Review %J J Med Internet Res %G English %X Background: Mental health disorders are currently the main contributor to poor quality of life and years lived with disability. Symptoms common to many mental health disorders lead to impairments or changes in the use of language, which are observable in the routine use of social media. Detection of these linguistic cues has been explored throughout the last quarter century, but interest and methodological development have burgeoned following the COVID-19 pandemic. The next decade may see the development of reliable methods for predicting mental health status using social media data. This might have implications for clinical practice and public health policy, particularly in the context of early intervention in mental health care. Objective: This study aims to examine the state of the art in methods for predicting mental health statuses of social media users. Our focus is the development of artificial intelligence–driven methods, particularly natural language processing, for analyzing large volumes of written text. This study details constraints affecting research in this area. These include the dearth of high-quality public datasets for methodological benchmarking and the need to adopt ethical and privacy frameworks acknowledging the stigma experienced by those with a mental illness. Methods: A Google Scholar search yielded peer-reviewed articles dated between 1999 and 2024. We manually grouped the articles by 4 primary areas of interest: datasets on social media and mental health, methods for predicting mental health status, longitudinal analyses of mental health, and ethical aspects of the data and analysis of mental health. Selected articles from these groups formed our narrative review. Results: Larger datasets with precise dates of participants’ diagnoses are needed to support the development of methods for predicting mental health status, particularly in severe disorders such as schizophrenia. Inviting users to donate their social media data for research purposes could help overcome widespread ethical and privacy concerns. In any event, multimodal methods for predicting mental health status appear likely to provide advancements that may not be achievable using natural language processing alone. Conclusions: Multimodal methods for predicting mental health status from voice, image, and video-based social media data need to be further developed before they may be considered for adoption in health care, medical support, or as consumer-facing products. Such methods are likely to garner greater public confidence in their efficacy than those that rely on text alone. To achieve this, more high-quality social media datasets need to be made available and privacy concerns regarding the use of these data must be formally addressed. A social media platform feature that invites users to share their data upon publication is a possible solution. Finally, a review of literature studying the effects of social media use on a user’s depression and anxiety is merited. %M 39546783 %R 10.2196/59225 %U https://www.jmir.org/2024/1/e59225 %U https://doi.org/10.2196/59225 %U http://www.ncbi.nlm.nih.gov/pubmed/39546783 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53768 %T Use of Random Forest to Predict Adherence in an Online Intervention for Depression Using Baseline and Early Usage Data: Model Development and Validation on Retrospective Routine Care Log Data %A Wenger,Franziska %A Allenhof,Caroline %A Schreynemackers,Simon %A Hegerl,Ulrich %A Reich,Hanna %+ Clinic for Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University Frankfurt, Heinrich-Hoffmann-Str. 10, Frankfurt am Main, 60528, Germany, 49 3412238744, franziska.wenger@deutsche-depressionshilfe.de %K depression %K adherence %K machine learning %K digital interventions %K random forest %K iFightDepression %K iFD %K online intervention %D 2024 %7 15.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online interventions, such as the iFightDepression (iFD) tool, are increasingly recognized as effective alternatives to traditional face-to-face psychotherapy or pharmacotherapy for treating depression. However, particularly when used outside of study settings, low adherence rates and the resulting diminished benefits of the intervention can limit their effectiveness. Understanding the factors that predict adherence would allow for early, tailored interventions for individuals at risk of nonadherence, thereby enhancing user engagement and optimizing therapeutic outcomes. Objective: This study aims to develop and evaluate a random forest model that predicts adherence to the iFD tool to identify users at risk of noncompletion. The model was based on characteristics collected during baseline and the first week of the intervention in patients with depression. Methods: Log data from 4187 adult patients who registered for the iFD tool between October 1, 2016, and May 5, 2022, and provided informed consent were statistically analyzed. The resulting data set was divided into training (2932/4187, 70%) and test (1255/4187, 30%) sets using a randomly stratified split. The training data set was utilized to train a random forest model aimed at predicting each user’s adherence at baseline, based on the hypothesized predictors: age, self-reported gender, expectations of the intervention, current or previous depression treatments, confirmed diagnosis of depression, baseline 9-item Patient Health Questionnaire (PHQ-9) score, accompanying guide profession, and usage behavior within the first week. After training, the random forest model was evaluated on the test data set to assess its predictive performance. The importance of each variable in predicting adherence was analyzed using mean decrease accuracy, mean decrease Gini, and Shapley Additive Explanations values. Results: Of the 4187 patients evaluated, 1019 (24.34%) were classified as adherent based on our predefined definition. An initial random forest model that relied solely on sociodemographic and clinical predictors collected at baseline did not yield a statistically significant adherence prediction. However, after incorporating each patient’s usage behavior during the first week, we achieved a significant prediction of adherence (P<.001). Within this prediction, the model achieved an accuracy of 0.82 (95% CI 0.79-0.84), an F1-score of 0.53, an area under the curve of 0.83, and a specificity of 0.94 for predicting nonadherent users. The key predictors of adherence included logs, word count on the first workshop’s worksheet, and time spent on the tool, all measured during the first week. Conclusions: Our results highlight that early engagement, particularly usage behavior during the first week of the online intervention, is a far greater predictor of adherence than any sociodemographic or clinical factors. Therefore, analyzing usage behavior within the first week and identifying nonadherers through the algorithm could be beneficial for tailoring interventions aimed at improving user adherence. This could include follow-up calls or face-to-face discussions, optimizing resource utilization in the process. %M 39546342 %R 10.2196/53768 %U https://formative.jmir.org/2024/1/e53768 %U https://doi.org/10.2196/53768 %U http://www.ncbi.nlm.nih.gov/pubmed/39546342 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59329 %T Collaborative Care to Improve Quality of Life for Anxiety and Depression in Posttraumatic Epilepsy (CoCarePTE): Protocol for a Randomized Hybrid Effectiveness-Implementation Trial %A Munger Clary,Heidi M %A Snively,Beverly M %A Cagle,Christian %A Kennerly,Richard %A Kimball,James N %A Alexander,Halley B %A Brenes,Gretchen A %A Moore,Justin B %A Hurley,Robin A %+ Department of Neurology, Wake Forest University School of Medicine, 1 Medical Center Blvd., Winston-Salem, NC, 27157, United States, 1 3367167110, hmungerc@wakehealth.edu %K integrated care %K mental health %K seizures %K psychiatric comorbidity %K neurology clinic %K epilepsy %D 2024 %7 13.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anxiety and depression in people with epilepsy are common and associated with poor outcomes; yet, they often go untreated due to poor mental health specialist access. Collaborative care is an integrated care model with a strong evidence base in primary care and medical settings, but it has not been evaluated in neurology clinics. Evaluating implementation outcomes when translating evidence-based interventions to new clinical settings to inform future scaling and incorporation into real-world practice is important. Objective: The Collaborative Care for Posttraumatic Epilepsy (CoCarePTE) trial aims to evaluate the effectiveness (improvement in emotional quality of life) and implementation of a collaborative care intervention for people with anxiety or depressive symptoms and posttraumatic epilepsy. Methods: CoCarePTE is a 2-site, randomized, single-blind, hybrid type 1 effectiveness-implementation trial that will randomize 60 adults to receive either neurology-based collaborative care or usual care. Adults receiving neurological care at participating centers with anxiety or depressive symptoms and a history of at least mild traumatic brain injury before epilepsy onset will be enrolled. The collaborative care intervention is a 24-week stepped-care model with video or telephone calls every 2 weeks by a care manager for measurement-based anxiety and depression care, seizure care monitoring, and brief therapy intervention delivery. This is supplemented by antidepressant prescribing recommendations by psychiatrists for neurologists via case conferences and care manager–facilitated team communication. In step 2 of the intervention, individuals with <50% symptom reduction by 10 weeks will receive an added 8-session remote cognitive behavioral therapy program. The study is powered to detect a moderate improvement in emotional quality of life. As a hybrid type 1 trial, effectiveness is the primary focus, with the primary outcome being a change in emotional quality of life at 6 months in the intervention group compared to control. Secondary effectiveness outcomes are 6-month changes in depression, anxiety, and overall quality of life. Implementation outcomes, including fidelity, acceptability, feasibility, and appropriateness, are evaluated before implementation and at 3 months. The primary effectiveness analysis will compare changes in emotional quality of life scores from baseline to 6 months between the intervention and control arms using multiple linear regression modeling, adjusting for study site and using an intent-to-treat approach. Results: Enrollment commenced in 2023, with modifications in the inclusion and exclusion made after the first 6 enrollees due to slow recruitment. Enrollment is expected to continue at least into early 2025. Conclusions: The CoCarePTE trial is novel in its use of a hybrid effectiveness-implementation design to evaluate an evidence-based mental health intervention in epilepsy, and by incorporating seizure care into a collaborative care model. If a significant improvement in emotional quality of life is found in the intervention group compared to usual care, this would support next step scaling or clinical implementation. Trial Registration: ClinicalTrials.gov NCT05353452; https://www.clinicaltrials.gov/study/NCT05353452 International Registered Report Identifier (IRRID): DERR1-10.2196/59329 %M 39535875 %R 10.2196/59329 %U https://www.researchprotocols.org/2024/1/e59329 %U https://doi.org/10.2196/59329 %U http://www.ncbi.nlm.nih.gov/pubmed/39535875 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e50418 %T School Climate and School Identification as Determinants of Internet Gaming Disorder Among Chinese Adolescent Internet Gamers: Cross-Sectional Mediation Study %A Yu,Yanqiu %A Yen,Stefanie H Y %A Wang,Deborah Baofeng %A Wu,Anise M S %A Chen,Juliet Honglei %A Zhang,Guohua %A Du,Mengni %A Du,Dajin %A Du,Mingxuan %A Lau,Joseph T F %K school climate %K school identification %K adolescent %K structural equation modeling %K internet gaming disorder %D 2024 %7 12.11.2024 %9 %J JMIR Serious Games %G English %X Background: School climate and school identification are important features of the school environment and potential determinants of adolescent internet gaming disorder (IGD). Objective: This novel study investigated their joint effects on IGD and related mediation mechanisms via the interpersonal factor of teacher-student relationship and the individual factors of academic stress and anxiety. Methods: A large-scale cross-sectional study was conducted among adolescent internet gamers of junior, senior, and vocational middle schools in Taizhou City, China, from February to March 2022 (N=5778). Participants self-administered an anonymous, structured questionnaire in classrooms. Adjusted logistic regression and structural equation modeling (SEM) were used for data analysis. Results: Among all participants, the prevalence of IGD was 8% (461/5778). The 4 school climate subscales (student-student relationship subscale: adjusted odds ratio [ORa] 0.88, 95% CI 0.85-0.91; student-staff relations subscale: ORa 0.87, 95% CI 0.84-0.90; academic emphasis subscale: ORa 0.88, 95% CI 0.85-0.91; shared values approach: ORa 0.88, 95% CI 0.85-0.90), the school identification subscale (ORa 0.85, 95% CI 0.83-0.88), and teacher-student relationship (ORa 0.80, 95% CI 0.76-0.84) were significant protective factors against IGD, while academic stress (ORa 1.18, 95% CI 1.14-1.23) and anxiety (ORa 1.16, 95% CI 1.14-1.18) were risk factors of IGD. The SEM showed that the negative associations between school climate and IGD and between school identification and IGD were mediated via (1) three 2-step paths, each involving a single mediator—teacher-student relationship, academic stress, and anxiety, respectively—and (2) two 3-step paths involving 2 mediators—teacher-student relationship and academic stress first, respectively, and then anxiety. The direct effect of school climate on IGD was statistically nonsignificant (ie, full mediation with effect size ranging from 4.2% to 20.4%), while that of school identification was statistically significant (ie, partial mediation with effect size ranging from 4.5% to 38.2%). Conclusions: The relatively high prevalence of IGD among Chinese adolescents may be reduced through school-based interventions to improve school climate and school identification. Such improvements may reduce the levels of risk factors of IGD (poor teacher-student relationship, academic stress, and anxiety) and hence the risk of IGD. Future longitudinal and intervention studies are needed to confirm the findings. %R 10.2196/50418 %U https://games.jmir.org/2024/1/e50418 %U https://doi.org/10.2196/50418 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54585 %T Scalable Technology for Adolescents and Youth to Reduce Stress in the Treatment of Common Mental Disorders in Jordan: Protocol for a Randomized Controlled Trial %A Akhtar,Aemal %A de Graaff,Anne Marijn %A Habashneh,Rand %A Keyan,Dharani %A Abualhaija,Adnan %A Fanatseh,Sarah %A Faroun,Muhannad %A Aqel,Ibrahim Said %A Dardas,Latefa %A Servili,Chiara %A van Ommeren,Mark %A Bryant,Richard %A Carswell,Kenneth %+ Department of Mental Health Brain health and Substance Use, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland, 41 792493513, degraaffa@who.int %K mHealth %K psychosocial intervention %K youths %K depression %K anxiety %K minimally guided digital intervention %K low- and middle-income countries %K barriers %K access %K mental health %K digital self-help %K chatbots %K conversational agents %K effectiveness %K Scalable Technology for Adolescents and Youth to Reduce Stress %K randomized controlled trial %K Jordan %K psychological distress %K mental disorders %K disability %D 2024 %7 8.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young people in low- and middle-income countries encounter significant barriers to accessing mental health support due to various factors, including a substantial treatment gap and limited health care budgets allocated to mental health. Using innovative strategies, such as scalable digital self-help psychological interventions, offers a potential solution for improving access to mental health support. However, digital mental health interventions come with their own set of challenges, including issues related to low user engagement. Chatbots, with their interactive and engaging nature, may present a promising avenue for the delivery of these interventions. Objective: This study aims to explore the effectiveness of a newly developed World Health Organization (WHO) digital mental health intervention, titled Scalable Technology for Adolescents and Youth to Reduce Stress (STARS). Methods: A single-blind, 2-arm randomized controlled trial will be conducted nationally across Jordan. Participants will include 344 young adults, aged 18-21 years, currently residing in Jordan. Inclusion criteria are heightened levels of psychological distress as determined through the 10-item Kessler Psychological Distress Scale (≥20). Assessment measures will be conducted at baseline, 1-week post intervention, and 3-month follow-up. Following baseline assessments, eligible participants will be randomized to receive STARS or enhanced usual care. The primary outcomes are the reduction of symptoms of depression and anxiety (Hopkins Symptom Checklist, 25 subscales) at 3-month follow-up. Secondary outcomes include general functioning (WHO Disability Assessment Schedule 2.0), well-being (WHO-5 Well-Being Index), personal problems (Psychological Outcomes Profile), and agency (State Hope Scale subscale). Results: The study was funded in January 2020 by the Research for Health in Humanitarian Crises Programme (Elhra) and recruitment for the trial started on July 16, 2023. As of November 15, 2023, we randomized 228 participants. Conclusions: This trial intends to contribute to the growing digital mental health evidence base by exploring technological solutions to address global public health challenges. Given the widespread use of technology globally, even in resource-constrained settings, and the high adoption rates among adolescents and young individuals, digital initiatives such as STARS present promising opportunities for the future of mental health care in low- and middle-income countries. Trial Registration: ISRCTN Registry ISRCTN10152961; https://www.isrctn.com/ISRCTN10152961 International Registered Report Identifier (IRRID): DERR1-10.2196/54585 %M 39514860 %R 10.2196/54585 %U https://www.researchprotocols.org/2024/1/e54585 %U https://doi.org/10.2196/54585 %U http://www.ncbi.nlm.nih.gov/pubmed/39514860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51832 %T Exploring Psychotherapists’ Attitudes on Internet- and Mobile-Based Interventions in Germany: Thematic Analysis %A Hildebrand,Anne Sophie %A Planert,Jari %A Machulska,Alla %A Margraf,Lena Maria %A Roesmann,Kati %A Klucken,Tim %+ Department of Clinical Psychology and Psychotherapy, University of Siegen, Obergraben 23, Siegen, 57072, Germany, 49 271 740 3688, Anne.Hildebrand@uni-siegen.de %K eHealth %K psychotherapy %K psychotherapists’ perspectives %K thematic analysis %K internet- and mobile-based intervention %D 2024 %7 7.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, internet- and mobile-based interventions (IMIs) have become increasingly relevant in mental health care and have sparked societal debates. Psychotherapists’ perspectives are essential for identifying potential opportunities for improvement, facilitating conditions, and barriers to the implementation of these interventions. Objective: This study aims to explore psychotherapists’ perspectives on opportunities for improvement, facilitating conditions, and barriers to using IMIs. Methods: The study used a qualitative research design, utilizing open-ended items in a cross-sectional survey. A total of 350 psychotherapists were asked to provide their written opinions on various aspects of IMIs. Thematic analysis was conducted to analyze the data and identify core themes. Results: The analysis revealed 11 core themes related to the use of IMIs, which were categorized into 4 superordinate categories: “Applicability,” “Treatment Resources,” “Technology,” and “Perceived Risks and Barriers.” While many psychotherapists viewed IMIs as a valuable support for conventional psychotherapy, they expressed skepticism about using IMIs as a substitute. Several factors were perceived as hindrances to the applicability of IMIs in clinical practice, including technological issues, subjective concerns about potential data protection risks, a lack of individualization due to the manualized nature of most IMIs, and the high time and financial costs for both psychotherapists and patients. They expressed a desire for easily accessible information on evidence and programs to reduce the time and effort required for training and advocated for this information to be integrated into the conceptualization of new IMIs. Conclusions: The findings of this study emphasize the importance of considering psychotherapists’ attitudes in the development, evaluation, and implementation of IMIs. This study revealed that psychotherapists recognized both the opportunities and risks associated with the use of IMIs, with most agreeing that IMIs serve as a tool to support traditional psychotherapy rather than as a substitute for it. Furthermore, it is essential to involve psychotherapists in discussions about IMIs specifically, as well as in the development of new methodologies in psychotherapy more broadly. Overall, this study can advance the use of IMIs in mental health care and contribute to the ongoing societal debate surrounding these interventions. %M 39510514 %R 10.2196/51832 %U https://formative.jmir.org/2024/1/e51832 %U https://doi.org/10.2196/51832 %U http://www.ncbi.nlm.nih.gov/pubmed/39510514 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56201 %T Facilitating Thought Progression to Reduce Depressive Symptoms: Randomized Controlled Trial %A Yatziv,Shai-Lee %A Pedrelli,Paola %A Baror,Shira %A DeCaro,Sydney Ann %A Shachar,Noam %A Sofer,Bar %A Hull,Sunday %A Curtiss,Joshua %A Bar,Moshe %+ The Leslie and Susan Gonda Brain Science Center, Bar- Ilan University Building number 901, Ramat-Gan, 5290002, Israel, 972 35317795, moshe.bar@biu.ac.il %K depression %K cognitive neuroscience %K facilitating thought progression %K FTP %K mobile phone %K digital health %K gamification %K depression symptoms %K randomized controlled trial %K RCT %K app %K depressive disorder %K web-based platforms %K effectiveness %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The constant rise in the prevalence of major depressive disorder calls for new, effective, and accessible interventions that can rapidly and effectively reach a wide range of audiences. Recent developments in the digital health domain suggest that dedicated online platforms may potentially address this gap. Focusing on targeting ruminative thought, a major symptomatic hallmark of depression, in this study we hypothesized that delivering a digital health–based intervention designed to systematically facilitate thought progression would substantially alleviate depression. Objective: The study aims to investigate the efficacy of a novel digital intervention on the reduction of depressive symptoms. This intervention was designed as an easy-to-use gamified app specifically aimed to facilitate thought progression through intense practicing of associative, semantically broad, fast, and creative thought patterns. Methods: A randomized clinical trial was conducted, comparing changes in depression symptoms between participants who used the app in the intervention group (n=74) and waitlist control group (n=27) over the course of 8 weeks. All participants filled out a battery of clinical questionnaires to assess the severity of depression at baseline and 4 and 8 weeks after starting the study. These primarily included the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health Questionnaire-9 as well as the Positive Affect Negative Affect Scale-Negative Affect Score, Ruminative Response Scale, and Symptoms of Depression Questionnaire. Additional questionnaires were implemented to assess anxiety, positive affect, anhedonia, and quality of life. Results: The results indicate that across multiple clinical measurements, participants in the intervention group who played the gamified app showed greater and faster improvement in depressive symptoms compared with their waitlist control counterparts. The difference between the groups in MADRS improvement was –7.01 points (95% CI –10.72 to –3.29; P<.001; Cohen d=0.67). Furthermore, the difference in improvement between groups persisted up to 4 weeks posttrial (MADRS differences at week 12: F49,2=6.62; P=.003; ηp2=0.21). At the end of the trial, participants who played the app showed high interest in continuing using the app. Conclusions: The results demonstrate that a gamified app designed to facilitate thought progression is associated with improvement in depressive symptoms. Given its innovative and accessibility features, this gamified method aiming to facilitate thought progression may successfully complement traditional treatments for depression in the future, providing a safe and impactful way to enhance the lives of individuals experiencing depression and anxiety. Trial Registration: ClinicalTrials.gov NCT05685758; https://clinicaltrials.gov/study/NCT05685758 %M 39350528 %R 10.2196/56201 %U https://www.jmir.org/2024/1/e56201 %U https://doi.org/10.2196/56201 %U http://www.ncbi.nlm.nih.gov/pubmed/39350528 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48696 %T Predictors of Engagement in Multiple Modalities of Digital Mental Health Treatments: Longitudinal Study %A Nowels,Molly Aideen %A McDarby,Meghan %A Brody,Lilla %A Kleiman,Evan %A Sagui Henson,Sara %A Castro Sweet,Cynthia %A Kozlov,Elissa %+ Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, 525 E 68th St, New York, NY, 10065, United States, 1 212 746 4888, mon2007@med.cornell.edu %K digital health %K mental health %K health care benefit %K prediction %K technology %K digital mental health %K employer-based %K teletherapy %K coaching %K utilization %K mobile phone %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology-enhanced mental health platforms may serve as a pathway to accessible and scalable mental health care; specifically, those that leverage stepped care models have the potential to address many barriers to patient care, including low mental health literacy, mental health provider shortages, perceived acceptability of care, and equitable access to evidence-based treatment. Driving meaningful engagement in care through these platforms remains a challenge. Objective: This study aimed to examine predictors of engagement in self-directed digital mental health services offered as part of an employer-based mental health benefit that uses a technology-enabled care platform. Methods: Using a prospective, longitudinal design, we examined usage data from employees who had access to an employer-sponsored mental health care benefit. Participants had access to a digital library of mental health resources, which they could use at any time, including daily exercises, interactive programs, podcasts, and mindfulness exercises. Coaching and teletherapy were also available to. The outcome was engagement with the self-directed digital mental health resources, measured by the number of interactions. Poisson regression models included sociodemographic characteristics, patient activation, mental health literacy, well-being, PHQ-9 and GAD-7 scores at baseline, primary concern for engaging in treatment, and the use of coaching or teletherapy sessions. Results: In total 950 individuals enrolled in the study, with 38% using any self-directed digital mental health resources. Approximately 44% of the sample did not use the app during the study period. Those using both self-directed digital and 1:1 modalities made up about one-quarter of the sample (235/950, 24.7%). Those using only coaching or therapy (170/950, 17.9%) and those using only self-directed digital mental health resources (126/950, 13.3%) make up the rest. At baseline, these groups statistically significantly differed on age, PHQ-9, GAD-7, MHLS, and primary concern. Receipt of coaching and teletherapy was associated with the number of self-directed digital mental health resources interactions in adjusted Poisson regression modeling. Use of any coach visit was associated with 82% (rate ratio [RR] 1.82, 95% CI 1.63-2.03) more self-directed digital mental health resource interactions while use of any teletherapy session was associated with 80% (RR 1.80, 95% CI 1.55-2.07) more digital mental health resources interactions (both P<.001). Each additional year of age was associated with increased digital mental health resources interactions (RR 1.04, 95% CI (1.03-1.05), and women had 23% more self-directed digital resources interactions than men (RR 1.23, 95% CI 1.09-1.39). Conclusions: Our key finding was that the use of coaching or teletherapy was associated with increased self-directed digital mental health resource use. Higher self-directed digital resource engagement among those receiving coaching or therapy may be a result of provider encouragement. On the other hand, when a participant engages with 1 modality in the platform, they may be more likely to begin engaging with others, becoming “super users” of all resources. %R 10.2196/48696 %U https://www.jmir.org/2024/1/e48696 %U https://doi.org/10.2196/48696 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58068 %T Building Mutually Beneficial Collaborations Between Digital Navigators, Mental Health Professionals, and Clients: Naturalistic Observational Case Study %A Gorban,Carla %A McKenna,Sarah %A Chong,Min K %A Capon,William %A Battisti,Robert %A Crowley,Alison %A Whitwell,Bradley %A Ottavio,Antonia %A Scott,Elizabeth M %A Hickie,Ian B %A Iorfino,Frank %K digital navigator %K digital coach %K clinical technology specialist %K mental health services %K shared decision-making %K lived experience %K implementation %K poor engagement %K decision-making %K mental health %K digital mental health %K digital mental health technology %D 2024 %7 6.11.2024 %9 %J JMIR Ment Health %G English %X Despite the efficacy of digital mental health technologies (DMHTs) in clinical trials, low uptake and poor engagement are common in real-world settings. Accordingly, digital technology experts or “digital navigators” are increasingly being used to enhance engagement and shared decision-making between health professionals and clients. However, this area is relatively underexplored and there is a lack of data from naturalistic settings. In this paper, we report observational findings from the implementation of a digital navigator in a multidisciplinary mental health clinic in Sydney, Australia. The digital navigator supported clients and health professionals to use a measurement-based DMHT (the Innowell platform) for improved multidimensional outcome assessment and to guide personalized decision-making. Observational data are reported from implementation logs, platform usage statistics, and response rates to digital navigator emails and phone calls. Ultimately, support from the digital navigator led to improved data collection and clearer communications about goals for using the DMHT to track client outcomes; however, this required strong partnerships between health professionals, the digital navigator, and clients. The digital navigator helped to facilitate the integration of DMHT into care, rather than providing a stand-alone service. Thus, collaborations between health professionals and digital navigators are mutually beneficial and empower clients to be more engaged in their own care. %R 10.2196/58068 %U https://mental.jmir.org/2024/1/e58068 %U https://doi.org/10.2196/58068 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56235 %T Virtual Reality Exposure Therapy for Reducing School Anxiety in Adolescents: Pilot Study %A Beele,Gesa %A Liesong,Paula %A Bojanowski,Sabine %A Hildebrand,Kristian %A Weingart,Malte %A Asbrand,Julia %A Correll,Christoph U %A Morina,Nexhmedin %A Uhlhaas,Peter J %+ Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Augustenburgerplatz 1, Berlin, 13353, Germany, 49 30450 ext 516193, peter.uhlhaas@charite.de %K virtual reality exposure therapy %K VRET %K school anxiety %K social anxiety %K adolescents %K virtual reality %K VR %K autonomic arousal %K exposure therapy %K posttreatment %K digital health %K simulation %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Virtual reality exposure therapy (VRET) is a promising treatment approach for anxiety disorders. However, while its efficacy has been demonstrated in adults, research on the efficacy of VRET in the treatment of adolescents with anxiety disorders is largely lacking. Objective: A pilot study was carried out to test whether exposure to a virtual reality (VR) school environment elicits state anxiety and autonomic arousal in adolescents with school anxiety (diagnoses covering social anxiety disorder or specific phobia involving school contexts). In addition, we examined whether repeated VR exposure led to a reduction in this fear response, trait school anxiety, and social anxiety symptoms. Moreover, the relationship of presence, the subjective sense of “being there,” during VR exposure with anxiety measures and treatment response was examined. Methods: In a pilot study, 10 adolescents with school anxiety (age range 14 to 17 years) participated in five VRET sessions. Self-reported state anxiety, heart rate, and presence during exposure, as well as trait school anxiety and social anxiety before and after treatment, were measured. Results: The VR scenario induced state anxiety and autonomic arousal. After VRET, a significant reduction in state anxiety (η2=0.74) and social anxiety symptoms (d=0.82) as well as a trend toward a decrease in trait school anxiety were observed, while autonomic arousal did not change. In addition, presence during VR exposure was associated with state anxiety and treatment response. Conclusions: Our findings indicate the feasibility and potential effectiveness of VRET as a treatment method for symptoms of school and social anxiety in adolescents. %M 39499549 %R 10.2196/56235 %U https://mental.jmir.org/2024/1/e56235 %U https://doi.org/10.2196/56235 %U http://www.ncbi.nlm.nih.gov/pubmed/39499549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64494 %T Using Extended Reality to Enhance Effectiveness and Group Identification in Remote Group Therapy for Anxiety Disorders: A Critical Analysis %A Bouguettaya,Ayoub %A Aboujaoude,Elias %+ Program of Internet, Health, and Society, Biomedical Sciences, Cedars-Sinai Medical Center, 6500 Wilshire Blvd, Los Angeles, CA, 90048, United States, 1 4152443724, elias.aboujaoude@cshs.org %K group therapy %K psychotherapy %K telepsychiatry %K mental health %K extended reality %K augmented reality %K virtual reality therapy %K anxiety %K cognitive behavioral therapy %D 2024 %7 4.11.2024 %9 Viewpoint %J JMIR Form Res %G English %X Group therapy is a scalable and effective treatment for anxiety disorders. However, when performed online, the reduced ability to identify with group members and the reduced interactivity can limit its appeal and effectiveness. Extended reality (XR) technology, including virtual reality and augmented reality, may help address these limitations, thereby enhancing the reach of online group therapy and the benefits that can be drawn from it. To understand how the incorporation of XR technology may improve online group therapy for anxiety disorders, this viewpoint paper examines evidence related to the treatment of anxiety disorders using offline group therapy, online group therapy, and virtual reality, as well as ways to increase social identification and interactivity with the platform, the therapist, and other users. This viewpoint paper suggests ways to integrate these research streams to leverage the strengths of XR platforms and improve group therapeutic offerings. %M 39496150 %R 10.2196/64494 %U https://formative.jmir.org/2024/1/e64494 %U https://doi.org/10.2196/64494 %U http://www.ncbi.nlm.nih.gov/pubmed/39496150 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60165 %T Effectiveness of Computer-Based Psychoeducational Self-Help Platforms for Eating Disorders (With or Without an Associated App): Protocol for a Systematic Review %A Gentile,Alessandra %A Kristian,Yosua Yan %A Cini,Erica %+ Division of Medicine, University College London, Gower St, London, WC1E 6BT, United Kingdom, 44 020 7679 2000, yosua.kristian.23@ucl.ac.uk %K self-help %K online self-help %K eating disorders %K anorexia nervosa %K psychoeducational intervention %K psychoeducation %K binge eating %K anorexia %K bulimia %K access to care %K patient education %K patient self-help %D 2024 %7 4.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Access to psychological health care is extremely difficult, especially for individuals with severely stigmatized disorders such as eating disorders (EDs). There has been an increase in children, adolescents, and adults with ED symptoms and ED, especially following the COVID-19 pandemic. Computer-based self-help platforms (± associated apps) allow people to bridge the treatment gap and receive support when in-person treatment is unavailable or not preferred. Objective: The aim of this systematic review is to evaluate the effectiveness of computer-based self-help platforms for EDs, some of which may have associated apps. Methods: The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This review will report and evaluate the literature concerning the efficacy of self-help platforms for EDs. Articles were obtained from the Ovid MEDLINE, Embase, Global Health, and APA PsycInfo. The inclusion criteria included research with original data and gray literature; research evaluating the efficacy of web-based psychoeducational self-help platforms for EDs; people with an ED diagnosis, ED symptoms, at risk of developing EDs, or from the general population without ED-related behaviors; pre– and post–computer-based ± associated apps intervention clinical outcome of ED symptoms; pre– and post–computer-based ± associated apps intervention associated mental health difficulties; and literature in English. The exclusion criteria were solely guided self-help platforms, only in-person interventions with no computer-based ± associated apps comparison group, only in-person–delivered CBT, self-help platforms for conditions other than eating disorders, systematic reviews, meta-analyses, posters, leaflets, books, reviews, and research that only reported physical outcomes. Two independent authors used the search terms to conduct the initial search. The collated articles then were screened by their titles and abstracts, and finally, full-text screenings were conducted. The Cochrane Risk of Bias 2 tool will be used to assess the risks of bias in the included studies. Data extraction will be conducted, included studies will undergo narrative synthesis, and results will be presented in tables. The systematic review will be submitted to a peer-reviewed journal. Results: The authors conducted a database search for articles published by May 31, 2024. In total, 14 studies were included in the systematic review. Data charting, synthesis, and analysis were completed in Microsoft Excel by the end of July 2024. Results will be grouped based on the intervention stages. The results are expected to be published by the end of 2024. Overall, the systematic review found that computer-based self-help platforms are effective in reducing global ED psychopathology and ED-related behaviors. Conclusions: Self-help platforms are helpful first-stage resource in a tiered health care system. Trial Registration: PROSPERO CRD42024520866; https://tinyurl.com/5ys2unsw International Registered Report Identifier (IRRID): DERR1-10.2196/60165 %M 39495557 %R 10.2196/60165 %U https://www.researchprotocols.org/2024/1/e60165 %U https://doi.org/10.2196/60165 %U http://www.ncbi.nlm.nih.gov/pubmed/39495557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53744 %T Web-Based Intervention (SunnysideFlex) to Promote Resilience to Posttraumatic Stress Disorder Symptoms During Pregnancy: Development and Pilot Study %A Paltell,Katherine C %A Duffecy,Jennifer %A Maki,Pauline M %A Edalatian Zakeri,Shiva %A Vujanovic,Anka A %A Berenz,Erin C %+ Department of Psychology, University of Illinois at Chicago, 1007 W Harrison St, M/C 285, Chicago, IL, 60607, United States, 1 312 315 0808, kpaltell@uic.edu %K trauma %K posttraumatic stress disorder %K pregnancy %K perinatal %K web-based intervention %K stress %K postpartum %K depression %K child health %K treatment %K behavioral therapy %K SunnysideFlex %D 2024 %7 1.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 4% to 8% of pregnant individuals meet the criteria for current posttraumatic stress disorder (PTSD), a known risk factor for a multitude of adverse maternal and child health outcomes. However, PTSD is rarely detected or treated in obstetric settings. Moreover, available prenatal PTSD treatments require in-person services that are often inaccessible due to barriers to care. Thus, web-based interventions offer great potential in extending PTSD treatment to high-risk pregnant individuals by providing affordable, accessible care. However, there are currently no web-based interventions designed specifically for the treatment of PTSD symptoms during pregnancy. Objective: This study aims to develop and pilot a 6-week, web-based, cognitive behavioral therapy intervention for PTSD, SunnysideFlex, in a sample of 10 pregnant women with current probable PTSD. Consistent with established guidelines for developing and testing novel interventions, the focus of this pilot study was to evaluate the initial feasibility and acceptability of the SunnysideFlex intervention and preintervention to postintervention changes in PTSD and depression symptoms. This approach will allow for early refinement and optimization of the SunnysideFlex intervention to increase the odds of success in a larger-scale clinical trial. Methods: The SunnysideFlex intervention adapted an existing web-based platform for postpartum depression, Sunnyside for Moms, to include revised, trauma-focused content. A total of 10 pregnant women in weeks 16 to 28 of their pregnancy who reported lifetime interpersonal trauma exposure (ie, sexual or physical assault) and with current probable PTSD (scores ≥33 per the PTSD checklist for DSM-5) were enrolled in the SunnysideFlex intervention. Assessments took place at baseline and 6 weeks (postintervention). Results: All participants were retained through the postintervention assessment period. Engagement was high; participants on average accessed 90% of their lessons, logged on to the platform at least weekly, and reported a generally positive user experience. Moreover, 80% (8/10) of participants demonstrated clinically meaningful reductions in PTSD symptoms from baseline to postintervention, and 50% (5/10) of participants no longer screened positive for probable PTSD at postintervention. Most (6/10, 60%) of the participants maintained subclinical depression symptoms from baseline to postintervention. Conclusions: Findings from this small pilot study indicate that SunnysideFlex may be a feasible and acceptable mechanism for delivering PTSD intervention to high-risk, trauma-exposed pregnant women who might otherwise not have opportunities for services. Larger-scale trials of the intervention are necessary to better understand the impact of SunnysideFlex on PTSD symptoms during pregnancy and the postpartum period. %M 39485381 %R 10.2196/53744 %U https://formative.jmir.org/2024/1/e53744 %U https://doi.org/10.2196/53744 %U http://www.ncbi.nlm.nih.gov/pubmed/39485381 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e63341 %T Using the Person-Based Approach to Co-Create and Optimize an App-Based Intervention to Support Better Sleep for Adolescents in the United Kingdom: Mixed Methods Study %A Bennett,Sarah E %A Johnston,Milly H %A Treneman-Evans,Georgia %A Denison-Day,James %A Duffy,Anthony %A Brigden,Amberly %A Kuberka,Paula %A Christoforou,Nicholas %A Ritterband,Lee %A Koh,Jewel %A Meadows,Robert %A Alamoudi,Doaa %A Nabney,Ian %A Yardley,Lucy %+ School of Psychological Science, University of Bristol, 12A Priory Rd, Bristol, BS8 1TU, United Kingdom, 44 07590334234, sarah.bennett@bristol.ac.uk %K behavior change %K digital intervention %K insomnia %K depression %K anxiety %K sleep %K qualitative research %K mobile phone %D 2024 %7 31.10.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Poor sleep is a common problem in adolescents aged 14 to 18 years. Difficulties with sleep have been found to have a bidirectional link to mental health problems. Objective: This new research sought to involve young people in the co-creation of a new app, particularly those from underserved communities. The Sleep Solved app uses science-based advice to improve sleep-related behaviors and well-being. The app was developed using the person-based approach, underpinned by the social cognitive theory and the social-ecological model of sleep health. Methods: Young people (aged 14-18 y) were recruited from across the United Kingdom to contribute to patient and public involvement (PPI) activities. In partnership with our peer researcher (MHJ), we used a multitude of methods to engage with PPI contributors, including web-based workshops, surveys, think-aloud interviews, focus groups, and app beta testing. Results: A total of 85 young people provided PPI feedback: 54 (64%) young women, 27 (32%) young men, 2 (2%) genderfluid people, 1 (1%) nonbinary person, and 1 (1%) who reported “prefer not to say.” Their levels of deprivation ranged from among the 40% most deprived to the 20% least deprived areas. Most had self-identified sleep problems, ranging from 2 to 3 times per week to >4 times per week. Attitudes toward the app were positive, with praise for its usability and use of science-based yet accessible information. Think-aloud interviews and a focus group identified a range of elements that may influence the use of the app, including the need to pay attention to language choices and readability. User experiences in the form of narrated audio clips were used to normalize sleep problems and provide examples of how the app had helped these users. Conclusions: Young people were interested in using an app to better support their sleep and mental health. The app was co-created with strong links to theory- and evidence-based sleep hygiene behaviors. Future work to establish the effectiveness of the intervention, perhaps in a randomized controlled trial, would provide support for potential UK-wide rollout. %M 39481107 %R 10.2196/63341 %U https://humanfactors.jmir.org/2024/1/e63341 %U https://doi.org/10.2196/63341 %U http://www.ncbi.nlm.nih.gov/pubmed/39481107 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60317 %T Digital Youth and Family Engagement Program for Adolescents Who Receive Outpatient Mental Health Services: Qualitative Evaluation %A Ramirez,Ana %A Kramer,Justin %A Hazim,Katrina %A Roberge,Jason %+ Department of Anthropology, University of North Carolina at Chapel Hill, 207 E Cameron Aveue Chapel Hill, NC 27599-3115, Chapel Hill, NC, 27599, United States, 1 9199621243, ana_ramirez@unc.edu %K telemedicine %K telepsychiatry %K adolescents %K mental health %K psychiatry %K coaching %K qualitative assessment %K patient satisfaction %K family engagement %K depression %K anxiety %K suicidal ideation %D 2024 %7 31.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Incidents of depression, anxiety, and suicidal ideation among adolescents have increased in recent years. Mental health interventions tailored to adolescents and families need to consider mechanisms for increasing enrollment and sustaining program engagement. A telephone-based, health coach intervention for adolescents and families was implemented at a Southeastern US health system with the goals of improving psychiatric appointment attendance, medication adherence, reduction in emergency department visits, and assisting with crisis management (“Youth and Family Engagement” [YFE] program). Objective: This study aims to explore patients’ and parents’ perceptions of a mental health program and the factors that impact enrollment and sustained engagement. Methods: Semistructured interviews were conducted with adolescent patients (n=9, 56%), parents (n=11, 92%), and clinicians who placed patient referrals (n=6, 100%). Interviews were in English (participants: 19/26, 73%) or Spanish (parents: 7/11, 64%), depending upon participants’ preference. Interviews explored perceptions of the YFE program, experiences working with health coaches, suggestions for program changes, and program goals. The data were analyzed using inductive coding methodologies, with thematic analysis used to organize emergent themes. Two qualitatively trained researchers, one bilingual in English and Spanish, facilitated all data collection and collaboratively performed data analysis. Results: The YFE program’s structure was often mentioned as promoting engagement, with telephone appointments and health coaches’ ability to accommodate inflexible work or school schedules alleviating participation barriers. Skills learned from health coaches were frequently referenced, with adolescents generally citing internal processes, such as positive thinking and mindfulness. Parents discussed behaviors relative to their children, such as improvements with discipline, setting boundaries, and improved parent-child communication. Many participants discussed the importance of health coaches assisting families in navigating social systems, such as accessing resources (eg, housing) and navigating school processes (eg, individualized educational plans), with clinicians suggesting an increased emphasis on adolescents’ nutrition and engagement in primary care. Spanish-speaking parents highlighted numerous advantages of working with bilingual health coaches, emphasizing both enhanced communication and cultural understanding. They specifically noted the coaches’ ability to grasp their lived experiences and challenges as immigrants in the United States, which significantly enriched their participation in the program. Conclusions: Prioritizing convenient engagement for adolescents and families may be important for sustained program participation, as inflexible schedules and competing priorities pose barriers to traditional appointments. Future programs should carefully consider health coach–participant relationships, specifically cultural competency, providing services in native languages, and assisting families with wraparound care, as these may be crucial to sustained engagement. %M 39481102 %R 10.2196/60317 %U https://formative.jmir.org/2024/1/e60317 %U https://doi.org/10.2196/60317 %U http://www.ncbi.nlm.nih.gov/pubmed/39481102 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58409 %T Automated Real-Time Tool for Promoting Crisis Resource Use for Suicide Risk (ResourceBot): Development and Usability Study %A Coppersmith,Daniel DL %A Bentley,Kate H %A Kleiman,Evan M %A Jaroszewski,Adam C %A Daniel,Merryn %A Nock,Matthew K %+ Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA, 02138, United States, 1 617 495 3800, dcoppersmith@g.harvard.edu %K suicidal thoughts %K suicidal behaviors %K ecological momentary assessment %K crisis resources %K real-time tool %K self-report %K psychoeducation %K app %D 2024 %7 31.10.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Real-time monitoring captures information about suicidal thoughts and behaviors (STBs) as they occur and offers great promise to learn about STBs. However, this approach also introduces questions about how to monitor and respond to real-time information about STBs. Given the increasing use of real-time monitoring, there is a need for novel, effective, and scalable tools for responding to suicide risk in real time. Objective: The goal of this study was to develop and test an automated tool (ResourceBot) that promotes the use of crisis services (eg, 988) in real time through a rule-based (ie, if-then) brief barrier reduction intervention. Methods: ResourceBot was tested in a 2-week real-time monitoring study of 74 adults with recent suicidal thoughts. Results: ResourceBot was deployed 221 times to 36 participants. There was high engagement with ResourceBot (ie, 87% of the time ResourceBot was deployed, a participant opened the tool and submitted a response to it), but zero participants reported using crisis services after engaging with ResourceBot. The most reported reasons for not using crisis services were beliefs that the resources would not help, wanting to handle things on one’s own, and the resources requiring too much time or effort. At the end of the study, participants rated ResourceBot with good usability (mean of 75.6 out of 100) and satisfaction (mean of 20.8 out of 32). Conclusions: This study highlights both the possibilities and challenges of developing effective real-time interventions for suicide risk and areas for refinement in future work. %M 39481100 %R 10.2196/58409 %U https://mental.jmir.org/2024/1/e58409 %U https://doi.org/10.2196/58409 %U http://www.ncbi.nlm.nih.gov/pubmed/39481100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54528 %T Evaluating the Implementation and Clinical Effectiveness of an Innovative Digital First Care Model for Behavioral Health Using the RE-AIM Framework: Quantitative Evaluation %A Nordberg,Samuel S %A Jaso-Yim,Brittany A %A Sah,Pratha %A Schuler,Keke %A Eyllon,Mara %A Pennine,Mariesa %A Hoyler,Georgia H %A Barnes,J Ben %A Murillo,Lily Hong %A O'Dea,Heather %A Orth,Laura %A Rogers,Elizabeth %A Welch,George %A Peloquin,Gabrielle %A Youn,Soo Jeong %+ Reliant Medical Group, OptumCare, 5 Neponset St., Worcester, MA, 01606, United States, 1 5088560732, Samuel.Nordberg@reliantmedicalgroup.org %K digital mental health interventions %K implementation %K clinical effectiveness %K practice-oriented research %K access to care %D 2024 %7 30.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United States, innovation is needed to address the increasing need for mental health care services and widen the patient-to-provider ratio. Despite the benefits of digital mental health interventions (DMHIs), they have not been effective in addressing patients’ behavioral health challenges as stand-alone treatments. Objective: This study evaluates the implementation and effectiveness of precision behavioral health (PBH), a digital-first behavioral health care model embedded within routine primary care that refers patients to an ecosystem of evidence-based DMHIs with strategically placed human support. Methods: Patient demographic information, triage visit outcomes, multidimensional patient-reported outcome measure, enrollment, and engagement with the DMHIs were analyzed using data from the electronic health record and vendor-reported data files. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework was used to evaluate the implementation and clinical effectiveness outcomes of PBH. Results: PBH had a 47.58% reach rate, defined as patients accepting the PBH referral from their behavioral health integrated clinician. PBH patients had high DMHI registration rates (79.62%), high activation rates (76.54%), and high retention rates at 15 days (57.69%) and 30 days (44.58%) compared to literature benchmarks. In total, 74.01% (n=168) of patients showed clinical improvement, 22.47% (n=51) showed no clinical change, and 3.52% (n=8) showed clinical deterioration in symptoms. PBH had high adoption rates, with behavioral health integrated clinicians referring on average 4.35 (SD 0.46) patients to PBH per month and 90%-100% of clinicians (n=12) consistently referring at least 1 patient to PBH each month. A third (32%, n=1114) of patients were offered PBH as a treatment option during their triage visit. Conclusions: PBH as a care model with evidence-based DMHIs, human support for patients, and integration within routine settings offers a credible service to support patients with mild to moderate mental health challenges. This type of model has the potential to address real-life access to care problems faced by health care settings. %M 39476366 %R 10.2196/54528 %U https://www.jmir.org/2024/1/e54528 %U https://doi.org/10.2196/54528 %U http://www.ncbi.nlm.nih.gov/pubmed/39476366 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56950 %T The Impact of Different Types of Social Media Use on the Mental Health of UK Adults: Longitudinal Observational Study %A Yu,Yue %A Dykxhoorn,Jennifer %A Plackett,Ruth %+ Research Department of Primary Care and Population Health, University College London, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 203108309, ruth.plackett.15@ucl.ac.uk %K social media %K mental health %K depression %K anxiety %K mental disorders %K cohort studies %K United Kingdom %K longitudinal observational study %D 2024 %7 30.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have explored the association between social media use and mental health among adolescents. However, few studies using nationally representative longitudinal data have explored this relationship for adults and how the effect might change depending on how people use social media. Objective: This study investigated the longitudinal relationship between the frequency of viewing and posting on social media and mental health problems among UK adults. Methods: This study included 15,836 adults (aged 16 years and older) who participated in Understanding Society, a UK longitudinal survey. Social media use was measured with questions about the frequency of viewing social media and posting on social media in Understanding Society Wave 11 (2019-2021). We explored viewing and posting separately, as well as a combined exposure: (1) high viewing, high posting; (2) high viewing, low posting; (3) low viewing, high posting; and (4) low viewing, low posting. Mental health problems were measured in Wave 12 (2020-2022) using the General Health Questionnaire (GHQ-12), a validated scale for identifying symptoms of common mental health problems, where higher scores indicated more mental health problems (0 to 36). Unadjusted and adjusted linear regression models were estimated for viewing social media and posting on social media, adjusting for the baseline GHQ score, gender, age, ethnicity, employment, and education. We found no evidence for effect modification by gender and age so overall associations were reported. Results: In our adjusted models, we found no evidence of an association between the frequency of viewing social media and mental health problems in the following year. We found that adults who posted daily on social media had more mental health problems than those who never posted on social media, corresponding to a 0.35-point increase in GHQ score (β=0.35, 95% CI 0.01-0.68; P=.04). When we considered both social media behaviors, we found that those who frequently viewed and posted on social media scored 0.31 points higher on the GHQ score (β=0.31, 95% CI 0.04-0.58; P=.03) in the following year compared to those who rarely viewed or posted on social media. Conclusions: We found that a high frequency of posting on social media was associated with increased mental health problems a year later. However, we did not find evidence of a similar association based on the frequency of viewing social media content. This provides evidence that some types of active social media use (ie, posting) have a stronger link to mental health outcomes than some types of passive social media use (viewing). These results highlighted that the relationship between social media use and mental health is complex, and more research is needed to understand the mechanisms underlying these patterns to inform targeted interventions and policies. %M 39476374 %R 10.2196/56950 %U https://www.jmir.org/2024/1/e56950 %U https://doi.org/10.2196/56950 %U http://www.ncbi.nlm.nih.gov/pubmed/39476374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64412 %T Short-Term Outcomes of a Healthy Relationship Intervention for the Prevention of Sexual Harassment and Sexual Assault in the US Military: Pilot Pretest-Postest Study %A Hernandez,Belinda %A Shegog,Ross %A Markham,Christine %A Emery,Susan %A Baumler,Elizabeth %A Thormaehlen,Laura %A Andina Teixeira,Rejane %A Rivera,Yanneth %A Pertuit,Olive %A Kanipe,Chelsey %A Witherspoon,Iraina %A Doss,Janis %A Jones,Victor %A Peskin,Melissa %+ Department of Health Promotion and Behavioral Science, The University of Texas Health Science Center at Houston School of Public Health, 7411 John Smith Dr., Suite 1100, San Antonio, TX, 78229, United States, 1 210 276 9021, belinda.hernandez@uth.tmc.edu %K sexual assault prevention %K sexual harassment prevention %K healthy relationships %K military %K technology-based interventions %K intervention mapping %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual harassment (SH) and sexual assault (SA) are serious public health problems among US service members. Few SH and SA prevention interventions have been developed exclusively for the military. Code of Respect (X-CoRe) is an innovative web-based, multilevel, SA and SH intervention designed exclusively for the active-duty Air Force. The program’s goal is to increase Airmen’s knowledge and skills to build and maintain respectful relationships, ultimately reducing SH and SA and enhancing Airmen’s overall well-being and mission readiness. Objective: This pilot study aimed to assess the short-term psychosocial impact (eg, knowledge, attitudes, and self-efficacy) of the web-based component of X-CoRe on a sample of junior enlisted and midlevel Airmen. Methods: Airmen from a military installation located in the Northeastern United States were recruited to complete the 10 web-based modules in X-CoRe (9/15, 60% male; 7/15, 54% aged 30-35 years). Participants were given pretests and posttests to measure short-term psychosocial outcomes associated with SH and SA. Descriptive statistics and paired 2-tailed t tests were conducted to assess differences from preintervention to postintervention time points. Results: After completing X-CoRe, participants had a significantly greater understanding of active consent (P=.04), confidence in their healthy relationship skills (P=.045), and confidence to intervene as bystanders (P=.01). Although not statistically significant (P>.05), mean scores in attitudes about SH, couple violence, and cyberbullying; perceptions of sexual misconduct as part of military life; and relationship skills self-efficacy with a romantic partner and friend also improved. Conclusions: The findings from this study demonstrate X-CoRe’s effectiveness in improving critical determinants of SH and SA, making it a promising intervention for SH and SA prevention. More rigorous research is needed to determine X-CoRe’s impact on SH and SA victimization and the long-term impact on associated psychosocial determinants. %M 39471370 %R 10.2196/64412 %U https://formative.jmir.org/2024/1/e64412 %U https://doi.org/10.2196/64412 %U http://www.ncbi.nlm.nih.gov/pubmed/39471370 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51376 %T Digital Mental Health Interventions for Adolescents in Low- and Middle-Income Countries: Scoping Review %A Wani,Carolina %A McCann,Lisa %A Lennon,Marilyn %A Radu,Caterina %+ Department of Computer and Information Sciences, University of Strathclyde, 16 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 0141 548 3189, carolina.wani@strath.ac.uk %K adolescents %K mental health %K low- and middle-income countries %K LMICs %K digital mental health interventions %K DMHIs %K cultural appropriateness %K implementation %K design %K evaluation %K mobile phone %D 2024 %7 29.10.2024 %9 Review %J J Med Internet Res %G English %X Background: Digital mental health interventions (DMHIs) are increasingly recognized as potential solutions for adolescent mental health, particularly in low- and middle-income countries (LMICs). The United Nations’ Sustainable Development Goals and universal health coverage are instrumental tools for achieving mental health for all. Within this context, understanding the design, evaluation, as well as the barriers and facilitators impacting adolescent engagement with mental health care through DMHIs is essential. Objective: This scoping review aims to provide insights into the current landscape of DMHIs for adolescents in LMICs. Methods: The Joanna Briggs Institute scoping review methodology was used, following the recommendations of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Our search strategy incorporated 3 key concepts: population "adolescents," concept "digital mental health interventions," and context "LMICs." We adapted this strategy for various databases, including ACM Digital Library, APA PsycINFO, Cochrane Library, Google Scholar (including gray literature), IEEE Xplore, ProQuest, PubMed (NLM), ScienceDirect, Scopus, and Web of Science. The articles were screened against a specific eligibility criterion from January 2019 to March 2024. Results: We analyzed 20 papers focusing on DMHIs for various mental health conditions among adolescents, such as depression, well-being, anxiety, stigma, self-harm, and suicide ideation. These interventions were delivered in diverse formats, including group delivery and self-guided interventions, with support from mental health professionals or involving lay professionals. The study designs and evaluation encompassed a range of methodologies, including randomized controlled trials, mixed methods studies, and feasibility studies. Conclusions: While there have been notable advancements in DMHIs for adolescents in LMICs, the research base remains limited. Significant knowledge gaps persist regarding the long-term clinical benefits, the maturity and readiness of LMIC digital infrastructure, cultural appropriateness, and cost-effectiveness across the heterogeneous LMIC settings. Addressing these gaps necessitates large-scale, co-designed, and culturally sensitive DMHI trials. Future work should address this. %M 39471371 %R 10.2196/51376 %U https://www.jmir.org/2024/1/e51376 %U https://doi.org/10.2196/51376 %U http://www.ncbi.nlm.nih.gov/pubmed/39471371 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e49660 %T Blended Psychological Therapy for the Treatment of Psychological Disorders in Adult Patients: Systematic Review and Meta-Analysis %A Ferrao Nunes-Zlotkowski,Kelly %A Shepherd,Heather L %A Beatty,Lisa %A Butow,Phyllis %A Shaw,Joanne Margaret %+ Psycho-Oncology Co-operative Research Group (PoCoG), School of Psychology, The University of Sydney, Rm 311B Level 3 Griffith Taylor (A19), Manning Road, Sydney, NSW 2006, Australia, 61 2 9351 3761, joanne.shaw@sydney.edu.au %K systematic review %K blended psychological therapy %K blended care %K face-to-face %K online %K psychological intervention %K intervention design %K digital care %K digital mental health %K psychological disorder %D 2024 %7 29.10.2024 %9 Review %J Interact J Med Res %G English %X Background: Blended therapy (BT) combines digital with face-to-face psychological interventions. BT may improve access to treatment, therapy uptake, and adherence. However, research is scarce on the structure of BT models. Objective: We synthesized the literature to describe BT models used for the treatment of psychological disorders in adults. We investigated whether BT structure, content, and ratio affected treatment efficacy, uptake, and adherence. We also conducted meta-analyses to examine treatment efficacy in intervention-control dyads and associations between treatment outcomes versus BT model structure. Methods: PsycINFO, CINAHL, Embase, ProQuest, and MEDLINE databases were searched. Eligibility criteria included articles published in English till March 2023 that described digital and face-to-face elements as part of an intervention plan for treating psychological disorders in adult patients. We developed a coding framework to characterize the BT interventions. A meta-analysis was conducted to calculate effect size (ES; Cohen d and 95% CIs) regarding pre- and posttreatment outcomes in depression and anxiety versus BT structure. The review was registered with PROSPERO and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: Searches identified 8436 articles, and data were extracted from 29 studies. BT interventions were analyzed and classified according to mode of interaction between digital and face-to-face components (integrated vs sequential), role of the components (core vs supplementary), component delivery (alternate vs case-by-case), and digital materials assignment mode (standardized vs personalized). Most BT interventions (n=24) used a cognitive behavioral therapy approach for anxiety or depression treatment. Mean rates of uptake (91%) and adherence (81%) were reported across individual studies. BT interventions were more effective or noninferior to treatment as usual, with large spread in the data and a moderate to large ES in the treatment of depression (n=9; Cohen d=–1.1, 95% CI –0.6 to –1.6, P<.001, and z score=–4.3). A small, nonsignificant ES was found for anxiety outcomes (n=5; Cohen d=–0.1, 95% CI –0.3 to 0.05, P=.17, and z score=–1.4). Higher ESs were found in blended interventions with supplementary design (depression: n=11, Cohen d=–0.75, 95% CI –0.56 to –0.95; anxiety: n=8, Cohen d=–0.9, 95% CI –0.6 to –1.2); fewer (≤6) face-to-face sessions (depression: n=9, Cohen d=–0.7, 95% CI –0.5 to –0.9; anxiety: n=7, Cohen d=–0.8, 95% CI –0.3 to –1.3); and a lower ratio (≤50%) of face-to-face versus digital sessions (depression: n=5, Cohen d=–0.8, 95% CI –0.6 to –1.1; anxiety: n=4, Cohen d=–0.8, 95% CI 0.006 to –1.6). Conclusions: This study confirmed integrated BT models as feasible to deliver. We found BT to be effective in depression treatment, but anxiety treatment results were nonsignificant. Future studies assessing outcomes across different psychological disorders and therapeutic approaches are required. Trial Registration: PROSPERO CRD42021258977; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258977 %M 39470720 %R 10.2196/49660 %U https://www.i-jmr.org/2024/1/e49660 %U https://doi.org/10.2196/49660 %U http://www.ncbi.nlm.nih.gov/pubmed/39470720 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56882 %T A Tailored Postpartum eHealth Physical Activity Intervention for Individuals at High Risk of Postpartum Depression—the POstpartum Wellness Study (POW): Protocol and Data Overview for a Randomized Controlled Trial %A Ramsey,Maya %A Oberman,Nina %A Quesenberry Jr,Charles P %A Kurtovich,Elaine %A Gomez Chavez,Lizeth %A Chess,Aaloni %A Brown,Susan Denise %A Albright,Cheryl L %A Bhalala,Mibhali %A Badon,Sylvia E %A Avalos,Lyndsay A %+ Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr., Pleasanton, CA, 94588, United States, 1 5108210300, Lyndsay.A.Avalos@kp.org %K postpartum depression %K depression %K eHealth %K online workout videos %K exercise videos %K physical activity %K wellness %K health promotion %K digital interventions %D 2024 %7 29.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Postpartum depression (PPD) is associated with significant health consequences for the parent and child. Current recommendations for PPD prevention require intense health care system resources. Evidence-based interventions for PPD prevention that do not further burden the health care system are needed. Evidence suggests that physical activity (PA) can generally reduce depressive symptoms. Technology-based interventions may help decrease common barriers to PA. Objective: This study aims to report the protocol and provide a data overview of the POstpartum Wellness study (POW)—an effectiveness trial evaluating whether an eHealth PA intervention tailored for postpartum individuals increased PA and decreased depressive symptoms among individuals at high PPD risk. Methods: This remote parallel-group randomized controlled trial included postpartum individuals with a history of depression or at least moderate current depressive symptoms not meeting the PPD diagnostic threshold and with low PA levels from an integrated health care delivery system. Participants were randomized to an eHealth PA intervention or usual care. The intervention group received access to a library of web-based workout videos designed for postpartum individuals, which included interaction with their infants. At baseline and follow-up (3 and 6 months), PA was measured using questionnaires and a wrist-worn accelerometer. Depressive symptoms were measured using the Patient Health Questionnaire-8 (PHQ-8). Data were collected to assess exploratory outcomes of sleep, perceived stress, anxiety, parent-infant bonding, and infant development. Results: The study was funded in January 2020. Participants were enrolled via REDCap (Research Electronic Data Capture) or telephonically between November 2020 and September 2022; data collection ended in April 2023. Randomized participants (N=99) were 4 months post partum at baseline with moderately severe depressive symptoms (mean PHQ-8 score 12.6, SD 2.2). Intervention (n=50) and usual care (n=49) groups had similar sociodemographic characteristics, months post partum, baseline depressive symptoms, number of children at home, and prepregnancy PA levels. Retention in assessments was ≥66% for questionnaires and ≥48% for accelerometry, with modest differences by group. At 3-month follow-up, 73 of 99 (74%) participants (intervention: 35/50, 70%; usual care: 38/49, 78%) completed questionnaires; 53 of 99 (54%) wore the accelerometer for 7 days (27 of 50 (54%) intervention, 26 of 49 (53%) usual care). At 6-month follow-up, 66 of 99 (67%) participants (30 of 50 (60%) intervention, 36 of 49 (73%) usual care) completed questionnaires and 43 of 99 (43%) wore the accelerometer for 7 days (21 of 50 (42%) intervention, 22 of 49 (45%) usual care). Data analysis is completed, and a manuscript with these findings is currently under review for publication. Conclusions: The POW trial evaluates the effectiveness of an eHealth PA intervention for improving depressive symptoms and increasing PA among postpartum individuals at high PPD risk. Results have implications for the design and delivery of behavioral interventions among vulnerable patients. Trial Registration: ClinicalTrials.gov NCT04414696; https://clinicaltrials.gov/ct2/show/NCT04414696 International Registered Report Identifier (IRRID): DERR1-10.2196/56882 %M 39470705 %R 10.2196/56882 %U https://www.researchprotocols.org/2024/1/e56882 %U https://doi.org/10.2196/56882 %U http://www.ncbi.nlm.nih.gov/pubmed/39470705 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52609 %T Acceptability of Digital Mental Health Interventions for Depression and Anxiety: Systematic Review %A Lau,Carrie K Y %A Saad,Anthony %A Camara,Bettina %A Rahman,Dia %A Bolea-Alamanac,Blanca %+ Department of Psychiatry, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 647 331 2707, Blanca.BoleaAlamanac@wchospital.ca %K acceptability %K mental health %K depression %K anxiety %K mobile app %K internet %K mobile phone %K mobile health %K mHealth %K digital health %D 2024 %7 28.10.2024 %9 Review %J J Med Internet Res %G English %X Background: Depression and anxiety disorders are common, and treatment often includes psychological interventions. Digital health interventions, delivered through technologies such as web-based programs and mobile apps, are increasingly used in mental health treatment. Acceptability, the extent to which an intervention is viewed positively, has been identified as contributing to patient adherence and engagement with digital health interventions. Acceptability, therefore, impacts the benefit derived from using digital health interventions in treatment. Understanding the acceptability of digital mental health interventions among patients with depression or anxiety disorders is essential to maximize the effectiveness of their treatment. Objective: This review investigated the acceptability of technology-based interventions among patients with depression or anxiety disorders. Methods: A systematic review was performed based on PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines. We searched PubMed, Web of Science, and Ovid in May 2022. Studies were included if they evaluated digital interventions for the treatment of depression or anxiety disorders and investigated their acceptability among adult patients. Studies were excluded if they targeted only specific populations (eg, those with specific physical health conditions), investigated acceptability in healthy individuals or patients under the age of 18 years, involved no direct interaction between patients and technologies, used technology only as a platform for traditional care (eg, videoconferencing), had patients using technologies only in clinical or laboratory settings, or involved virtual reality technologies. Acceptability outcome data were narratively synthesized by the direction of acceptability using vote counting. Included studies were evaluated using levels of evidence from the Oxford Centre for Evidence-Based Medicine. The risk of bias was assessed using a tool designed for this review and GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). Results: A total of 143 articles met the inclusion criteria, comprising 67 (47%) articles on interventions for depression, 65 (45%) articles on interventions for anxiety disorders, and 11 (8%) articles on interventions for both. Overall, 90 (63%) were randomized controlled trials, 50 (35%) were other quantitative studies, and 3 (2%) were qualitative studies. Interventions used web-based programs, mobile apps, and computer programs. Cognitive behavioral therapy was the basis of 71% (102/143) of the interventions. Digital mental health interventions were generally acceptable among patients with depression or anxiety disorders, with 88% (126/143) indicating positive acceptability, 8% (11/143) mixed results, and 4% (6/143) insufficient information to categorize the direction of acceptability. The available research evidence was of moderate quality. Conclusions: Digital mental health interventions seem to be acceptable to patients with depression or anxiety disorders. Consistent use of validated measures for acceptability would enhance the quality of evidence. Careful design of acceptability as an evaluation outcome can further improve the quality of evidence and reduce the risk of bias. Trial Registration: Open Science Framework Y7MJ4; https://doi.org/10.17605/OSF.IO/SPR8M %M 39466300 %R 10.2196/52609 %U https://www.jmir.org/2024/1/e52609 %U https://doi.org/10.2196/52609 %U http://www.ncbi.nlm.nih.gov/pubmed/39466300 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64454 %T Client Perspectives of Case Stories in Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Study %A Price,Jill AB %A Gregory,Julia %A McCall,Hugh C %A Landry,Caeleigh A %A Beahm,Janine D %A Hadjistavropoulos,Heather D %+ Canadian Institute for Public Safety Research and Treatment, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S0A2, Canada, 1 3063378418, jill.price@uregina.ca %K internet-delivered cognitive behavioral therapy %K case stories %K public safety personnel %K public safety %K mental health %K internet interventions %K digital mental health interventions %K first responders %D 2024 %7 25.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective and convenient means of offering cognitive behavioral therapy to the general population. To increase access to ICBT among Canadian public safety personnel (PSP)—a group that experiences elevated rates of mental health concerns and barriers to mental health care—a clinical research unit called PSPNET has tailored ICBT to PSP, primarily through offering case stories and PSP-specific examples within an ICBT program. PSPNET’s first and most frequently used ICBT program, called the PSP Wellbeing Course, has been found to reduce symptoms of mental disorders (eg, anxiety, depression, and posttraumatic stress) among PSP. Little research, however, has investigated clients’ perceptions of the case stories in this course. Objective: This study was designed to expand the literature on the use and evaluation of case stories in ICBT among PSP. Specifically, this study investigated (1) PSP’s perceptions of the case stories using the theoretical model provided by Shaffer and Zikmund-Fisher and (2) PSP feedback on the case stories in the PSP Wellbeing Course. Methods: This study included 41 clients who completed the PSP Wellbeing Course. Of these, 27 clients completed a bespoke questionnaire called the Stories Questionnaire, 10 of whom also participated in a semistructured interview. Results: Findings show that perceptions of the case stories in the PSP Wellbeing Course were largely positive and that the case stories were generally successful in achieving the 5 purposes of case stories (ie, informing, comforting, modeling, engaging, and persuading) proposed by Shaffer and Zikmund-Fisher. Client feedback also identified 3 tangible areas for story improvement: characters, content, and delivery. Each area highlights the need for and potential benefits of story development. Not all PSP engaged with the case stories, though, so results must be interpreted with caution. Conclusions: Overall, this study adds to the growing body of research supporting the use of case stories in internet-delivered interventions among PSP. Trial Registration: ClinicalTrials.gov NCT04127032; https://www.clinicaltrials.gov/ct2/show/NCT04127032 %M 39453705 %R 10.2196/64454 %U https://formative.jmir.org/2024/1/e64454 %U https://doi.org/10.2196/64454 %U http://www.ncbi.nlm.nih.gov/pubmed/39453705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59501 %T Role of Synchronous, Moderated, and Anonymous Peer Support Chats on Reducing Momentary Loneliness in Older Adults: Retrospective Observational Study %A Dana,Zara %A Nagra,Harpreet %A Kilby,Kimberly %+ Supportiv, 2222 Harold Way, Berkeley, CA, 94704, United States, 1 800 845 0015, harpreet@supportiv.com %K digital peer support %K social loneliness %K chat-based interactions %K older adults %D 2024 %7 25.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Older adults have a high rate of loneliness, which contributes to increased psychosocial risk, medical morbidity, and mortality. Digital emotional support interventions provide a convenient and rapid avenue for additional support. Digital peer support interventions for emotional struggles contrast the usual provider-based clinical care models because they offer more accessible, direct support for empowerment, highlighting the users’ autonomy, competence, and relatedness. Objective: This study aims to examine a novel anonymous and synchronous peer-to-peer digital chat service facilitated by trained human moderators. The experience of a cohort of 699 adults aged ≥65 years was analyzed to determine (1) if participation, alone, led to measurable aggregate change in momentary loneliness and optimism and (2) the impact of peers on momentary loneliness and optimism. Methods: Participants were each prompted with a single question: “What’s your struggle?” Using a proprietary artificial intelligence model, the free-text response automatched the respondent based on their self-expressed emotional struggle to peers and a chat moderator. Exchanged messages were analyzed to quantitatively measure the change in momentary loneliness and optimism using a third-party, public, natural language processing model (GPT-4 [OpenAI]). The sentiment change analysis was initially performed at the individual level and then averaged across all users with similar emotion types to produce a statistically significant (P<.05) collective trend per emotion. To evaluate the peer impact on momentary loneliness and optimism, we performed propensity matching to align the moderator+single user and moderator+small group chat cohorts and then compare the emotion trends between the matched cohorts. Results: Loneliness and optimism trends significantly improved after 8 (P=.02) to 9 minutes (P=.03) into the chat. We observed a significant improvement in the momentary loneliness and optimism trends between the moderator+small group compared to the moderator+single user chat cohort after 19 (P=.049) and 21 minutes (P=.04) for optimism and loneliness, respectively. Conclusions: Chat-based peer support may be a viable intervention to help address momentary loneliness in older adults and present an alternative to traditional care. The promising results support the need for further study to expand the evidence for such cost-effective options. %M 39453688 %R 10.2196/59501 %U https://formative.jmir.org/2024/1/e59501 %U https://doi.org/10.2196/59501 %U http://www.ncbi.nlm.nih.gov/pubmed/39453688 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59119 %T The Evaluation of a Web-Based Intervention (Deprexis) to Decrease Depression and Restore Functioning in Veterans: Protocol for a Randomized Controlled Trial %A Pearson,Rahel %A Beevers,Christopher G %A Mignogna,Joseph %A Benzer,Justin %A Pfeiffer,Paul N %A Post,Edward %A Creech,Suzannah K %+ Veterans Integrated Service Network 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, 4800 Memorial Drive (151C), Waco, TX, 76711, United States, 1 254 297 5155, rahel.pearson@va.gov %K depression %K eHealth %K mental health %K randomized controlled trial %K RCT %K mobile phone %D 2024 %7 24.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depressive symptoms are common in veterans, and the presence of these symptoms increases disability as well as suicidal thoughts and behaviors. However, there is evidence that these symptoms often go untreated. Intervening before symptoms become severe and entrenched is related to better long-term outcomes, including improved functioning and less disease chronicity. Computer-delivered interventions may be especially appropriate for those veterans with mild to moderate depressive symptoms, because these interventions can require fewer resources and have lower barriers to access and thus have potential for wider reach. Despite this potential, there is a dearth of research examining computerized interventions for depressive symptoms in veteran samples. Objective: The aim of this study is to evaluate the efficacy of Deprexis (GAIA AG), a computerized intervention for depressive symptoms and related functional impairment. Methods: Veterans will be recruited through the US Department of Veterans Affairs electronic medical record and through primary care and specialty clinics. First, qualitative interviews will be completed with a small subset of veterans (n=16-20) to assess the acceptability of treatment procedures. Next, veterans (n=132) with mild to moderate depressive symptoms will be randomly assigned to the fully automated Deprexis intervention or a treatment-as-usual control group. The primary outcomes will be self-reported depressive symptoms and various dimensions of psychosocial functioning. Results: This project was funded in May 2024, and data collection will be conducted between October 2024 and April 2029. Overall, 4 participants have been recruited as of the submission of the manuscript, and data analysis is expected in June 2029, with initial results expected in November 2029. Conclusions: This study will provide initial evidence for the efficacy of self-guided, computerized interventions for depressive symptoms and functional impairment in veterans. If effective, these types of interventions could improve veteran access to low-resource psychosocial treatments. Trial Registration: ClinicalTrials.gov NCT06217198; https://www.clinicaltrials.gov/study/NCT06217198 International Registered Report Identifier (IRRID): PRR1-10.2196/59119 %M 39446432 %R 10.2196/59119 %U https://www.researchprotocols.org/2024/1/e59119 %U https://doi.org/10.2196/59119 %U http://www.ncbi.nlm.nih.gov/pubmed/39446432 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47083 %T Patient Perspectives on Blended Internet-Based and Face-to-Face Cognitive Behavioral Therapy for Alcohol Use Disorder: Qualitative Study %A Tarp,Kristine %A Christiansen,Regina %A Bilberg,Randi %A Borkner,Simone %A Dalsgaard,Caroline %A Paldam Folker,Marie %A Søgaard Nielsen,Anette %+ Psychiatric University Hospital, University Function, Region of Southern Denmark, J.B. Winsløws Vej 18, Odense, 5000, Denmark, 45 6550 7221, reginachristiansen@health.sdu.dk %K internet-based %K alcohol use disorder treatment %K user perspective %K qualitative %K blended treatment %K blended learning %K cognitive behavioral therapy %K alcoholism %K alcohol use disorder %K treatment %K barriers %K patient perspectives %K rehabilitation %D 2024 %7 23.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Harmful alcohol consumption has been identified as a major contributor to disease, mortality, and social harm, accounting for 5.3% of worldwide deaths annually. In Denmark, an estimated 150,000 people suffer from alcohol use disorder (AUD), but a low proportion seek treatment due to person- and treatment-related barriers. Internet-based cognitive behavioral therapy (iCBT) has shown positive effects on the treatment gap, with patients reporting benefits such as increased knowledge and flexibility. However, there is a lack of research on blended cognitive behavioral therapy (bCBT), which combines face-to-face CBT (FtF CBT) and iCBT for AUD. Objective: This study aims to investigate user experiences of bCBT. More specifically, it seeks to explore the advantages and disadvantages that users have experienced with bCBT for AUD, as well as their motivations for choosing this treatment format. Methods: A total of 30 patients who had participated in the Blend-A (Blending Internet Treatment into Conventional Face-to-Face Treatment for AUD) study and received the intervention were contacted and offered the opportunity to participate in semistructured individual telephone interviews. Of these, 12 patients consented to participate. Furthermore, an additional participant was approached at a municipal clinic and agreed to engage in an individual FtF interview. Thus, the final sample consisted of 13 patients. The interviews explored their background, experiences with digital technology, motivations for choosing internet-based treatment, and experiences with the program during AUD treatment. The interviews were audio-recorded and transcribed in full length and analyzed using thematic analysis. All data were anonymized and securely stored. Results: We found that users experienced several advantages of iCBT over a larger part of the treatment course, including increased anonymity and privacy. Most importantly, it offered flexibility, allowing patients to focus on their rehabilitation process at their own pace. Patients appreciated the availability of written text in the online program, finding it helpful for gaining knowledge and understanding of AUD and its impact on the individual with the condition. They emphasized how the assignments helped them fully engage in treatment by first acknowledging their problem with alcohol and then dedicating time to self-reflection before FtF sessions, allowing for more in-depth discussions with the therapist. They also appreciated the reminders, which motivated them to complete their assignments. Conclusions: Overall, patients perceived more benefits than disadvantages in using bCBT. Essentially, bCBT offers a form of assisted autonomy that cannot be fully achieved through iCBT or FtF CBT alone. It is only through their combination that patients can fully appreciate the benefits of the treatment, as they have time for self-reflection, with guidance from the therapist between FtF CBT sessions. Trial Registration: ClinicalTrials.gov NCT04535258; https://clinicaltrials.gov/ct2/show/NCT04535258 %M 39441642 %R 10.2196/47083 %U https://www.jmir.org/2024/1/e47083 %U https://doi.org/10.2196/47083 %U http://www.ncbi.nlm.nih.gov/pubmed/39441642 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58994 %T Measurement-Based Care in a Remote Intensive Outpatient Program: Pilot Implementation Initiative %A Kumar,Komal %A Childs,Amber W %A Kohlmeier,Jonathan %A Kroll,Elizabeth %A Zant,Izabella %A Stolzenbach,Stephanie %A Fenkel,Caroline %+ Charlie Health, Inc, 233 E Main St STE 401, Bozeman, MT, 59715, United States, 1 6506226061, komal0719@gmail.com %K measurement-based care %K MBC %K remote %K intensive outpatient program %K IOP %K mental health %K implementation %D 2024 %7 23.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The ongoing mental health crisis, especially among youth, has led to a greater demand for intensive treatment at the intermediate level, such as intensive outpatient programs (IOPs). Defining best practices in remote IOPs more broadly is critical to understanding the impact of these offerings for individuals with high-acuity mental health service needs in the outpatient setting. Measurement-based care (MBC), or the routine and systematic collection of patient-reported data throughout the course of care to make meaningful changes to treatment, is one such practice that has been shown to improve patient outcomes in mental health treatment. Despite the literature linking MBC to beneficial clinical outcomes, the adoption of MBC in clinical practice has been slow and inconsistent, and more research is needed around MBC in youth-serving settings. Objective: The aim of this paper is to help bridge these gaps, illustrating the implementation of MBC within an organization that provides remote-first, youth-oriented IOP for individuals with high-acuity psychiatric needs. Methods: A series of 2 quality improvement pilot studies were conducted with select clinicians and their clients at Charlie Health, a remote IOP program that treats high-acuity teenagers and young adults who present with a range of mental health disorders. Both studies were carefully designed, including thorough preparation and planning, clinician training, feedback collection, and data analysis. Using process evaluation data, MBC deployment was repeatedly refined to enhance the clinical workflow and clinician experience. Results: The survey completion rate was 80.08% (3216/4016) and 86.01% (4218/4904) for study 1 and study 2, respectively. Quantitative clinician feedback showed marked improvement from study 1 to study 2. Rates of successful treatment completion were 22% and 29% higher for MBC pilot clients in study 1 and study 2, respectively. Depression, anxiety, and psychological well-being symptom reduction were statistically significantly greater for MBC pilot clients (P<.05). Conclusions: Our findings support the feasibility and clinician acceptability of a rigorous MBC process in a real-world, youth-serving, remote-first, intermediate care setting. High survey completion data across both studies and improved clinician feedback over time suggest strong clinician buy-in. Client outcomes data suggest MBC is positively correlated with increased treatment completion and symptom reduction. This paper provides practical guidance for MBC implementation in IOPs and can extend to other mental health care settings. %M 39441653 %R 10.2196/58994 %U https://formative.jmir.org/2024/1/e58994 %U https://doi.org/10.2196/58994 %U http://www.ncbi.nlm.nih.gov/pubmed/39441653 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48481 %T A Universal Digital Stress Management Intervention for Employees: Randomized Controlled Trial with Health-Economic Evaluation %A Freund,Johanna %A Smit,Filip %A Lehr,Dirk %A Zarski,Anna-Carlotta %A Berking,Matthias %A Riper,Heleen %A Funk,Burkhardt %A Ebert,David Daniel %A Buntrock,Claudia %+ Department of Health Psychology and Applied Biological Psychology, Leuphana University of Lueneburg, Universitätsallee 1, Lueneburg, 21335, Germany, 49 4131 677 2720, lehr@leuphana.de %K economic evaluation %K cost-effectiveness %K cost-utility %K cost-benefit %K return-on-investment %K employees %K universal prevention %K internet-based %K stress management %D 2024 %7 22.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Stress is highly prevalent and known to be a risk factor for a wide range of physical and mental disorders. The effectiveness of digital stress management interventions has been confirmed; however, research on its economic merits is still limited. Objective: This study aims to assess the cost-effectiveness, cost-utility, and cost-benefit of a universal digital stress management intervention for employees compared with a waitlist control condition within a time horizon of 6 months. Methods: Recruitment was directed at the German working population. A sample of 396 employees was randomly assigned to the intervention group (n=198) or the waitlist control condition (WLC) group (n=198). The digital stress management intervention included 7 sessions plus 1 booster session, which was offered without therapeutic guidance. Health service use, patient and family expenditures, and productivity losses were self-assessed and used for costing from a societal and an employer’s perspective. Costs were related to symptom-free status (PSS-10 [Perceived Stress Scale] score 2 SDs below the study population baseline mean) and quality-adjusted life years (QALYs) gained. The sampling error was handled using nonparametric bootstrapping. Results: From a societal perspective, the digital intervention was likely to be dominant compared with WLC, with a 56% probability of being cost-effective at a willingness-to-pay (WTP) of €0 per symptom-free person gained. At the same WTP threshold, the digital intervention had a probability of 55% being cost-effective per QALY gained relative to the WLC. This probability increased to 80% at a societal WTP of €20,000 per QALY gained. Taking the employer’s perspective, the digital intervention showed a probability of a positive return on investment of 78%. Conclusions: Digital preventive stress management for employees appears to be cost-effective societally and provides a favorable return on investment for employers. Trial Registration: German Clinical Trials Register DRKS00005699; https://drks.de/search/en/trial/DRKS00005699 %M 39437382 %R 10.2196/48481 %U https://www.jmir.org/2024/1/e48481 %U https://doi.org/10.2196/48481 %U http://www.ncbi.nlm.nih.gov/pubmed/39437382 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e65692 %T Assessing the Usage and Usability of a Mental Health Advice Telephone Service in Uganda: Mixed Methods Study %A Kabukye,Johnblack K %A Nakku,Juliet %A Niwemuhwezi,Jackline %A Nsereko,James %A Namagembe,Rosemary %A Groen,Iris Dorothee Emilie %A Neumbe,Ritah %A Mubiru,Denis %A Kisakye,Caroline %A Nanyonga,Roseline %A Sjölinder,Marie %A Nilsson,Susanne %A Wamala-Larsson,Caroline %+ Swedish Program for ICT in Developing Regions (SPIDER), Department of Computer and Systems Science, Stockholm University, Borgarfjordsgatan 12, Kista, Stockholm, 164 55, Sweden, 46 8162000, kabukye@dsv.su.se %K mHealth %K mental health %K telephone service %K usability %K satisfaction %K evaluation %K mixed method %K Uganda %K Africa %D 2024 %7 21.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Harnessing mobile health (mHealth) solutions could improve the delivery of mental health services and mitigate their impact in Uganda and similar low-resource settings. However, successful adoption requires that mHealth solutions have good usability. We have previously implemented a telephone service to provide mental health information and advice in English and Luganda, utilizing an automated interactive voice response (IVR) system linked to live agents, including mental health care workers and peer support workers. Objective: This study aims to assess the usage and usability of this mental health telephone service. Methods: We obtained usage data from the system’s call logs over 18 months to study call volumes and trends. We then surveyed callers to gather their characteristics and assess usability using the Telehealth Usability Questionnaire. Additionally, call recordings were evaluated for conversation quality by 3 independent health care professionals, using the Telephone Nursing Dialogue Process, and correlations between quality and usability aspects were investigated. Results: Over 18 months, the system received 2863 meaningful calls (ie, calls that went past the welcome message) from 1125 unique telephone numbers. Of these, 1153 calls (40.27%) stopped at the prerecorded IVR information, while 1710 calls (59.73%) opted to speak to an agent. Among those who chose to speak with an agent, 1292 calls (75.56%) were answered, 393 calls (22.98%) went to voicemail and were returned in the following working days, and 25 calls (1.46%) were not answered. Usage was generally sustained over time, with spikes in call volume corresponding to marketing events. The survey (n=240) revealed that most callers were caregivers of patients with mental health issues (n=144, 60.0%) or members of the general public (n=46, 19.2%), while a few were patients with mental health issues (n=44, 18.3%). Additionally, the majority were male (n=143, 59.6%), spoke English (n=180, 75.0%), had postsecondary education (n=164, 68.3%), lived within 1 hour or less from Butabika Hospital (n=187, 77.9%), and were aged 25-44 years (n=160, 66.7%). The overall usability score for the system was 4.12 on a 5-point scale, significantly higher than the recommended target usability score of 4 (P=.006). The mean scores for usability components ranged from 3.66 for reliability to 4.41 for ease of use, with all components, except reliability, scoring higher than 4 or falling within its CI. Usability scores were higher for Luganda speakers compared with English speakers, but there was no association with other participant characteristics such as sex, distance from the hospital, age, marital status, duration of symptoms, or treatment status. The quality of call conversations (n=50) was rated at 4.35 out of 5 and showed a significant correlation with usability (Pearson r=0.34, P=.02). Conclusions: We found sustained usage of the mental health telephone service, along with a positive user experience and high satisfaction across various user characteristics. mHealth solutions like this should be embraced and replicated to enhance the delivery of health services in Uganda and similar low-resource settings. %M 39432895 %R 10.2196/65692 %U https://www.jmir.org/2024/1/e65692 %U https://doi.org/10.2196/65692 %U http://www.ncbi.nlm.nih.gov/pubmed/39432895 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55679 %T Virtual Reality–Based Exposure With 360° Environments for Social Anxiety Disorder: Usability and Feasibility Study %A Ernst,Mathias %A Bouchard,Stéphane %A Andersen,Tonny %A Orskov,Per Trads %A Tarp,Kristine %A Lichtenstein,Mia Beck %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 26218846, mlichtenstein@health.sdu.dk %K anxiety %K exposure therapy %K social anxiety disorder %K virtual reality %K 360° %K mixed methods %K interactive %D 2024 %7 21.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social anxiety disorder (SAD) is a long-term and overwhelming fear of social situations that can affect work, school, and other daily activities. Although cognitive behavioral therapy is effective, few seek treatment, and many who do start often drop out. This may be due to the component of exposure inherent to cognitive behavioral therapy, where the patient confronts feared stimuli outside the therapist’s office, which they otherwise try to avoid. As an alternative, research has explored the effectiveness of virtual reality (VR)–based exposure therapy with promising results. However, few studies have investigated the feasibility of VR tools using mixed methodologies before assessing their efficacy. Objective: This study aims to assess the usability, feasibility, and presence of four 360° virtual environments and whether these were able to evoke anxiety in patients with SAD. Methods: A total of 10 adult participants with SAD and 10 healthy controls were recruited for 1 experimental session (age range 21-32 y; 12/20, 60% male participants). Questionnaire and interview data were collected and analyzed. A mixed methods triangulation design was applied to analyze and compare the data. Results: Participants with SAD experienced increased anxiety when exposed to VR, and environments were considered relevant and useful as an exposure tool. Participants with SAD reported significantly higher average anxiety levels (P=.01) and peak anxiety levels (P=.01) compared with controls during exposure; however, significant differences in anxiety when accounting for baseline anxiety levels were only found in 2 of 4 environments (P=.01, P=.01, P=.07, and P=.06). While presence scores were acceptable in both groups, participants with SAD scored significantly lower than controls. Qualitative analyses highlight this finding within the SAD group, where some participants experienced presence reduction due to being observed while in VR and in situations with reduced interaction in VR. Conclusions: VR exposure with 360° videos seems to be useful as a first step of exposure therapy for patients with SAD. Future exploration in the clinical application of VR-based exposure for SAD, as well as means of increasing presence within the virtual environments, may be useful. %M 39432344 %R 10.2196/55679 %U https://formative.jmir.org/2024/1/e55679 %U https://doi.org/10.2196/55679 %U http://www.ncbi.nlm.nih.gov/pubmed/39432344 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55441 %T Enhancing Research Involvement of Young People With Lived Expertise: Reflecting on Experiences in Digital Mental Health Research %A Brogden,Josephine %A de Haan,Zsofi %A Gorban,Carla %A Hockey,Samuel J %A Hutcheon,Alexis %A Iorfino,Frank %A Song,Yun Ju C %A Scott,Elizabeth %A Hickie,Ian B %A McKenna,Sarah %+ Brain and Mind Centre, The University of Sydney, 94-100 Mallett St, Camperdown, NSW, 2050, Australia, 61 (02) 9351 0774, sarah.mckenna@sydney.edu.au %K youth mental health %K digital mental health %K lived expertise %K young people %K youth %K adolescence %K technologies %K university %K universities %K Sydney %K real-world %K engagement %K work environment %D 2024 %7 18.10.2024 %9 Viewpoint %J J Med Internet Res %G English %X Given the rapid development of digital mental health technologies and a focus on connecting with youth, there is an urgent need to enhance the engagement of young people with lived expertise in research. Even so, youth with lived experience of accessing mental health services are particularly affected by power imbalances and may receive limited compensation in academic settings. Therefore, an emphasis on how research engagement not only improves the work but can benefit young people themselves is required. Here, 5 young people with lived expertise report on their experience of being employed as researchers at the University of Sydney’s Brain and Mind Centre. As such, this team is uniquely placed to offer reflections from their work across multiple stages of research. This led to four key insights, including (1) creating accepting work cultures, (2) providing diverse opportunities for involvement, (3) giving young people agency and flexibility around sharing lived experiences, and (4) creating accommodating work environments for all researchers. We suggest that these insights can support more diverse ways of engaging young people and maximizing the value of participation for both researchers and young people themselves. %M 39423372 %R 10.2196/55441 %U https://www.jmir.org/2024/1/e55441 %U https://doi.org/10.2196/55441 %U http://www.ncbi.nlm.nih.gov/pubmed/39423372 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51110 %T Exploring the Role of Mobile Apps for Insomnia in Depression: Systematic Review %A Chiu,Yi-Hang %A Lee,Yen-Fen %A Lin,Huang-Li %A Cheng,Li-Chen %+ Department of Information and Finance Management, National Taipei University of Technology, Number 1, Section 3, Zhongxiao East Road, Da’an District, Taipei City, 10608, Taiwan, 886 2771 2171 ext 6720, lijen.cheng@gmail.com %K depression %K insomnia %K chatbots %K conversational agents %K medical apps %K systematic review %K technical aspects %K PRISMA %D 2024 %7 18.10.2024 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has profoundly affected mental health, leading to an increased prevalence of depression and insomnia. Currently, artificial intelligence (AI) and deep learning have thoroughly transformed health care–related mobile apps, offered more effective mental health support, and alleviated the psychological stress that may have emerged during the pandemic. Early reviews outlined the use of mobile apps for dealing with depression and insomnia separately. However, there is now an urgent need for a systematic evaluation of mobile apps that address both depression and insomnia to reveal new applications and research gaps. Objective: This study aims to systematically review and evaluate mobile apps targeting depression and insomnia, highlighting their features, effectiveness, and gaps in the current research. Methods: We systematically searched PubMed, Scopus, and Web of Science for peer-reviewed journal articles published between 2017 and 2023. The inclusion criteria were studies that (1) focused on mobile apps addressing both depression and insomnia, (2) involved young people or adult participants, and (3) provided data on treatment efficacy. Data extraction was independently conducted by 2 reviewers. Title and abstract screening, as well as full-text screening, were completed in duplicate. Data were extracted by a single reviewer and verified by a second reviewer, and risk of bias assessments were completed accordingly. Results: Of the initial 383 studies we found, 365 were excluded after title, abstract screening, and removal of duplicates. Eventually, 18 full-text articles met our criteria and underwent full-text screening. The analysis revealed that mobile apps related to depression and insomnia were primarily utilized for early detection, assessment, and screening (n=5 studies); counseling and psychological support (n=3 studies); and cognitive behavioral therapy (CBT; n=10 studies). Among the 10 studies related to depression, our findings showed that chatbots demonstrated significant advantages in improving depression symptoms, a promising development in the field. Additionally, 2 studies evaluated the effectiveness of mobile apps as alternative interventions for depression and sleep, further expanding the potential applications of this technology. Conclusions: The integration of AI and deep learning into mobile apps, particularly chatbots, is a promising avenue for personalized mental health support. Through innovative features, such as early detection, assessment, counseling, and CBT, these apps significantly contribute toward improving sleep quality and addressing depression. The reviewed chatbots leveraged advanced technologies, including natural language processing, machine learning, and generative dialog, to provide intelligent and autonomous interactions. Compared with traditional face-to-face therapies, their feasibility, acceptability, and potential efficacy highlight their user-friendly, cost-effective, and accessible nature with the aim of enhancing sleep and mental health outcomes. %M 39423009 %R 10.2196/51110 %U https://www.jmir.org/2024/1/e51110 %U https://doi.org/10.2196/51110 %U http://www.ncbi.nlm.nih.gov/pubmed/39423009 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e60502 %T Clinical Effects of Asynchronous Provider-Guided Practice Sessions During Blended Care Therapy for Anxiety and Depression: Pragmatic Retrospective Cohort Study %A Espel-Huynh,Hallie M %A Wang,Lu %A Lattie,Emily G %A Wickham,Robert E %A Varra,Alethea %A Chen,Connie E %A Lungu,Anita %A Lee,Jennifer L %+ Lyra Health, 270 East Lane, Burlingame, CA, 94010, United States, 1 (877) 505 7147, hespel-huynh@lyrahealth.com %K anxiety %K depression %K blended care therapy %K guided practice sessions %K mental health care %K digital mental health %K psychotherapy outcomes %D 2024 %7 18.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Blended care therapy models are intended to increase the efficiency and effectiveness of evidence-based psychotherapy by combining synchronous and asynchronous components of care. Objective: This retrospective cohort study evaluated the clinical effects of synchronous video therapy sessions and asynchronous guided practice session elements on anxiety and depression in a blended care therapy program, with a novel focus on asynchronous provider feedback messages. Methods: Participants were adults (N=33,492) with clinical symptoms of anxiety (Generalized Anxiety Disorder 7-item scale [GAD-7] score of ≥8) and depression (Patient Health Questionnaire 9-item scale [PHQ-9] score of ≥10) at intake. Symptom trajectories were evaluated via individual growth curve models. Time-varying covariates evaluated effects of synchronous video session attendance and the presence or absence of each asynchronous guided practice session element occurring within 7 days and 8-14 days prior to each clinical outcome assessment. Guided practice session elements included client digital lesson completion, client digital exercise completion, and feedback messages sent by providers. Results: Approximately 86.6% (29,012/33,492) of clients met criteria for clinical improvement by end of care (median 6, IQR 4-8 synchronous sessions). Synchronous video session attendance and client digital lesson completion in the past 7 days and in the past 8-14 days were each uniquely and significantly associated with lower GAD-7 scores (video session effects: bsession7=–0.82, bsession8-14=–0.58, P values<.001; digital lesson effects: blesson7=–0.18, blesson8-14=–0.26, P values <.001) and PHQ-9 scores (video session effects: bsession7=–0.89, bsession8-14=–0.67, P values <.001; digital lesson effects: blesson7=–0.12, blesson8-14=–0.30, P values <.001). Client digital exercise completion in the past 8-14 days was significantly associated with lower GAD-7 scores (bexercise8-14=–0.10; P<.001) but exercise completion in the 7 days prior to clinical outcome assessment was not (bexercise7=0.00; P=.89). Exercise completion in the past 7 days was significantly associated with lower PHQ-9 scores (bexercise7=–0.16; P<.001) but exercise completion in the past 8-14 days was not (bexercise8-14=–0.05; P=.09). Provider feedback messaging in the past 7 days and in the past 8-14 days was significantly associated with lower GAD-7 and PHQ-9 scores, respectively (GAD-7: bfeedback7=–0.12, P<.001; bfeedback8-14=–0.07, P=.004; PHQ-9: bfeedback7=–0.15, P<.001; bfeedback8-14=–0.08, P=.01). Conclusions: Provider feedback between synchronous therapy sessions provided significant benefit for symptom reduction, beyond the effects of client digital engagement and synchronous video sessions. When guided practice sessions are well integrated into care, blended care therapy provides meaningful improvements upon the traditional, synchronous session–only therapy model. Provider guidance and feedback for clients between synchronous sessions support more efficient and effective mental health care overall. %M 39422996 %R 10.2196/60502 %U https://www.jmir.org/2024/1/e60502 %U https://doi.org/10.2196/60502 %U http://www.ncbi.nlm.nih.gov/pubmed/39422996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e62963 %T Describing the Framework for AI Tool Assessment in Mental Health and Applying It to a Generative AI Obsessive-Compulsive Disorder Platform: Tutorial %A Golden,Ashleigh %A Aboujaoude,Elias %+ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94304, United States, 1 650 498 9111, eaboujaoude@stanford.edu %K artificial intelligence %K ChatGPT %K generative artificial intelligence %K generative AI %K large language model %K chatbots %K machine learning %K digital health %K telemedicine %K psychotherapy %K obsessive-compulsive disorder %D 2024 %7 18.10.2024 %9 Tutorial %J JMIR Form Res %G English %X As artificial intelligence (AI) technologies occupy a bigger role in psychiatric and psychological care and become the object of increased research attention, industry investment, and public scrutiny, tools for evaluating their clinical, ethical, and user-centricity standards have become essential. In this paper, we first review the history of rating systems used to evaluate AI mental health interventions. We then describe the recently introduced Framework for AI Tool Assessment in Mental Health (FAITA-Mental Health), whose scoring system allows users to grade AI mental health platforms on key domains, including credibility, user experience, crisis management, user agency, health equity, and transparency. Finally, we demonstrate the use of FAITA-Mental Health scale by systematically applying it to OCD Coach, a generative AI tool readily available on the ChatGPT store and designed to help manage the symptoms of obsessive-compulsive disorder. The results offer insights into the utility and limitations of FAITA-Mental Health when applied to “real-world” generative AI platforms in the mental health space, suggesting that the framework effectively identifies key strengths and gaps in AI-driven mental health tools, particularly in areas such as credibility, user experience, and acute crisis management. The results also highlight the need for stringent standards to guide AI integration into mental health care in a manner that is not only effective but also safe and protective of the users’ rights and welfare. %M 39423001 %R 10.2196/62963 %U https://formative.jmir.org/2024/1/e62963 %U https://doi.org/10.2196/62963 %U http://www.ncbi.nlm.nih.gov/pubmed/39423001 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e58403 %T Digital Health Innovations for Screening and Mitigating Mental Health Impacts of Adverse Childhood Experiences: Narrative Review %A White,Brianna M %A Prasad,Rameshwari %A Ammar,Nariman %A Yaun,Jason A %A Shaban-Nejad,Arash %K digital health %K digital technology %K digital intervention %K digital health technology %K artificial intelligence %K machine learning %K adverse childhood experience %K ACE %K positive childhood experiences %K children’s mental health %K mental health %K mental illness %K mental disorder %K pediatric mental health %K disease surveillance %D 2024 %7 16.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Exposures to both negative and positive experiences in childhood have proven to influence cardiovascular, immune, metabolic, and neurologic function throughout an individual’s life. As such, adverse childhood experiences (ACEs) could have severe consequences on health and well-being into adulthood. Objective: This study presents a narrative review of the use of digital health technologies (DHTs) and artificial intelligence to screen and mitigate risks and mental health consequences associated with ACEs among children and youth. Methods: Several databases were searched for studies published from August 2017 to August 2022. Selected studies (1) explored the relationship between digital health interventions and mitigation of negative health outcomes associated with mental health in childhood and adolescence and (2) examined prevention of ACE occurrence associated with mental illness in childhood and adolescence. A total of 18 search papers were selected, according to our inclusion and exclusion criteria, to evaluate and identify means by which existing digital solutions may be useful in mitigating the mental health consequences associated with the occurrence of ACEs in childhood and adolescence and preventing ACE occurrence due to mental health consequences. We also highlighted a few knowledge gaps or barriers to DHT implementation and usability. Results: Findings from the search suggest that the incorporation of DHTs, if implemented successfully, has the potential to improve the quality of related care provisions for the management of mental health consequences of adverse or traumatic events in childhood, including posttraumatic stress disorder, suicidal behavior or ideation, anxiety or depression, and attention-deficit/hyperactivity disorder. Conclusions: The use of DHTs, machine learning tools, natural learning processing, and artificial intelligence can positively help in mitigating ACEs and associated risk factors. Under proper legal regulations, security, privacy, and confidentiality assurances, digital technologies could also assist in promoting positive childhood experiences in children and young adults, bolstering resilience, and providing reliable public health resources to serve populations in need. %R 10.2196/58403 %U https://pediatrics.jmir.org/2024/1/e58403 %U https://doi.org/10.2196/58403 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58681 %T Using Digital Media to Improve Adolescent Resilience and Prevent Mental Health Problems: Protocol for a Scoping Review %A Rachmayanti,Riris D %A Dewi,Fatwa Sari Tetra %A Setiyawati,Diana %A Megatsari,Hario %A Diana,Rian %A Vinarti,Retno %+ Department of Epidemiology, Biostatistic, Population Study and Health Promotion, Public Health Faculty, Universitas Airlangga, Dr. Ir. H. Soekarno Street, Surabaya, 60115, Indonesia, 62 85733922339, riris.diana@fkm.unair.ac.id %K adolescents %K digital media %K mental health %K resilience %K scoping review %D 2024 %7 16.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Global databases show a high prevalence of mental health problems among adolescents (13.5% among those aged 10-14 years and 14.65% for those aged 15-19 years). Successful coping depends on risk and protective factors and how their interaction influences resilience. Higher resilience has been shown to correlate with fewer mental health problems. Digital mental health interventions may help address these problems. Objective: This protocol serves as a framework for planning a scoping review to map the types of digital communication media and their effectiveness in increasing resilience in youths. Methods: The Joanna Briggs Institute guidelines will be used: defining the research questions; identifying relevant studies; study selection (we will select articles based on titles and abstracts); charting the data; collating, summarizing, and reporting the results; and consultation. The synthesis will focus on the type of digital media used to increase adolescent resilience skills and the impact they have on adolescent resilience skills. Quantitative and qualitative analyses will be conducted. Results: The study selection based on keywords was completed in December 2023, the study screening and review were completed in February 2024, and the results manuscript is currently being prepared. This scoping review protocol was funded by the Center for Higher Education Funding and the Indonesia Endowment Fund for Education. Conclusions: The results of the study will provide a comprehensive overview of commonly used digital media types and their effectiveness in increasing youth resilience. Thus, the results of this scoping review protocol can serve as foundational evidence in deciding further research or interventions. This study may also be used as a guideline for mapping and identifying the type and impact of communication media used to increase adolescents’ resilience skills. International Registered Report Identifier (IRRID): DERR1-10.2196/58681 %R 10.2196/58681 %U https://www.researchprotocols.org/2024/1/e58681 %U https://doi.org/10.2196/58681 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57294 %T A French-Language Web-Based Intervention Targeting Prolonged Grief Symptoms in People Who Are Bereaved and Separated: Randomized Controlled Trial %A Debrot,Anik %A Efinger,Liliane %A Kheyar,Maya %A Pomini,Valentino %A Berthoud,Laurent %+ Institute of Psychology, Faculty of Social and Political Sciences, University of Lausanne, Géopolis, Rue de la Mouline 11, Lausanne, 1015, Switzerland, 41 216923239, anik.debrot@unil.ch %K web-based interventions %K randomized controlled trial %K grief %K bereavement %K separation %K guidance %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Losing a loved one, through death or separation, counts among the most stressful life events and is detrimental to health and well-being. About 15% of people show clinically significant difficulties coping with such an event. Web-based interventions (WBIs) are effective for a variety of mental health disorders, including prolonged grief. However, no validated WBI is available in French for treating prolonged grief symptoms. Objective: This study aimed to compare the efficacy and adherence rates of 2 WBIs for prolonged grief symptoms following the loss of a loved one through death or romantic separation. Methods: LIVIA 2.0 was developed relying on theoretical and empirical findings on bereavement processes and WBIs, and is compared with LIVIA 1, which has already demonstrated its efficacy. We conducted a randomized controlled trial and provided on-demand guidance to participants. Outcomes were assessed through web-based questionnaires before the intervention, after the intervention (12 weeks later), and at follow-up (24 weeks later). Primary outcomes were grief symptoms, depressive symptoms, and well-being. Secondary outcomes were anxiety symptoms, grief coping strategies, aspects related to self-identity, and program satisfaction. Results: In total, 62 participants were randomized (intent-to-treat [ITT] sample), 29 (47%) in LIVIA 2.0 (active arm) and 33 (53%) in LIVIA 1 (control arm). The dropout rate was 40% (37/62), and 10 participants were removed due to exclusion criteria, leading to a final per-protocol sample of 27 (44%) completers who differed from noncompleters only based on reporting fewer anxiety symptoms (t60=3.03; P=.004). Participants who are separated reported more grief symptoms (t60=2.22; P=.03) and attachment anxiety (t60=2.26; P=.03), compared to participants who are bereaved. There were pre-post within-group differences for both programs in the ITT sample, with significant reductions in grief (Cohen d=−0.90), depressive symptoms (Cohen d=−0.31), and centrality of the loss (Cohen d=−0.45). The same pattern was observed in the per-protocol sample, with the exception that anxiety symptoms also significantly diminished (Cohen d=−0.45). No difference was found in efficacy between the 2 programs (all P>.33). Participants (ITT sample) reported overall high levels of program satisfaction (mean 3.18, SD 0.54; over a maximum of 4). Effect stability was confirmed at the 6-month follow-up for all outcomes, with an improvement in self-concept clarity. Conclusions: The 2 grief-related WBIs were effective in reducing grief, depressive and anxiety symptoms for participants who are bereaved or separated. The analyses did not reveal any pre-post between-group differences, suggesting that the innovations brought to LIVIA 2.0 did not significantly affect the outcome. However, caution is warranted with the interpretation of the results given the limited power of the sample, which only allows the detection of medium effect sizes. Trial Registration: ClinicalTrials.gov NCT05219760; https://clinicaltrials.gov/study/NCT05219760 International Registered Report Identifier (IRRID): RR2-10.2196/39026 %M 39412869 %R 10.2196/57294 %U https://formative.jmir.org/2024/1/e57294 %U https://doi.org/10.2196/57294 %U http://www.ncbi.nlm.nih.gov/pubmed/39412869 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e48910 %T Perspectives of Children and Adolescents on Engaging With a Web-Based Mental Health Program: Focus Group Study %A Cahill,Christopher %A Connolly,Jennifer %A Appleton,Shelley %A White,Melanie Jade %K motivation %K demotivation %K external motivation %K internal motivation %K digital health interventions %K engagement %K internet interventions %K mental health %K eHealth %K youth %K children %K adolescents %D 2024 %7 15.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Despite accessibility and clinical benefits, open access trials of self-guided digital health interventions (DHIs) for young people have been plagued by high drop-out rates, with some DHIs recording completion rates of less than 3%. Objective: The aim of this study was to explore how young people motivate themselves to complete an unpleasant task and to explore perceived motivators and demotivators for engaging with a DHI. Methods: In this qualitative research study, 30 children and adolescents aged between 7 and 17 years were recruited to participate in 7 focus groups conducted over a 3-month period. Focus group activities and discussions explored sources of motivation to complete tasks and engage in a hypothetical 6-week DHI for anxiety. Results: Children (aged 7-11 years) reported greater reliance on external motivators such as following parent instruction to complete unpleasant tasks, while adolescents (aged 12-17 years) reported greater internal motivation such as self-discipline. Program factors, such as engaging content, were the most commonly mentioned motivators for engaging with a DHI across both age groups. After that, internal sources of motivation were most commonly mentioned, such as perceived future benefits. External factors were the most commonly mentioned demotivators across all ages, with time commitment being the most frequently mentioned. Conclusions: The study’s findings have implications for enhancing adherence in future DHIs targeted to children and adolescents. Recommendations include the need for supportive parental involvement for children, while adolescents would likely benefit from mechanisms that promote autonomy, establish a supportive environment, and align with personal interests and values. Belief that a DHI will provide short-term benefits is important to both children and adolescents, as well as having confidence that future benefits will be realized. %R 10.2196/48910 %U https://pediatrics.jmir.org/2024/1/e48910 %U https://doi.org/10.2196/48910 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52354 %T Internet Search Activity for Intentional Self-Harm Forums After a High-Profile News Publication: Interrupted Time Series Analysis %A Kelsall,Nora Clancy %A Gimbrone,Catherine %A Olfson,Mark %A Gould,Madelyn %A Shaman,Jeffrey %A Keyes,Katherine %+ Department of Epidemiology, Columbia University, 722 West 168th Street, Suite 724, New York, NY, 10032, United States, 1 212 304 5652, kmk2104@cumc.columbia.edu %K suicide risk %K suicide %K journalism %K media %K self-harm %K Google Trends %K websites %K mental health %K depression %K quality of life %K harmful information %D 2024 %7 15.10.2024 %9 Research Letter %J J Med Internet Res %G English %X Searches for “pro-suicide” websites in the United States peaked during the week a high-profile news story was published and remained elevated for 6 months afterward, highlighting the need to avoid mentioning specific sources of explicit suicide instructions in media publications. %M 39405095 %R 10.2196/52354 %U https://www.jmir.org/2024/1/e52354 %U https://doi.org/10.2196/52354 %U http://www.ncbi.nlm.nih.gov/pubmed/39405095 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55234 %T Examining the Effects of Cognitive Behavioral Therapy With a Virtual Agent on User Motivation and Improvement in Psychological Distress and Anxiety: Two-Session Experimental Study %A Frischholz,Katja %A Tanaka,Hiroki %A Shidara,Kazuhiro %A Onishi,Kazuyo %A Nakamura,Satoshi %+ Department of Psychology, University of Regensburg, Universitätsstraße 31, Regensburg, 93053, Germany, 49 941 943 4413, katja.frischholz@psychologie.uni-regensburg.de %K cognitive behavioral therapy %K cognitive restructuring %K motivation %K virtual agent %K automatic negative thoughts %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy (CBT) is a valuable treatment for mood disorders and anxiety. CBT methods, such as cognitive restructuring, are employed to change automatic negative thoughts to more realistic ones. Objective: This study extends on previous research conducted by the authors, focused on the process of correcting automatic negative thoughts to realistic ones and reducing distress and anxiety via CBT with a virtual agent. It was aimed to investigate whether the previously applied virtual agent would achieve changes in automatic negative thoughts when modifications to the previous experimental paradigm are applied and when user motivation is taken into consideration. Furthermore, the potential effects of existing participant knowledge concerning CBT or automatic thoughts were explored. Methods: A single-group, 2-session experiment was conducted using a within-group design. The study recruited 35 participants from May 15, 2023, to June 2, 2023, via Inter Group Corporation, with data collection following from June 5 to June 20, 2023, at Nara Institute of Science and Technology, Japan. There were 19 male and 16 female participants (age range: 18-50 years; mean 33.66, SD 10.77 years). Participants answered multiple questionnaires covering depressive symptomatology and other cognitive variables before and after a CBT session. CBT was carried out using a virtual agent, who participants conversed with using a CBT dialogue scenario on the topic of automatic negative thoughts. Session 2 of the experiment took place 1 week after session 1. Changes in distress and state anxiety were analyzed using a Wilcoxon signed-rank test and t-test for paired samples. The relationships of motivation with cognitive changes and distress or anxiety changes were investigated via correlation analysis. Multiple linear regression was used to analyze the potential predictive qualities of previous knowledge of CBT and automatic negative thoughts regarding outcome measures. Results: Significant reductions in distress (all P<.001) and state anxiety (all P<.003) emerged throughout the first and second experimental sessions. The CBT intervention increased participants’ recognition of their negative thinking and their intention to change it, namely their motivation to change it. However, no clear correlations of motivation with changes in distress or anxiety were found (all P>.04). Participants reported moderate subjective changes in their cognition, which were in part positively correlated with their motivation (all P<.007). Lastly, existing knowledge of CBT did not predict reductions in distress during the first session of the experiment (P=.02). Conclusions: CBT using a virtual agent and a CBT dialogue scenario was successful in reducing distress and anxiety when talking about automatic negative thoughts. The promotion of client motivation needs to be critically considered when designing interventions using CBT with a virtual agent, and further experimental investigations on the causal influences between motivation and outcome measures need to be conducted. %M 39405101 %R 10.2196/55234 %U https://formative.jmir.org/2024/1/e55234 %U https://doi.org/10.2196/55234 %U http://www.ncbi.nlm.nih.gov/pubmed/39405101 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57939 %T Feasibility and Acceptability of a Family-Based Telehealth Intervention for Families Impacted by the Child Welfare System: Formative Mixed Methods Evaluation %A Folk,Johanna B %A Valencia-Ayala,Cynthia %A Holloway,Evan D %A Anvar,Sarah %A Czopp,Alison %A Tolou-Shams,Marina %+ Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, 1001 Potrero Avenue, Building 5, 7M8, San Francisco, CA, 94110, United States, 1 4156029521, Johanna.folk@ucsf.edu %K family-based intervention %K affect management %K child welfare system %K telehealth %K formative evaluation %K trauma exposure %K substance misuse %K adverse childhood experiences %K trauma-informed care %K adolescent health %D 2024 %7 15.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite elevated rates of trauma exposure, substance misuse, mental health problems, and suicide, systems-impacted teens and their caregivers have limited access to empirically supported behavioral health services. Family-based interventions are the most effective for improving mental health, education, substance use, and delinquency outcomes, yet the familial and placement disruption that occurs during child welfare involvement can interfere with the delivery of family-based interventions. Objective: To address this gap in access to services, we adapted an in-person, empirically supported, family-based affect management intervention using a trauma-informed lens to be delivered via telehealth to families impacted by the child welfare system (Family Telehealth Project). We describe the intervention adaptation process and an open trial to evaluate its feasibility, acceptability, and impact. Methods: Adaptations to the in-person, family-based affect management intervention were conducted iteratively with input from youth, caregivers, and systems partners. Through focus groups and collaborative meetings with systems partners, a caregiver-only version of the intervention was also developed. An open trial of the intervention was conducted to assess family perspectives of its acceptability and feasibility and inform further refinements prior to a larger-scale evaluation. Participants included English-speaking families involved in the child welfare system in the past 12 months with teens (aged 12-18 years). Caregivers were eligible to participate either individually (caregivers of origin, kinship caregivers, or foster parents; n=7) or with their teen (caregiver of origin only; n=6 dyads). Participants completed session feedback forms and surveys at pretreatment, posttreatment, and 3-month posttreatment time points. Qualitative exit interviews were conducted with a subset of participants (12/19, 63%) to further understand their experiences with the intervention. Results: Session attendance was high, and both caregivers and teens reported high acceptability of clinicians and sessions on feedback forms. Families were comfortable with video technology, with very few (<5%) sessions having reported technology problems. Thematic analysis of exit interview transcripts indicated that families used effective communication and affect management skills taught during the intervention. Regarding challenges and barriers, some caregiver-only participants expressed a desire to have their teen also participate in the intervention. All interview participants reported that they would recommend the intervention to others and perceptions of the intervention were overwhelmingly positive. Quantitative surveys revealed differential responses to the intervention regarding affect management and communication. Conclusions: An open trial of the Family Telehealth Project, a skills-based telehealth intervention for families impacted by the child welfare system, suggests high levels of intervention feasibility and acceptability. Participants noted improvements in areas often hindered by the impacts of trauma and family separation: communication and affect management. Perceptions of the intervention were positive overall for both teens and caregivers. The Family Telehealth Project shows promise in addressing the gaps in behavioral health access for systems-impacted families. Trial Registration: ClinicalTrials.gov NCT04488523; https://clinicaltrials.gov/study/NCT04488523 %M 39405104 %R 10.2196/57939 %U https://formative.jmir.org/2024/1/e57939 %U https://doi.org/10.2196/57939 %U http://www.ncbi.nlm.nih.gov/pubmed/39405104 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e60589 %T Use of AI in Mental Health Care: Community and Mental Health Professionals Survey %A Cross,Shane %A Bell,Imogen %A Nicholas,Jennifer %A Valentine,Lee %A Mangelsdorf,Shaminka %A Baker,Simon %A Titov,Nick %A Alvarez-Jimenez,Mario %K mental health %K health care %K AI %K community members %K mental health professional %K web-based survey %K Australia %K descriptive statistic %K thematic analysis %K cost reduction %K data security %K digital health %K digital intervention %K artificial intelligence %D 2024 %7 11.10.2024 %9 %J JMIR Ment Health %G English %X Background: Artificial intelligence (AI) has been increasingly recognized as a potential solution to address mental health service challenges by automating tasks and providing new forms of support. Objective: This study is the first in a series which aims to estimate the current rates of AI technology use as well as perceived benefits, harms, and risks experienced by community members (CMs) and mental health professionals (MHPs). Methods: This study involved 2 web-based surveys conducted in Australia. The surveys collected data on demographics, technology comfort, attitudes toward AI, specific AI use cases, and experiences of benefits and harms from AI use. Descriptive statistics were calculated, and thematic analysis of open-ended responses were conducted. Results: The final sample consisted of 107 CMs and 86 MHPs. General attitudes toward AI varied, with CMs reporting neutral and MHPs reporting more positive attitudes. Regarding AI usage, 28% (30/108) of CMs used AI, primarily for quick support (18/30, 60%) and as a personal therapist (14/30, 47%). Among MHPs, 43% (37/86) used AI; mostly for research (24/37, 65%) and report writing (20/37, 54%). While the majority found AI to be generally beneficial (23/30, 77% of CMs and 34/37, 92% of MHPs), specific harms and concerns were experienced by 47% (14/30) of CMs and 51% (19/37) of MHPs. There was an equal mix of positive and negative sentiment toward the future of AI in mental health care in open feedback. Conclusions: Commercial AI tools are increasingly being used by CMs and MHPs. Respondents believe AI will offer future advantages for mental health care in terms of accessibility, cost reduction, personalization, and work efficiency. However, they were equally concerned about reducing human connection, ethics, privacy and regulation, medical errors, potential for misuse, and data security. Despite the immense potential, integration into mental health systems must be approached with caution, addressing legal and ethical concerns while developing safeguards to mitigate potential harms. Future surveys are planned to track use and acceptability of AI and associated issues over time. %R 10.2196/60589 %U https://mental.jmir.org/2024/1/e60589 %U https://doi.org/10.2196/60589 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59029 %T Parenting-Related Social Networking Site Use and Psychological Distress in Parents of Infants: Cross-sectional Study Exploring the Moderating Effects of Loneliness and Parenting Anxiety %A Onishi,Ryuta %K social networking sites %K social media %K psychological distress %K loneliness %K anxiety %K social support %K mother %K father %K infant %K psychological %K distress %K children %K web-based questionnaire %K parent %D 2024 %7 11.10.2024 %9 %J JMIR Pediatr Parent %G English %X Background: In the digital age, social networking sites (SNSs) have revolutionized the approach to parenting. These platforms, widely used to access parenting information and support, affect parents both positively and negatively, with negative effects potentially increasing for those experiencing loneliness or anxiety. Objective: This study examined the relationship between SNS use and psychological distress among parents of young children, controlling for the moderating effects of loneliness and parenting anxiety. We hypothesized that higher SNS use correlates to greater psychological distress, particularly among parents with elevated levels of loneliness or parenting anxiety. Methods: A cross-sectional survey design using a closed web-based questionnaire was employed. Participants included 429 parents (205 mothers and 224 fathers) of children aged 0‐3 years recruited through a web-based survey company in Japan. The majority of the participants were couples, with some living with extended family members. The sample also encompassed individuals in cohabiting partnerships and single parents. The survey included measures of psychological distress, loneliness, parenting anxiety, frequency of SNS use for parenting, and covariates. Analytical models to explain psychological distress included interactions between loneliness or parenting anxiety and SNS use, individually for both fathers and mothers. Results: For mothers, a significant interaction effect was determined only between parenting anxiety and SNS use (b=0.247, SE 0.091; P=.008). Meanwhile, for fathers, significant interaction effects were observed for both loneliness (b=0.324, SE 0.127; P=.012) and parenting anxiety (b=0.144, SE 0.069; P=.038) with SNS use. A simple slope analysis for mothers indicated that SNS use was related to psychological distress only at higher levels of parenting anxiety (b=0.304, SE 0.090, β=.317; P<.001). Among fathers, SNS use was associated with psychological distress at higher levels of either parenting anxiety (b=0.330, SE 0.069, β=.346; P<.001) or loneliness (b=0.390, SE 0.098, β=.409; P<.001). Conclusions: The study concluded that the relationship between SNS use and psychological distress among parents of young children is moderated by loneliness and parenting anxiety. The findings highlight the need for tailored approaches to help parents manage SNS use, particularly focusing on those with higher levels of loneliness and parenting anxiety. It is imperative that health professionals provide nuanced guidance to parents on SNS use, considering individual psychological factors and potential gender differences in the impact of SNSs on mental well-being. %R 10.2196/59029 %U https://pediatrics.jmir.org/2024/1/e59029 %U https://doi.org/10.2196/59029 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58428 %T Exploring Client Preferences for Psychological Counselors in a Chinese Online Health Community: Longitudinal Study %A Feng,Xiandong %A Hu,Yinhuan %A Pfaff,Holger %A Liu,Sha %A Xie,Jinzhu %A Zhang,Zemiao %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 83692730, hyh288@hotmail.com %K signaling theory %K psychological counselor %K online health communities %K clients’ choice %D 2024 %7 10.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Although online health communities are acknowledged for their role in bridging the supply-demand gap in mental health services, the client decision-making process in these environments remains underexplored. Objective: This study aimed to explore the impact of different signals presented on psychological counselors’ home pages on clients’ choices. Methods: Adopting signaling theory as the framework, this study classified information into online and offline signals and developed a theoretical model to examine client choice behaviors. We collected data from 487 psychological counselors in a leading Chinese online mental health community during March, June, September, and December 2023. Based on these data, we constructed a 4-period balanced panel dataset. A fixed effects model was used to analyze which signals influence clients’ choices of psychological counselors. Results: Regarding online signals, the service price (β=0.186, P<.001) and online reputation (β=0.489, P=.002) of psychological counselors positively influence clients’ choices. Concerning offline signals, psychological counselors’ practical experience (β=0.007, P<.001) is positively related to clients’ choices. Moreover, the results indicate that the relationship between a counselor’s prosocial behavior and clients’ choices is not linear but rather exhibits an inverted U-shape. Conclusions: This study reveals that the varied information provided by psychological counselors has distinct impacts on clients’ choices in online health communities. It broadens the application of signaling theory to online behaviors and emphasizes the importance of both online and offline signals. These insights offer strategic guidance for counselors and online platforms to better meet potential clients’ needs by optimizing the information presented on psychological counselors’ home pages. %M 39388694 %R 10.2196/58428 %U https://www.jmir.org/2024/1/e58428 %U https://doi.org/10.2196/58428 %U http://www.ncbi.nlm.nih.gov/pubmed/39388694 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58195 %T A Novel Cognitive Behavioral Therapy–Based Generative AI Tool (Socrates 2.0) to Facilitate Socratic Dialogue: Protocol for a Mixed Methods Feasibility Study %A Held,Philip %A Pridgen,Sarah A %A Chen,Yaozhong %A Akhtar,Zuhaib %A Amin,Darpan %A Pohorence,Sean %+ Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson Blvd, Suite 602, Chicago, IL, 60612, United States, 1 3129421423, philip_held@rush.edu %K generative artificial intelligence %K mental health %K feasibility %K cognitive restructuring %K Socratic dialogue %K mobile phone %D 2024 %7 10.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital mental health tools, designed to augment traditional mental health treatments, are becoming increasingly important due to a wide range of barriers to accessing mental health care, including a growing shortage of clinicians. Most existing tools use rule-based algorithms, often leading to interactions that feel unnatural compared with human therapists. Large language models (LLMs) offer a solution for the development of more natural, engaging digital tools. In this paper, we detail the development of Socrates 2.0, which was designed to engage users in Socratic dialogue surrounding unrealistic or unhelpful beliefs, a core technique in cognitive behavioral therapies. The multiagent LLM-based tool features an artificial intelligence (AI) therapist, Socrates, which receives automated feedback from an AI supervisor and an AI rater. The combination of multiple agents appeared to help address common LLM issues such as looping, and it improved the overall dialogue experience. Initial user feedback from individuals with lived experiences of mental health problems as well as cognitive behavioral therapists has been positive. Moreover, tests in approximately 500 scenarios showed that Socrates 2.0 engaged in harmful responses in under 1% of cases, with the AI supervisor promptly correcting the dialogue each time. However, formal feasibility studies with potential end users are needed. Objective: This mixed methods study examines the feasibility of Socrates 2.0. Methods: On the basis of the initial data, we devised a formal feasibility study of Socrates 2.0 to gather qualitative and quantitative data about users’ and clinicians’ experience of interacting with the tool. Using a mixed method approach, the goal is to gather feasibility and acceptability data from 100 users and 50 clinicians to inform the eventual implementation of generative AI tools, such as Socrates 2.0, in mental health treatment. We designed this study to better understand how users and clinicians interact with the tool, including the frequency, length, and time of interactions, users’ satisfaction with the tool overall, quality of each dialogue and individual responses, as well as ways in which the tool should be improved before it is used in efficacy trials. Descriptive and inferential analyses will be performed on data from validated usability measures. Thematic analysis will be performed on the qualitative data. Results: Recruitment will begin in February 2024 and is expected to conclude by February 2025. As of September 25, 2024, overall, 55 participants have been recruited. Conclusions: The development of Socrates 2.0 and the outlined feasibility study are important first steps in applying generative AI to mental health treatment delivery and lay the foundation for formal feasibility studies. International Registered Report Identifier (IRRID): DERR1-10.2196/58195 %M 39388255 %R 10.2196/58195 %U https://www.researchprotocols.org/2024/1/e58195 %U https://doi.org/10.2196/58195 %U http://www.ncbi.nlm.nih.gov/pubmed/39388255 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e66626 %T Supporting the Mind in Space: Psychological Tools for Long-Duration Missions %A Pagnini,Francesco %+ Department of Psychology, Università Cattolica del Sacro Cuore, L.go Gemelli 1, Milan, 20123, Italy, Francesco.Pagnini@unicatt.it %K space psychology %K astronauts %K psychotherapy %K isolated and confined environment %K mindfulness %K relaxation %K mind-body %D 2024 %7 9.10.2024 %9 Commentary %J Interact J Med Res %G English %X The psychological well-being of astronauts is becoming just as vital as their physical and technical readiness as space missions extend into deep space. Long-duration missions pose unique challenges, such as isolation, confinement, communication delays, and microgravity, which can significantly affect mental health and cognitive performance. This commentary discusses the need for innovative mental health support systems, including automated psychotherapy, as well as Earth-based training methods like mindfulness and relaxation techniques, to address the psychological demands of space travel. By integrating these approaches into pre-mission preparation and in-flight routines, astronauts can develop self-regulation strategies to manage stress, improve focus, and enhance emotional resilience. Automated psychotherapy available 24-7 provides real-time confidential support when communication with Earth is delayed. As space exploration moves forward, the success of missions will depend not only on technological advancements but also on the development of psychological countermeasures that prioritize mental health alongside physical well-being. This paper emphasizes the importance of continued research and collaboration to refine and test these tools in analog environments, ensuring astronauts are mentally and emotionally prepared for the challenges of space. %M 39382951 %R 10.2196/66626 %U https://www.i-jmr.org/2024/1/e66626 %U https://doi.org/10.2196/66626 %U http://www.ncbi.nlm.nih.gov/pubmed/39382951 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e58803 %T Automated Psychotherapy in a Spaceflight Environment: Advantages, Drawbacks, and Unknowns %A Smith,Logan %+ Oklahoma State University, 306 Psychology Building, Stillwater, OK, 74078, United States, 1 772 242 5012, logan.smith12@okstate.edu %K mental health %K deep space %K astronauts %K aerospace medicine %K spaceflight %K flight %K psychotherapy %K privacy %K communication %D 2024 %7 9.10.2024 %9 Viewpoint %J Interact J Med Res %G English %X Various behavioral and mental health issues have been reported by space crews for decades, with the overall number of mental health complications expected to be higher than is publicly known. The broad range of mental health complications encountered in space is expected to grow as people venture deeper into space. Issues with privacy, dual relationships, and delayed communications make rendering effective psychological therapy difficult in a spaceflight environment and nearly impossible in deep space. Automated psychotherapy offers a way to provide psychotherapy to astronauts both in deep space and low Earth orbit. Although automated psychotherapy is growing in popularity on Earth, little is known about its efficacy in space. This viewpoint serves to highlight the knowns and unknowns regarding this treatment modality for future deep space missions, and places an emphasis on the need for further research into the applicability and practicality of automated psychotherapy for the spaceflight environment, especially as it relates to long-duration, deep space missions. %M 39382952 %R 10.2196/58803 %U https://www.i-jmr.org/2024/1/e58803 %U https://doi.org/10.2196/58803 %U http://www.ncbi.nlm.nih.gov/pubmed/39382952 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54751 %T Inclusion of Individuals With Lived Experiences in the Development of a Digital Intervention for Co-Occurring Depression and Cannabis Use: Mixed Methods Investigation %A Collins,Amanda C %A Bhattacharya,Sukanya %A Oh,Jenny Y %A Salzhauer,Abigail %A Taylor,Charles T %A Wolitzky-Taylor,Kate %A Aupperle,Robin L %A Budney,Alan J %A Jacobson,Nicholas C %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Pkwy, Suite 300, Lebanon, NH, 03766, United States, 1 4693210607, amanda.c.collins@dartmouth.edu %K digital intervention %K depression %K cannabis use %K positive affect %K formative research %K app development %D 2024 %7 7.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing interventions for co-occurring depression and cannabis use often do not treat both disorders simultaneously and can result in higher rates of symptom relapse. Traditional in-person interventions are often difficult to obtain due to financial and time limitations, which may further prevent individuals with co-occurring depression and cannabis use from receiving adequate treatment. Digital interventions can increase the scalability and accessibility for these individuals, but few digital interventions exist to treat both disorders simultaneously. Targeting transdiagnostic processes of these disorders with a digital intervention—specifically positive valence system dysfunction—may yield improved access and outcomes. Objective: Recent research has highlighted a need for the inclusion of individuals with lived experiences to assist in the co-design of interventions to enhance scalability and relevance of an intervention. Thus, the purpose of this study is to describe the process of eliciting feedback from individuals with elevated depressed symptoms and cannabis use and co-designing a digital intervention, Amplification of Positivity—Cannabis Use Disorder (AMP-C), focused on improving positive valence system dysfunction in these disorders. Methods: Ten individuals who endorsed moderate to severe depressive symptoms and regular cannabis use (2-3×/week) were recruited online via Meta ads. Using a mixed methods approach, participants completed a 1-hour mixed methods interview over Zoom (Zoom Technologies Inc) where they gave their feedback and suggestions for the development of a mental health app, based on an existing treatment targeting positive valence system dysfunction, for depressive symptoms and cannabis use. The qualitative approach allowed for a broader investigation of participants’ wants and needs regarding the engagement and scalability of AMP-C, and the quantitative approach allowed for specific ratings of intervention components to be potentially included. Results: Participants perceived the 13 different components of AMP-C as overall helpful (mean 3.9-4.4, SD 0.5-1.1) and interesting (mean 4.0-4.9, SD 0.3-1.1) on a scale from 1 (not at all) to 5 (extremely). They gave qualitative feedback for increasing engagement in the app, including adding a social component, using notifications, and being able to track their symptoms and progress over time. Conclusions: This study highlights the importance of including individuals with lived experiences in the development of interventions, including digital interventions. This inclusion resulted in valuable feedback and suggestions for improving the proposed digital intervention targeting the positive valence system, AMP-C, to better match the wants and needs of individuals with depressive symptoms and cannabis use. %M 39374076 %R 10.2196/54751 %U https://formative.jmir.org/2024/1/e54751 %U https://doi.org/10.2196/54751 %U http://www.ncbi.nlm.nih.gov/pubmed/39374076 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55921 %T Preferences Regarding Information Strategies for Digital Mental Health Interventions Among Medical Students: Discrete Choice Experiment %A Vomhof,Markus %A Bau,Jessica Tabea %A Hüter,Pia %A Stehl,Stefan %A Haastert,Burkhard %A Loerbroks,Adrian %A Icks,Andrea %A Calo,Stella Teresa %A Schuster,Luca %A Pischke,Claudia R %A Kairies-Schwarz,Nadja %A Angerer,Peter %A Apolinário-Hagen,Jennifer %+ Institute of Medical Sociology, Centre for Health and Society, Medical Faculty and University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany, 49 211 8106557, jessica.bau@hhu.de %K preferences %K digital mental health %K medical students %K innovation diffusion %K technology acceptance %K health information %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions (DMHIs) are capable of closing gaps in the prevention and therapy of common mental disorders. Despite their proven effectiveness and approval for prescription, use rates remain low. The reasons include a lack of familiarity and knowledge as well as lasting concerns. Medical students were shown to have a comparatively higher risk for common mental disorders and are thus an important target group for raising awareness about DMHIs. At best, knowledge is already imparted during medical school using context-sensitive information strategies. Yet, little is known about medical students’ information preferences regarding DMHIs. Objective: This study aims to explore information preferences for DMHIs for personal use among medical students in Germany. Methods: A discrete choice experiment was conducted, which was developed using an exploratory sequential mixed methods research approach. In total, 5 attributes (ie, source, delivery mode, timing, recommendation, and quality criteria), each with 3 to 4 levels, were identified using formative research. Data were analyzed using logistic regression models to estimate preference weights and the relative importance of attributes. To identify subgroups of students varying in information preferences, we additionally performed a latent class analysis. Results: Of 309 participants, 231 (74.8%) with reliable data were included in the main analysis (women: 217/309, 70.2%; age: mean 24.1, SD 4.0 y). Overall, the conditional logit model revealed that medical students preferred to receive information about DMHIs from the student council and favored being informed via social media early (ie, during their preclinic phase or their freshman week). Recommendations from other students or health professionals were preferred over recommendations from other users or no recommendations at all. Information about the scientific evidence base was the preferred quality criterion. Overall, the timing of information was the most relevant attribute (32.6%). Latent class analysis revealed 2 distinct subgroups. Class 1 preferred to receive extensive information about DMHIs in a seminar, while class 2 wanted to be informed digitally (via email or social media) and as early as possible in their studies. Conclusions: Medical students reported specific needs and preferences regarding DMHI information provided in medical school. Overall, the timing of information (early in medical education) was considered more important than the information source or delivery mode, which should be prioritized by decision makers (eg, members of faculties of medicine, universities, and ministries of education). Study findings suggest general and subgroup-specific information strategies, which could be implemented in a stepped approach. Easily accessible digital information may promote students’ interest in DMHIs in the first step that might lead to further information-seeking behavior and the attendance of seminars about DMHIs in the second step. %M 39365652 %R 10.2196/55921 %U https://formative.jmir.org/2024/1/e55921 %U https://doi.org/10.2196/55921 %U http://www.ncbi.nlm.nih.gov/pubmed/39365652 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60604 %T Videoconference-Delivered Cognitive Behavioral Therapy for Parents of Adolescents With Internet Addiction: Pilot Randomized Controlled Trial %A Horita,Hideki %A Seki,Yoichi %A Yamaguchi,Takumi %A Shiko,Yuki %A Kawasaki,Yohei %A Shimizu,Eiji %+ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 inohana, Chiba City, 2608670, Japan, 81 476207779, horitah@iuhw.ac.jp %K internet addiction %K adolescents %K parents %K cognitive behavioral therapy %K digital health %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The rise in internet addiction, including web-based gaming and social networking services, is a serious concern. Even with access to medical institutions and counseling services, individuals with internet addiction, particularly adolescents, often refuse medical treatment or counseling. Parent-focused psychological intervention may lead to positive outcomes by improving the parent-adolescent relationship and helping parents identify and modify their adolescent’s problematic behaviors, including internet addiction. Objective: This study was a pilot randomized controlled trial to test the feasibility of remote cognitive behavioral therapy via videoconferencing for parents of adolescents with internet addiction. Methods: A total of 13 parents of adolescents aged 12-20 years with internet addiction were recruited and randomly assigned to either 12 sessions of the videoconference-delivered cognitive behavioral therapy (vCBT) group (n=6, 46%) or the waitlist control group (n=7, 54%). The study period was from March 1, 2018, to March 31, 2022. The primary outcome was the scores of the Young Internet Addiction Test reported by the adolescents. The secondary outcomes were adolescents’ hours of internet use per day (Internet Addiction Test), reported by the adolescents and by their parents; the Young Diagnostic Questionnaire, completed by the parents; and the quality of life of the adolescents and the parents, measured by the EQ-5D-5L. These were evaluated at weeks 0 and 13. Results: As the primary outcome, the mean total Internet Addiction Test score decreased from 67.7 (SD 18.3; 6/13, 46%) at week 0 to 56.2 (SD 25.1; 5/9, 56%) at week 13 in the vCBT group, compared to an increase from 66.9 (SD 21.9; 7/13, 54%) to 68.0 (SD 18.7; 4/9, 44%) in the control group. For all outcomes, no significant differences were found between the 2 groups (all P>.05). Conclusions: This study suggested the practical feasibility of vCBT for parents of adolescents with internet addiction. Further large-scale, multicenter randomized controlled trials are necessary to examine the effectiveness. Trial Registration: UMIN Clinical Trials Registry UMIN000032483; https://tinyurl.com/yuhen6c9 %M 39361415 %R 10.2196/60604 %U https://pediatrics.jmir.org/2024/1/e60604 %U https://doi.org/10.2196/60604 %U http://www.ncbi.nlm.nih.gov/pubmed/39361415 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53786 %T Predictors of Participation in a Perinatal Text Message Screening Protocol for Maternal Depression and Anxiety: Prospective Cohort Study %A Barnwell,Julia %A Hénault Robert,Cindy %A Nguyen,Tuong-Vi %A Davis,Kelsey P %A Gratton,Chloé %A Elgbeili,Guillaume %A Pham,Hung %A Meaney,Michael J %A Montreuil,Tina C %A O'Donnell,Kieran J %+ Yale Child Study Center, Yale School of Medicine, 230 South Frontage Road, New Haven, CT, 06520, United States, 1 203 785 2540, kieran.odonnell@yale.edu %K perinatal mental health %K digital screening %K maternal depression %K maternal anxiety %K text messaging %K mHealth %K mobile health %K pregnancy %K mobile phone %D 2024 %7 3.10.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Universal screening for depression and anxiety in pregnancy has been recommended by several leading medical organizations, but the implementation of such screening protocols may overburden health care systems lacking relevant resources. Text message screening may provide a low-cost, accessible alternative to in-person screening assessments. However, it is critical to understand who is likely to participate in text message–based screening protocols before such approaches can be implemented at the population level. Objective: This study aimed to examine sources of selection bias in a texting–based screening protocol that assessed symptoms of depression and anxiety across pregnancy and into the postpartum period. Methods: Participants from the Montreal Antenatal Well-Being Study (n=1130) provided detailed sociodemographic information and completed questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale [EPDS]) and anxiety (State component of the State-Trait Anxiety Inventory [STAI-S]) at baseline between 8 and 20 weeks of gestation (mean 14.5, SD 3.8 weeks of gestation). Brief screening questionnaires, more suitable for delivery via text message, assessing depression (Whooley Questions) and anxiety symptoms (Generalized Anxiety Disorder 2-Item questionnaire) were also collected at baseline and then via text message at 14-day intervals. Two-tailed t tests and Fisher tests were used to identify maternal characteristics that differed between participants who responded to the text message screening questions and those who did not. Hurdle regression models were used to test if individuals with a greater burden of depression and anxiety at baseline responded to fewer text messages across the study period. Results: Participants who responded to the text messages (n=933) were more likely than nonrespondents (n=114) to self-identify as White (587/907, 64.7% vs 39/96, 40.6%; P<.001), report higher educational attainment (postgraduate: 268/909, 29.5% vs 15/94, 16%; P=.005), and report higher income levels (CAD $150,000 [a currency exchange rate of CAD $1=US $0.76 is applicable] or more: 176/832, 21.2% vs 10/84, 11.9%; P<.001). There were no significant differences in symptoms of depression and anxiety between the 2 groups at baseline or postpartum. However, baseline depression (EPDS) or anxiety (STAI-S) symptoms did predict the total number of text message time points answered by participants, corresponding to a decrease of 1% (eβ=0.99; P<.001) and 0.3% (eβ=0.997; P<.001) in the number of text message time points answered per point increase in EPDS or STAI-S score, respectively. Conclusions: Findings from this study highlight the feasibility of text message–based screening protocols with high participation rates. However, our findings also highlight how screening and service delivery via digital technology could exacerbate disparities in mental health between certain patient groups. %M 39361419 %R 10.2196/53786 %U https://pediatrics.jmir.org/2024/1/e53786 %U https://doi.org/10.2196/53786 %U http://www.ncbi.nlm.nih.gov/pubmed/39361419 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52130 %T Brief Peer-Supported Web-Based Skills Training in Affective and Interpersonal Regulation (BPS webSTAIR) for Trauma-Exposed Veterans in the Community: Randomized Controlled Trial %A Ong,Laura E %A Speicher,Sarah %A Villasenor,Diana %A Kim,Jamie %A Jacobs,Adam %A Macia,Kathryn S %A Cloitre,Marylene %+ National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, 425 First Street, Unit 3004, Palo Alto, CA, 94105, United States, 1 6504935000, Marylene.Cloitre@va.gov %K posttraumatic stress disorder %K PTSD %K depression %K depressive symptoms %K veterans %K veterans health %K mHealth %K mobile health %K peer support %K peer-to-peer %K transdiagnostic %K mental health %K mental health services %K community %K emotion regulation %K interpersonal regulation %K mHealth program %D 2024 %7 2.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Peer-supported mobile health (mHealth) programs hold the promise of providing a low-burden approach to increasing access to care and improving mental health. While peer support has been shown to improve engagement in care, there is limited investigation into the impact of peers on symptom outcomes. Trauma-exposed populations frequently endure co-occurring posttraumatic stress and depressive symptoms as well as difficulties in day-to-day functioning. This study evaluated the potential benefits of a peer-supported, transdiagnostic mHealth program on symptom outcomes and functioning. Objective: This randomized controlled trial tested the effectiveness of Brief Peer-Supported (BPS) web-based Skills Training in Affective and Interpersonal Regulation (webSTAIR), a 6-module transdiagnostic digital program derived from Skills Training in Affective and Interpersonal Regulation and compared to waitlist control in a community sample of veterans who screened positive for either posttraumatic stress disorder (PTSD) or depression. Methods: A total of 178 veterans were enrolled in this study using a 2:1 randomization scheme with 117 assigned to BPS webSTAIR and 61 assigned to waitlist control. PTSD and depressive symptoms as well as emotion regulation and psychosocial functioning were assessed at pretreatment, posttreatment, and 8-week follow-up time points. Mixed-effects models were used to assess change in outcome measures across time points. Exploratory analyses were conducted to determine whether the type and number of peer interactions influenced outcomes. Results: Significant interaction effects were observed for all outcomes such that participants randomized to BPS webSTAIR reported significantly greater improvement at the posttreatment time point compared to waitlist control with moderate effect sizes for PTSD (d=0.48), depression (d=0.64), emotion regulation (d=0.61), and functional impairment (d=0.61); gains were maintained at 8-week follow-up. An initial cohort of participants who were required to engage with a peer coach to progress through the modules interacted more frequently with peers but completed fewer modules compared to a later cohort for whom peer engagement was optional. Overall, those who completed more modules reported greater improvement in all outcomes. Conclusions: BPS webSTAIR was effective in improving PTSD and depression symptoms, emotion regulation, and psychosocial functioning in community veterans. Peer-supported, transdiagnostic mHealth programs may be a particularly efficient, effective, and low-burden approach to improving mental health among trauma-exposed populations. Investigation of peer-supported programs among other populations is necessary to evaluate the generalizability of the findings. Analyses comparing peer support that was required versus optional indicated that some veterans may not need or want peer support. Future research should evaluate how best to deliver peer support and for whom it is most beneficial. If successful, peer-supported tech programs may increase the Veteran Affairs workforce as well as improve veteran mental health services and outcomes. Trial Registration: ClinicalTrials.gov NCT04286165; https://clinicaltrials.gov/study/NCT04286165 %M 39012722 %R 10.2196/52130 %U https://www.jmir.org/2024/1/e52130 %U https://doi.org/10.2196/52130 %U http://www.ncbi.nlm.nih.gov/pubmed/39012722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58241 %T Exploring Trade-Offs for Online Mental Health Matching: Agent-Based Modeling Study %A Liu,Yuhan %A Fang,Anna %A Moriarty,Glen %A Firman,Cristopher %A Kraut,Robert E %A Zhu,Haiyi %+ Human-Computer Interaction Institute, Carnegie Mellon University, 5000 Forbes Avenue, Pittsburgh, PA, 15213, United States, 1 (412) 268 2000, annadfang@gmail.com %K agent-based modeling %K mental health %K algorithmic matching %K social computing %K online communities %D 2024 %7 1.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online mental health communities (OMHCs) are an effective and accessible channel to give and receive social support for individuals with mental and emotional issues. However, a key challenge on these platforms is finding suitable partners to interact with given that mechanisms to match users are currently underdeveloped or highly naive. Objective: In this study, we collaborated with one of the world’s largest OMHCs; our contribution is to show the application of agent-based modeling for the design of online community matching algorithms. We developed an agent-based simulation framework and showcased how it can uncover trade-offs in different matching algorithms between people seeking support and volunteer counselors. Methods: We used a comprehensive data set spanning January 2020 to April 2022 to create a simulation framework based on agent-based modeling that replicates the current matching mechanisms of our research site. After validating the accuracy of this simulated replication, we used this simulation framework as a “sandbox” to test different matching algorithms based on the deferred acceptance algorithm. We compared trade-offs among these different matching algorithms based on various metrics of interest, such as chat ratings and matching success rates. Results: Our study suggests that various tensions emerge through different algorithmic choices for these communities. For example, our simulation uncovered that increased waiting time for support seekers was an inherent consequence on these sites when intelligent matching was used to find more suitable matches. Our simulation also verified some intuitive effects, such as that the greatest number of support seeker–counselor matches occurred using a “first come, first served” protocol, whereas relatively fewer matches occurred using a “last come, first served” protocol. We also discuss practical findings regarding matching for vulnerable versus overall populations. Results by demographic group revealed disparities—underaged and gender minority groups had lower average chat ratings and higher blocking rates on the site when compared to their majority counterparts, indicating the potential benefits of algorithmically matching them. We found that some protocols, such as a “filter”-based approach that matched vulnerable support seekers only with a counselor of their same demographic, led to improvements for these groups but resulted in lower satisfaction (–12%) among the overall population. However, this trade-off between minority and majority groups was not observed when using “topic” as a matching criterion. Topic-based matching actually outperformed the filter-based protocol among underaged people and led to significant improvements over the status quo among all minority and majority groups—specifically, a 6% average chat rating improvement and a decrease in blocking incidents from 5.86% to 4.26%. Conclusions: Agent-based modeling can reveal significant design considerations in the OMHC context, including trade-offs in various outcome metrics and the potential benefits of algorithmic matching for marginalized communities. %M 39352736 %R 10.2196/58241 %U https://formative.jmir.org/2024/1/e58241 %U https://doi.org/10.2196/58241 %U http://www.ncbi.nlm.nih.gov/pubmed/39352736 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53767 %T Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial %A Dominguez-Rodriguez,Alejandro %A Sanz-Gomez,Sergio %A González Ramírez,Leivy Patricia %A Herdoiza-Arroyo,Paulina Erika %A Trevino Garcia,Lorena Edith %A de la Rosa-Gómez,Anabel %A González-Cantero,Joel Omar %A Macias-Aguinaga,Valeria %A Arenas Landgrave,Paulina %A Chávez-Valdez,Sarah Margarita %+ School of Medicine and Health Sciences, Tecnologico de Monterrey, Avenue Gral Ramón Corona #2514, Colonia Nuevo México, Zapopan, 45201, Mexico, 52 3336693000, leivy@tec.mx %K self-guided web-based intervention %K chat support %K depression %K anxiety %K COVID-19 %K opinion %K usability %K randomized control trial %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has had an impact on mental health worldwide. Low- and middle-income countries were largely affected by it. Mexico was one of the most affected countries. Extended periods of lockdowns, isolation, and social distancing, among other factors, highlighted the need to introduce web-based psychological interventions to the Mexican population. In this context, Mental Health COVID-19 emerged as a self-guided web-based intervention (SGWI) aimed at adults to improve mental health during the COVID-19 pandemic. Objective: This study aims to assess the efficacy of 2 modalities of a self-guided intervention (with and without chat support) in reducing depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation. In addition, it aimed to compare the moderating role of coping strategies, acceptance, and satisfaction in participants’ symptom reduction. We hypothesize that the self-guided, chat-supported modality will show higher efficacy than the modality without chat support in achieving clinical change and better performance as a moderator of depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation, as well as an increase in participants’ satisfaction and acceptability. Methods: A randomized controlled trial was conducted. Data were collected from May 2020 to June 2022. We performed intrasubject measures at 4 evaluation periods: pretest, posttest, and follow-up measurements at 3 and 6 months. Differences between intervention groups were assessed through the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Changes due to intervention were analyzed using Wilcoxon W test. Moderated regression analysis was performed to test the hypothesized moderating role of coping strategies, usability, and opinion about treatment on clinical change. Results: A total of 36 participants completed the intervention; of these, 5 (14%) were part of the SGWI group, and 31 (86%) were on the SGWI plus chat support (SGWI+C) group, which included a chat service with therapists. The perceived high complexity of the system for the SGWI group had a moderating effect associated with a lack of efficacy of the intervention regarding depression, but not when controlled for sociodemographic variables. A perception of lower helpfulness of the intervention was associated with poorer outcomes. Coping strategies did not show moderating effects. Conclusions: Enhancing the utility of web-based interventions for reducing clinical symptoms by incorporating a support chat to boost treatment adherence seemed to improve the perception of the intervention’s usefulness. Web-based interventions face several challenges, such as eliminating complexities in platform use and increasing the users’ perceived utility of the intervention, among other issues identified in the study. Trial Registration: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/study/NCT04468893?tab=results International Registered Report Identifier (IRRID): RR2-10.2196/23117 %M 39348893 %R 10.2196/53767 %U https://formative.jmir.org/2024/1/e53767 %U https://doi.org/10.2196/53767 %U http://www.ncbi.nlm.nih.gov/pubmed/39348893 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56355 %T Self-Care Program as a Tool for Alleviating Anxiety and Loneliness and Promoting Satisfaction With Life in High School Students and Staff: Randomized Survey Study %A Iyer,Priya %A Iyer,Lina %A Carter,Nicole %A Iyer,Ranjani %A Stirling,Amy %A Priya,Lakshmi %A Sriraman,Ushma %+ Department of Education, Heartfulness Institute, 2200 Goldenrod Ln, San Ramon, CA, 94582, United States, 1 2482559635, ranjani.heartfulness@gmail.com %K Heartfulness, anxiety, loneliness, high school, satisfaction with life %K self-care %K develop %K stress %K stress management %K effectiveness %K life satisfaction %K students %K student %K support %K web-based program %K time management %K educational %K mental health %K tool %K tools %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 global pandemic has led to a marked increase in anxiety levels, significantly affecting the well-being of individuals worldwide. In response to this growing concern, interventions aimed at enhancing social-emotional skills and promoting mental health are more crucial than ever. Objective: This global study aimed to examine the effectiveness of a self-care program on anxiety, loneliness, and satisfaction with life in high school students and staff in a randomized, waitlist control trial with baseline and postintervention assessments. Methods: The 4-week web-based self-care program, offered by the Heartfulness Institute, is designed to develop social-emotional skills through stress management and self-observation. The web-based program was a positive intervention that offered support to the students and staff to build specific skills, such as reflection, observation, positivity, time management, and goal setting. In this study, the sample consisted of a total of 203 high school students and staff randomized into a control waitlisted group (students: n=57 and staff: n=45) and a Heartfulness group (students: n=57 and staff: n=44) from 3 schools. Both the groups completed web-based surveys at weeks 0, 4, and 8, assessing their anxiety, loneliness, and satisfaction with life scores using Generalized Anxiety Disorder-7 Scale (GAD-7 and Severity Measure for Generalized Anxiety Disorder—Child Age 11-17), Satisfaction With Life scale (SWLS) and Satisfaction With Life Scale-Child (SWLS-C), and the University of California, Los Angeles (UCLA) Loneliness Scale. Survey responses were each individually analyzed using repeated measures ANOVA. Results: The study received institutional review board approval on February 3, 2022. Participant recruitment lasted from the approval date until March 30, 2022. The 4-week program for the Heartfulness group started on April 4, 2024. There was a significant 3-way interaction among time, group, and school showing a decrease in anxiety and loneliness scores and an increase in satisfaction-with-life scores (P<.05). In students in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). In staff in the Heartfulness group, there was strong evidence to suggest a significant mean difference in GAD-7, SWLS, and UCLA scores between week 0 and week 4 at all schools (P<.001). Conclusions: The pandemic brought severe educational and social changes that triggered a decline in mental health in schools. This study showed the effectiveness of noninvasive self-care tools used digitally to significantly decrease anxiety and loneliness scores and increase satisfaction of life scores in the participants. Trial Registration: ClinicalTrials.gov NCT05874232; https://clinicaltrials.gov/ct2/show/NCT05874232 %M 39047180 %R 10.2196/56355 %U https://formative.jmir.org/2024/1/e56355 %U https://doi.org/10.2196/56355 %U http://www.ncbi.nlm.nih.gov/pubmed/39047180 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57150 %T Leveraging Personal Technologies in the Treatment of Schizophrenia Spectrum Disorders: Scoping Review %A D'Arcey,Jessica %A Torous,John %A Asuncion,Toni-Rose %A Tackaberry-Giddens,Leah %A Zahid,Aqsa %A Ishak,Mira %A Foussias,George %A Kidd,Sean %+ Schizophrenia Division, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J 1H1, Canada, 1 647 385 2490, jessica.darcey@mail.utoronto.ca %K schizophrenia %K digital mental health %K personal technology %K access to specialized resources %K mental health %K scoping review %K mental health care %K feasibility %K efficacy %K clinical integration %K support %K specialized care %K care %K database %K schizophrenia spectrum disorder %K text messaging %K text %K user feedback %K usability %K acceptability %K satisfaction %K engagement %K digital health %K digital mental health %K technology %K health technology %K mood disorder %K mood disorders %K neurodevelopment %K eHealth %K mobile phone %D 2024 %7 30.9.2024 %9 Review %J JMIR Ment Health %G English %X Background: Digital mental health is a rapidly growing field with an increasing evidence base due to its potential scalability and impacts on access to mental health care. Further, within underfunded service systems, leveraging personal technologies to deliver or support specialized service delivery has garnered attention as a feasible and cost-effective means of improving access. Digital health relevance has also improved as technology ownership in individuals with schizophrenia has improved and is comparable to that of the general population. However, less digital health research has been conducted in groups with schizophrenia spectrum disorders compared to other mental health conditions, and overall feasibility, efficacy, and clinical integration remain largely unknown. Objective: This review aims to describe the available literature investigating the use of personal technologies (ie, phone, computer, tablet, and wearables) to deliver or support specialized care for schizophrenia and examine opportunities and barriers to integrating this technology into care. Methods: Given the size of this review, we used scoping review methods. We searched 3 major databases with search teams related to schizophrenia spectrum disorders, various personal technologies, and intervention outcomes related to recovery. We included studies from the full spectrum of methodologies, from development papers to implementation trials. Methods and reporting follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: This search resulted in 999 studies, which, through review by at least 2 reviewers, included 92 publications. Included studies were published from 2010 to 2023. Most studies examined multitechnology interventions (40/92, 43%) or smartphone apps (25/92, 27%), followed by SMS text messaging (16/92, 17%) and internet-based interventions (11/92, 12%). No studies used wearable technology on its own to deliver an intervention. Regarding the stage of research in the field, the largest number of publications were pilot studies (32/92, 35%), followed by randomized control trials (RCTs; 20/92, 22%), secondary analyses (16/92, 17%), RCT protocols (16/92, 17%), development papers (5/92, 5%), and nonrandomized or quasi-experimental trials (3/92, 3%). Most studies did not report on safety indices (55/92, 60%) or privacy precautions (64/92, 70%). Included studies tend to report consistent positive user feedback regarding the usability, acceptability, and satisfaction with technology; however, engagement metrics are highly variable and report mixed outcomes. Furthermore, efficacy at both the pilot and RCT levels report mixed findings on primary outcomes. Conclusions: Overall, the findings of this review highlight the discrepancy between the high levels of acceptability and usability of these digital interventions, mixed efficacy results, and difficulties with sustained engagement. The discussion highlights common patterns that may underscore this observation in the field; however, as this was a scoping review, a more in-depth systematic review or meta-analysis may be required to better understand the trends outlined in this review. %M 39348196 %R 10.2196/57150 %U https://mental.jmir.org/2024/1/e57150 %U https://doi.org/10.2196/57150 %U http://www.ncbi.nlm.nih.gov/pubmed/39348196 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55500 %T Digital Psychotherapies for Adults Experiencing Depressive Symptoms: Systematic Review and Meta-Analysis %A Omylinska-Thurston,Joanna %A Aithal,Supritha %A Liverpool,Shaun %A Clark,Rebecca %A Moula,Zoe %A Wood,January %A Viliardos,Laura %A Rodríguez-Dorans,Edgar %A Farish-Edwards,Fleur %A Parsons,Ailsa %A Eisenstadt,Mia %A Bull,Marcus %A Dubrow-Marshall,Linda %A Thurston,Scott %A Karkou,Vicky %+ School of Health and Society, University of Salford, Frederick Road Campus, Broad Street, Manchester, M6 6PU, United Kingdom, 44 0161 295 0000, j.omylinska-thurston1@salford.ac.uk %K digital psychotherapies %K depression %K adults %K systematic review %K meta-analysis %K mobile phone %D 2024 %7 30.9.2024 %9 Review %J JMIR Ment Health %G English %X Background: Depression affects 5% of adults and it is a major cause of disability worldwide. Digital psychotherapies offer an accessible solution addressing this issue. This systematic review examines a spectrum of digital psychotherapies for depression, considering both their effectiveness and user perspectives. Objective: This review focuses on identifying (1) the most common types of digital psychotherapies, (2) clients’ and practitioners’ perspectives on helpful and unhelpful aspects, and (3) the effectiveness of digital psychotherapies for adults with depression. Methods: A mixed methods protocol was developed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search strategy used the Population, Intervention, Comparison, Outcomes, and Study Design (PICOS) framework covering 2010 to 2024 and 7 databases were searched. Overall, 13 authors extracted data, and all aspects of the review were checked by >1 reviewer to minimize biases. Quality appraisal was conducted for all studies. The clients’ and therapists’ perceptions on helpful and unhelpful factors were identified using qualitative narrative synthesis. Meta-analyses of depression outcomes were conducted using the standardized mean difference (calculated as Hedges g) of the postintervention change between digital psychotherapy and control groups. Results: Of 3303 initial records, 186 records (5.63%; 160 studies) were included in the review. Quantitative studies (131/160, 81.8%) with a randomized controlled trial design (88/160, 55%) were most common. The overall sample size included 70,720 participants (female: n=51,677, 73.07%; male: n=16,779, 23.73%). Digital interventions included “stand-alone” or non–human contact interventions (58/160, 36.2%), “human contact” interventions (11/160, 6.8%), and “blended” including stand-alone and human contact interventions (91/160, 56.8%). What clients and practitioners perceived as helpful in digital interventions included support with motivation and accessibility, explanation of task reminders, resources, and learning skills to manage symptoms. What was perceived as unhelpful included problems with usability and a lack of direction or explanation. A total of 80 studies with 16,072 participants were included in the meta-analysis, revealing a moderate to large effect in favor of digital psychotherapies for depression (Hedges g=–0.61, 95% CI –0.75 to –0.47; Z=–8.58; P<.001). Subgroup analyses of the studies with different intervention delivery formats and session frequency did not have a statistically significant effect on the results (P=.48 and P=.97, respectively). However, blended approaches revealed a large effect size (Hedges g=–0.793), while interventions involving human contact (Hedges g=–0.42) or no human contact (Hedges g=–0.40) had slightly smaller effect sizes. Conclusions: Digital interventions for depression were found to be effective regardless of format and frequency. Blended interventions have larger effect size than those involving human contact or no human contact. Digital interventions were helpful especially for diverse ethnic groups and young women. Future research should focus on understanding the sources of heterogeneity based on intervention and population characteristics. Trial Registration: PROSPERO CRD42021238462; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=238462 %M 39348177 %R 10.2196/55500 %U https://mental.jmir.org/2024/1/e55500 %U https://doi.org/10.2196/55500 %U http://www.ncbi.nlm.nih.gov/pubmed/39348177 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47357 %T Examining the Popularity, Content, and Intersections With the Substance Abuse and Mental Health Services Administration’s Definition of Recovery in a Nonclinical Online Cannabis Cessation Community: Infodemiology Study of Reddit Posts %A Thulin,Elyse J %A Walton,Maureen A %A Bonar,Erin E %A Fernandez,Anne %+ University of Michigan, 1109 Geddes Ave, Ann Arbor, MI, 48109, United States, 1 (734) 764 0478, ethulin@umich.edu %K cannabis use disorder %K online community %K cannabis %K human-computer interaction %K mobile phone %D 2024 %7 27.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cannabis consumption has increased in recent years, as has cannabis use disorder. While researchers have explored public online community discussions of active cannabis use, less is known about the popularity and content of publicly available online communities intended to support cannabis cessation. Objective: This study aims to examine the level of engagement and dominant content of an online community for cannabis cessation through 3 specific aims. First, we examine the use of a subreddit cannabis cessation community (r/leaves) over time to evaluate the popularity of this type of resource for individuals who want to stop using cannabis. Second, we examine the content of posts in the community to identify popular topics related to cessation. Third, we compare the thematic findings relative to the 4 domains of recovery defined by the Substance Abuse and Mental Health Services Administration (SAMHSA). By examining these 3 gaps, we take the initial steps toward understanding the experiences being shared online among individuals interested in cannabis cessation and compare them with the principles outlined in the SAMHSA definition of recovery. Methods: Using the Pushshift application programming interface, we collected the count of posts by year between 2011 and 2021 and the narrative of the 100 posts with the most comments per year in a popular cannabis cessation–focused subreddit (r/leaves). A linear model and a nonlinear model were compared to evaluate change in the number of posts by year. Mixed natural language processing and qualitative analyses were applied to identify top terms, phrases, and themes present in posts over time. Overlap between themes and the 4 SAMHSA domains of recovery (health, purpose, community, and home) were examined. Results: The number of annual posts in r/leaves increased from 420 in 2011 to 34,841 in 2021 (83-fold increase), with exponential growth since 2018. The term that was the most common across posts was “smoke” (2019 posts). Five major themes were identified, and a narrative arc was represented, from motivations and perceived benefits of cannabis use to the negative consequences of use, strategies to change behaviors, and the positive and negative consequences of change. There was substantial overlap between these 5 themes and 3 of SAMHSA’s 4 domains of recovery: health, purpose, and community. However, the domain of home was less commonly identified. Conclusions: Engagement in this online cannabis support community appears to be increasing. Individuals using this forum discussed several topics, including multiple aspects of recovery defined by the SAMHSA. Online communities, such as this one may, serve as an important pathway for individuals seeking to reduce or cease their consumption of cannabis. %M 39331460 %R 10.2196/47357 %U https://www.jmir.org/2024/1/e47357 %U https://doi.org/10.2196/47357 %U http://www.ncbi.nlm.nih.gov/pubmed/39331460 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57362 %T The Most Effective Interventions for Classification Model Development to Predict Chat Outcomes Based on the Conversation Content in Online Suicide Prevention Chats: Machine Learning Approach %A Salmi,Salim %A Mérelle,Saskia %A Gilissen,Renske %A van der Mei,Rob %A Bhulai,Sandjai %+ Research Department, 113 Suicide Prevention, Paasheuvelweg 25, Amsterdam, 1105 BP, Netherlands, 31 640673474, s.salmi@113.nl %K suicide %K suicidality %K suicide prevention %K helpline %K suicide helpline %K classification %K interpretable AI %K explainable AI %K conversations %K BERT %K bidirectional encoder representations from transformers %K machine learning %K artificial intelligence %K large language models %K LLM %K natural language processing %D 2024 %7 26.9.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: For the provision of optimal care in a suicide prevention helpline, it is important to know what contributes to positive or negative effects on help seekers. Helplines can often be contacted through text-based chat services, which produce large amounts of text data for use in large-scale analysis. Objective: We trained a machine learning classification model to predict chat outcomes based on the content of the chat conversations in suicide helplines and identified the counsellor utterances that had the most impact on its outputs. Methods: From August 2021 until January 2023, help seekers (N=6903) scored themselves on factors known to be associated with suicidality (eg, hopelessness, feeling entrapped, will to live) before and after a chat conversation with the suicide prevention helpline in the Netherlands (113 Suicide Prevention). Machine learning text analysis was used to predict help seeker scores on these factors. Using 2 approaches for interpreting machine learning models, we identified text messages from helpers in a chat that contributed the most to the prediction of the model. Results: According to the machine learning model, helpers’ positive affirmations and expressing involvement contributed to improved scores of the help seekers. Use of macros and ending the chat prematurely due to the help seeker being in an unsafe situation had negative effects on help seekers. Conclusions: This study reveals insights for improving helpline chats, emphasizing the value of an evocative style with questions, positive affirmations, and practical advice. It also underscores the potential of machine learning in helpline chat analysis. %M 39326039 %R 10.2196/57362 %U https://mental.jmir.org/2024/1/e57362 %U https://doi.org/10.2196/57362 %U http://www.ncbi.nlm.nih.gov/pubmed/39326039 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e62679 %T Empathy Toward Artificial Intelligence Versus Human Experiences and the Role of Transparency in Mental Health and Social Support Chatbot Design: Comparative Study %A Shen,Jocelyn %A DiPaola,Daniella %A Ali,Safinah %A Sap,Maarten %A Park,Hae Won %A Breazeal,Cynthia %+ MIT Media Lab, 75 Amherst Street, Cambridge, MA, 02139, United States, 1 3109802254, joceshen@mit.edu %K empathy %K large language models %K ethics %K transparency %K crowdsourcing %K human-computer interaction %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Empathy is a driving force in our connection to others, our mental well-being, and resilience to challenges. With the rise of generative artificial intelligence (AI) systems, mental health chatbots, and AI social support companions, it is important to understand how empathy unfolds toward stories from human versus AI narrators and how transparency plays a role in user emotions. Objective: We aim to understand how empathy shifts across human-written versus AI-written stories, and how these findings inform ethical implications and human-centered design of using mental health chatbots as objects of empathy. Methods: We conducted crowd-sourced studies with 985 participants who each wrote a personal story and then rated empathy toward 2 retrieved stories, where one was written by a language model, and another was written by a human. Our studies varied disclosing whether a story was written by a human or an AI system to see how transparent author information affects empathy toward the narrator. We conducted mixed methods analyses: through statistical tests, we compared user’s self-reported state empathy toward the stories across different conditions. In addition, we qualitatively coded open-ended feedback about reactions to the stories to understand how and why transparency affects empathy toward human versus AI storytellers. Results: We found that participants significantly empathized with human-written over AI-written stories in almost all conditions, regardless of whether they are aware (t196=7.07, P<.001, Cohen d=0.60) or not aware (t298=3.46, P<.001, Cohen d=0.24) that an AI system wrote the story. We also found that participants reported greater willingness to empathize with AI-written stories when there was transparency about the story author (t494=–5.49, P<.001, Cohen d=0.36). Conclusions: Our work sheds light on how empathy toward AI or human narrators is tied to the way the text is presented, thus informing ethical considerations of empathetic artificial social support or mental health chatbots. %M 39321450 %R 10.2196/62679 %U https://mental.jmir.org/2024/1/e62679 %U https://doi.org/10.2196/62679 %U http://www.ncbi.nlm.nih.gov/pubmed/39321450 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56691 %T Long-Term Effects of Internet-Based Cognitive Behavioral Therapy on Depression Prevention Among University Students: Randomized Controlled Factorial Trial %A Nakagami,Yukako %A Uwatoko,Teruhisa %A Shimamoto,Tomonari %A Sakata,Masatsugu %A Toyomoto,Rie %A Yoshida,Kazufumi %A Luo,Yan %A Shiraishi,Nao %A Tajika,Aran %A Sahker,Ethan %A Horikoshi,Masaru %A Noma,Hisashi %A Iwami,Taku %A Furukawa,Toshi A %K iCBT %K depression prevention %K student mental health %K factorial randomized controlled trial %K mobile phone %D 2024 %7 24.9.2024 %9 %J JMIR Ment Health %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) shows promise in the prevention of depression. However, the specific iCBT components that contribute to its effectiveness remain unclear. Objective: We aim to evaluate the effects of iCBT components in preventing depression among university students. Methods: Using a smartphone cognitive behavioral therapy (CBT) app, we randomly allocated university students to the presence or absence of 5 different iCBT components: self-monitoring, behavioral activation, cognitive restructuring, assertiveness training, and problem-solving. The active intervention lasted 8 weeks but the app remained accessible through the follow-up. The primary outcome was the onset of a major depressive episode (MDE) between baseline and the follow-up after 52 weeks, as assessed with the computerized World Health Organization Composite International Diagnostic Interview. Secondary outcomes included changes in the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, and CBT Skills Scale. Results: During the 12-month follow-up, 133 of 1301 (10.22%) participants reported the onset of an MDE. There were no significant differences in the incidence of MDEs between the groups with or without each component (hazard ratios ranged from 0.85, 95% CI 0.60‐1.20, for assertiveness training to 1.26, 95% CI 0.88‐1.79, for self-monitoring). Furthermore, there were no significant differences in the changes on the 9-item Patient Health Questionnaire, 7-item General Anxiety Disorder, or for CBT Skills Scale between component allocation groups. However, significant reductions in depression and anxiety symptoms were observed among all participants at the 52-week follow-up. Conclusions: In this study, we could not identify any specific iCBT components that were effective in preventing depression or the acquisition of CBT skills over the 12-month follow-up period, but all participants with and without intervention of each iCBT component demonstrated significant improvements in depressive and anxiety symptoms. Further research is needed to explore the potential impact of frequency of psychological assessments, nonspecific intervention effects, natural change in the mental state, and the baseline depression level. Trial Registration: UMINCTR UMIN000031307; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000035735 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2719-z %R 10.2196/56691 %U https://mental.jmir.org/2024/1/e56691 %U https://doi.org/10.2196/56691 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59939 %T Equity in Digital Mental Health Interventions in the United States: Where to Next? %A Robinson,Athena %A Flom,Megan %A Forman-Hoffman,Valerie L %A Histon,Trina %A Levy,Monique %A Darcy,Alison %A Ajayi,Toluwalase %A Mohr,David C %A Wicks,Paul %A Greene,Carolyn %A Montgomery,Robert M %+ Woebot Health, 535 Mission St Fl 14, San Francisco, CA, 94105, United States, 1 707 563 1759, scicomms@woebothealth.com %K Digital Mental Health Interventions %K mental health %K health equity %K access to health care %K health plan implementations %D 2024 %7 24.9.2024 %9 Viewpoint %J J Med Internet Res %G English %X Health care technologies have the ability to bridge or hinder equitable care. Advocates of digital mental health interventions (DMHIs) report that such technologies are poised to reduce the documented gross health care inequities that have plagued generations of people seeking care in the United States. This is due to a multitude of factors such as their potential to revolutionize access; mitigate logistical barriers to in-person mental health care; and leverage patient inputs to formulate tailored, responsive, and personalized experiences. Although we agree with the potential of DMHIs to advance health equity, we articulate several steps essential to mobilize and sustain meaningful forward progression in this endeavor, reflecting on decades of research and learnings drawn from multiple fields of expertise and real-world experience. First, DMHI manufacturers must build diversity, equity, inclusion, and belonging (DEIB) processes into the full spectrum of product evolution itself (eg, product design, evidence generation) as well as into the fabric of internal company practices (eg, talent recruitment, communication principles, and advisory boards). Second, awareness of the DEIB efforts—or lack thereof—in DMHI research trials is needed to refine and optimize future study design for inclusivity as well as proactively address potential barriers to doing so. Trials should incorporate thoughtful, inclusive, and creative approaches to recruitment, enrollment, and measurement of social determinants of health and self-identity, as well as a prioritization of planned and exploratory analyses examining outcomes across various groups of people. Third, mental health care advocacy, research funding policies, and local and federal legislation can advance these pursuits, with directives from the US Preventive Services Taskforce, National Institutes of Health, and Food and Drug Administration applied as poignant examples. For products with artificial intelligence/machine learning, maintaining a “human in the loop” as well as prespecified and adaptive analytic frameworks to monitor and remediate potential algorithmic bias can reduce the risk of increasing inequity. Last, but certainly not least, is a call for partnership and transparency within and across ecosystems (academic, industry, payer, provider, regulatory agencies, and value-based care organizations) to reliably build health equity into real-world DMHI product deployments and evidence-generation strategies. All these considerations should also extend into the context of an equity-informed commercial strategy for DMHI manufacturers and health care organizations alike. The potential to advance health equity in innovation with DMHI is apparent. We advocate the field’s thoughtful and evergreen advancement in inclusivity, thereby redefining the mental health care experience for this generation and those to come. %M 39316436 %R 10.2196/59939 %U https://www.jmir.org/2024/1/e59939 %U https://doi.org/10.2196/59939 %U http://www.ncbi.nlm.nih.gov/pubmed/39316436 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e57304 %T The Mediating Role of Problematic Use of Loot Boxes Between Internet Gaming Disorder and Online Gambling Disorder: Cross-Sectional Analytical Study %A González-Cabrera,Joaquín %A Caba-Machado,Vanessa %A Díaz-López,Adoración %A Jiménez-Murcia,Susana %A Mestre-Bach,Gemma %A Machimbarrena,Juan M %K loot boxes %K loot box %K gaming %K gambling %K problematic %K video games %K game %K games %K addict %K addiction %K addictions %K addictive %K internet %K virtual object %K virtual objects %K gamification %K IGD %K OGD %K monetize %K monetization %K reward %K rewards %K incentive %K incentives %K internet gaming disorder %K online gambling disorder %D 2024 %7 20.9.2024 %9 %J JMIR Serious Games %G English %X Background: The video game industry has introduced a new form of monetization through microtransactions. A controversial example has been the so-called “loot boxes” (LBs) as virtual objects, which are randomized and bought with legal money. In recent years, LBs have come to connect 2 distinct problem behaviors, namely internet gaming disorder (IGD) and online gambling disorder (OGD). Many association studies have been conducted on the 3 constructs, but few have delved into the relationship of problematic use of LBs (PU-LB) with IGD and OGD. Objective: This study aims to explore the mediating role of the PU-LB between IGD and OGD. Methods: This cross-sectional and analytical study used incidental sampling in 24 Spanish schools. The final sample consisted of 542 participants (male: n=523, 96.5%; age: range 11‐30 y) who played video games, bought LBs, and had gambled online in the last 12 months. Participants then completed the Spanish versions of the Internet Gaming Disorder Scale–Short Form, Online Gambling Disorder Questionnaire, and PU-LB scale. Results: IGD scores were found to be significantly associated with both PU-LB (r=0.473, P<.001) and OGD (r=0.209, P<.001). Moreover, PU-LB was significantly associated with OGD (r=0.351, P<.001). The structural equation model results indicated that IGD had no significant direct effect on OGD (P=.903). However, the indirect effect of IGD on OGD through PU-LB was significant (P<.001). Therefore, PU-LB fully mediated the relationship between IGD and OGD. Furthermore, these results were found in the subsamples of both minors (<18 y) and young adults (≥18 y). Conclusions: It is suggested that there is a mediation effect of problematic LB use between internet gambling and online gambling problems in both minors and young adults. This has potential practical implications by providing more evidence on how LBs have become a hinge feature between 2 clinically relevant and independent issues. In this regard, adequate industry self-regulation is needed, and effective legislation for the protection of minors is necessary. %R 10.2196/57304 %U https://games.jmir.org/2024/1/e57304 %U https://doi.org/10.2196/57304 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58198 %T We Have Spent Time, Money, and Effort Making Self-Help Digital Mental Health Interventions: Is Anyone Going to Come to the Party? %A Fitzpatrick,Skye %A Crenshaw,Alexander O %A Donkin,Victoria %A Collins,Alexis %A Xiang,Angela %A Earle,Elizabeth A %A Goenka,Kamya %A Varma,Sonya %A Bushe,Julianne %A McFadden,Tara %A Librado,Andrea %A Monson,Candice %+ York University, 4700 Keele St, Toronto, ON, M3J1P3, Canada, 1 4167362100 ext 66214, skyefitz@yorku.ca %K online interventions %K self-help %K digital interventions %K mental health %K psychotherapy %K intervention desirability %D 2024 %7 19.9.2024 %9 Viewpoint %J J Med Internet Res %G English %X Although efficacious psychotherapies exist, a limited number of mental health care providers and significant demand make their accessibility a fundamental problem. Clinical researchers, funders, and investors alike have converged on self-help digital mental health interventions (self-help DMHIs) as a low-cost, low-burden, and broadly scalable solution to the global mental health burden. Consequently, exorbitant financial and time-based resources have been invested in developing, testing, and disseminating these interventions. However, the public’s assumed desirability for self-help DMHIs by experts has largely proceeded without question. This commentary critically evaluates whether self-help DMHIs can, and will, reach their purported potential as a solution to the public burden of mental illness, with an emphasis on evaluating their real-world desirability. Our review finds that self-help DMHIs are often perceived as less desirable and credible than in-person treatments, with lower usage rates and, perhaps accordingly, clinical trials testing self-help DMHIs suffering from widespread recruitment challenges. We highlight two fundamental challenges that may be interfering with the desirability of, and engagement in, self-help DMHIs: (1) difficulty competing with technology companies that have advantages in resources, marketing, and user experience design (but may not be delivering evidence-based interventions) and (2) difficulty retaining (vs initially attracting) users. We discuss a range of potential solutions, including highlighting self-help DMHIs in public mental health awareness campaigns; public education about evidence-based interventions that can guide consumers to appropriate self-help DMHI selection; increased financial and expert support to clinical researchers for marketing, design, and user experience in self-help DMHI development; increased involvement of stakeholders in the design of self-help DMHIs; and investing in more research on ways to improve retention (versus initial engagement). We suggest that, through these efforts, self-help DMHIs may fully realize their promise for reducing the global burden of mental illness. %M 39298760 %R 10.2196/58198 %U https://www.jmir.org/2024/1/e58198 %U https://doi.org/10.2196/58198 %U http://www.ncbi.nlm.nih.gov/pubmed/39298760 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e48439 %T Association Between Internet Gaming Disorder and Suicidal Ideation Mediated by Psychosocial Resources and Psychosocial Problems Among Adolescent Internet Gamers in China: Cross-Sectional Study %A Yu,Yanqiu %A Wu,Anise M S %A Fong,Vivian W I %A Zhang,Jianxin %A Li,Ji-bin %A Lau,Joseph T F %+ Public Mental Health Center, School of Mental Health, Wenzhou Medical University, Ouhai District, Wenzhou, 325000, China, 86 57786689810, jlau@cuhk.edu.hk %K internet gaming disorder %K suicidal ideation %K adolescents %K mediation %K structural equation modelling %K resilience %K loneliness %K social support %K social anxiety %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Adolescent internet gaming disorder (IGD) was associated with severe harm, including suicidal ideation. While suicidal ideation was predictive of completed suicides, further research is required to clarify the association between IGD and suicidal ideation among adolescents, as well as the mechanisms involved. Objective: This study aimed to investigate the understudied association between IGD and suicidal ideation, as well as novel mechanisms associated with it, among Chinese adolescent internet gamers through psychosocial coping resources and psychosocial problems. Methods: An anonymous, self-administered, cross-sectional survey was conducted among secondary school students who had played internet games in the past year in Guangzhou and Chengdu, China (from October 2019 to January 2020). In total, 1693 adolescent internet gamers were included in this study; the mean age was 13.48 (SD 0.80) years, and 60% (n=1016) were males. IGD was assessed by the 9-item Internet Gaming Disorder Checklist of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]), while a single item assessed suicidal ideation: “Have you ever considered committing suicide in the past 12 months?” Univariate and multivariate logistic regression associations were conducted to test the significance and directions of the potential factors for suicidal ideation. The mediation mechanism was examined by structural equation modeling. Results: Among all participants, the prevalence of IGD and suicidal ideation was 16.95% (287/1693) and 43.06% (729/1693), respectively. IGD cases were 2.42 times more likely than non-IGD cases to report suicidal ideation (adjusted odds ratio [OR] 2.42, 95% CI 1.73-3.37). Other significant factors of suicidal ideation included psychosocial coping resources (resilience and social support, both adjusted OR 0.97, 95% CI 0.96-0.98) and psychosocial problems (social anxiety: adjusted OR 1.07, 95% CI 1.05-1.09; loneliness, adjusted OR 1.13, 95% CI 1.10-1.16). The association between IGD and suicidal ideation was partially mediated by 3 indirect paths, including (1) the 2-step path that IGD reduced psychosocial coping resources, which in turn increased suicidal ideation; (2) the 2-step path that IGD increased psychosocial problems, which in turn increased suicidal ideation; and (3) the 3-step path that IGD reduced psychosocial coping resources which then increased psychosocial problems, which in turn increased suicidal ideation, with effect sizes of 10.7% (indirect effect/total effect: 0.016/0.15), 30.0% (0.05/0.15), and 13.3% (0.02/0.15), respectively. The direct path remained statistically significant. Conclusions: IGD and suicidal ideation were alarmingly prevalent. Evidently and importantly, IGD was a significant risk factor for suicidal ideation. The association was partially explained by psychosocial coping resources of resilience and social support and psychosocial problems of social anxiety and loneliness. Longitudinal studies are needed to confirm the findings. Pilot randomized controlled trials are recommended to evaluate the effectiveness of interventions in reducing suicidal ideation by reducing IGD, improving psychosocial coping resources, and reducing psychosocial problems investigated in this study. %M 39298753 %R 10.2196/48439 %U https://games.jmir.org/2024/1/e48439 %U https://doi.org/10.2196/48439 %U http://www.ncbi.nlm.nih.gov/pubmed/39298753 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e51366 %T Engagement, Acceptability, and Effectiveness of the Self-Care and Coach-Supported Versions of the Vira Digital Behavior Change Platform Among Young Adults at Risk for Depression and Obesity: Pilot Randomized Controlled Trial %A Weiner,Lauren S %A Crowley,Ryann N %A Sheeber,Lisa B %A Koegler,Frank H %A Davis,Jon F %A Wells,Megan %A Funkhouser,Carter J %A Auerbach,Randy P %A Allen,Nicholas B %+ Ksana Health, 2288 Alder Street, Eugene, OR, 97405, United States, 1 541 912 2883, lauren.weiner@ksanahealth.com %K depression %K behavioral activation %K digital health %K mental health %K behavior change %K mobile sensing %K anxiety %K health coaching %K mobile phone %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescence and early adulthood are pivotal stages for the onset of mental health disorders and the development of health behaviors. Digital behavioral activation interventions, with or without coaching support, hold promise for addressing risk factors for both mental and physical health problems by offering scalable approaches to expand access to evidence-based mental health support. Objective: This 2-arm pilot randomized controlled trial evaluated 2 versions of a digital behavioral health product, Vira (Ksana Health Inc), for their feasibility, acceptability, and preliminary effectiveness in improving mental health in young adults with depressive symptoms and obesity risk factors. Methods: A total of 73 participants recruited throughout the United States were randomly assigned to use Vira either as a self-guided product (Vira Self-Care) or with support from a health coach (Vira+Coaching) for 12 weeks. The Vira smartphone app used passive sensing of behavioral data related to mental health and obesity risk factors (ie, activity, sleep, mobility, and language patterns) and offered users personalized insights into patterns of behavior associated with their daily mood. Participants completed self-reported outcome measures at baseline and follow-up (12 weeks). All study procedures were completed via digital communications. Results: Both versions of Vira showed strong user engagement, acceptability, and evidence of effectiveness in improving mental health and stress. However, users receiving coaching exhibited more sustained engagement with the platform and reported greater reductions in depression (Cohen d=0.45, 95% CI 0.10-0.82) and anxiety (Cohen d=0.50, 95% CI 0.13-0.86) compared to self-care users. Both interventions also resulted in reduced stress (Vira+Coaching: Cohen d=–1.05, 95% CI –1.57 to –-0.50; Vira Self-Care: Cohen d=–0.78, 95% CI –1.33 to –0.23) and were perceived as useful and easy to use. Coached users also reported reductions in sleep-related impairment (Cohen d=–0.51, 95% CI –1.00 to –0.01). Moreover, participants increased their motivation for and confidence in making behavioral changes, with greater improvements in confidence among coached users. Conclusions: An app-based intervention using passive mobile sensing to track behavior and deliver personalized insights into behavior-mood associations demonstrated feasibility, acceptability, and preliminary effectiveness for reducing depressive symptoms and other mental health problems in young adults. Future directions include (1) optimizing the interventions, (2) conducting a fully powered trial that includes an active control condition, and (3) testing mediators and moderators of outcome effects. Trial Registration: ClinicalTrials.gov NCT05638516; https://clinicaltrials.gov/study/NCT05638516 %M 39298763 %R 10.2196/51366 %U https://mental.jmir.org/2024/1/e51366 %U https://doi.org/10.2196/51366 %U http://www.ncbi.nlm.nih.gov/pubmed/39298763 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58288 %T Testing the Effectiveness of a Mobile Smartphone App Designed to Improve the Mental Health of Junior Physicians: Protocol for a Randomized Controlled Trial %A Lai,Lauren %A Sanatkar,Samineh %A Mackinnon,Andrew %A Deady,Mark %A Petrie,Katherine %A Lipscomb,Rosie %A Counson,Isabelle %A Francis-Taylor,Rohan %A Dean,Kimberlie %A Harvey,Samuel %+ Black Dog Institute, Hospital Rd, Randwick, 2031, Australia, 61 9382 4530, lauren.lai@blackdog.org.au %K junior physicians %K digital mental health %K smartphone app %K depression %K mobile phone %D 2024 %7 19.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Shift (Black Dog Institute) is the first mobile health smartphone app created to support the mental health of junior physicians. Junior physicians experience demanding work conditions, leading to high levels of psychological distress and burnout. However, they are often concerned about the potential career impacts of seeking mental health support. The confidentiality and ease of access of digital interventions may be particularly suited to address these concerns. The Shift app provides therapeutic and psychoeducational content and strategies contextualized for the specific needs of physicians in training. App content includes information on mental health, help seeking, mindfulness, and common workplace-related concerns of junior physicians. Objective: This study aims to test, at scale, the effectiveness of Shift among junior physicians working in Australia using a randomized controlled trial design. The primary aim is to examine whether junior physicians using Shift experience a reduction in depressive symptoms compared with a waitlist control group. The secondary aim is to examine whether the app intervention group experiences improvements in anxiety, work and social functioning, help seeking, quality of life, and burnout compared with the control group. Methods: A total of 778 junior physicians were recruited over the internet through government and nongovernment medical organizations across Australia, as well as through paid social media advertisements. They were randomly allocated to one of 2 groups: (1) the intervention group, who were asked to use the Shift app for a period of 30 days, or (2) the waitlist control group, who were placed on a waitlist and were asked to use the app after 3 months. Participants completed psychometric measures for self-assessing mental health and wellbeing outcomes, with assessments occurring at baseline, 1 month after completing the baseline period, and 3 months after completing the baseline period. Participants in the waitlist control group were asked to complete an additional web-based questionnaire 1 month after receiving access to the app or 4 months after completing the baseline survey. Participants took part in the study on the internet; the study was completely automated. Results: The study was funded from November 2022 to December 2024 by the New South Wales Ministry of Health. Data collection for the study occurred between January and August 2024, with 780 participants enrolling in the study during this time. Data analysis is underway; the effectiveness of the intervention will be estimated on an intention-to-treat basis using a mixed-model, repeated measures analysis. Results are expected to be submitted for publication in 2025. Conclusions: To the best of our knowledge, this is the first randomized controlled trial to examine the effectiveness of a mobile health smartphone app specifically designed to support the mental health of junior physicians. Trial Registration: Australia and New Zealand Clinical Trials Registry ACTRN12623000664640; https://tinyurl.com/7xt24dhk International Registered Report Identifier (IRRID): DERR1-10.2196/58288 %M 39298756 %R 10.2196/58288 %U https://www.researchprotocols.org/2024/1/e58288 %U https://doi.org/10.2196/58288 %U http://www.ncbi.nlm.nih.gov/pubmed/39298756 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57093 %T Exploring Adaptive Virtual Reality Systems Used in Interventions for Children With Autism Spectrum Disorder: Systematic Review %A Maddalon,Luna %A Minissi,Maria Eleonora %A Parsons,Thomas %A Hervas,Amaia %A Alcaniz,Mariano %+ Laboratory of Immersive Neurotechnologies, Institute Human-Tech, Universitat Politècnica de València, Camino de Vera s/n, Polytechnic City of Innovation: Access N – Building 8B – 3rd Floor, Valencia, 46022, Spain, 34 963877518 ext 67018, lmaddal@upv.edu.es %K adaptive system %K virtual reality %K autism spectrum disorder %K intervention %K training %K children %K machine learning %K biosignal %D 2024 %7 18.9.2024 %9 Review %J J Med Internet Res %G English %X Background: Adaptive systems serve to personalize interventions or training based on the user’s needs and performance. The adaptation techniques rely on an underlying engine responsible for processing incoming data and generating tailored responses. Adaptive virtual reality (VR) systems have proven to be efficient in data monitoring and manipulation, as well as in their ability to transfer learning outcomes to the real world. In recent years, there has been significant interest in applying these systems to improve deficits associated with autism spectrum disorder (ASD). This is driven by the heterogeneity of symptoms among the population affected, highlighting the need for early customized interventions that target each individual’s specific symptom configuration. Objective: Recognizing these technology-driven therapeutic tools as efficient solutions, this systematic review aims to explore the application of adaptive VR systems in interventions for young individuals with ASD. Methods: An extensive search was conducted across 3 different databases—PubMed Central, Scopus, and Web of Science—to identify relevant studies from approximately the past decade. Each author independently screened the included studies to assess the risk of bias. Studies satisfying the following inclusion criteria were selected: (1) the experimental tasks were delivered via a VR system, (2) system adaptation was automated, (3) the VR system was designed for intervention or training of ASD symptoms, (4) participants’ ages ranged from 6 to 19 years, (5) the sample included at least 1 group with ASD, and (6) the adaptation strategy was thoroughly explained. Relevant information extracted from the studies included the sample size and mean age, the study’s objectives, the skill trained, the implemented device, the adaptive strategy used, the engine techniques, and the signal used to adapt the systems. Results: Overall, a total of 10 articles were included, involving 129 participants, 76% of whom had ASD. The studies included level switching (7/10, 70%), adaptive feedback strategies (9/10, 90%), and weighing the choice between a machine learning (ML) adaptive engine (3/10, 30%) and a non-ML adaptive engine (8/10, 80%). Adaptation signals ranged from explicit behavioral indicators (6/10, 60%), such as task performance, to implicit biosignals, such as motor movements, eye gaze, speech, and peripheral physiological responses (7/10, 70%). Conclusions: The findings reveal promising trends in the field, suggesting that automated VR systems leveraging real-time progression level switching and verbal feedback driven by non-ML techniques using explicit or, better yet, implicit signal processing have the potential to enhance interventions for young individuals with ASD. The limitations discussed mainly stem from the fact that no technological or automated tools were used to handle data, potentially introducing bias due to human error. %M 39293060 %R 10.2196/57093 %U https://www.jmir.org/2024/1/e57093 %U https://doi.org/10.2196/57093 %U http://www.ncbi.nlm.nih.gov/pubmed/39293060 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54754 %T Introducing and Evaluating the Effectiveness of Online Cognitive Behavior Therapy for Gambling Disorder in Routine Addiction Care: Comparative Cohort Study %A Molander,Olof %A Berman,Anne H %A Jakobson,Miriam %A Gajecki,Mikael %A Hällström,Hanna %A Ramnerö,Jonas %A Bjureberg,Johan %A Carlbring,Per %A Lindner,Philip %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stationsgatan 69, 7th floor, Stockholm, SE-113 64, Sweden, 46 700011241, olof.molander@ki.se %K gambling disorder %K internet-delivered cognitive behavioral therapy %K routine addiction care %K registry study %K gambling %K addiction %K health care setting %K iCBT %K Sweden %K feasibility %K clinic %K hospital %K psychological treatment %K digital intervention %K addictive disorder %K eHealth %K digital care %K survival analysis %K comorbidity %D 2024 %7 18.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Several treatment-related challenges exist for gambling disorder, in particular at-scale dissemination in health care settings. Objective: This study describes the introduction of a newly developed internet-delivered cognitive behavioral therapy (iCBT) program for gambling disorder (GD), provided with therapist support in routine addiction care, in a nationally recruited sample in Sweden. The study details the introduction of the iCBT program, evaluates its effectiveness and acceptability, and compares registry outcomes among iCBT patients with other patients with GD at the clinic who received face-to-face psychological treatment as usual. Methods: The study site was the Stockholm Addiction eClinic, which offers digital interventions for addictive disorders in routine care. The iCBT program was introduced nationally for treatment-seeking patients through the Swedish eHealth platform. After approximately 2 years of routine treatment provision, we conducted a registry study, including ordinary patients in routine digital care (n=218), and a reference sample receiving face-to-face psychological treatment for GD (n=216). Results: A statistically significant reduction in the Gambling Symptom Assessment Scale scores during the treatment was observed (B=–1.33, SE=0.17, P<.001), corresponding to a large within-group Cohen d effect size of d=1.39. The iCBT program was rated high for satisfaction. A registry-based survival analysis, controlling for psychiatric comorbidity, showed that patients receiving iCBT exhibited posttreatment outcomes (re-engagement in outpatient addiction care, receiving new psychiatric prescriptions, enrollment in psychiatric inpatient care, and care events indicative of contact with social services) similar to comparable patients who underwent face-to-face treatment-as-usual. Conclusions: A lack of randomized allocation notwithstanding, the iCBT program for GD evaluated in this study was well-received by patients in routine addiction care, was associated with the expected symptom decrease during treatment, and appears to result in posttreatment registry outcomes similar to face-to-face treatment. Future studies on treatment mechanisms and moderators are warranted. International Registered Report Identifier (IRRID): RR2-10.1186/s40814-020-00647-5 %M 39293054 %R 10.2196/54754 %U https://www.jmir.org/2024/1/e54754 %U https://doi.org/10.2196/54754 %U http://www.ncbi.nlm.nih.gov/pubmed/39293054 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52293 %T A Suicide Prevention Digital Technology for Individuals Experiencing an Acute Suicide Crisis in Emergency Departments: Naturalistic Observational Study of Real-World Acceptability, Feasibility, and Safety %A Dimeff,Linda A %A Koerner,Kelly %A Heard,Kandi %A Ruork,Allison K %A Kelley-Brimer,Angela %A Witterholt,Suzanne T %A Lardizabal,Mary Beth %A Clubb,Joseph R %A McComish,Julie %A Waghray,Arpan %A Dowdy,Roger %A Asad-Pursley,Sara %A Ilac,Maria %A Lawrence,Hannah %A Zhou,Frank %A Beadnell,Blair %+ Evidence-Based Practice Institute, 9450 SW Gemini Dr, PMB 68735, Beaverton, OR, 97008-7105, United States, 1 253 765 0455, linda.dimeff@jasprhealth.com %K suicide %K emergency department %K ED %K digital technology %K suicide prevention best practices %K individual %K particular %K suicide prevention %K evidence-based intervention %K Emergency department %K hospital %K vulnerable population %K Jaspr Health %K psychiatric %K psychiatrist %K care %K safety %D 2024 %7 16.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Emergency departments (EDs) are the front line in providing suicide care. Expert consensus recommends the delivery of several suicide prevention evidence-based interventions for individuals with acute suicidal ideation in the ED. ED personnel demands and staff shortages compromise delivery and contribute to long wait times and unnecessary hospitalization. Digital technologies can play an important role in helping EDs deliver suicide care without placing further demands on the care team if their use is safe to patients in a routine care context. Objective: This study evaluates the safety and effectiveness of an evidence-based digital technology (Jaspr Health) designed for persons with acute suicidal ideation seeking psychiatric crisis ED services when used as part of routine ED-based suicide care. This study deployed Jaspr Health for real-world use in 2 large health care systems in the United States and aimed to evaluate (1) how and whether Jaspr Health could be safely and effectively used outside the context of a researcher-facilitated clinical trial, and (2) that Jaspr’s use would be associated with improved patient agitation and distress. Methods: Under the auspices of a nonsignificant risk device study, ED patients with acute suicidal ideation (N=962) from 2 health care systems representing 10 EDs received access to Jaspr Health as part of their routine suicide care. Primary outcome measures included how many eligible patients were assigned Jaspr Health, which modules were assigned and completed, and finally, the number of adverse events reported by patients or by medical staff. Secondary outcome measures were patient agitation, distress, and satisfaction. Results: The most frequent modules assigned were Comfort and Skills (98% of users; n=942) and lethal means assessment (90% of patient users; n=870). Patient task completion rates for all modules ranged from 51% to 79%. No adverse events were reported, suggesting that digital technologies can be safely used for people seeking ED-based psychiatric services. Statistically significant (P<.001) reductions in agitation and distress were reported after using the app. Average patient satisfaction ratings by site were 7.81 (SD 2.22) and 7.10 (SD 2.65), with 88.8% (n=325) and 84% (n=90) of patients recommending the app to others. Conclusions: Digital technologies such as Jaspr Health may be safely and effectively integrated into existing workflows to help deliver evidence-based suicide care in EDs. These findings hold promise for the use of digital technologies in delivering evidence-based care to other vulnerable populations in complex environments. %M 39283664 %R 10.2196/52293 %U https://formative.jmir.org/2024/1/e52293 %U https://doi.org/10.2196/52293 %U http://www.ncbi.nlm.nih.gov/pubmed/39283664 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59171 %T Psychological Interventions and Those With Elements of Positive Psychology for Child and Youth Mental Health During the COVID-19 Pandemic: Literature Review, Lessons Learned, and Areas for Future Knowledge Dissemination %A Lyzwinski,Lynnette %A Zwicker,Jennifer D %A Mcdonald,Sheila %A Tough,Suzanne %+ Department of Pediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Drive, Calgary, AB, T2N4N1, Canada, 1 1 403 220 6843, lynnette.lyzwinski@ucalgary.ca %K positive psychology %K mindfulness %K resilience %K mental health %K flourishing %K knowledge translation %K depression %K anxiety %K stress %D 2024 %7 13.9.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: There was a marked decline in child and teenage mental health worldwide during the pandemic, with increasing prevalence of depression, anxiety, and suicide. Research indicates that positive psychological interventions may be beneficial for mental health. Objective: The aims of this review were to evaluate positive psychological interventions for child and youth mental health implemented during the COVID-19 pandemic and assess overall effectiveness for mental health and knowledge. Methods: We undertook a literature search of PubMed, MEDLINE, and Google Scholar for all eligible studies on digital and hybrid in-person psychological interventions for youth mental health during the COVID-19 pandemic. A particular emphasis was placed on positive psychological interventions or interventions that had components of positive psychology, including gratitude, acceptance, positive emotions, or resilience building. Results: A total of 41 interventions were included in this review. Most of the interventions were digital. Overall, most of the interventions assisted with one or more mental health or psychological indicators, such as depression, anxiety, posttraumatic stress disorder, stress, and resilience. However, findings were mixed when it came to targeting both depression and anxiety together. The interventions that promoted youth mental health most often had a range of diverse positive psychology components and were evidence based. Not all studies measured changes in mindfulness. Few studies examined knowledge acquired on mental health self-care, managing mental health problems, knowledge of positive psychological techniques, mindfulness knowledge, or mental health self-efficacy. Conclusions: Diverse multicomponent interventions appear to assist with youth mental health overall, although their effects on both depression and anxiety are less clear. There is also a need for more research on knowledge gains to determine whether the interventions improved knowledge on mental health–supportive behaviors, which may be sustained beyond the intervention. Finally, more studies need to evaluate whether the interventions assisted with increasing self-efficacy for practicing positive psychological techniques as well as changes in mindfulness levels. Future studies should not only assess effectiveness for mental health outcomes but also assess knowledge translation, with valid measures of knowledge and self-efficacy for mental health–supportive behaviors and positive psychological skills acquired (eg, the ability to practice mindfulness). %M 39269752 %R 10.2196/59171 %U https://pediatrics.jmir.org/2024/1/e59171 %U https://doi.org/10.2196/59171 %U http://www.ncbi.nlm.nih.gov/pubmed/39269752 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54005 %T Assessment of a Pilot Program for Remote Support on Mental Health for Young Physicians in Rural Settings in Peru: Mixed Methods Study %A De la Cruz-Torralva,Kelly %A Escobar-Agreda,Stefan %A Riega López,Pedro %A Amaro,James %A Reategui-Rivera,C Mahony %A Rojas-Mezarina,Leonardo %+ Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Av Grau 755, Cercado de Lima, 15001, Peru, 51 619 7000 ext 4650, priegal@unmsm.edu.pe %K telemedicine %K screening %K treatment %K mental health %K suicide %K depression %K anxiety %K alcoholism %K physicians %K rural areas %K Peru %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine-based interventions show promise in addressing mental health issues among rural populations, yet evidence regarding their impact among the health care workforce in these contexts remains limited. Objective: This study aimed to evaluate the characteristics and the responses and perceptions of recently graduated physicians who work in rural areas of Peru as part of the Servicio Rural Urbano Marginal en Salud (Rural-Urban Marginal Health Service [SERUMS], in Spanish) toward a telehealth intervention to provide remote orientation and accompaniment in mental health. Methods: A mixed methods study was carried out involving physicians who graduated from the Universidad Nacional Mayor de San Marcos and participated in the Mental Health Accompaniment Program (MHAP) from August 2022 to February 2023. This program included the assessment of mental health conditions via online forms, the dissemination of informational materials through a website, and, for those with moderate or high levels of mental health issues, the provision of personalized follow-up by trained personnel. Quantitative analysis explored the mental health issues identified among physicians, while qualitative analysis, using semistructured interviews, examined their perceptions of the services provided. Results: Of 75 physicians initially enrolled to the MHAP, 30 (41.6%) opted to undergo assessment and use the services. The average age of the participants was 26.8 (SD 1.9) years, with 17 (56.7%) being female. About 11 (36.7%) reported have current or previous mental health issues, 17 (56.7%) indicating some level of depression, 14 (46.7%) indicated some level of anxiety, 5 (16.6%) presenting a suicidal risk, and 2 (6.7%) attempted suicide during the program. Physicians who did not use the program services reported a lack of advertising and related information, reliance on personal mental health resources, or neglect of symptoms. Those who used the program expressed a positive perception regarding the services, including evaluation and follow-up, although some faced challenges accessing the website. Conclusions: The MHAP has been effective in identifying and managing mental health problems among SERUMS physicians in rural Peru, although it faced challenges related to access and participation. The importance of mental health interventions in this context is highlighted, with recommendations to improve accessibility and promote self-care among participants. %M 39255480 %R 10.2196/54005 %U https://formative.jmir.org/2024/1/e54005 %U https://doi.org/10.2196/54005 %U http://www.ncbi.nlm.nih.gov/pubmed/39255480 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56650 %T Digital Mental Health Interventions for Alleviating Depression and Anxiety During Psychotherapy Waiting Lists: Systematic Review %A Huang,Sijia %A Wang,Yiyue %A Li,Gen %A Hall,Brian J %A Nyman,Thomas J %+ School of Psychology and Clinical Language Sciences, University of Reading, Earley, Reading, RG6 6ET, United Kingdom, 44 1189875123, t.nyman@reading.ac.uk %K digital health %K digital technology %K digital intervention %K digital interventions %K waiting list %K digital mental health intervention %K DMHI %K digital mental health interventions %K DMHIs %K digital mental health %K mental health intervention %K mental health interventions %K mental health %K mental illness %K mental disease %K mental diseases %K mental illnesses %K depression %K depressed %K major depressive disorder %K MDD %K depressive disorder %K depressive %K anxiety %K anxious %K self-guided %K self-guidance %K self-mediated %K self-mediation %K systematic review %K systematic reviews %K mood disorder %K therapy %K tele-therapy %K web-based therapy %D 2024 %7 10.9.2024 %9 Review %J JMIR Ment Health %G English %X Background: Depression and anxiety have become increasingly prevalent across the globe. The rising need for treatment and the lack of clinicians has resulted in prolonged waiting times for patients to receive their first session. Responding to this gap, digital mental health interventions (DMHIs) have been found effective in treating depression and anxiety and are potentially promising pretreatments for patients who are awaiting face-to-face psychotherapy. Nevertheless, whether digital interventions effectively alleviate symptoms for patients on waiting lists for face-to-face psychotherapy remains unclear. Objective: This review aimed to synthesize the effectiveness of DMHIs for relieving depression and anxiety symptoms of patients on waiting lists for face-to-face therapy. This review also investigated the features, perceived credibility, and usability of DMHIs during waiting times. Methods: In this systematic review, we searched PubMed, PsycINFO, Cochrane, and Web of Science for research studies investigating the effectiveness of DMHIs in reducing either depression or anxiety symptoms among individuals waiting for face-to-face psychotherapy. The search was conducted in June 2024, and we have included the studies that met the inclusion criteria and were published before June 6, 2024. Results: Of the 9267 unique records identified, 8 studies met the eligibility criteria and were included in the systematic review. Five studies were randomized controlled trials (RCTs), and 3 studies were not. Among the RCTs, we found that digital interventions reduced depression and anxiety symptoms, but the majority of interventions were not more effective compared to the control groups where participants simply waited or received a self-help book. For the non-RCTs, the interventions also reduced symptoms, but without control groups, the interpretation of the findings is limited. Finally, participants in the included studies perceived the digital interventions to be credible and useful, but high dropout rates raised concerns about treatment adherence. Conclusions: Due to the lack of effective interventions among the reviewed studies, especially among the RCTs, our results suggest that waiting list DMHIs are not more effective compared to simply waiting or using a self-help book. However, more high-quality RCTs with larger sample sizes are warranted in order to draw a more robust conclusion. Additionally, as this review revealed concerns regarding the high dropout rate in digital interventions, future studies could perhaps adopt more personalized and human-centered functions in interventions to increase user engagement, with the potential to increase treatment adherence and effectiveness. %M 39255015 %R 10.2196/56650 %U https://mental.jmir.org/2024/1/e56650 %U https://doi.org/10.2196/56650 %U http://www.ncbi.nlm.nih.gov/pubmed/39255015 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58939 %T Research Into Digital Health Intervention for Mental Health: 25-Year Retrospective on the Ethical and Legal Challenges %A Hall,Charlotte L %A Gómez Bergin,Aislinn D %A Rennick-Egglestone,Stefan %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 11582 ext 30926, stefan.egglestone@nottingham.ac.uk %K digital mental health intervention %K research ethics %K compliance %K regulation %K digital health %K mobile health %K mhealth %K intervention %K interventions %K mental health %K retrospective %K ethical %K legal %K challenge %K challenges %D 2024 %7 9.9.2024 %9 Viewpoint %J J Med Internet Res %G English %X Digital mental health interventions are routinely integrated into mental health services internationally and can contribute to reducing the global mental health treatment gap identified by the World Health Organization. Research teams designing and delivering evaluations frequently invest substantial effort in deliberating on ethical and legal challenges around digital mental health interventions. In this article, we reflect on our own research experience with digital mental health intervention design and evaluation to identify 8 of the most critical challenges that we or others have faced, and that have ethical or legal consequences. These include: (1) harm caused by online recruitment work; (2) monitoring of intervention safety; (3) exclusion of specific demographic or clinical groups; (4) inadequate robustness of effectiveness and cost-effectiveness findings; (5) adequately conceptualizing and supporting engagement and adherence; (6) structural barriers to implementation; (7) data protection and intellectual property; and (8) regulatory ambiguity relating to digital mental health interventions that are medical devices. As we describe these challenges, we have highlighted serious consequences that can or have occurred, such as substantial delays to studies if regulations around Software as a Medical Device (SaMD) are not fully understood, or if regulations change substantially during the study lifecycle. Collectively, the challenges we have identified highlight a substantial body of required knowledge and expertise, either within the team or through access to external experts. Ensuring access to knowledge requires careful planning and adequate financial resources (for example, paying public contributors to engage in debate on critical ethical issues or paying for legal opinions on regulatory issues). Access to such resources can be planned for on a per-study basis and enabled through funding proposals. However, organizations regularly engaged in the development and evaluation of digital mental health interventions should consider creating or supporting structures such as advisory groups that can retain necessary competencies, such as in medical device regulation. %M 39250796 %R 10.2196/58939 %U https://www.jmir.org/2024/1/e58939 %U https://doi.org/10.2196/58939 %U http://www.ncbi.nlm.nih.gov/pubmed/39250796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59003 %T Comparing Email Versus Text Messaging as Delivery Platforms for Supporting Patients With Major Depressive Disorder: Noninferiority Randomized Controlled Trial %A Adu,Medard K %A Eboreime,Oghenekome %A Shalaby,Reham %A Eboreime,Ejemai %A Agyapong,Belinda %A da Luz Dias,Raquel %A Sapara,Adegboyega O %A Agyapong,Vincent I O %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 17802157771, vn602367@dal.ca %K major depressive disorder %K Text4Support %K SMS text messaging %K email messaging %K digital health %K mental health %K mobile phone %K depressive disorder %K health communication %K global health %K treatments %K patient %K text messaging-based %K cognitive behavioral therapy %K communication %K effectiveness %K mental health support %K digital intervention %K digital interventions %K mental health care %K well-being %K depression symptoms %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of major depressive disorder (MDD) poses significant global health challenges, with available treatments often insufficient in achieving remission for many patients. Digital health technologies, such as SMS text messaging–based cognitive behavioral therapy, offer accessible alternatives but may not reach all individuals. Email communication presents a secure avenue for health communication, yet its effectiveness compared to SMS text messaging in providing mental health support for patients with MDD remains uncertain. Objective: This study aims to compare the efficacy of email versus SMS text messaging as delivery platforms for supporting patients with MDD, addressing a critical gap in understanding optimal digital interventions for mental health care. Methods: A randomized noninferiority pilot trial was conducted, comparing outcomes for patients receiving 6-week daily supportive messages via email with those receiving messages via SMS text message. This duration corresponds to a minimum of 180 days of message delivery. The supportive messages maintained consistent length and structure across both delivery methods. Participants (N=66) were recruited from the Access 24/7 clinic in Edmonton, Alberta, among those who were diagnosed with MDD. The outcomes were measured at baseline and 6 months after enrollment using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the World Health Organization Well-Being Index (WHO-5). Results: Most of the participants were females (n=43, 65%), aged between 26 and 40 years (n=34, 55%), had high school education (n=35, 58%), employed (n=33, 50%), and single (n=24, 36%). Again, most participants had had no history of any major physical illness (n=56, 85%) and (n=61, 92%) responded “No” to having a history of admission for treatment of mood disorders. There was no statistically significant difference in the mean changes in PHQ-9, GAD-7, and WHO-5 scores between the email and SMS text messaging groups (mean difference, 95% CI: –1.90, 95% CI –6.53 to 2.74; 5.78, 95% CI –1.94 to 13.50; and 11.85, 95% CI –3.81 to 27.51), respectively. Both supportive modalities showed potential in reducing depressive symptoms and improving quality of life. Conclusions: The study’s findings suggest that both email and SMS text messaging interventions have equivalent effectiveness in reducing depression symptoms among individuals with MDD. As digital technology continues to evolve, harnessing the power of multiple digital platforms for mental health interventions can significantly contribute to bridging the existing treatment gaps and improving the overall well-being of individuals with depressive conditions. Further research is needed with a larger sample size to confirm and expand upon these findings. Trial Registration: ClinicalTrials.gov NCT04638231; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8552095/ %M 39250182 %R 10.2196/59003 %U https://formative.jmir.org/2024/1/e59003 %U https://doi.org/10.2196/59003 %U http://www.ncbi.nlm.nih.gov/pubmed/39250182 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56396 %T Breaking Down Barriers to a Suicide Prevention Helpline: Web-Based Randomized Controlled Trial %A Van der Burgt,Margot C A %A Mérelle,Saskia %A Brinkman,Willem-Paul %A Beekman,Aartjan T F %A Gilissen,Renske %K barrier reduction intervention %K suicidal ideation %K self-help %K suicide prevention helpline %K randomized controlled trial %K help-seeking %K suicide %K RCT %K self-test %K effectiveness %K prevention %K middle-aged %K behavioral %K attitudinal %K website visitors %K website visitor %K website %K men %K suicide prevention %D 2024 %7 5.9.2024 %9 %J JMIR Ment Health %G English %X Background: Every month, around 3800 people complete an anonymous self-test for suicidal thoughts on the website of the Dutch suicide prevention helpline. Although 70% score high on the severity of suicidal thoughts, <10% navigate to the web page about contacting the helpline. Objective: This study aimed to test the effectiveness of a brief barrier reduction intervention (BRI) in motivating people with severe suicidal thoughts to contact the suicide prevention helpline, specifically in high-risk groups such as men and middle-aged people. Methods: We conducted a fully automated, web-based, randomized controlled trial. Respondents with severe suicidal thoughts and little motivation to contact the helpline were randomly allocated either to a brief BRI, in which they received a short, tailored message based on their self-reported barrier to the helpline (n=610), or a general advisory text (care as usual as the control group: n=612). Effectiveness was evaluated using both behavioral and attitudinal measurements. The primary outcome measure was the use of a direct link to contact the helpline after completing the intervention or control condition. Secondary outcomes were the self-reported likelihood of contacting the helpline and satisfaction with the received self-test. Results: In total, 2124 website visitors completed the Suicidal Ideation Attributes Scale and the demographic questions in the entry screening questionnaire. Among them, 1222 were randomized into the intervention or control group. Eventually, 772 respondents completed the randomized controlled trial (intervention group: n=369; control group: n=403). The most selected barrier in both groups was “I don’t think that my problems are serious enough.” At the end of the trial, 33.1% (n=122) of the respondents in the intervention group used the direct link to the helpline. This was not significantly different from the respondents in the control group (144/403, 35.7%; odds ratio 0.87, 95% CI 0.64‐1.18, P=.38). However, the respondents who received the BRI did score higher on their self-reported likelihood of contacting the helpline at a later point in time (B=0.22, 95% CI 0.12‐0.32, P≤.001) and on satisfaction with the self-test (B=0.27, 95% CI 0.01‐0.53, P=.04). For male and middle-aged respondents specifically, the results were comparable to that of the whole group. Conclusions: This trial was the first time the helpline was able to connect with high-risk website visitors who were hesitant to contact the helpline. Although the BRI could not ensure that those respondents immediately used the direct link to the helpline at the end of the trial, it is encouraging that respondents indicated that they were more likely to contact the helpline at a later point in time. In addition, this low-cost intervention provided greater insight into the perceived barriers to service. Follow-up research should be focused on identifying the added value of other components (eg, video or photo material) in the BRI and increasing its effectiveness, especially for men and middle-aged people. Trial Registration: ClinicalTrials.gov NCT05458830; https://clinicaltrials.gov/study/NCT05458830 International Registered Report Identifier (IRRID): RR2-10.2196/41078 %R 10.2196/56396 %U https://mental.jmir.org/2024/1/e56396 %U https://doi.org/10.2196/56396 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56326 %T Smartphone-Delivered Attentional Bias Modification Training for Mental Health: Systematic Review and Meta-Analysis %A Banire,Bilikis %A Orr,Matt %A Burns,Hailey %A McGowan,Youna %A Orji,Rita %A Meier,Sandra %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, Sir Charles Tupper Building, 13th Fl., 5850 College Street, Halifax, NS, B34 3H7, Canada, 1 17828825242, banire.bilikis.o@gmail.com %K attentional bias %K mental health problem %K anxiety %K depression %K systematic review %K meta-analysis %K smartphone %K mobile phone %D 2024 %7 2.9.2024 %9 Review %J JMIR Ment Health %G English %X Background: Smartphone-delivered attentional bias modification training (ABMT) intervention has gained popularity as a remote solution for alleviating symptoms of mental health problems. However, the existing literature presents mixed results indicating both significant and insignificant effects of smartphone-delivered interventions. Objective: This systematic review and meta-analysis aims to assess the impact of smartphone-delivered ABMT on attentional bias and symptoms of mental health problems. Specifically, we examined different design approaches and methods of administration, focusing on common mental health issues, such as anxiety and depression, and design elements, including gamification and stimulus types. Methods: Our search spanned from 2014 to 2023 and encompassed 4 major databases: MEDLINE, PsycINFO, PubMed, and Scopus. Study selection, data extraction, and critical appraisal were performed independently by 3 authors using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. When necessary, we pooled the standardized mean difference with a 95% CI. In addition, we conducted sensitivity, subgroup, and meta-regression analyses to explore moderator variables of active and placebo ABMT interventions on reducing symptoms of mental health problems and attentional bias. Results: Our review included 12 papers, involving a total of 24,503 participants, and we were able to conduct a meta-analysis on 20 different study samples from 11 papers. Active ABMT exhibited an effect size (Hedges g) of –0.18 (P=.03) in reducing symptoms of mental health problems, while the overall effect remained significant. Similarly, placebo ABMT showed an effect size of –0.38 (P=.008) in reducing symptoms of mental health problems. In addition, active ABMT (Hedges g –0.17; P=.004) had significant effects on reducing attentional bias, while placebo ABMT did not significantly alter attentional bias (Hedges g –0.04; P=.66). Conclusions: Our understanding of smartphone-delivered ABMT’s potential highlights the value of both active and placebo interventions in mental health care. The insights from the moderator analysis also showed that tailoring smartphone-delivered ABMT interventions to specific threat stimuli and considering exposure duration are crucial for optimizing their efficacy. This research underscores the need for personalized approaches in ABMT to effectively reduce attentional bias and symptoms of mental health problems. Trial Registration: PROSPERO CRD42023460749; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=460749 %M 39222349 %R 10.2196/56326 %U https://mental.jmir.org/2024/1/e56326 %U https://doi.org/10.2196/56326 %U http://www.ncbi.nlm.nih.gov/pubmed/39222349 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56957 %T Feasibility and Acceptability Study of a Culturally Adapted Web-Based Intervention to Reduce Suicidal Ideation for Syrian Asylum Seekers and Refugees in the United Kingdom: Protocol for a Mixed Methods Study %A Beuthin,Oliver %A Shahid,Sadiya %A Yu,Ly-Mee %A Bhui,Kamaldeep %+ Department of Psychiatry, University of Oxford, Linacre College, St Cross Road, Oxford, OX1 3JA, United Kingdom, 44 1865 618200, oliver.beuthin@linacre.ox.ac.uk %K cultural adaptation %K digital mental health %K suicidal ideation %K refugee mental health %K Syrian refugee %K experience-based co-design %K mental health %K suicide %K suicidal %K refugee %K immigrant %K ethnic minority %K asylum %K user experience %K cultural %K Syria %K Syrian %K refugees %K feasibility %K acceptability %K depression %K anxiety %K posttraumatic stress disorder %K United Kingdom %K Arabic-speaking %D 2024 %7 2.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The war in Syria has displaced over 6.8 million people, more than any other conflict since the Second World War. As a result, Syrian asylum seekers and refugees have experienced several life-changing events, resulting in high rates of anxiety, depression, posttraumatic stress disorder, and suicidal ideation (SI). To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI developed for general populations was culturally adapted for and with Syrian asylum seekers and refugees in the United Kingdom. The study revealed the importance of understanding their lived experience with migration and the acculturative process in providing treatment for SI. This study will now assess the feasibility and acceptability of the culturally adapted intervention for this population. Objective: The first phase of the study will include recruiting participants and delivering the web-based intervention (1) to assess the feasibility of meeting recruitment goals and recruitment rates and (2) to assess the feasibility of outcome measures. The second phase of the study will include one-to-one semistructured interviews (1) to assess the suitability of the culturally adapted intervention in terms of recruitment and adherence rates and barriers and facilitators to engagement and (2) to assess the acceptability of the intervention in terms of its cultural relevance and appropriateness. Methods: This is a protocol for a single-group, noncontrolled, mixed methods feasibility and acceptability study of a culturally adapted web-based intervention to reduce SI for Syrian asylum seekers and refugees in the United Kingdom. The study will assess the feasibility of recruitment goals, recruitment rates, adherence rates, and outcome measures using individual participant tracking forms, which will be analyzed quantitatively. The suitability and acceptability of the intervention will be assessed using one-to-one semistructured interviews with 12 participants who completed the intervention, which will be analyzed qualitatively. Results: Recruitment began in February 2024 and will run until 30 participants are recruited to the study or until the end of July 2024. Thus far, 19 participants have provided informed consent, 16 were eligible and enrolled, and 12 have completed a postintervention interview. No data have been analyzed. The study, including the write-up period, is expected to end in December 2024. Conclusions: Despite experiencing several stressors related to forced displacement and high rates of mental health issues, access to treatment is still limited for Syrian asylum seekers and refugees in the United Kingdom. To address the treatment gap and reduce the burden of help-seeking, a web-based intervention to reduce SI was culturally adapted in collaboration with Syrian asylum seekers and refugees in the United Kingdom. This study will now assess the feasibility and acceptability of the intervention and culturally appropriate recruitment strategies. Trial Registration: ISRCTN ISRCTN11417025; https://www.isrctn.com/ISRCTN11417025 International Registered Report Identifier (IRRID): PRR1-10.2196/56957 %M 39222345 %R 10.2196/56957 %U https://www.researchprotocols.org/2024/1/e56957 %U https://doi.org/10.2196/56957 %U http://www.ncbi.nlm.nih.gov/pubmed/39222345 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e54252 %T Examining a Fully Automated Mobile-Based Behavioral Activation Intervention in Depression: Randomized Controlled Trial %A Santopetro,Nicholas %A Jones,Danielle %A Garron,Andrew %A Meyer,Alexandria %A Joyner,Keanan %A Hajcak,Greg %K digital intervention %K digital health %K digital application %K digital applications %K mobile health %K mHealth %K automation %K automate %K automated %K behavioral activation %K BA %K BA intervention %K depression %K depressed %K depressive %K depressive symptoms %K anhedonia %K anhedonia symptoms %K anxiety %K anxious %K anxiety symptoms %K adults %K adult %K psychiatry %K psych %K psychology %K major depressive disorder %K MDD %D 2024 %7 30.8.2024 %9 %J JMIR Ment Health %G English %X Background: Despite significant progress in our understanding of depression, prevalence rates have substantially increased in recent years. Thus, there is an imperative need for more cost-effective and scalable mental health treatment options, including digital interventions that minimize therapist burden. Objective: This study focuses on a fully automated digital implementation of behavioral activation (BA)—a core behavioral component of cognitive behavioral therapy for depression. We examine the efficacy of a 1-month fully automated SMS text message–based BA intervention for reducing depressive symptoms and anhedonia. Methods: To this end, adults reporting at least moderate current depressive symptoms (8-item Patient Health Questionnaire score ≥10) were recruited online across the United States and randomized to one of three conditions: enjoyable activities (ie, BA), healthy activities (ie, an active control condition), and passive control (ie, no contact). Participants randomized to enjoyable and healthy activities received daily SMS text messages prompting them to complete 2 activities per day; participants also provided a daily report on the number and enjoyment of activities completed the prior day. Results: A total of 126 adults (mean age 32.46, SD 7.41 years) with current moderate depressive symptoms (mean score 16.53, SD 3.90) were recruited. Participants in the enjoyable activities condition (BA; n=39) experienced significantly greater reductions in depressive symptoms compared to participants in the passive condition (n=46). Participants in both active conditions—enjoyable activities and healthy activities (n=41)—reported reduced symptoms of anxiety compared to those in the control condition. Conclusions: These findings provide preliminary evidence regarding the efficacy of a fully automated digital BA intervention for depression and anxiety symptoms. Moreover, reminders to complete healthy activities may be a promising intervention for reducing anxiety symptoms. Trial Registration: ClincalTrials.gov NCT06492824; https://clinicaltrials.gov/study/NCT06492824 %R 10.2196/54252 %U https://mental.jmir.org/2024/1/e54252 %U https://doi.org/10.2196/54252 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50071 %T Effectiveness of a Smartphone-Based Stress Management Program for Depression in Hospital Nurses During COVID-19 in Vietnam and Thailand: 2-Arm Parallel-Group Randomized Controlled Trial %A Watanabe,Kazuhiro %A Tran,Thuy Thi Thu %A Sripo,Narisara %A Sakuraya,Asuka %A Imamura,Kotaro %A Boonyamalik,Plernpit %A Sasaki,Natsu %A Tienthong,Thanate %A Asaoka,Hiroki %A Iida,Mako %A Nguyen,Quynh Thuy %A Nguyen,Nga Thi %A Vu,Son Thai %A Ngo,Thuy Thi %A Luyen,Tham Thi %A Nguyen,Long Duc %A Nguyen,Nga Thi Viet %A Nguyen,Binh Thanh %A Matsuyama,Yutaka %A Takemura,Yukie %A Nishi,Daisuke %A Tsutsumi,Akizumi %A Nguyen,Huong Thanh %A Kaewboonchoo,Orawan %A Kawakami,Norito %+ Department of Digital Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 3 5800 9621, nkawakami@m.u-tokyo.ac.jp %K digital mental health intervention %K unguided program %K universal prevention %K health care workers %K nurses %K COVID-19 %K depression %K mobile phone %D 2024 %7 30.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, health care professionals experienced high levels of depression. However, extant research has not highlighted effective internet-based psychological interventions to improve the mental health in this population during the pandemic. It remains unclear whether self-guided, internet-based cognitive behavioral therapy (iCBT) programs are effective in improving the mental health of health care workers during the COVID-19 pandemic. Objective: The aim of this study was to evaluate the effectiveness of a smartphone-based iCBT stress management program for reducing the depression experienced by nurses in Vietnam and Thailand. Methods: From March to April 2022, a 2-arm, parallel-group randomized controlled trial was implemented. One arm offered a 7-week self-guided iCBT program, and the other offered treatment as usual as a control arm. Full-time nurses were recruited from 6 hospitals: 2 hospitals in Vietnam and 4 hospitals in Thailand. The primary outcome of this program was the severity of depression measured by the Depression Anxiety Stress Scale-21 items. Follow-up surveys were conducted to measure the change in depression severity at 3 months (July-August 2022) and at 6 months (October-November 2022) after baseline. Mixed modeling for repeated measures was used to test the effects of the intervention compared with the control for the follow-up. Results: A total of 1203 nurses were included in this study: 602 in the intervention group and 601 in the control group. The follow-up rate at 3 and 6 months ranged from 85.7% (515/601) to 87.5% (527/602). The completion rate for the program was 68.1% (410/602). The group difference in depression was significant at the 3-month follow-up (coefficient=–0.92, 95% CI –1.66 to –0.18; P=.02) and nonsignificant at the 6-month follow-up (coefficient=–0.33, 95% CI –1.11 to 0.45; P=.41). The estimated effect sizes were –0.15 and –0.06 at the 3- and 6-month follow-ups, respectively. Conclusions: Our study shows that the smartphone-based iCBT program was effective in reducing depression at the 3-month follow-up among hospital nurses in Vietnam and Thailand during the COVID-19 pandemic. However, the effect size was small, and therefore, these results may not be clinically meaningful. Trial Registration: UMIN Clinical Trials Registry UMIN000044145; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000050128 International Registered Report Identifier (IRRID): RR2-10.20944/preprints202303.0450.v1 %M 39213033 %R 10.2196/50071 %U https://www.jmir.org/2024/1/e50071 %U https://doi.org/10.2196/50071 %U http://www.ncbi.nlm.nih.gov/pubmed/39213033 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57401 %T Evaluation of Digital Mental Health Technologies in the United States: Systematic Literature Review and Framework Synthesis %A Catania,Julianna %A Beaver,Steph %A Kamath,Rakshitha S %A Worthington,Emma %A Lu,Minyi %A Gandhi,Hema %A Waters,Heidi C %A Malone,Daniel C %+ Department of Pharmacotherapy, Skaggs College of Pharmacy, University of Utah, Room 4922, 30 S 2000 East, Salt Lake City, UT, 84112, United States, 1 801 581 6257, dan.malone@utah.edu %K mental health %K mobile health %K mHealth %K digital health %K digital therapeutics %K systematic review %K framework synthesis %K mixed methods %D 2024 %7 30.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: Digital mental health technologies (DMHTs) have the potential to enhance mental health care delivery. However, there is little information on how DMHTs are evaluated and what factors influence their use. Objective: A systematic literature review was conducted to understand how DMHTs are valued in the United States from user, payer, and employer perspectives. Methods: Articles published after 2017 were identified from MEDLINE, Embase, PsycINFO, Cochrane Library, the Health Technology Assessment Database, and digital and mental health congresses. Each article was evaluated by 2 independent reviewers to identify US studies reporting on factors considered in the evaluation of DMHTs targeting mental health, Alzheimer disease, epilepsy, autism spectrum disorder, or attention-deficit/hyperactivity disorder. Study quality was assessed using the Critical Appraisal Skills Program Qualitative and Cohort Studies Checklists. Studies were coded and indexed using the American Psychiatric Association’s Mental Health App Evaluation Framework to extract and synthesize relevant information, and novel themes were added iteratively as identified. Results: Of the 4353 articles screened, data from 26 unique studies from patient, caregiver, and health care provider perspectives were included. Engagement style was the most reported theme (23/26, 88%), with users valuing DMHT usability, particularly alignment with therapeutic goals through features including anxiety management tools. Key barriers to DMHT use included limited internet access, poor technical literacy, and privacy concerns. Novel findings included the discreetness of DMHTs to avoid stigma. Conclusions: Usability, cost, accessibility, technical considerations, and alignment with therapeutic goals are important to users, although DMHT valuation varies across individuals. DMHT apps should be developed and selected with specific user needs in mind. %M 39213023 %R 10.2196/57401 %U https://mental.jmir.org/2024/1/e57401 %U https://doi.org/10.2196/57401 %U http://www.ncbi.nlm.nih.gov/pubmed/39213023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e56119 %T Web-Based Coping Skills Training and Coach Support for Women Living With a Partner With an Alcohol Use Disorder: Randomized Controlled Trial %A Rychtarik,Robert G %A Danaher,Brian G %A McGillicuddy,Neil B %A Tyler,Milagra S %A Barrick,Christopher %A Leong,Florence %A Kosty,Derek B %+ Department of Psychiatry and Clinical and Research Institute on Addictions, University at Buffalo, The State University of New York, 1021 Main Street, Buffalo, NY, 14203, United States, 1 7168872591, rgr@buffalo.edu %K alcohol use disorder %K AUD %K spouses %K coping skills training %K eHealth %K coaching %K telehealth %K web-based %K women %K randomized controlled trial %K RCT %K mobile phone %D 2024 %7 29.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals living with a partner with an alcohol use disorder (AUD) can experience significant psychological distress and use health care more than those without a partner with an AUD. However, the prevailing treatment system’s focus on the partner and personal barriers limit these individuals from getting help for themselves. Preliminary work on a self-directed, web-based coping skills training program, Stop Spinning My Wheels (SSMW), shows promise in broadening available treatments for this population. In this study, we conducted a robust evaluation of SSMW primary outcomes. Objective: The study aims to test whether women with a partner with an AUD assigned to SSMW experienced a greater reduction in negative affect (depression and anger) (1) than a usual web care (UWC) control and (2) with brief phone coach support (SSMW+coach) rather than without (SSMW only) and (3) whether baseline negative affect moderated treatment effects. Methods: Women (mean age 45.7, SD 10.8 years; Black: 17/456, 3.7%; White: 408/456, 89.5%) were randomized to SSMW only, SSMW+coach, or UWC. Depression (Beck Depression Inventory–II) and anger (State-Trait Anger Expression Inventory 2–State Anger) were assessed at baseline, 12-week posttest, and 6- and 12-month follow-ups. Results: Participants in all conditions decreased in depression from baseline to posttest and from baseline to follow-up; SSMW-only and SSMW+coach participants decreased in anger, but UWC participants did not. Compared to UWC participants, SSMW-only participants experienced greater anger reduction (P=.03), and SSMW+coach participants experienced a greater reduction in depression (P<.001) from baseline to posttest. However, from baseline to follow-up, only a greater, but not statistically significant (P=.052), reduction in anger occurred in SSMW+coach compared to UWC. Although the SSMW conditions did not differ from each other in negative affect outcomes (P=.06-.57), SSMW+coach had higher program engagement and satisfaction (all P<.004). Baseline negative affect did not moderate effects, although remission from baseline clinically relevant depressive symptoms (Beck Depression Inventory≥14) was higher in SSMW only (33/67, 49%; odds ratio 2.13, 95% CI 1.05-4.30; P=.03) and SSMW+coach (46/74, 62%; odds ratio 3.60, 95% CI 1.79-7.23; P<.001) than in UWC (21/67, 31%); remission rates did not differ between the SSMW conditions (P=.12). Conclusions: The results partially supported the hypotheses. The SSMW conditions had earlier effects than UWC, but positive change in UWC mitigated the hypothesized long-term SSMW-UWC differences. The results highlight the importance of incorporating active controls in web-based clinical trials. Although SSMW+coach showed benefits over SSMW only on engagement and satisfaction measures and in the number needed to treat (5.6 for SSMW only; 3.2 for SSMW+coach), the SSMW conditions were comparable and superior to UWC on depressive symptom remission levels. Overall, SSMW with or without a coach can reduce clinically meaningful distress and add to available treatment options for this large, underserved group. Trial Registration: ClinicalTrials.gov NCT02984241; https://www.clinicaltrials.gov/study/NCT02984241 %M 39208412 %R 10.2196/56119 %U https://www.jmir.org/2024/1/e56119 %U https://doi.org/10.2196/56119 %U http://www.ncbi.nlm.nih.gov/pubmed/39208412 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59993 %T Reducing Alcohol Misuse and Promoting Treatment Initiation Among Veterans Through a Brief Internet-Based Intervention: Protocol for a Randomized Controlled Trial %A Pedersen,Eric R %A Davis,Jordan P %A Hummer,Justin F %A Bouskill,Kathryn %A Buch,Keegan D %A Shute,Ireland M %A Fitzke,Reagan E %A Tran,Denise D %A Neighbors,Clayton %A Saba,Shaddy %+ Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Los Angeles, CA, 90089, United States, 1 3234424046, eric.pedersen@med.usc.edu %K military %K mental health %K substance use %K mobile %K PTSD %K posttraumatic stress disorder %K drinking %K mobile intervention %K digital intervention %K alcohol %K alcohol misuse %K veterans %K young adults %K depression %K alcohol use %K veteran health %K veteran %D 2024 %7 22.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young adult veterans who served after the September 11 attacks on the United States in 2001 (ie, post-9/11) are at heightened risk for experiencing behavioral health distress and disorders including hazardous drinking, posttraumatic stress disorder, and depression. These veterans often face significant barriers to behavioral health treatment, and reaching them through brief mobile phone–based interventions may help reduce drinking and promote treatment engagement. Objective: Following a successful pilot study, this randomized controlled trial (RCT) aims to further test the efficacy of a brief (ie, single session) mobile phone–delivered personalized normative feedback intervention enhanced with content to promote treatment engagement. Methods: We will conduct an RCT with 800 post-9/11 young adult veterans (aged 18 to 40 years) with potentially hazardous drinking and who have not recently received treatment for any behavioral health problems. Participants will be randomly assigned to the personalized intervention or a control condition with resources for seeking care. The personalized normative feedback module in the intervention focuses on the correction of misperceived norms of peer alcohol use and uses empirically informed approaches to increase motivation to address alcohol use and co-occurring behavioral health problems. Past 30-day drinking, alcohol-related consequences, and treatment-seeking behaviors will be assessed at baseline and 3, 6, 9, and 12 months post intervention. Sex, barriers to care, posttraumatic stress disorder, depression, and severity of alcohol use disorder symptoms will be explored as potential moderators of outcomes. Results: We expect recruitment to be completed within 6 months, with data collection taking 12 months for each enrolled participant. Analyses will begin within 3 months of the final data collection point (ie, 12 months follow-up). Conclusions: This RCT will evaluate the efficacy of a novel intervention for non–treatment-seeking veterans who struggle with hazardous drinking and possible co-occurring behavioral health problems. This intervention has the potential to improve veteran health outcomes and overcome significant barriers to treatment. Trial Registration: ClinicalTrials.gov NCT04244461; https://clinicaltrials.gov/study/NCT04244461 International Registered Report Identifier (IRRID): DERR1-10.2196/59993 %M 39173142 %R 10.2196/59993 %U https://www.researchprotocols.org/2024/1/e59993 %U https://doi.org/10.2196/59993 %U http://www.ncbi.nlm.nih.gov/pubmed/39173142 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e57990 %T Assessing Predictive Factors of Attitudes Toward Peer-Supported Mental Health Interventions in the Metaverse: Mixed Methods Study %A Ramos,Francisco Nicolas %A Bernstein,Rachel A %A Ezawa,Iony D %+ Department of Psychology, University of Southern California, 3620 S McClintock Ave, Los Angeles, CA, 90089, United States, 1 (213) 740 2203, ezawa@usc.edu %K metaverse %K mental health intervention %K consumer attitude %K digital mental health intervention %K virtual world %D 2024 %7 22.8.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: The metaverse is a promising avenue for accessible, effective digital mental health treatments. However, general attitudes toward peer-supported metaverse mental health interventions (MMHIs) remain largely unexplored. Objective: This study examined the relation of sociodemographic, mental health, and technology factors in predicting attitudes toward MMHIs. Methods: We used a mixed methods design with a self-report online survey (N=545 participants) to assess participant attitudes toward MMHIs and sociodemographic, mental health, and technology factors. Ordinal logistic regression was used to examine predictors of general interest in peer-supported MMHIs and binary logistic regression to examine predictors of preference for MMHIs versus face-to-face interventions. Inductive content analysis was performed on 483 open-ended responses regarding intervention preference. Results: Older age (odds ratio [OR] 1.03, 95% CI 1.02-1.05; P<.001), higher ethnic identity centrality (OR 1.44, 95% CI 1.25-1.66; P<.001), more positive mental help–seeking attitudes (OR 1.22, 95% CI 1.06-1.42; P=.007), more online video game use (OR 1.26, 95% CI 1.09-1.44; P=.001), and greater virtual reality experience (OR 1.55, 95% CI 1.28-1.90; P<.001) were associated with greater odds of reporting more interest in MMHIs. Internet access was associated with greater odds of reporting less interest in MMHIs (OR 0.50, 95% CI 0.30-0.84; P=.01). Hispanic ethnicity (OR 1.81, 95% CI 1.13-2.90; P=.01), older age (OR 1.04, 95% CI 1.02-1.05; P<.001), higher ethnic identity centrality (OR 1.28, 95% CI 1.09-1.51; P=.003), smartphone access (OR 10.46, 95% CI 2.87-50.71; P<.001), higher self-reported video game use (OR 1.25, 95% CI 1.05-1.48; P=.01), and more positive computer attitudes (OR 1.05, 95% CI 1.01-1.10; P=.02) predicted greater odds of preference for MMHIs (versus face-to-face interventions), whereas the male gender (OR 0.43, 95% CI 0.28-0.68; P<.001), internet access (OR 0.12, 95% CI 0.02-0.40; P=.002), more positive mental help–seeking attitudes (OR 0.76, 95% CI 0.62-0.92; P=.005), and moderately severe (OR 0.20, 95% CI 0.07-0.51; P=.001) and severe (OR 0.26, 95% CI 0.08-0.79; P=.02) levels of depression symptoms predicted lower odds of preference for MMHIs. Qualitative analysis revealed 14 themes describing reasons for intervention preference. Anonymity (133/483, 27.5%), social aversion (38/483, 7.9%), ease of use and accessibility (35/483, 7.2%), anxiety (28/483, 5.8%), and comfort (26/483, 5.4%) tended to be endorsed by those preferring MMHIs. Ecological validity of social interactions (99/483, 20.5%), ecological validity of interventions (75/483, 15.5%), aversion/distrust toward technology (42/483, 8.7%), impersonal quality (31/483, 6.4%), and immersion/engagement (11/483, 2.3%) tended to be endorsed by those who preferred face-to-face interventions. Mental health attitudes (28/483, 5.8%), privacy (19/483, 3.9%), and miscellaneous reasons (46/483, 9.5%) were endorsed equally between preferences. Novelty (21/483, 4.3%) was most cited by those who expressed no preference. Conclusions: This study identified several factors associated with attitudes toward peer-supported MMHIs, which may be leveraged to inform mental health outreach to interested populations. %R 10.2196/57990 %U https://xr.jmir.org/2024/1/e57990 %U https://doi.org/10.2196/57990 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50580 %T Capturing Patients’ and Clinicians’ Experiences of Using Video Consultations in Mental Health Outpatient Services: Qualitative Thematic Analysis %A Shaker,Ali Abbas %A Simonsen,Erik %A Tarp,Kristine %A Borisov,Radoslav Aleksandrov %A Sørensen,John Aasted %A Bechmann,Henrik %A Austin,Stephen F %+ Psychiatric Research Unit, Fælledvej 6, Bygning 3, 4. sal, Slagelse, 4200, Denmark, 45 58536070, ashak@regionsjaelland.dk %K telemedicine %K telepsychiatry %K video consultation %K mobile health %K mHealth %K COVID-19 %K synchronous technology %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the last decade, there has been an increase in the evidence base supporting the efficacy of video consultations (VCs) in mental health services. Furthermore, the potential of VC treatment was also demonstrated during the COVID-19 pandemic. Despite these promising results and conducive conditions for VCs, several studies have highlighted that the uptake and implementation of VCs continues to be slow, even after the pandemic. To facilitate and strengthen the implementation of VCs and exploit their potential as a useful tool for mental health disorder treatment, there is a need for a deeper understanding of the issues and experiences of implementing and using VCs as a treatment modality in clinical practice. Objective: The aim of this study was to investigate patients’ and clinicians’ experiences and attitudes toward using VCs in clinical practice. Methods: Treatment was conducted through the VC modality. Semistructured interviews were conducted individually with patients (n=10) and focus group interview were conducted with clinicians (n=4). Patients had participated in weekly VC treatment over 2 months as part of mental health outpatient services in Denmark. Data from these interviews were analyzed using thematic analysis. Results: Thematic analysis of the patient interviews yielded two main themes: (1) adjusting to the practicalities of the VC format and (2) the practice of therapy using VCs. Patients experienced that using VCs was easy and convenient, and it was possible to establish and maintain a therapeutic alliance. They also described the contact as different to in-person therapy. The thematic analysis conducted on clinicians’ experiences of using VCs yielded three themes: (1) a shift in mindset from resistance to acceptance, (2) the contact is different when using the VC modality, and (3) adapting to a new way of working. Clinicians experienced that their initial concerns and resistance toward VC implementation gradually diminished over time as they gained clinical experience of using the modality. They expressed that contact with patients can be different when using the VC modality and that it took time to adjust to a new way of working therapeutically. Conclusions: Both patients and clinicians experienced that VCs could enhance access to treatment and be meaningfully integrated into clinical practice. In addition, both groups described the contact when using the VC modality as being different to in-person therapy. Future research could examine patients’ and clinicians’ perceived differences regarding contact when using the VC modality and the implications for therapeutic interventions. %M 39167796 %R 10.2196/50580 %U https://formative.jmir.org/2024/1/e50580 %U https://doi.org/10.2196/50580 %U http://www.ncbi.nlm.nih.gov/pubmed/39167796 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e54637 %T Refining the Universal, School-Based OurFutures Mental Health Program to Be Trauma Informed, Gender and Sexuality Diversity Affirmative, and Adherent to Proportionate Universalism: Mixed Methods Participatory Design Process %A Grummitt,Lucinda %A Bailey,Sasha %A Kelly,Erin V %A Birrell,Louise %A Gardner,Lauren A %A Halladay,Jillian %A Chapman,Cath %A Andrews,Jack L %A Champion,Katrina E %A Hunter,Emily %A Egan,Lyra %A Conroy,Chloe %A Tiko,Raaya %A Nguyen,An %A Teesson,Maree %A Newton,Nicola C %A Barrett,Emma L %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, The University of Sydney, Sydney, 2006, Australia, 61 86279014, lucinda.grummitt@sydney.edu.au %K mental health %K prevention %K school %K depression %K anxiety %K proportionate universalism %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Mental disorders are the leading cause of disease burden among youth. Effective prevention of mental disorders during adolescence is a critical public health strategy to reduce both individual and societal harms. Schools are an important setting for prevention; however, existing universal school-based mental health interventions have shown null, and occasionally iatrogenic, effects in preventing symptoms of common disorders, such as depression and anxiety. Objective: This study aims to report the adaptation process of an established, universal, school-based prevention program for depression and anxiety, OurFutures Mental Health. Using a 4-stage process; triangulating quantitative, qualitative, and evidence syntheses; and centering the voices of young people, the revised program is trauma-informed; lesbian, gay, bisexual, transgender, nonbinary, queer, questioning, and otherwise gender and sexuality diverse (LGBTQA+) affirmative; relevant to contemporary youth; and designed to tailor intervention dosage to those who need it most (proportionate universalism). Methods: Program adaptation occurred from April 2022 to July 2023 and involved 4 stages. Stage 1 comprised mixed methods analysis of student evaluation data (n=762; mean age 13.5, SD 0.62 y), collected immediately after delivering the OurFutures Mental Health program in a previous trial. Stage 2 consisted of 3 focus groups with high school students (n=39); regular meetings with a purpose-built, 8-member LGBTQA+ youth advisory committee; and 2 individual semistructured, in-depth interviews with LGBTQA+ young people via Zoom (Zoom Video Communications) or WhatsApp (Meta) text message. Stage 3 involved a clinical psychologist providing an in-depth review of all program materials with the view of enhancing readability, improving utility, and normalizing emotions while retaining key cognitive behavioral therapy elements. Finally, stage 4 involved fortnightly consultations among researchers and clinicians on the intervention adaptation, drawing on the latest evidence from existing literature in school-based prevention interventions, trauma-informed practice, and adolescent mental health. Results: Drawing on feedback from youth, clinical psychologists, and expert youth mental health researchers, sourced from stages 1 to 4, a series of adaptations were made to the storylines, characters, and delivery of therapeutic content contained in the weekly manualized program content, classroom activities, and weekly student and teacher lesson summaries. Conclusions: The updated OurFutures Mental Health program is a trauma-informed, LBGTQA+ affirmative program aligned with the principles of proportionate universalism. The program adaptation responds to recent mixed findings on universal school-based mental health prevention programs, which include null, small beneficial, and small iatrogenic effects. The efficacy of the refined OurFutures Mental Health program is currently being tested through a cluster randomized controlled trial with up to 1400 students in 14 schools across Australia. It is hoped that the refined program will advance the current stalemate in universal school-based prevention of common mental disorders and ultimately improve the mental health and well-being of young people in schools. %M 39167794 %R 10.2196/54637 %U https://pediatrics.jmir.org/2024/1/e54637 %U https://doi.org/10.2196/54637 %U http://www.ncbi.nlm.nih.gov/pubmed/39167794 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53714 %T Machine Learning, Deep Learning, and Data Preprocessing Techniques for Detecting, Predicting, and Monitoring Stress and Stress-Related Mental Disorders: Scoping Review %A Razavi,Moein %A Ziyadidegan,Samira %A Mahmoudzadeh,Ahmadreza %A Kazeminasab,Saber %A Baharlouei,Elaheh %A Janfaza,Vahid %A Jahromi,Reza %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843-3131, United States, 1 979 458 2337, sasangohar@tamu.edu %K machine learning %K deep learning %K data preprocessing %K stress detection %K stress prediction %K stress monitoring %K mental disorders %D 2024 %7 21.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: Mental stress and its consequent mental health disorders (MDs) constitute a significant public health issue. With the advent of machine learning (ML), there is potential to harness computational techniques for better understanding and addressing mental stress and MDs. This comprehensive review seeks to elucidate the current ML methodologies used in this domain to pave the way for enhanced detection, prediction, and analysis of mental stress and its subsequent MDs. Objective: This review aims to investigate the scope of ML methodologies used in the detection, prediction, and analysis of mental stress and its consequent MDs. Methods: Using a rigorous scoping review process with PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, this investigation delves into the latest ML algorithms, preprocessing techniques, and data types used in the context of stress and stress-related MDs. Results: A total of 98 peer-reviewed publications were examined for this review. The findings highlight that support vector machine, neural network, and random forest models consistently exhibited superior accuracy and robustness among all ML algorithms examined. Physiological parameters such as heart rate measurements and skin response are prevalently used as stress predictors due to their rich explanatory information concerning stress and stress-related MDs, as well as the relative ease of data acquisition. The application of dimensionality reduction techniques, including mappings, feature selection, filtering, and noise reduction, is frequently observed as a crucial step preceding the training of ML algorithms. Conclusions: The synthesis of this review identified significant research gaps and outlines future directions for the field. These encompass areas such as model interpretability, model personalization, the incorporation of naturalistic settings, and real-time processing capabilities for the detection and prediction of stress and stress-related MDs. %M 39167782 %R 10.2196/53714 %U https://mental.jmir.org/2024/1/e53714 %U https://doi.org/10.2196/53714 %U http://www.ncbi.nlm.nih.gov/pubmed/39167782 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e59560 %T Self-Administered Interventions Based on Natural Language Processing Models for Reducing Depressive and Anxiety Symptoms: Systematic Review and Meta-Analysis %A Villarreal-Zegarra,David %A Reategui-Rivera,C Mahony %A García-Serna,Jackeline %A Quispe-Callo,Gleni %A Lázaro-Cruz,Gabriel %A Centeno-Terrazas,Gianfranco %A Galvez-Arevalo,Ricardo %A Escobar-Agreda,Stefan %A Dominguez-Rodriguez,Alejandro %A Finkelstein,Joseph %+ Department of Biomedical Informatics, School of Medicine, University of Utah, 421 Wakara Way, Salt Lake City, UT, 84108, United States, 1 (801) 581 4080, mahony.reategui@utah.edu %K natural language processing %K depression %K anxiety %K systematic review %K artificial intelligence %K AI %D 2024 %7 21.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: The introduction of natural language processing (NLP) technologies has significantly enhanced the potential of self-administered interventions for treating anxiety and depression by improving human-computer interactions. Although these advances, particularly in complex models such as generative artificial intelligence (AI), are highly promising, robust evidence validating the effectiveness of the interventions remains sparse. Objective: The aim of this study was to determine whether self-administered interventions based on NLP models can reduce depressive and anxiety symptoms. Methods: We conducted a systematic review and meta-analysis. We searched Web of Science, Scopus, MEDLINE, PsycINFO, IEEE Xplore, Embase, and Cochrane Library from inception to November 3, 2023. We included studies with participants of any age diagnosed with depression or anxiety through professional consultation or validated psychometric instruments. Interventions had to be self-administered and based on NLP models, with passive or active comparators. Outcomes measured included depressive and anxiety symptom scores. We included randomized controlled trials and quasi-experimental studies but excluded narrative, systematic, and scoping reviews. Data extraction was performed independently by pairs of authors using a predefined form. Meta-analysis was conducted using standardized mean differences (SMDs) and random effects models to account for heterogeneity. Results: In all, 21 articles were selected for review, of which 76% (16/21) were included in the meta-analysis for each outcome. Most of the studies (16/21, 76%) were recent (2020-2023), with interventions being mostly AI-based NLP models (11/21, 52%); most (19/21, 90%) delivered some form of therapy (primarily cognitive behavioral therapy: 16/19, 84%). The overall meta-analysis showed that self-administered interventions based on NLP models were significantly more effective in reducing both depressive (SMD 0.819, 95% CI 0.389-1.250; P<.001) and anxiety (SMD 0.272, 95% CI 0.116-0.428; P=.001) symptoms compared to various control conditions. Subgroup analysis indicated that AI-based NLP models were effective in reducing depressive symptoms (SMD 0.821, 95% CI 0.207-1.436; P<.001) compared to pooled control conditions. Rule-based NLP models showed effectiveness in reducing both depressive (SMD 0.854, 95% CI 0.172-1.537; P=.01) and anxiety (SMD 0.347, 95% CI 0.116-0.578; P=.003) symptoms. The meta-regression showed no significant association between participants’ mean age and treatment outcomes (all P>.05). Although the findings were positive, the overall certainty of evidence was very low, mainly due to a high risk of bias, heterogeneity, and potential publication bias. Conclusions: Our findings support the effectiveness of self-administered NLP-based interventions in alleviating depressive and anxiety symptoms, highlighting their potential to increase accessibility to, and reduce costs in, mental health care. Although the results were encouraging, the certainty of evidence was low, underscoring the need for further high-quality randomized controlled trials and studies examining implementation and usability. These interventions could become valuable components of public health strategies to address mental health issues. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023472120; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023472120 %M 39167795 %R 10.2196/59560 %U https://mental.jmir.org/2024/1/e59560 %U https://doi.org/10.2196/59560 %U http://www.ncbi.nlm.nih.gov/pubmed/39167795 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53794 %T Skill Enactment Among University Students Using a Brief Video-Based Mental Health Intervention: Mixed Methods Study Within a Randomized Controlled Trial %A Jackson,Hayley M %A Batterham,Philip J %A Calear,Alison L %A Ohan,Jeneva L %A Farrer,Louise M %+ Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, 63 Eggleston Road, Acton ACT, 2601, Australia, 61 416913323, hayley.jackson@anu.edu.au %K university students %K young people %K internet %K computer-assisted therapy %K engagement %K skill enactment %K depression %K anxiety %K randomized controlled trial %K mobile phone %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health problems are common among university students, yet many students do not seek professional help. Digital mental health interventions can increase students’ access to support and have been shown to be effective in preventing and treating mental health problems. However, little is known about the extent to which students implement therapeutic skills from these programs in everyday life (ie, skill enactment) or about the impact of skill enactment on outcomes. Objective: This study aims to assess the effects of a low-intensity video-based intervention, Uni Virtual Clinic Lite (UVC-Lite), in improving skill enactment relative to an attention-control program (primary aim) and examine whether skill enactment influences symptoms of depression and anxiety (secondary aim). The study also qualitatively explored participants’ experiences of, and motivations for, engaging with the therapeutic techniques. Methods: We analyzed data from a randomized controlled trial testing the effectiveness of UVC-Lite for symptoms of depression and anxiety among university students with mild to moderate levels of psychological distress. Participants were recruited from universities across Australia and randomly assigned to 6 weeks of self-guided use of UVC-Lite (243/487, 49.9%) or an attention-control program (244/487, 50.1%). Quantitative data on skill enactment, depression, and anxiety were collected through baseline, postintervention, and 3- and 6-month follow-up surveys. Qualitative data were obtained from 29 intervention-group participants through open-ended questions during postintervention surveys (n=17, 59%) and semistructured interviews (n=12, 41%) after the intervention period concluded. Results: Mixed model repeated measures ANOVA demonstrated that the intervention did not significantly improve skill enactment (F3,215.36=0.50; P=.68). Skill enactment was also not found to influence change in symptoms of depression (F3,241.10=1.69; P=.17) or anxiety (F3,233.71=1.11; P=.35). However, higher levels of skill enactment were associated with lower symptom levels among both intervention and control group participants across time points (depression: F1,541.87=134.61; P<.001; anxiety: F1,535.11=73.08; P<.001). Inductive content analysis confirmed low levels of skill enactment among intervention group participants. Participants were motivated to use techniques and skills that were perceived to be personally relevant, easily integrated into daily life, and that were novel or had worked for them in the past. Conclusions: The intervention did not improve skill enactment or mental health among students with mild to moderate psychological distress. Low adherence impacted our ability to draw robust conclusions regarding the intervention’s impact on outcomes. Factors influencing skill enactment differed across individuals, suggesting that it may be necessary to tailor therapeutic skills and engagement strategies to the individual user. Theoretically informed research involving collaboration with end users is needed to understand the processes underlying skill enactment in digital mental health interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://tinyurl.com/7b9ar54r %M 39167783 %R 10.2196/53794 %U https://mental.jmir.org/2024/1/e53794 %U https://doi.org/10.2196/53794 %U http://www.ncbi.nlm.nih.gov/pubmed/39167783 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56960 %T Evaluating the Efficacy of a Digital Therapeutic (CT-152) as an Adjunct to Antidepressant Treatment in Adults With Major Depressive Disorder: Protocol for the MIRAI Remote Study %A Rothman,Brian %A Slomkowski,Mary %A Speier,Austin %A Rush,A John %A Trivedi,Madhukar H %A Lawson,Erica %A Fahmy,Michael %A Carpenter,Daniel %A Chen,Dalei %A Forbes,Ainslie %+ Otsuka Pharmaceutical Development & Commercialization, Inc, 508 Carnegie Center Dr, Princeton, NJ, 08540, United States, 1 609 524 6788, brian.rothman@otsuka-us.com %K adherence %K digital placebo %K sham control %K cognitive-emotional training %K Emotional Faces Memory Task %K mobile phone %D 2024 %7 20.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Major depressive disorder (MDD) is common worldwide and can be highly disabling. People with MDD face many barriers to treatment and may not experience full symptom relief even when treated. Therefore, new treatment modalities are needed for MDD. Digital therapeutics (DTx) may provide people with MDD an additional treatment option. Objective: This study aimed to describe a phase 3 remote, multicenter, randomized, masked, sham-controlled trial evaluating the efficacy of a smartphone app–based DTx (CT-152) in adult participants diagnosed with MDD, used as an adjunct to antidepressant therapy (ADT). Methods: Participants aged 22-64 years with a current primary diagnosis of MDD and an inadequate response to ADT were included. Participants were randomized 1:1 to CT-152 or a sham DTx. CT-152 is a smartphone app–based DTx that delivers a cognitive-emotional and behavioral therapeutic intervention. The core components of CT-152 are the Emotional Faces Memory Task exercises, brief lessons to learn and apply key therapeutic skills, and SMS text messaging to reinforce lessons and encourage engagement with the app. The sham DTx is a digital working memory exercise with emotionally neutral stimuli designed to match CT-152 for time and attention. Participants took part in the trial for up to 13 weeks. The trial included a screening period of up to 3 weeks, a treatment period of 6 weeks, and an extension period of 4 weeks to assess the durability of the effect. Sites and participants had the option of an in-person or remote screening visit; the remaining trial visits were remote. Efficacy was evaluated using the Montgomery-Åsberg Depression Rating Scale, the Generalized Anxiety Disorder-7, Clinical Global Impression–Severity scale, the Patient Health Questionnaire-9, and the World Health Organization Disability Assessment Schedule 2.0. The durability of the effect was evaluated with the Montgomery-Åsberg Depression Rating Scale and Generalized Anxiety Disorder-7 scale. Adverse events were also assessed. Satisfaction, measured by the Participant and Healthcare Professional Satisfaction Scales, and health status, measured by the EQ-5D-5L, were summarized using descriptive statistics. Results: This study was initiated in February 2021 and had a primary completion date in October 2022. Conclusions: This represents the methodological design for the first evaluation of CT-152 as an adjunct to ADT. This study protocol is methodologically robust and incorporates many aspects of conventional pivotal pharmaceutical phase 3 trial design, such as randomization and safety end points. Novel considerations included the use of a sham comparator, masking considerations for visible app content, and outcome measures relevant to DTx. The rigor of this methodology will provide a more comprehensive understanding of the effectiveness of CT-152. Trial Registration: ClinicalTrials.gov NCT04770285; https://clinicaltrials.gov/study/NCT04770285 International Registered Report Identifier (IRRID): RR1-10.2196/56960 %M 39163592 %R 10.2196/56960 %U https://www.researchprotocols.org/2024/1/e56960 %U https://doi.org/10.2196/56960 %U http://www.ncbi.nlm.nih.gov/pubmed/39163592 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54816 %T Using a Digital Mental Health Intervention for Crisis Support and Mental Health Care Among Children and Adolescents With Self-Injurious Thoughts and Behaviors: Retrospective Study %A Lawrence-Sidebottom,Darian %A Huffman,Landry Goodgame %A Beam,Aislinn Brenna %A McAlister,Kelsey %A Guerra,Rachael %A Parikh,Amit %A Roots,Monika %A Huberty,Jennifer %+ Bend Health, Inc, Ste 200, 821 E Washington Ave, Madison, WI, 53703, United States, 1 8005160975, darian.lawrence@bendhealth.com %K suicide %K self-harm %K collaborative care %K behavioral health %K telehealth %K telemedicine %K eHealth %K collaborative %K collaboration %K suicidal %K self-injury %K crisis %K crises %K mental health %K self-injurious %K anxiety %K depression %K pediatric %K pediatrics %K child %K children %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K mobile phone %D 2024 %7 16.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-injurious thoughts and behaviors (SITBs) are increasing dramatically among children and adolescents. Crisis support is intended to provide immediate mental health care, risk mitigation, and intervention for those experiencing SITBs and acute mental health distress. Digital mental health interventions (DMHIs) have emerged as accessible and effective alternatives to in-person care; however, most do not provide crisis support or ongoing care for children and adolescents with SITBs. Objective: To inform the development of digital crisis support and mental health care for children and adolescents presenting with SITBs, this study aims to (1) characterize children and adolescents with SITBs who participate in a digital crisis response service, (2) compare anxiety and depressive symptoms of children and adolescents presenting with SITBs versus those without SITBs throughout care, and (3) suggest future steps for the implementation of digital crisis support and mental health care for children and adolescents presenting with SITBs. Methods: This retrospective study was conducted using data from children and adolescents (aged 1-17 y; N=2161) involved in a pediatric collaborative care DMHI. SITB prevalence was assessed during each live session. For children and adolescents who exhibited SITBs during live sessions, a rapid crisis support team provided evidence-based crisis support services. Assessments were completed approximately once a month to measure anxiety and depressive symptom severity. Demographics, mental health symptoms, and change in the mental health symptoms of children and adolescents presenting with SITBs (group with SITBs) were compared to those of children and adolescents with no SITBs (group without SITBs). Results: Compared to the group without SITBs (1977/2161, 91.49%), the group with SITBs (184/2161, 8.51%) was mostly made up of adolescents (107/184, 58.2%) and female children and adolescents (118/184, 64.1%). At baseline, compared to the group without SITBs, the group with SITBs had more severe anxiety and depressive symptoms. From before to after mental health care with the DMHI, the 2 groups did not differ in the rate of children and adolescents with anxiety symptom improvement (group with SITBs: 54/70, 77% vs group without SITBs: 367/440, 83.4%; χ21=1.2; P=.32) as well as depressive symptom improvement (group with SITBs: 58/72, 81% vs group without SITBs: 255/313, 81.5%; χ21=0; P=.99). The 2 groups also did not differ in the amount of change in symptom severity during care with the DMHI for anxiety (t80.20=1.37; P=.28) and depressive (t83.75=–0.08; P=.99) symptoms. Conclusions: This study demonstrates that participation in a collaborative care DMHI is associated with improved mental health outcomes in children and adolescents experiencing SITBs. These results provide preliminary insights for the use of pediatric DMHIs in crisis support and mental health care for children and adolescents presenting with SITBs, thereby addressing the public health issue of acute mental health crisis in children and adolescents. %M 39151166 %R 10.2196/54816 %U https://formative.jmir.org/2024/1/e54816 %U https://doi.org/10.2196/54816 %U http://www.ncbi.nlm.nih.gov/pubmed/39151166 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59699 %T Impact of an Online Discussion Forum on Self-Guided Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Randomized Trial %A McCall,Hugh C %A Hadjistavropoulos,Heather D %+ Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK, S4S 0A2, Canada, 1 306 585 5133, Heather.Hadjistavropoulos@uregina.ca %K internet %K cognitive behavioral therapy %K forum %K persuasive design %K generalized anxiety disorder %K major depressive disorder %K posttraumatic stress disorder %K public safety personnel %D 2024 %7 14.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective and accessible treatment for various mental health concerns. ICBT has shown promising treatment outcomes among public safety personnel (PSP), who experience high rates of mental health problems and face barriers to accessing other mental health services. Client engagement and clinical outcomes are better in ICBT with therapist guidance, but ICBT is easier to implement on a large scale when it is self-guided. Therefore, it is important to identify strategies to improve outcomes and engagement in self-guided ICBT and other self-guided digital mental health interventions. One such strategy is the use of online discussion forums to provide ICBT clients with opportunities for mutual social support. Self-guided interventions accompanied by online discussion forums have shown excellent treatment outcomes, but there is a need for research experimentally testing the impact of online discussion forums in ICBT. Objective: We aimed to evaluate a transdiagnostic, self-guided ICBT intervention tailored specifically for PSP (which had not previously been assessed), assess the impact of adding a therapist-moderated online discussion forum on outcomes, and analyze participants’ feedback to inform future research and implementation efforts. Methods: In this randomized trial, we randomly assigned participating PSP (N=107) to access an 8-week transdiagnostic, self-guided ICBT course with or without a built-in online discussion forum. Enrollment and participation were entirely web-based. We assessed changes in depression, anxiety, and posttraumatic stress as well as several secondary outcome measures (eg, treatment engagement and satisfaction) using questionnaires at the pre-enrollment, 8-week postenrollment, and 20-week postenrollment time points. Mixed methods analyses included multilevel modeling and qualitative content analysis. Results: Participants engaged minimally with the forum, creating 9 posts. There were no differences in treatment outcomes between participants who were randomly assigned to access the forum (56/107, 52.3%) and those who were not (51/107, 47.7%). Across conditions, participants who reported clinically significant symptoms during enrollment showed large and statistically significant reductions in symptoms (P<.05 and d>0.97 in all cases). Participants also showed good treatment engagement and satisfaction, with 43% (46/107) of participants fully completing the intervention during the course of the study and 96% (79/82) indicating that the intervention was worth their time. Conclusions: Previous research has shown excellent clinical outcomes for self-guided ICBT accompanied by discussion forums and good engagement with those forums. Although clinical outcomes in our study were excellent across conditions, engagement with the forum was poor, in contrast to previous research. We discuss several possible interpretations of this finding (eg, related to the population under study or the design of the forum). Our findings highlight a need for more research evaluating the impact of online discussion forums and other strategies for improving outcomes and engagement in self-guided ICBT and other digital mental health interventions. Trial Registration: ClinicalTrials.gov NCT05145582; https://clinicaltrials.gov/study/NCT05145582 %M 39141899 %R 10.2196/59699 %U https://www.jmir.org/2024/1/e59699 %U https://doi.org/10.2196/59699 %U http://www.ncbi.nlm.nih.gov/pubmed/39141899 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56045 %T Application of Positive Psychology in Digital Interventions for Children, Adolescents, and Young Adults: Systematic Review and Meta-Analysis of Controlled Trials %A Saboor,Sundas %A Medina,Adrian %A Marciano,Laura %+ Lee Kum Sheung Center for Health and Happiness, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, United States, 1 6175828025, lmarciano@hsph.harvard.edu %K positive psychology %K digital interventions %K ill-being %K well-being %K systematic review %K meta-analysis %K smartphone %K mobile phone %D 2024 %7 14.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: The rising prevalence of mental health issues in children, adolescents, and young adults has become an escalating public health issue, impacting approximately 10%-20% of young people on a global scale. Positive psychology interventions (PPIs) can act as powerful mental health promotion tools to reach wide-ranging audiences that might otherwise be challenging to access. This increased access would enable prevention of mental disorders and promotion of widespread well-being by enhancing self-efficacy, thereby supporting the achievement of tangible objectives. Objective: We aimed to conduct a comprehensive synthesis of all randomized controlled trials and controlled trials involving children, adolescents, and young adults, encompassing both clinical and nonclinical populations, to comprehensively evaluate the effectiveness of digital PPIs in this age group. Methods: After a literature search in 9 electronic databases until January 12, 2023, and gray literature until April 2023, we carried out a systematic review of 35 articles, of which 18 (51%) provided data for the meta-analysis. We included randomized controlled trials and controlled trials mainly based on web-based, digital, or smartphone-based interventions using a positive psychology framework as the main component. Studies included participants with a mean age of <35 years. Outcomes of PPIs were classified into indicators of well-being (compassion, life satisfaction, optimism, happiness, resilience, emotion regulation and emotion awareness, hope, mindfulness, purpose, quality of life, gratitude, empathy, forgiveness, motivation, and kindness) and ill-being (depression, anxiety, stress, loneliness, and burnout). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used for the selection of studies and data extraction. Quality assessment was performed following the CONSORT (Consolidated Standards of Reporting Trials) guidelines. Results: For well-being outcomes, meta-analytic results showed that PPIs augmented the feeling of purpose, gratitude, and hope (Hedges g=0.555), compassion (Hedges g=0.447), positive coping behaviors (Hedges g=0.421), body image–related outcomes (Hedges g=0.238), and positive mindset predisposition (Hedges g=0.304). For ill-being outcomes, PPIs reduced cognitive biases (Hedges g=–0.637), negative emotions and mood (Hedges g=–0.369), and stress levels (Hedges g=–0.342). Of note, larger effect sizes were found when a waiting list control group was considered versus a digital control group. A funnel plot showed no publication bias. Meta-regression analyses showed that PPIs tended to show a larger effect size on well-being outcomes in studies including young adults, whereas no specific effect was found for ill-being outcomes. Conclusions: Revised evidence suggests that PPIs benefit young people’s well-being and mitigate ill-being symptoms. Digital platforms offer a unique way to address their mental health challenges, although not without limitations. Future research should explore how they work for the needs of the young population and further examine what specific PPIs or combination of interventions is most beneficial with respect to other digital control groups. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023420092; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=420092 %M 39141906 %R 10.2196/56045 %U https://mental.jmir.org/2024/1/e56045 %U https://doi.org/10.2196/56045 %U http://www.ncbi.nlm.nih.gov/pubmed/39141906 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53598 %T A Transdiagnostic Video-Based Internet Intervention (Uni Virtual Clinic-Lite) to Improve the Mental Health of University Students: Randomized Controlled Trial %A Farrer,Louise M %A Jackson,Hayley M %A Gulliver,Amelia %A Calear,Alison L %A Leach,Liana %A Hasking,Penelope %A Katruss,Natasha %A Batterham,Philip J %+ Centre for Mental Health Research, National Centre for Epidemiology and Population Health, The Australian National University, 63 Eggleston Rd, Canberra, 2601, Australia, 61 6125 8859, louise.farrer@anu.edu.au %K university students %K internet-based intervention %K randomized controlled trial %K mental health %K transdiagnostic %D 2024 %7 13.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous studies have demonstrated the effectiveness of digital interventions for improving the mental health of university students. However, low rates of engagement with these interventions are an ongoing challenge and can compromise effectiveness. Brief, transdiagnostic, web-based video interventions are capable of targeting key mental health and related issues affecting university students and may be more engaging and accessible for this population. Objective: This study used a 2-arm randomized controlled trial to evaluate the effectiveness of Uni Virtual Clinic-Lite (UVC-Lite), a fully automated, transdiagnostic, web-based video intervention, relative to an attention-control condition. The primary outcomes were symptoms of depression and generalized anxiety disorder. The secondary outcomes included psychological distress, social anxiety symptoms, body appreciation, quality of life, well-being, functioning, general self-efficacy, academic self-efficacy, and help seeking. Program use (intervention uptake and engagement) and satisfaction were also assessed. Methods: University students (n=487) with mild to moderate symptoms of distress were recruited from universities across Australia and randomly allocated to receive access to the UVC-Lite intervention or an attention-control condition targeting general health for a period of 6 weeks. UVC-Lite includes 12 modules, each comprising a brief animated video and an accompanying exercise. Of the 12 modules, 7 also included a brief symptom screening quiz. Outcomes were assessed at baseline, postintervention, and 3- and 6-months postintervention. Results: The primary and secondary outcomes were analyzed on an intention-to-treat basis using mixed models repeated measures ANOVA. The intervention was not found to be effective relative to the control condition on any of the primary or secondary outcomes. While 67.9% (114/168) of participants accessed at least 1 module of the intervention, module completion was extremely low. Subgroup analyses among those who engaged with the program (completed at least 1 video) and those with higher baseline distress (Distress Questionnaire-5 score ≥15) did not reveal any differences between the conditions over time. However, uptake (accessing at least 1 video) and engagement (completing at least 1 video) were higher among those with higher baseline symptoms. Satisfaction with the intervention was high. Conclusions: The UVC-Lite intervention was not effective relative to a control program, although it was associated with high satisfaction among students and was not associated with symptom deterioration. Given the challenges faced by universities in meeting demand for mental health services, flexible and accessible interventions such as UVC-Lite have the potential to assist students to manage symptoms of mental health problems. However, low uptake and engagement (particularly among students with lower levels of symptomatology) are significant challenges that require further attention. Future studies should examine the effectiveness of the intervention in a more highly symptomatic sample, as well as implementation pathways to optimize effective engagement with the intervention. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000375853; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380146 %M 39137012 %R 10.2196/53598 %U https://www.jmir.org/2024/1/e53598 %U https://doi.org/10.2196/53598 %U http://www.ncbi.nlm.nih.gov/pubmed/39137012 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59224 %T An Automated Text Messaging Intervention to Reduce Substance Use Self-Stigma (Project RESTART): Protocol for a Feasibility and Acceptability Pilot Study %A Sibley,Adams L %A Noar,Seth M %A Muessig,Kathryn E %A O'Shea,Nisha G %A Paquette,Catherine E %A Spears,Abby G %A Miller,William C %A Go,Vivian F %+ Department of Health Behavior, University of North Carolina-Chapel Hill, 302 Rosenau Hall CB# 7400, 135 Dauer Dr., Chapel Hill, NC, 27599, United States, 1 919 966 3761, asibley@live.unc.edu %K substance use %K harm reduction %K stigma %K self-stigma %K stigma resistance %K mobile health %K mHealth %K SMS text messaging %K mobile phone %D 2024 %7 9.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stigma is a barrier to treatment and harm reduction seeking in people who use drugs. Most stigma reduction interventions offer psychotherapy or psychoeducation in group-based clinical settings, failing to reach people who are not in treatment. SMS text messaging is an effective and acceptable modality for delivering health information to people who use drugs and may be a suitable conduit for providing information and advice to understand and cope with stigma. Objective: This paper presents the protocol for a study that aims to determine the feasibility, acceptability, and preliminary effectiveness of a 4-week automated SMS text message intervention to increase stigma resistance and reduce self-stigma in people who use drugs. Methods: We designed a novel automated SMS text message intervention to address the four personal-level constructs of stigma resistance: (1) not believing stigma and catching and challenging stigmatizing thoughts, (2) empowering oneself through learning about substance use and one’s recovery, (3) maintaining one’s recovery and proving stigma wrong, and (4) developing a meaningful identity and purpose apart from one’s substance use. Theory-based messages were developed and pilot-tested in qualitative elicitation interviews with 22 people who use drugs, resulting in a library of 56 messages. In a single-group, within-subjects, community-based pilot trial, we will enroll 30 participants in the Resisting Stigma and Revaluating Your Thoughts (RESTART) intervention. Participants will receive 2 daily SMS text messages for 4 weeks. Implementation feasibility will be assessed through recruitment, enrollment, retention, and message delivery statistics. User feasibility and acceptability will be assessed at follow-up using 23 survey items informed by the Theoretical Framework of Acceptability. Primary effectiveness outcomes are changes in self-stigma (Substance Abuse Self-Stigma Scale) and stigma resistance (Stigma Resistance Scale) from baseline to follow-up measured via a self-administered survey. Secondary outcomes are changes in hope (Adult Dispositional Hope Scale) and self-esteem (Rosenberg Self-Esteem Scale). Feasibility and acceptability will be assessed with descriptive statistics; effectiveness outcomes will be assessed with paired 2-tailed t tests, and group differences will be explored using ANOVA. Overall, 12 participants will also be selected to complete acceptability interviews. Results: This pilot study was funded by the National Institute on Drug Abuse in April 2023 and received regulatory approval in January 2024 by the University of North Carolina-Chapel Hill Institutional Review Board. Recruitment and enrollment began in March 2024. Follow-up visits are expected to conclude by May 2024. Results will be disseminated in relevant peer-reviewed journals. Conclusions: To the best of our knowledge, this is the first study to address substance use stigma via a self-help SMS text messaging program. Results will add to the nascent literature on stigma reduction in people who use drugs. This protocol may interest researchers who are considering text messaging to address psychosocial needs in hard-to-reach populations. Trial Registration: ClinicalTrials.gov NCT06281548; https://clinicaltrials.gov/ct2/show/NCT06281548 International Registered Report Identifier (IRRID): DERR1-10.2196/59224 %M 39121478 %R 10.2196/59224 %U https://www.researchprotocols.org/2024/1/e59224 %U https://doi.org/10.2196/59224 %U http://www.ncbi.nlm.nih.gov/pubmed/39121478 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55151 %T Differences in Fear and Negativity Levels Between Formal and Informal Health-Related Websites: Analysis of Sentiments and Emotions %A Paradise Vit,Abigail %A Magid,Avi %+ Department of Information Systems, The Max Stern Yezreel Valley College, Emek Yezreel 1, Emek Yezreel, 1930600, Israel, 972 509903930, abigailparadise@gmail.com %K emotions %K sentiment %K health websites %K fear %D 2024 %7 9.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Searching for web-based health-related information is frequently performed by the public and may affect public behavior regarding health decision-making. Particularly, it may result in anxiety, erroneous, and harmful self-diagnosis. Most searched health-related topics are cancer, cardiovascular diseases, and infectious diseases. A health-related web-based search may result in either formal or informal medical website, both of which may evoke feelings of fear and negativity. Objective: Our study aimed to assess whether there is a difference in fear and negativity levels between information appearing on formal and informal health-related websites. Methods: A web search was performed to retrieve the contents of websites containing symptoms of selected diseases, using selected common symptoms. Retrieved websites were classified into formal and informal websites. Fear and negativity of each content were evaluated using 3 transformer models. A fourth transformer model was fine-tuned using an existing emotion data set obtained from a web-based health community. For formal and informal websites, fear and negativity levels were aggregated. t tests were conducted to evaluate the differences in fear and negativity levels between formal and informal websites. Results: In this study, unique websites (N=1448) were collected, of which 534 were considered formal and 914 were considered informal. There were 1820 result pages from formal websites and 1494 result pages from informal websites. According to our findings, fear levels were statistically higher (t2753=3.331; P<.001) on formal websites (mean 0.388, SD 0.177) than on informal websites (mean 0.366, SD 0.168). The results also show that the level of negativity was statistically higher (t2753=2.726; P=.006) on formal websites (mean 0.657, SD 0.211) than on informal websites (mean 0.636, SD 0.201). Conclusions: Positive texts may increase the credibility of formal health websites and increase their usage by the general public and the public’s compliance to the recommendations. Increasing the usage of natural language processing tools before publishing health-related information to achieve a more positive and less stressful text to be disseminated to the public is recommended. %M 39120928 %R 10.2196/55151 %U https://www.jmir.org/2024/1/e55151 %U https://doi.org/10.2196/55151 %U http://www.ncbi.nlm.nih.gov/pubmed/39120928 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47100 %T Comparing Federal Communications Commission and Microsoft Estimates of Broadband Access for Mental Health Video Telemedicine Among Veterans: Retrospective Cohort Study %A O'Shea,Amy MJ %A Mulligan,Kailey %A Carter,Knute D %A Haraldsson,Bjarni %A Wray,Charlie M %A Shahnazi,Ariana %A Kaboli,Peter J %+ Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, 601 US Hwy 6, Iowa City, IA, 52246, United States, 1 3193380581, amy.oshea@va.gov %K broadband %K telemedicine %K Federal Communications Commission %K veterans %K United States Department of Veterans Affairs %K internet %K mental health care %K veteran health %K broadband access %K web-based %K digital %D 2024 %7 8.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic highlighted the importance of telemedicine in health care. However, video telemedicine requires adequate broadband internet speeds. As video-based telemedicine grows, variations in broadband access must be accurately measured and characterized. Objective: This study aims to compare the Federal Communications Commission (FCC) and Microsoft US broadband use data sources to measure county-level broadband access among veterans receiving mental health care from the Veterans Health Administration (VHA). Methods: Retrospective observational cohort study using administrative data to identify mental health visits from January 1, 2019, to December 31, 2020, among 1161 VHA mental health clinics. The exposure is county-level broadband percentages calculated as the percentage of the county population with access to adequate broadband speeds (ie, download >25 megabits per second) as measured by the FCC and Microsoft. All veterans receiving VHA mental health services during the study period were included and categorized based on their use of video mental health visits. Broadband access was compared between and within data sources, stratified by video versus no video telemedicine use. Results: Over the 2-year study period, 1,474,024 veterans with VHA mental health visits were identified. Average broadband percentages varied by source (FCC mean 91.3%, SD 12.5% vs Microsoft mean 48.2%, SD 18.1%; P<.001). Within each data source, broadband percentages generally increased from 2019 to 2020. Adjusted regression analyses estimated the change after pandemic onset versus before the pandemic in quarterly county-based mental health visit counts at prespecified broadband percentages. Using FCC model estimates, given all other covariates are constant and assuming an FCC percentage set at 70%, the incidence rate ratio (IRR) of county-level quarterly mental video visits during the COVID-19 pandemic was 6.81 times (95% CI 6.49-7.13) the rate before the pandemic. In comparison, the model using Microsoft data exhibited a stronger association (IRR 7.28; 95% CI 6.78-7.81). This relationship held across all broadband access levels assessed. Conclusions: This study found FCC broadband data estimated higher and less variable county-level broadband percentages compared to those estimated using Microsoft data. Regardless of the data source, veterans without mental health video visits lived in counties with lower broadband access, highlighting the need for accurate broadband speeds to prioritize infrastructure and intervention development based on the greatest community-level impacts. Future work should link broadband access to differences in clinical outcomes. %M 39116440 %R 10.2196/47100 %U https://www.jmir.org/2024/1/e47100 %U https://doi.org/10.2196/47100 %U http://www.ncbi.nlm.nih.gov/pubmed/39116440 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e51512 %T Developing an Automated Virtual Reality Therapy for Improving Positive Self-Beliefs and Psychological Well-Being (Phoenix VR Self-Confidence Therapy): Tutorial %A Rosebrock,Laina %A Freeman,Jason %A Rovira,Aitor %A Miguel,Andre Lages %A Ward,Rupert %A Bousfield,Matthew %A Riffiod,Ludovic %A Kamvar,Roya %A Kabir,Thomas %A Waite,Felicity %A Freeman,Daniel %K virtual reality %K VR %K psychosis %K cognitive behavioural therapy %K psychological well-being %K design process %K self-beliefs %K psychological therapy %K real-world %K efficacy %K well-being %K mental health %K participant %K stakeholder %K user %K Phoenix VR Self-Confidence Therapy %D 2024 %7 7.8.2024 %9 %J JMIR Serious Games %G English %X Virtual reality (VR) is an immersive technology in which delivery of psychological therapy techniques can be automated. Techniques can be implemented similarly to real-world delivery or in ways that are not possible in the real world to enhance efficacy. The potential is for greater access for patients to effective therapy. Despite an increase in the use of VR for mental health, there are few descriptions of how to build and design automated VR therapies. We describe the development of Phoenix VR Self-Confidence Therapy, designed to increase positive self-beliefs in young patients diagnosed with psychosis in order to improve psychological well-being. A double-diamond, user-centered design process conducted over the course of 18 months was used, involving stakeholders from multiple areas: individuals with lived experience of psychosis, clinical psychologists, treatment designers, and VR software developers. Thirteen meetings were held with young patients diagnosed with psychosis to increase the understanding and improve the assessment of positive self-beliefs, help design the scenarios for implementing therapeutic techniques, and conduct user testing. The resulting Phoenix therapy is a class I United Kingdom Conformity Assessed (UKCA)–certified medical device designed to be used on the standalone Meta Quest 2 (Meta Platforms) headset. Phoenix aims to build up 3 types of positive self-beliefs that are connected to psychological well-being. In a community farm area, tasks are designed to increase a sense of mastery and achievement (“I can make a difference”); in a TV studio, users complete an activity with graded levels of difficulty to promote success in the face of a challenge (“I can do this”); and in a forest by a lake, activities are designed to encourage feelings of pleasure and enjoyment (“I can enjoy things”). Phoenix is delivered over the course of approximately 6 weekly sessions supported by a mental health provider. Patients can take the headsets home to use in between sessions. Usability testing with individuals with lived experience of psychosis, as well as patients in the National Health Service (aged 16‐26 years), demonstrated that Phoenix is engaging, easy to use, and has high levels of satisfaction. %R 10.2196/51512 %U https://games.jmir.org/2024/1/e51512 %U https://doi.org/10.2196/51512 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57082 %T Application of an Adapted Health Action Process Approach Model to Predict Engagement With a Digital Mental Health Website: Cross-Sectional Study %A Rouvere,Julien %A Blanchard,Brittany E %A Johnson,Morgan %A Griffith Fillipo,Isabell %A Mosser,Brittany %A Romanelli,Meghan %A Nguyen,Theresa %A Rushton,Kevin %A Marion,John %A Althoff,Tim %A Areán,Patricia A %A Pullmann,Michael D %+ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, United States, 1 206 221 5498, rouvere@uw.edu %K Health Action Process Approach (HAPA) %K digital health %K health behavior %K Mental Health America (MHA) %K digital mental health engagement %K mental health website %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown. Objective: This study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website. Methods: Visitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages). Results: Participants chose to engage with the MHA website in 94.3% (15,161/16,078) of the sessions. Perceived need (β=.66; P<.001), outcome expectancies (β=.49; P<.001), self-efficacy (β=.44; P<.001), and perceived risk (β=.17-.18; P<.001) significantly predicted intention, and intention (β=.77; P<.001) significantly predicted planning. Planning was not significantly associated with choice to engage (β=.03; P=.18). Within participants who chose to engage, the association between planning with level of engagement was statistically significant (β=.12; P<.001). Model fit indices for both engagement outcomes were poor, with the adapted HAPA model accounting for only 0.1% and 1.4% of the variance in choice to engage and level of engagement, respectively. Conclusions: Our data suggest that the HAPA model did not predict engagement with DMH via a self-guided website. More research is needed to identify appropriate theoretical frameworks and practical strategies (eg, digital design) to optimize DMH tool engagement. %M 39110965 %R 10.2196/57082 %U https://humanfactors.jmir.org/2024/1/e57082 %U https://doi.org/10.2196/57082 %U http://www.ncbi.nlm.nih.gov/pubmed/39110965 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e51716 %T Assessing the Short-Term Efficacy of Digital Cognitive Behavioral Therapy for Insomnia With Different Types of Coaching: Randomized Controlled Comparative Trial %A Chan,Wai Sze %A Cheng,Wing Yee %A Lok,Samson Hoi Chun %A Cheah,Amanda Kah Mun %A Lee,Anna Kai Win %A Ng,Albe Sin Ying %A Kowatsch,Tobias %+ Department of Psychology, The University of Hong Kong, Room 627, the Jockey Club Tower, Pokfulam, Hong Kong, Hong Kong, China (Hong Kong), 852 39172295, chanwais@hku.hk %K insomnia %K cognitive behavioral therapy %K digital intervention %K mobile health %K mHealth %K chatbot-based coaching %K human support %K mobile phone %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital cognitive behavioral therapy for insomnia (dCBTi) is an effective intervention for treating insomnia. The findings regarding its efficacy compared to face-to-face cognitive behavioral therapy for insomnia are inconclusive but suggest that dCBTi might be inferior. The lack of human support and low treatment adherence are believed to be barriers to dCBTi achieving its optimal efficacy. However, there has yet to be a direct comparative trial of dCBTi with different types of coaching support. Objective: This study examines whether adding chatbot-based and human coaching would improve the treatment efficacy of, and adherence to, dCBTi. Methods: Overall, 129 participants (n=98, 76% women; age: mean 34.09, SD 12.05 y) whose scores on the Insomnia Severity Index [ISI] were greater than 9 were recruited. A randomized controlled comparative trial with 5 arms was conducted: dCBTi with chatbot-based coaching and therapist support (dCBTi-therapist), dCBTi with chatbot-based coaching and research assistant support, dCBTi with chatbot-based coaching only, dCBTi without any coaching, and digital sleep hygiene and self-monitoring control. Participants were blinded to the condition assignment and study hypotheses, and the outcomes were self-assessed using questionnaires administered on the web. The outcomes included measures of insomnia (the ISI and the Sleep Condition Indicator), mood disturbances, fatigue, daytime sleepiness, quality of life, dysfunctional beliefs about sleep, and sleep-related safety behaviors administered at baseline, after treatment, and at 4-week follow-up. Treatment adherence was measured by the completion of video sessions and sleep diaries. An intention-to-treat analysis was conducted. Results: Significant condition-by-time interaction effects showed that dCBTi recipients, regardless of having any coaching, had greater improvements in insomnia measured by the Sleep Condition Indicator (P=.003; d=0.45) but not the ISI (P=.86; d=–0.28), depressive symptoms (P<.001; d=–0.62), anxiety (P=.01; d=–0.40), fatigue (P=.02; d=–0.35), dysfunctional beliefs about sleep (P<.001; d=–0.53), and safety behaviors related to sleep (P=.001; d=–0.50) than those who received digital sleep hygiene and self-monitoring control. The addition of chatbot-based coaching and human support did not improve treatment efficacy. However, adding human support promoted greater reductions in fatigue (P=.03; d=–0.33) and sleep-related safety behaviors (P=.05; d=–0.30) than dCBTi with chatbot-based coaching only at 4-week follow-up. dCBTi-therapist had the highest video and diary completion rates compared to other conditions (video: 16/25, 60% in dCBTi-therapist vs <3/21, <25% in dCBTi without any coaching), indicating greater treatment adherence. Conclusions: Our findings support the efficacy of dCBTi in treating insomnia, reducing thoughts and behaviors that perpetuate insomnia, reducing mood disturbances and fatigue, and improving quality of life. Adding chatbot-based coaching and human support did not significantly improve the efficacy of dCBTi after treatment. However, adding human support had incremental benefits on reducing fatigue and behaviors that could perpetuate insomnia, and hence may improve long-term efficacy. Trial Registration: ClinicalTrials.gov NCT05136638; https://www.clinicaltrials.gov/study/NCT05136638 %M 39110971 %R 10.2196/51716 %U https://mental.jmir.org/2024/1/e51716 %U https://doi.org/10.2196/51716 %U http://www.ncbi.nlm.nih.gov/pubmed/39110971 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59826 %T Beyond Step Count: Are We Ready to Use Digital Phenotyping to Make Actionable Individual Predictions in Psychiatry? %A Ortiz,Abigail %A Mulsant,Benoit H %+ Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 8th Floor, 250 College Street, Toronto, ON, M5T 1R8, Canada, 1 416 979 6948, benoit.mulsant@utoronto.ca %K digital phenotype %K digital phenotyping %K prediction %K predictions %K mental health %K mental illness %K mental illnesses %K mental disorder %K mental disorders %K US National Institute of Mental Health %K NIMH %K psychiatry %K psychiatrist %K psychiatrists %D 2024 %7 5.8.2024 %9 Viewpoint %J J Med Internet Res %G English %X Some models for mental disorders or behaviors (eg, suicide) have been successfully developed, allowing predictions at the population level. However, current demographic and clinical variables are neither sensitive nor specific enough for making individual actionable clinical predictions. A major hope of the “Decade of the Brain” was that biological measures (biomarkers) would solve these issues and lead to precision psychiatry. However, as models are based on sociodemographic and clinical data, even when these biomarkers differ significantly between groups of patients and control participants, they are still neither sensitive nor specific enough to be applied to individual patients. Technological advances over the past decade offer a promising approach based on new measures that may be essential for understanding mental disorders and predicting their trajectories. Several new tools allow us to continuously monitor objective behavioral measures (eg, hours of sleep) and densely sample subjective measures (eg, mood). The promise of this approach, referred to as digital phenotyping, was recognized almost a decade ago, with its potential impact on psychiatry being compared to the impact of the microscope on biological sciences. However, despite the intuitive belief that collecting densely sampled data (big data) improves clinical outcomes, recent clinical trials have not shown that incorporating digital phenotyping improves clinical outcomes. This viewpoint provides a stepwise development and implementation approach, similar to the one that has been successful in the prediction and prevention of cardiovascular disease, to achieve clinically actionable predictions in psychiatry. %M 39102686 %R 10.2196/59826 %U https://www.jmir.org/2024/1/e59826 %U https://doi.org/10.2196/59826 %U http://www.ncbi.nlm.nih.gov/pubmed/39102686 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e57577 %T Behavior Change Techniques Within Digital Interventions for the Treatment of Eating Disorders: Systematic Review and Meta-Analysis %A Thomas,Pamela Carien %A Curtis,Kristina %A Potts,Henry W W %A Bark,Pippa %A Perowne,Rachel %A Rookes,Tasmin %A Rowe,Sarah %+ Department of Epidemiology & Applied Clinical Research, Division of Psychiatry, University College London, 6th Floor, Wings A and B, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, 44 0207 679 9000, s.rowe@ucl.ac.uk %K digital health %K eHealth %K mobile health %K mHealth %K mobile apps %K smartphone %K behavior change %K behavior change technique %K systematic review %K eating disorders %K disordered eating %K binge eating %K bulimia nervosa %K mobile phone %D 2024 %7 1.8.2024 %9 Review %J JMIR Ment Health %G English %X Background: Previous systematic reviews of digital eating disorder interventions have demonstrated effectiveness at improving symptoms of eating disorders; however, our understanding of how these interventions work and what contributes to their effectiveness is limited. Understanding the behavior change techniques (BCTs) that are most commonly included within effective interventions may provide valuable information for researchers and developers. Establishing whether these techniques have been informed by theory will identify whether they target those mechanisms of action that have been identified as core to changing eating disorder behaviors. It will also evaluate the importance of a theoretical approach to digital intervention design. Objective: This study aims to define the BCTs within digital self-management interventions or minimally guided self-help interventions for adults with eating disorders that have been evaluated within randomized controlled trials. It also assessed which of the digital interventions were grounded in theory and the range of modes of delivery included. Methods: A literature search identified randomized controlled trials of digital intervention for the treatment of adults with eating disorders with minimal therapist support. Each digital intervention was coded for BCTs using the established BCT Taxonomy v1; for the application of theory using an adapted version of the theory coding scheme (TCS); and for modes of delivery using the Mode of Delivery Ontology. A meta-analysis evaluated the evidence that any individual BCT moderated effect size or that other potential factors such as the application of theory or number of modes of delivery had an effect on eating disorder outcomes. Results: Digital interventions included an average of 14 (SD 2.6; range 9-18) BCTs. Self-monitoring of behavior was included in all effective interventions, with Problem-solving, Information about antecedents, Feedback on behavior, Self-monitoring of outcomes of behavior, and Action planning identified in >75% (13/17) of effective interventions. Social support and Information about health consequences were more evident in effective interventions at follow-up compared with postintervention measurement. The mean number of modes of delivery was 4 (SD 1.6; range 2-7) out of 12 possible modes, with most interventions (15/17, 88%) being web based. Digital interventions that had a higher score on the TCS had a greater effect size than those with a lower TCS score (subgroup differences: χ21=9.7; P=.002; I²=89.7%) within the meta-analysis. No other subgroup analyses had statistically significant results. Conclusions: There was a high level of consistency in terms of the most common BCTs within effective interventions; however, there was no evidence that any specific BCT contributed to intervention efficacy. The interventions that were more strongly informed by theory demonstrated greater improvements in eating disorder outcomes compared to waitlist or treatment-as-usual controls. These results can be used to inform the development of future digital eating disorder interventions. Trial Registration: PROSPERO CRD42023410060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410060 %M 39088817 %R 10.2196/57577 %U https://mental.jmir.org/2024/1/e57577 %U https://doi.org/10.2196/57577 %U http://www.ncbi.nlm.nih.gov/pubmed/39088817 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e59479 %T The Opportunities and Risks of Large Language Models in Mental Health %A Lawrence,Hannah R %A Schneider,Renee A %A Rubin,Susan B %A Matarić,Maja J %A McDuff,Daniel J %A Jones Bell,Megan %K artificial intelligence %K AI %K generative AI %K large language models %K mental health %K mental health education %K language model %K mental health care %K health equity %K ethical %K development %K deployment %D 2024 %7 29.7.2024 %9 %J JMIR Ment Health %G English %X Global rates of mental health concerns are rising, and there is increasing realization that existing models of mental health care will not adequately expand to meet the demand. With the emergence of large language models (LLMs) has come great optimism regarding their promise to create novel, large-scale solutions to support mental health. Despite their nascence, LLMs have already been applied to mental health–related tasks. In this paper, we summarize the extant literature on efforts to use LLMs to provide mental health education, assessment, and intervention and highlight key opportunities for positive impact in each area. We then highlight risks associated with LLMs’ application to mental health and encourage the adoption of strategies to mitigate these risks. The urgent need for mental health support must be balanced with responsible development, testing, and deployment of mental health LLMs. It is especially critical to ensure that mental health LLMs are fine-tuned for mental health, enhance mental health equity, and adhere to ethical standards and that people, including those with lived experience with mental health concerns, are involved in all stages from development through deployment. Prioritizing these efforts will minimize potential harms to mental health and maximize the likelihood that LLMs will positively impact mental health globally. %R 10.2196/59479 %U https://mental.jmir.org/2024/1/e59479 %U https://doi.org/10.2196/59479 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55366 %T eHealth-Integrated Psychosocial and Physical Interventions for Chronic Pain in Older Adults: Scoping Review %A De Lucia,Annalisa %A Perlini,Cinzia %A Chiarotto,Alessandro %A Pachera,Sara %A Pasini,Ilenia %A Del Piccolo,Lidia %A Donisi,Valeria %+ Section of Clinical Psychology, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Piazzale Ludovico Antonio Scuro 10, Verona, 37134, Italy, 39 0458124038, cinzia.perlini@univr.it %K chronic pain %K older adults %K eHealth %K scoping review %K psychological intervention %K physical intervention %K multimodal intervention %K biopsychosocial model for chronic pain %K self-management %K mobile phone %D 2024 %7 29.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Chronic noncancer pain (CNCP) is highly present among older adults, affecting their physical, psychological, and social functioning. A biopsychosocial multimodal approach to CNCP management is currently extensively suggested by international clinical practice guidelines. Recently, the growing development and application of eHealth within pain management has yielded encouraging results in terms of effectiveness and feasibility; however, its use among the older population remains underexamined. Objective: The overall aim of this scoping review was to systematically map existing literature about eHealth multimodal interventions (including both physical and psychosocial components) targeting older adults with CNCP. Methods: This review adhered to the JBI methodology, a protocol was a priori registered as a preprint on the medRxiv platform, and the results were reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Four electronic databases (PubMed, Cochrane Central Register of Controlled Trials, Web of Science, and PsycINFO) were systematically searched for relevant articles. Studies were included if they reported on multimodal interventions (including both physical and psychosocial components) delivered through any eHealth modality to an older population with any type of CNCP. Two reviewers selected the studies: first by screening titles and abstracts and second by screening full-text articles. The quality of the included studies was evaluated using the Quality Assessment Tool for Studies with Diverse Designs. The results of the studies were summarized narratively. Results: A total of 9 studies (n=6, 67% published between 2021 and 2023) with quality rated as medium to high were included, of which 7 (78%) were randomized controlled trials (n=5, 71% were pilot and feasibility studies). All the included studies evaluated self-management interventions, most of them (n=7, 78%) specifically designed for older adults. The participants were aged between 65 and 75 years on average (mean 68.5, SD 3.5 y) and had been diagnosed with different types of CNCP (eg, osteoarthritis and chronic low back pain). Most of the included studies (5/9, 56%) involved the use of multiple eHealth modalities, with a higher use of web-based programs and video consulting. Only 1 (11%) of the 9 studies involved a virtual reality–based intervention. The evaluated interventions showed signs of effectiveness in the targeted biopsychosocial outcomes, and the participants’ engagement and ratings of satisfaction were generally positive. However, several research gaps were identified and discussed. Conclusions: Overall, of late, there has been a growing interest in the potential that eHealth multimodal interventions offer in terms of improving pain, physical, and psychosocial outcomes in older adults with CNCP. However, existing literature on this topic still seems scarce and highly heterogeneous, with few proper randomized controlled trials, precluding robust conclusions. Several gaps emerged in terms of the older population considered and the lack of evaluation of comorbidities. International Registered Report Identifier (IRRID): RR2-10.1101/2023.07.27.23293235 %M 39073865 %R 10.2196/55366 %U https://www.jmir.org/2024/1/e55366 %U https://doi.org/10.2196/55366 %U http://www.ncbi.nlm.nih.gov/pubmed/39073865 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50555 %T Efficacy of Mobile App–Based Cognitive Behavioral Therapy for Insomnia: Multicenter, Single-Blind Randomized Clinical Trial %A Shin,Jiyoon %A Kim,Sujin %A Lee,Jooyoung %A Gu,Hyerin %A Ahn,Jihye %A Park,Chowon %A Seo,Mincheol %A Jeon,Jeong Eun %A Lee,Ha Young %A Yeom,Ji Won %A Kim,Sojeong %A Yoon,Yeaseul %A Lee,Heon-Jeong %A Kim,Seog Ju %A Lee,Yu Jin %+ Department of Psychiatry and Center for Sleep and Chronobiology, Seoul National University Hospital, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 2456, ewpsyche@snu.ac.kr %K digital therapeutics %K mobile app–based cognitive behavioral therapy for insomnia %K cognitive behavioral therapy %K insomnia %K mental health %K mobile phone %D 2024 %7 26.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy for insomnia (CBTi) is the first-line therapy for chronic insomnia. Mobile app–based CBTi (MCBTi) can enhance the accessibility of CBTi treatment; however, few studies have evaluated the effectiveness of MCBTi using a multicenter, randomized controlled trial design. Objective: We aimed to assess the efficacy of Somzz, an MCBTi that provides real-time and tailored feedback to users, through comparison with an active comparator app. Methods: In our multicenter, single-blind randomized controlled trial study, participants were recruited from 3 university hospitals and randomized into a Somzz group and a sleep hygiene education (SHE) group at a 1:1 ratio. The intervention included 6 sessions for 6 weeks, with follow-up visits over a 4-month period. The Somzz group received audiovisual sleep education, guidance on relaxation therapy, and real-time feedback on sleep behavior. The primary outcome was the Insomnia Severity Index score, and secondary outcomes included sleep diary measures and mental health self-reports. We analyzed the outcomes based on the intention-to-treat principle. Results: A total of 98 participants were randomized into the Somzz (n=49, 50%) and SHE (n=49, 50%) groups. Insomnia Severity Index scores for the Somzz group were significantly lower at the postintervention time point (9.0 vs 12.8; t95=3.85; F2,95=22.76; ηp2=0.13; P<.001) and at the 3-month follow-up visit (11.3 vs 14.7; t68=2.61; F2,68=5.85; ηp2=0.03; P=.01) compared to those of the SHE group. The Somzz group maintained their treatment effect at the postintervention time point and follow-ups, with a moderate to large effect size (Cohen d=–0.62 to –1.35; P<.01 in all cases). Furthermore, the Somzz group showed better sleep efficiency (t95=–3.32; F2,91=69.87; ηp2=0.41; P=.001), wake after sleep onset (t95=2.55; F2,91=51.81; ηp2=0.36; P=.01), satisfaction (t95=–2.05; F2,91=26.63; ηp2=0.20; P=.04) related to sleep, and mental health outcomes, including depression (t95=2.11; F2,94=29.64; ηp2=0.21; P=.04) and quality of life (t95=–3.13; F2,94=54.20; ηp2=0.33; P=.002), compared to the SHE group after the intervention. The attrition rate in the Somzz group was 12% (6/49). Conclusions: Somzz outperformed SHE in improving insomnia, mental health, and quality of life. The MCBTi can be a highly accessible, time-efficient, and effective treatment option for chronic insomnia, with high compliance. Trial Registration: Clinical Research Information Service (CRiS) KCT0007292; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=22214&search_page=L %M 39058549 %R 10.2196/50555 %U https://www.jmir.org/2024/1/e50555 %U https://doi.org/10.2196/50555 %U http://www.ncbi.nlm.nih.gov/pubmed/39058549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57938 %T Changes in the Frequency of Actions Associated With Mental Health During Online Treatment: Analysis of Demographic and Clinical Factors %A Bisby,Madelyne %A Staples,Lauren %A Dear,Blake %A Titov,Nickolai %+ MindSpot Clinic, MQ Health, Macquarie University, 16 University Avenue, Sydney, 2109, Australia, 61 298508724, madelyne.bisby@mq.edu.au %K anxiety %K depression %K daily actions %K treatments %K personalization %K mental health %K digital treatment %K analysis %K clinical factors %K questionnaire %K depression symptoms %K anxiety symptoms %K patients %K Australian %K Australia %K digital psychology service %K psychology %K symptom severity %K severity %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Specific daily actions (eg, goal setting, meaningful activities) are associated with mental health. Performing specific daily actions at a higher frequency is associated with significantly lower baseline symptoms of depression and anxiety, as well as better psychological treatment outcomes for depression and anxiety. Objective: This study explored how the frequency of specific daily actions associated with mental health may differ prior to, during, and following treatment according to demographic and clinical characteristics. Methods: Using a sample of 448 patients from an Australian national digital psychology service, we examined baseline differences in daily action frequency and changes in daily action frequency during a digital psychological treatment according to demographic and clinical subgroups. A total of 5 specific types of daily actions were measured using the Things You Do Questionnaire: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections. Results: The frequency of daily actions differed according to employment status (largest P=.005) and educational level (largest P=.004). Daily action frequency was lower in those participants with more severe or chronic depression or anxiety symptoms (largest P=.004). Participants reported larger increases in how often they did these daily actions from baseline to midtreatment compared to mid- to posttreatment. Depression duration (P=.01) and severity (P<.001) were associated with differences in how daily action frequency changed during treatment. Conclusions: The findings of this study support continued research exploring the relationship between daily actions and mental health, how this relationship might differ between individuals, and the clinical potential of supporting individuals to increase the frequency of daily actions to improve mental health. %M 39052998 %R 10.2196/57938 %U https://formative.jmir.org/2024/1/e57938 %U https://doi.org/10.2196/57938 %U http://www.ncbi.nlm.nih.gov/pubmed/39052998 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e38413 %T Extended Reality for Mental Health Evaluation: Scoping Review %A Omisore,Olatunji Mumini %A Odenigbo,Ifeanyi %A Orji,Joseph %A Beltran,Amelia Itzel Hernandez %A Meier,Sandra %A Baghaei,Nilufar %A Orji,Rita %+ Research Centre for Medical Robotics and Minimally Invasive Surgical Devices, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, 1068 XueYuan Avenue, Xili, NanShan District, Shenzhen, 518055, China, 86 13172482240, omisore@siat.ac.cn %K extended reality %K mental disorder %K depression %K anxiety %K exposure therapy %D 2024 %7 24.7.2024 %9 Review %J JMIR Serious Games %G English %X Background: Mental health disorders are the leading cause of health-related problems worldwide. It is projected that mental health disorders will be the leading cause of morbidity among adults as the incidence rates of anxiety and depression grow worldwide. Recently, “extended reality” (XR), a general term covering virtual reality (VR), augmented reality (AR), and mixed reality (MR), is paving the way for the delivery of mental health care. Objective: We aimed to investigate the adoption and implementation of XR technology used in interventions for mental disorders and to provide statistical analyses of the design, usage, and effectiveness of XR technology for mental health interventions with a worldwide demographic focus. Methods: In this paper, we conducted a scoping review of the development and application of XR in the area of mental disorders. We performed a database search to identify relevant studies indexed in Google Scholar, PubMed, and the ACM Digital Library. A search period between August 2016 and December 2023 was defined to select papers related to the usage of VR, AR, and MR in a mental health context. The database search was performed with predefined queries, and a total of 831 papers were identified. Ten papers were identified through professional recommendation. Inclusion and exclusion criteria were designed and applied to ensure that only relevant studies were included in the literature review. Results: We identified a total of 85 studies from 27 countries worldwide that used different types of VR, AR, and MR techniques for managing 14 types of mental disorders. By performing data analysis, we found that most of the studies focused on high-income countries, such as the United States (n=14, 16.47%) and Germany (n=12, 14.12%). None of the studies were for African countries. The majority of papers reported that XR techniques lead to a significant reduction in symptoms of anxiety or depression. The majority of studies were published in 2021 (n=26, 30.59%). This could indicate that mental disorder intervention received higher attention when COVID-19 emerged. Most studies (n=65, 76.47%) focused on a population in the age range of 18-65 years, while few studies (n=2, 3.35%) focused on teenagers (ie, subjects in the age range of 10-19 years). In addition, more studies were conducted experimentally (n=67, 78.82%) rather than by using analytical and modeling approaches (n=8, 9.41%). This shows that there is a rapid development of XR technology for mental health care. Furthermore, these studies showed that XR technology can effectively be used for evaluating mental disorders in a similar or better way that conventional approaches. Conclusions: In this scoping review, we studied the adoption and implementation of XR technology for mental disorder care. Our review shows that XR treatment yields high patient satisfaction, and follow-up assessments show significant improvement with large effect sizes. Moreover, the studies adopted unique designs that were set up to record and analyze the symptoms reported by their participants. This review may aid future research and development of various XR mechanisms for differentiated mental disorder procedures. %M 39047289 %R 10.2196/38413 %U https://games.jmir.org/2024/1/e38413 %U https://doi.org/10.2196/38413 %U http://www.ncbi.nlm.nih.gov/pubmed/39047289 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58263 %T Digitally Enabled Peer Support and Social Health Platform for Vulnerable Adults With Loneliness and Symptomatic Mental Illness: Cohort Analysis %A Bravata,Dena %A Russell,Daniel %A Fellows,Annette %A Goldman,Ron %A Pace,Elizabeth %+ Center for Primary Care and Outcomes Research, Stanford University, 1840 Lexington Av, San Mateo, CA, 94402, United States, 1 4157065829, dbravata@gmail.com %K peer support %K social isolation %K loneliness %K depression %K depressive %K mental health %K anxiety %K quality of life %K isolation %K isolated %K online support %K digital health %K vulnerable %K race %K racial ethnic %K ethnicity %K gender %K socioeconomic %K demographic %D 2024 %7 24.7.2024 %9 Research Letter %J JMIR Form Res %G English %X This study prospectively evaluated the effects of digitally enabled peer support on mental health outcomes and estimated medical cost reductions among vulnerable adults with symptomatic depression, anxiety, and significant loneliness to address the mental health crisis in the United States. %M 38941568 %R 10.2196/58263 %U https://formative.jmir.org/2024/1/e58263 %U https://doi.org/10.2196/58263 %U http://www.ncbi.nlm.nih.gov/pubmed/38941568 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54272 %T Technology-Assisted Mental Health Intervention Delivered by Frontline Workers at Community Doorsteps for Reducing Anxiety and Depression in Rural Pakistan: Protocol for the mPareshan Mixed Methods Implementation Trial %A Rabbani,Fauziah %A Nafis,Javeria %A Akhtar,Samina %A Khan,Muhammad Shahid %A Sayani,Saleem %A Siddiqui,Amna %A Siddiqi,Sameen %A Merali,Zul %+ Department of Community Health Sciences, Aga Khan University, Stadium Road, Karachi, 3500, Pakistan, 92 2134864864, fauziah.Rabbani@aku.edu %K anxiety %K depression %K feasibility %K mental health %K health workers %K mPareshan app %K implementation research %D 2024 %7 23.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a dearth of specialized mental health workforce in low- and middle-income countries. Use of mobile technology by frontline community health workers (CHWs) is gaining momentum in Pakistan and needs to be explored as an alternate strategy to improve mental well-being. Objective: The aim of this study is to assess the feasibility, acceptability, and usefulness of an app-based counseling intervention delivered by government lady health workers (LHWs) to reduce anxiety and depression in rural Pakistan. Methods: Project mPareshan is a single-arm, pre- and posttest implementation research trial in Badin District, Sindh, using mixed methods of data collection executed in 3 phases (preintervention, intervention, and postintervention). In the preintervention phase, formative qualitative assessments through focus group discussions and in-depth interviews assess the acceptability and appropriateness of intervention through perceptions of all concerned stakeholders using a specific interview guide. A REDCap (Research Electronic Data Capture)-based baseline survey using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 Scale (GAD-7) determines the point prevalence of depression and anxiety among consenting men and women older than 18 years. Individuals with mild and moderate anxiety and depression are identified as screen positives (SPs) and are eligible for mPareshan app–based intervention. Mental health literacy of health workers is improved through customized training adapting the World Health Organization’s Mental Health Gap Action Programme guide 2.0. The intervention (mPareshan app) consists of tracking, counseling, and referral segments. The tracking segment facilitates participant consent and enrollment while the referral segment is used by LHWs to transfer severe cases to the next level of specialist care. Through the counseling segment, identified SPs are engaged during LHWs’ routine home visits in 6 face-to-face 20-minute counseling sessions over 6 months. Each session imparts psychoeducation through audiovisual aids, breathing exercises, and coping skills to reduce stress. Clinical and implementation outcomes include change in mean anxiety and depression scores and identification of facilitators and barriers in intervention uptake and rollout. Results: At the time of this submission (April 2024), we are analyzing the results of 366 individuals who participated in the baseline prevalence survey, the change in knowledge and skills of 72 health workers who took the mPareshan training, change in anxiety and depression scores of 98 SPs recruited for app-based counseling intervention, and perceptions of stakeholders pre- and postintervention gathered through 8 focus group discussions and 18 in-depth interviews. Conclusions: This trial will assess the feasibility of early home-based mental health screening, counseling, and prompt referrals by frontline health workers to reduce anxiety and depression in the community. The study findings will set the stage for integrating mental health into primary health care. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12622000989741; https://tinyurl.com/5n844c8z International Registered Report Identifier (IRRID): DERR1-10.2196/54272 %M 39042878 %R 10.2196/54272 %U https://www.researchprotocols.org/2024/1/e54272 %U https://doi.org/10.2196/54272 %U http://www.ncbi.nlm.nih.gov/pubmed/39042878 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e50111 %T Can an Online Course, Life101: Mental and Physical Self-Care, Improve the Well-Being of College Students? %A Jafari,Mahtab %K self-care course %K stress management %K student mental health %K multimodal online course %K mental health interventions %D 2024 %7 22.7.2024 %9 %J JMIR Med Educ %G English %X The COVID-19 pandemic has had a significant impact on the mental health of college students worldwide. As colleges shifted to online instruction, students faced disruptions and increased stressors, leading to a decline in mental health that appears to continue in the postpandemic era. To alleviate this problem, academic institutions have implemented various interventions to address mental health issues; however, many of these interventions focus on a single approach and lack diverse delivery methods. This viewpoint introduces the concept of a multimodal self-care online course, Life101: Mental and Physical Self-Care, and discusses the potential effectiveness of such an intervention in improving students’ well-being. The course combines evidence-based interventions and incorporates interactive lectures, workshops, and guest speakers. Pre- and postcourse surveys were conducted over a span of 4 academic terms to evaluate the impact of this course on the well-being and self-care practices of students. The survey data suggest positive outcomes in students taking Life101, including the adoption of healthier habits, reduced stress levels, and increased knowledge and practice of self-care techniques. Life101 represents a novel multimodality intervention to address the epidemic of mental health issues faced by students today. By implementing similar evidence-based multimodal didactic curricula across campuses, academic institutions may be able to better equip students to navigate challenges and promote their overall well-being. %R 10.2196/50111 %U https://mededu.jmir.org/2024/1/e50111 %U https://doi.org/10.2196/50111 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55786 %T Effectiveness of Unguided Internet-Based Cognitive Behavioral Therapy for Subthreshold Social Anxiety Disorder in Adolescents and Young Adults: Multicenter Randomized Controlled Trial %A Matsumoto,Kazuki %A Hamatani,Sayo %A Shiga,Kiko %A Iiboshi,Kiyoko %A Kasai,Makiko %A Kimura,Yasuhiro %A Yokota,Satoshi %A Watanabe,Katsunori %A Kubo,Yoko %A Nakamura,Masayuki %+ Division of Clinical Psychology, Kagoshima University Hospital, Research and Education Assembly Medical and Dental Sciences Area, Kagoshima University, 1-8-35 Sakuragaoka, Kagoshima, 8908520, Japan, 81 0992655707, k2782199@kadai.jp %K adolescent %K social anxiety disorder %K general anxiety %K adolescents %K teens %K social anxiety %K teenagers %K internet-based cognitive behavioral therapy %K self-help %K randomized controlled trials %K young adults %K cognitive behavioral therapy %K anxiety %K mental health %K students %K colleges %K universities %K social socialize %K anxious %K fear %K mobile phone %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Social anxiety disorder (SAD) is a common mental disorder in adolescents and young adults. Early intervention and support could help prevent the development of full-blown SAD. Considering that adolescents with social anxiety symptoms do not prefer face-to-face sessions due to their fear of communicating with therapists, internet-based cognitive behavioral therapy (ICBT) was implemented. Objective: This study aimed to examine the effectiveness of complete self-help ICBT for subthreshold SAD in high school and college students with no history of mental disorders. Methods: A multicenter randomized controlled trial designed to demonstrate the objective was conducted from December 2022 to October 2023. Participants were students enrolled at 6 universities and 1 high school. The intervention was a complete self-help ICBT and consisted of 10 text-based sessions that taught cognitive behavioral therapy techniques for social anxiety in youths and young adults. The comparison was a no-treatment condition (control group), which was randomly assigned in a 1:1 ratio by a computer program. A total of 2 psychological scales were used to assess the severity of social anxiety, and 1 psychological scale each was used to measure symptoms of depression, general anxiety, and quality of life. Results: In total, 77 students were enrolled as study participants. Through the randomization procedure, 38 participants were included in the intervention group, and 39 patients were included in the control group. Results from the analysis of covariance with depression as covariates showed that the participants in the intervention group had significantly reduced symptoms of social anxiety, depression, and general anxiety compared to the control group. The response rate was 61% (19/31) in the intervention group and 24% (9/38) in the control group: odds ratio (OR) 4.97 (95% CI 1.61-16.53; P=.003) in the Fisher exact test. The recovery rate was 68% (21/31) in the intervention group and 34% (13/38) in the control group: OR 3.95 (95% CI 1.32-12.56; P=.008). The OR for the remission ratio was 2.01 (95% CI 0.64-6.60; P=.20) and for the risk of worsening was 0.23 (95% CI 0.002-1.33; P=.10), but no significant difference was observed. Conclusions: The results of this randomized controlled trial show that fully unguided ICBT improves subthreshold SAD in adolescents and young adults. Interpretation of the effectiveness in preventing SAD that meets the diagnostic criteria is limited by sample size and the follow-up period. Future studies should include more extended observations and larger sample sizes in high-risk populations. Trial Registration: UMIN-CTR UMIN000050064; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000057035 %M 39037759 %R 10.2196/55786 %U https://pediatrics.jmir.org/2024/1/e55786 %U https://doi.org/10.2196/55786 %U http://www.ncbi.nlm.nih.gov/pubmed/39037759 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52212 %T Desensitizing Anxiety Through Imperceptible Change: Feasibility Study on a Paradigm for Single-Session Exposure Therapy for Fear of Public Speaking %A Banakou,Domna %A Johnston,Tania %A Beacco,Alejandro %A Senel,Gizem %A Slater,Mel %+ Event Lab, Department of Clinical Psychology and Psychobiology, Institute of Neurosciences, University of Barcelona, Campus de Mundet Edifici CAVE, Passeig de la Vall d'Hebron 171, Barcelona, 08035, Spain, 34 93 403 ext 9618, melslater@ub.edu %K exposure therapy %K virtual reality %K gradual exposure %K fear of public speaking %K anxiety %K change blindness %K public speaking %K desensitization %K anxiety disorder %K feasibility study %D 2024 %7 22.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Exposure therapy (ET) for anxiety disorders involves introducing the participant to an anxiety-provoking situation over several treatment sessions. Each time, the participant is exposed to a higher anxiety-provoking stimulus; for example, in the case of fear of heights, the participant would successively experience being at a greater height. ET is effective, and its counterpart, virtual reality (VR) exposure therapy (VRET), where VR substitutes real-world exposure, is equally so. However, ET is time-consuming, requiring several sessions. Objective: This study aimed to compare the results of single-session exposure with those of traditional VRET with regard to reducing public speaking anxiety. Methods: We introduced a paradigm concerned with public speaking anxiety where the VR exposure occurred in a single session while the participant interacted with a virtual therapist. Over time, the therapist transformed into an entire audience with almost imperceptible changes. We carried out a feasibility study with 45 participants, comparing 3 conditions: single-session exposure (n=16, 36%); conventional multiple-session exposure (n=14, 31%), where the same content was delivered in successive segments over 5 sessions; and a control group (n=15, 33%), who interacted with a single virtual character to talk about everyday matters. A week later, the participants were required to speak on a stage in front of a large audience in VR. Results: Across most of the series of conventional public speaking anxiety measures, the single-session exposure was at least as effective in reducing anxiety as the multiple-session exposure, and both these conditions were better than the control condition. The 12-item Personal Report of Confidence as a Speaker was used to measure public speaking anxiety levels, where higher values indicated more anxiety. Using a Bayesian model, the posterior probabilities of improvement compared to a high baseline were at least 1.7 times greater for single- and multiple-session exposures compared to the control group. The State Perceived Index of Competence was used as a measure of anticipatory anxiety for speaking on a stage in front of a large audience, where lower values indicated higher anxiety. The probabilities of improvement were just over 4 times greater for single- and multiple-session exposures compared to the control group for a low baseline and 489 (single) and 53 (multiple) times greater for a middle baseline. Conclusions: Overall, the results of this feasibility study show that for moderate public speaking anxiety, the paradigm of gradual change in a single session is worth following up with further studies with more severe levels of anxiety and a larger sample size, first with a randomized controlled trial with nonpatients and subsequently, if the outcomes follow those that we have found, with a full clinical trial with patients. %M 39037760 %R 10.2196/52212 %U https://formative.jmir.org/2024/1/e52212 %U https://doi.org/10.2196/52212 %U http://www.ncbi.nlm.nih.gov/pubmed/39037760 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58352 %T Reliability and Validity of Ecological Momentary Assessment Response Time–Based Measures of Emotional Clarity: Secondary Data Analysis %A Hernandez,Raymond %A Hoogendoorn,Claire %A Gonzalez,Jeffrey S %A Pyatak,Elizabeth A %A Crespo-Ramos,Gladys %A Schneider,Stefan %+ Center for Economic and Social Research, University of Southern California, 635 Downey Way, , Los Angeles, CA, 90089, United States, 1 2138211899, hern939@usc.edu %K digital mental health %K drift-diffusion model %K ecological momentary assessment %K emotional clarity %K emotional health %K emotion regulation %K response time %K positive affect %K negative affect %K type 1 diabetes %K mobile phone %D 2024 %7 18.7.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Emotional clarity has often been assessed with self-report measures, but efforts have also been made to measure it passively, which has advantages such as avoiding potential inaccuracy in responses stemming from social desirability bias or poor insight into emotional clarity. Response times (RTs) to emotion items administered in ecological momentary assessments (EMAs) may be an indirect indicator of emotional clarity. Another proposed indicator is the drift rate parameter, which assumes that, aside from how fast a person responds to emotion items, the measurement of emotional clarity also requires the consideration of how careful participants were in providing responses. Objective: This paper aims to examine the reliability and validity of RTs and drift rate parameters from EMA emotion items as indicators of individual differences in emotional clarity. Methods: Secondary data analysis was conducted on data from 196 adults with type 1 diabetes who completed a 2-week EMA study involving the completion of 5 to 6 surveys daily. If lower RTs and higher drift rates (from EMA emotion items) were indicators of emotional clarity, we hypothesized that greater levels (ie, higher clarity) should be associated with greater life satisfaction; lower levels of neuroticism, depression, anxiety, and diabetes distress; and fewer difficulties with emotion regulation. Because prior literature suggested emotional clarity could be valence specific, EMA items for negative affect (NA) and positive affect were examined separately. Results: Reliability of the proposed indicators of emotional clarity was acceptable with a small number of EMA prompts (ie, 4 to 7 prompts in total or 1 to 2 days of EMA surveys). Consistent with expectations, the average drift rate of NA items across multiple EMAs had expected associations with other measures, such as correlations of r=–0.27 (P<.001) with depression symptoms, r=–0.27 (P=.001) with anxiety symptoms, r=–0.15 (P=.03) with emotion regulation difficulties, and r=0.63 (P<.001) with RTs to NA items. People with a higher NA drift rate responded faster to NA emotion items, had greater subjective well-being (eg, fewer depression symptoms), and had fewer difficulties with overall emotion regulation, which are all aligned with the expectation for an emotional clarity measure. Contrary to expectations, the validities of average RTs to NA items, the drift rate of positive affect items, and RTs to positive affect items were not strongly supported by our results. Conclusions: Study findings provided initial support for the validity of NA drift rate as an indicator of emotional clarity but not for that of other RT-based clarity measures. Evidence was preliminary because the sample size was not sufficient to detect small but potentially meaningful correlations, as the sample size of the diabetes EMA study was chosen for other more primary research questions. Further research on passive emotional clarity measures is needed. %M 39024004 %R 10.2196/58352 %U https://mental.jmir.org/2024/1/e58352 %U https://doi.org/10.2196/58352 %U http://www.ncbi.nlm.nih.gov/pubmed/39024004 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59131 %T Age Differences in Electronic Mental Health Literacy: Qualitative Study %A Xu,Richard Huan %A Tian,Lidan %A Zhu,Liling %A Cao,Yuan %A Chan,Sherry Kit-wa %A Dong,Dong %A Cheung,Wai-ling Annie %A Wong,Eliza Lai-yi %+ Department of Rehabilitaion Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, Kowloon, China (Hong Kong), 852 27664199, richard.xu@polyu.edu.hk %K eHealth literacy %K mental health %K mental health literacy %K age-related difference %K electronic mental health literacy %K eMHL %D 2024 %7 16.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic mental health literacy (eMHL) is critical for accessing and effectively using digital mental health resources. However, there is a paucity of research on how eMHL varies across age groups. Objective: This study aimed to investigate differences in eMHL among young, middle-aged, and older adults; provide insights into the needs, behaviors, and attitudes of different age groups in relation to digital mental health resources; and ultimately, inform the improvement of mental health services. Methods: A qualitative investigation was conducted to examine the differences in eMHL across different age demographics in the Chinese population in 2023. The study sample comprised 3 distinct age groups: 18-34 years, 35-64 years, and 65 years and older. Participants were recruited through purposive sampling to ensure a diverse representation of the population. Data were collected through semistructured one-on-one interviews, which allowed for in-depth exploration of individual experiences and perceptions. The gathered data were subsequently subjected to rigorous thematic analysis to enable the identification and interpretation of recurring patterns and themes. Results: The principal outcomes derived from these interviews were synthesized into 5 distinct dimensions: emotional needs, use of digital mental health resources, assessment of digital mental health information, engagement with social media to regulate emotions, and coping strategies. These dimensions were uniformly observed across the 3 age groups. Conclusions: We identified differences in knowledge, skills, and attitudes regarding the use of web-based information for managing mental health problems between the 3 age groups. The findings highlight the importance of age-specific strategies for improving eMHL. %M 39012686 %R 10.2196/59131 %U https://www.jmir.org/2024/1/e59131 %U https://doi.org/10.2196/59131 %U http://www.ncbi.nlm.nih.gov/pubmed/39012686 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e43931 %T Identifying Person-Specific Drivers of Depression in Adolescents: Protocol for a Smartphone-Based Ecological Momentary Assessment and Passive Sensing Study %A Ng,Mei Yi %A Frederick,Jennifer A %A Fisher,Aaron J %A Allen,Nicholas B %A Pettit,Jeremy W %A McMakin,Dana L %+ Department of Psychology and Center for Children and Families, Florida International University, 11200 SW 8th St AHC4-457, Miami, FL, 33199, United States, 1 305 348 9920, meiyi.ng@fiu.edu %K adolescents %K depression %K idiographic assessment %K network modeling %K treatment personalization %K ecological momentary assessment %K mobile sensing %K digital phenotyping %K actigraphy %K smartphones %D 2024 %7 16.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescence is marked by an increasing risk of depression and is an optimal window for prevention and early intervention. Personalizing interventions may be one way to maximize therapeutic benefit, especially given the marked heterogeneity in depressive presentations. However, empirical evidence that can guide personalized intervention for youth is lacking. Identifying person-specific symptom drivers during adolescence could improve outcomes by accounting for both developmental and individual differences. Objective: This study leverages adolescents’ everyday smartphone use to investigate person-specific drivers of depression and validate smartphone-based mobile sensing data against established ambulatory methods. We describe the methods of this study and provide an update on its status. After data collection is completed, we will address three specific aims: (1) identify idiographic drivers of dynamic variability in depressive symptoms, (2) test the validity of mobile sensing against ecological momentary assessment (EMA) and actigraphy for identifying these drivers, and (3) explore adolescent baseline characteristics as predictors of these drivers. Methods: A total of 50 adolescents with elevated symptoms of depression will participate in 28 days of (1) smartphone-based EMA assessing depressive symptoms, processes, affect, and sleep; (2) mobile sensing of mobility, physical activity, sleep, natural language use in typed interpersonal communication, screen-on time, and call frequency and duration using the Effortless Assessment of Risk States smartphone app; and (3) wrist actigraphy of physical activity and sleep. Adolescents and caregivers will complete developmental and clinical measures at baseline, as well as user feedback interviews at follow-up. Idiographic, within-subject networks of EMA symptoms will be modeled to identify each adolescent’s person-specific drivers of depression. Correlations among EMA, mobile sensor, and actigraph measures of sleep, physical, and social activity will be used to assess the validity of mobile sensing for identifying person-specific drivers. Data-driven analyses of mobile sensor variables predicting core depressive symptoms (self-reported mood and anhedonia) will also be used to assess the validity of mobile sensing for identifying drivers. Finally, between-subject baseline characteristics will be explored as predictors of person-specific drivers. Results: As of October 2023, 84 families were screened as eligible, of whom 70% (n=59) provided informed consent and 46% (n=39) met all inclusion criteria after completing baseline assessment. Of the 39 included families, 85% (n=33) completed the 28-day smartphone and actigraph data collection period and follow-up study visit. Conclusions: This study leverages depressed adolescents’ everyday smartphone use to identify person-specific drivers of adolescent depression and to assess the validity of mobile sensing for identifying these drivers. The findings are expected to offer novel insights into the structure and dynamics of depressive symptomatology during a sensitive period of development and to inform future development of a scalable, low-burden smartphone-based tool that can guide personalized treatment decisions for depressed adolescents. International Registered Report Identifier (IRRID): DERR1-10.2196/43931 %M 39012691 %R 10.2196/43931 %U https://www.researchprotocols.org/2024/1/e43931 %U https://doi.org/10.2196/43931 %U http://www.ncbi.nlm.nih.gov/pubmed/39012691 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e39707 %T Screen Use Time and Its Association With Mental Health Issues in Young Adults in India: Protocol for a Cross-Sectional Study %A Deshpande,Swasti %A Sachdev,Ashmeet %A Maharana,Anwesha %A Zadey,Siddhesh %A Dharmadhikari,Surabhi P %A Ghate,Swati %A Godatwar,Pawankumar %A Ojha,Nisha Kumari %A Sharma,Sanjeev %+ Association for Socially Applicable Research, D2 Sai Heritage, New D P Road, Aundh, Pune, 411007, India, 91 9196999557, sidzadey@asarforindia.org %K mental health %K India %K screen use %K computer use %K screen time %K depression %K stress %K anxiety %K low- and middle-income country %K LMIC %K questionnaire %K survey %K instrument %K young adult %K mental well-being %K cross sectional %K internet use %K phone use %K young adults %D 2024 %7 16.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Screen use time has increased in the past decade owing to the increased availability and accessibility of digital devices and the internet. Several studies have shown an association between increased screen use time and mental health issues such as anxiety and depression. However, studies in the young adult population—a demographic with high screen use—and in low- and middle-income country settings are limited. Objective: This protocol describes a study that aims to measure self-reported screen use times and patterns in young adults (18-24 y) in India and assess if increased screen use time is associated with poorer mental well-being. Methods: This protocol describes a cross-sectional study of a pan-India, web-based convenience sample of young adults (18-24 y) with access to digital devices with a screen and a minimum of secondary school education. Participants will be recruited through people in the professional networks of the investigators, which includes pediatricians. The survey will also be distributed via the social media pages of our organization (X [X Corp], Instagram [Meta], Facebook [Meta], etc). Sociodemographic details will be collected through a questionnaire designed by the authors; screen use time and patterns will be assessed using an adaptation of the Screen Time Questionnaire to include data on different apps and websites used on digital devices; and mental health parameters will be gauged using the Warwick-Edinburgh Mental Well-Being Scale, Generalized Anxiety Disorder Scale, Perceived Stress Scale, and Patient Health Questionnaire. For statistical analysis, we will consider the following variables: (1) the primary independent variable is screen use time; (2) other independent variables include age, gender, residence: rural or urban, educational qualifications, employment status, stress associated with familial financial status, average sleep time, number of people living in a house or rooms in that house, BMI, substance use, and past psychiatric history; and (3) dependent variables include mental well-being, depression, anxiety, and perceived stress. To quantify the association between screen use time and mental health, we will perform a Bayesian multivariate multiple regression analysis that models the possibility of multiple alternative hypotheses while accounting for relevant sociodemographic covariables. Results: The survey instrument has been designed, and feedback has been obtained from the domain experts and members of our organization whose profile is similar to the potential study participants. The final data received after this study has been conducted will be analyzed and shared. As of January 2023, we have not yet initiated the data collection. Conclusions: Based on the findings of this study, we will be able to establish a correlation between device- and use-specific screen use time and various mental health parameters. This will provide a direction to develop screen use time and mental health guidelines among young adults. International Registered Report Identifier (IRRID): PRR1-10.2196/39707 %M 39012657 %R 10.2196/39707 %U https://www.researchprotocols.org/2024/1/e39707 %U https://doi.org/10.2196/39707 %U http://www.ncbi.nlm.nih.gov/pubmed/39012657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51814 %T The Use of Telepsychiatry Services in Emergency Settings: Scoping Review %A Shalev,Ligat %A Eitan,Renana %A Rose,Adam J %+ School of Public Health, Hebrew University, Ein Kerem Campus, Jerusalem, 91120, Israel, 972 0507554025, Ligat.Shalev@gmail.com %K implementation science %K emergency department %K telepsychiatry %K organizational innovation %K eHealth %K mHealth %K scoping review %K implementation %K psychiatric patient %K clinical outcome %K rural %K feasible %K acceptable %K effectiveness %K electronic database %D 2024 %7 15.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Telepsychiatry (TP), a live video meeting, has been implemented in many contexts and settings. It has a distinct advantage in the psychiatric emergency department (ED) setting, as it expedites expert assessments for psychiatric patients. However, limited knowledge exits for TP’s effectiveness in the ED setting, as well as the process of implementing TP in this setting. Objective: This scoping review aimed to review the existing evidence for the administrative and clinical outcomes for TP in the ED setting and to identify the barriers and facilitators to implementing TP in this setting. Methods: The scoping review was conducted according to the guidelines for the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Three electronic databases were examined: PubMed, Embase, and Web of Science. The databases were searched from January 2013 to April 2023 for papers and their bibliography. A total of 2816 potentially relevant papers were retrieved from the initial search. Studies were screened and selected independently by 2 authors. Results: A total of 11 articles were included. Ten papers reported on administrative and clinical outcomes of TP use in the ED setting and 1 on the barriers and facilitators of its implementation. TP is used in urban and rural areas and for settings with and with no on-site psychiatric services. Evidence shows that TP reduced waiting time for psychiatric evaluation, but in some studies, it was associated with prolonged total length of stay in the ED compared with in-person evaluation. Findings indicate lower admission rates in patients assessed with TP in the ED. Limited data were reported for TP costs, its use for involuntary commitment evaluations, and its use for particular subgroups of patients (eg, those with a particular diagnosis). A single paper examined TP implementation process in the ED, which explored the barriers and facilitators for implementation among patients and staff in a rural setting. Conclusions: Based on the extant studies, TP seems to be generally feasible and acceptable to key stakeholders. However, this review detected a gap in the literature regarding TP’s effectiveness and implementation process in the ED setting. Specific attention should be paid to the examination of this service for specific groups of patients, as well as its use to enable assessments for possible involuntary commitment. %M 39008831 %R 10.2196/51814 %U https://www.jmir.org/2024/1/e51814 %U https://doi.org/10.2196/51814 %U http://www.ncbi.nlm.nih.gov/pubmed/39008831 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53541 %T Mindful Self-Compassion Smartphone Intervention for Worker Mental Health in Japan: Protocol for a Randomized Controlled Trial %A Kurosawa,Takumu %A Adachi,Koichiro %A Takizawa,Ryu %+ Department of Clinical Psychology, Graduate School of Education, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 358411397, takizawar-tky@umin.ac.jp %K self-compassion %K mindfulness %K smartphone apps %K preventive intervention %K mental health %K work performance %K smartphone intervention %K workers %K psychological support %K mindfulness meditation %K meditation %K work-related outcomes %K mobile phone %D 2024 %7 15.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health problems among workers cause enormous losses to companies in Japan. However, workers have been considered to have limited access to psychological support because of time constraints, which makes it difficult for them to engage in face-to-face psychological support interventions. Objective: This study aimed to present an intervention protocol that describes a randomized controlled trial to examine whether brief guided mindfulness meditation (MM) or self-compassion meditation (SCM) provided by a smartphone app is effective for mental health and work-related outcomes among workers. Methods: This is an open-label, 3-arm randomized controlled trial. The participants will be recruited through an open call on relevant websites with the following inclusion criteria: (1) employees who are working more than 20 hours per week, (2) between the ages of 18 and 54 years, (3) not on a leave of absence, (4) not business owners or students, and (5) not currently diagnosed with a mental disorder and have a Kessler Psychological Distress Scale-6 score below 13 points. We will include 200 participants and randomly assign them to an SCM course (n=67), an MM course (n=67), and a waitlist group (n=66). The intervention groups (SCM and MM) will be instructed to engage in daily guided self-help, self-compassion, and MMs lasting 6-12 minutes per day over 4 weeks. Primary outcomes will include psychological distress and job performance, and secondary outcomes will include somatic symptoms, cognitive flexibility, self-esteem, self-compassion, perceived stress, well-being, emotion regulation, work engagement, anger, psychological safety, and creativity. All procedures were approved by the ethics committee of the University of Tokyo (22-326). All participants will be informed of the study via the websites, and written informed consent will be collected via web-based forms. Results: The recruitment of participants began in December 2022, and the intervention began in January 2023. As of September 2023, a total of 375 participants have been enrolled. The intervention and data collection were completed in late October 2023. Conclusions: This study will contribute to the development of effective self-care intervention content that will improve mental health, work performance, and related outcomes and promote mindful and self-compassionate attitudes when faced with distress. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000049466; https://tinyurl.com/23x8m8nf International Registered Report Identifier (IRRID): DERR1-10.2196/53541 %M 39008345 %R 10.2196/53541 %U https://www.researchprotocols.org/2024/1/e53541 %U https://doi.org/10.2196/53541 %U http://www.ncbi.nlm.nih.gov/pubmed/39008345 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51506 %T Needs Expressed in Peer-to-Peer Web-Based Interactions Among People With Depression and Anxiety Disorders Hospitalized in a Mental Health Facility: Mixed Methods Study %A Storman,Dawid %A Jemioło,Paweł %A Sawiec,Zuzanna %A Swierz,Mateusz Jan %A Antonowicz,Ewa %A Bala,Malgorzata M %A Prokop-Dorner,Anna %+ Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kopernika 7, Kraków, 31-034, Poland, 48 124223720, dawid.storman@uj.edu.pl %K anxiety disorders %K depression %K peer-to-peer web-based interactions %K needs %K psychiatric hospitalization %D 2024 %7 12.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Hospitalization in psychiatric wards is a necessary step for many individuals experiencing severe mental health issues. However, being hospitalized can also be a stressful and unsettling experience. It is crucial to understand and address the various needs of hospitalized individuals with psychiatric disorders to promote their overall well-being and support their recovery. Objective: Our objectives were to identify and describe individual needs related to mental hospitals through peer-to-peer interactions on Polish web-based forums among individuals with depression and anxiety disorders and to assess whether these needs were addressed by peers. Methods: We conducted a search of web-based forums focused on depression and anxiety and selected samples of 160 and 176 posts, respectively, until we reached saturation. A mixed methods analysis that included an in-depth content analysis, the Pearson χ2 test, and φ coefficient was used to evaluate the posts. Results: The most frequently identified needs were the same for depression and anxiety forums and involved informational (105/160, 65.6% and 169/393, 43%, respectively), social life (17/160, 10.6% and 90/393, 22.9%, respectively), and emotional (9/160, 5.6% and 66/393, 16.8%, respectively) needs. The results show that there is no difference in the expression of needs between the analyzed forums. The needs were directly (42/47, 89% vs 98/110, 89.1% of times for depression and anxiety, respectively) and not fully (27/47, 57% vs 86/110, 78.2% of times for depression and anxiety, respectively) addressed by forum users. In quantitative analysis, we found that depression-related forums had more posts about the need for informational support and rectification, the expression of anger, and seeking professional support. By contrast, anxiety-related forums had more posts about the need for emotional support; social life; and information concerning medications, hope, and motivation. The most common co-occurrence of expressed needs was between sharing own experience and the need for professional support, with a strong positive association. The qualitative analysis showed that users join web-based communities to discuss their fears and questions about psychiatric hospitals. The posts revealed 4 mental and emotional representations of psychiatric hospitals: the hospital as an unknown place, the ambivalence of presumptions and needs, the negative representation of psychiatric hospitals, and the people associated with psychiatric hospitals. The tone of the posts was mostly negative, with discussions revolving around negative stereotypes; traumatic experiences; and beliefs that increased anxiety, shock, and fright and deterred users from hospitalization. Conclusions: Our study demonstrates that web-based forums can provide a platform for individuals with depression and anxiety disorders to express a wide range of needs. Most needs were addressed by peers but not sufficiently. Mental health professionals can benefit from these findings by gaining insights into the unique needs and concerns of their patients, thus allowing for more effective treatment and support. %R 10.2196/51506 %U https://www.jmir.org/2024/1/e51506 %U https://doi.org/10.2196/51506 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e56886 %T Impacts of Telehealth Adoption on the Quality of Care for Individuals With Serious Mental Illness: Retrospective Observational Analysis of Veterans Affairs Administrative Data %A Cummings,Camilla %A Raja,Pushpa %A Gabrielian,Sonya %A Doran,Neal %K telemedicine %K quality of care %K serious mental illness %K telehealth %K adoption %K mental illness %K patients %K patient %K veterans %K veteran %K psychotherapy %K psychosocial %K mental healthcare %K suicide %K rehabilitation %K mental health care %D 2024 %7 9.7.2024 %9 %J JMIR Ment Health %G English %X Background: Telehealth implementation can be challenging for persons with serious mental illness (SMI), which may impact their quality of care and health outcomes. The literature on telehealth’s impacts on SMI care outcomes is mixed, necessitating further investigation. Objective: We examined the impacts of facility-level telehealth adoption on quality of care metrics over time among patients with SMI. Methods: We analyzed Veterans Affairs (VA) administrative data across 138 facilities from January 2021 to December 2022. We performed longitudinal mixed-effects regressions to identify the relationships between the proportion of facility-level telehealth visits and SMI specialty care quality metrics: engagement with primary care; access and continuity of care across a range of mental health services including psychotherapy or psychosocial rehabilitation, SMI-specific intensive outpatient programs, and intensive case management; and continuity of mental health care after a high-risk event (eg, suicide attempt). Results: Facilities with a higher proportion of telehealth visits had reduced access and continuity of physical and mental health care for patients with SMI (P<.05). Higher telehealth adoption was associated with reduced primary care engagement (z=−4.04; P<.001), reduced access to and continuity in SMI-specific intensive case management (z=−4.49; P<.001; z=−3.15; P<.002), reductions in the continuity of care within psychotherapy and psychosocial rehabilitation (z=−3.74; P<.001), and continuity of care after a high-risk event (z=−2.46; P<.01). Telehealth uptake initially increased access to intensive outpatient but did not improve its continuity over time (z=−4.47; P<.001). Except for continuity within SMI-specific intensive case management (z=2.62; P<.009), continuity did not improve over time as telehealth became routinized. Conclusions: Although telehealth helped preserve health care access during the pandemic, telehealth may have tradeoffs with regard to quality of care for some individuals with SMI. These data suggest that engagement strategies used by SMI-specific intensive case management may have preserved quality and could benefit other settings. Strategies that enhance telehealth implementation—selected through a health equity lens—may improve quality of care among patients with SMI. %R 10.2196/56886 %U https://mental.jmir.org/2024/1/e56886 %U https://doi.org/10.2196/56886 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53980 %T In-Person and Teleconsultation Services at a National Hospital in Peru: Time Series Analysis of General and Psychiatric Care Amid the COVID-19 Pandemic %A Villarreal-Zegarra,David %A García-Serna,Jackeline %A Segovia-Bacilio,Piero %A Mayo-Puchoc,Nikol %A Navarro-Flores,Alba %A Huarcaya-Victoria,Jeff %+ Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Carretera Panamericana Sur N° 103, 113 y 123, Ica, Peru, 51 950322888, jeff.huarcaya@upsjb.edu.pe %K health care utilization %K mental health use %K COVID-19 %K mental health %K health care %K psychiatric care %K teleconsultation %K hospital %K Peru %K chronic %K patient %K patients %K telemonitoring %D 2024 %7 8.7.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic led to a global reduction in health care accessibility for both infected and noninfected patients, posing a particular burden on those with chronic conditions, including mental health issues. Peru experienced significant devastation from the pandemic, resulting in a collapsed health care system and leading to the world’s highest per capita mortality rate as a result of COVID-19. Understanding the trends in health care utilization, particularly in mental health care, is crucial for informing pandemic response efforts and guiding future recovery strategies. Objective: This study aims to analyze the trends of outpatient medical and psychiatric consultations during the COVID-19 pandemic in a national hospital in Peru. Methods: This observational study was conducted at a national hospital in Lima, Peru. We analyzed data on user care across all services, including psychiatric services, from May 2019 to December 2022. The data were calculated for users served per month, including the number of users seen monthly in mental health services. Sociodemographic variables such as sex (female or male), age (≥0 years), type of medical appointment (regular or additional), and modality of care (in-person or teleconsultations) were taken into account. An interrupted time series regression model was conducted to assess the number of outpatient medical and psychiatric consultations. Subgroup analyses were performed based on service modality, including overall consultations, telemonitoring/teleconsultations only, or face-to-face only, for all service users and for mental health service users. Results: A total of 1,515,439 participants were included, with females comprising 275,444/484,994 (56.80%) of the samples. Only 345,605/1,515,439 (22.81%) visits involved telemedicine. The total monthly outpatient visits were significantly reduced compared with the expected projection (P<.001) at the beginning of the pandemic, followed by a later monthly increment of 298.7 users. Face-to-face interventions experienced a significant reduction at the beginning of the pandemic (P<.001), gradually recovering in the following months. By contrast, telemedicine use initially increased but subsequently declined toward the end of the pandemic. A similar trend was observed in mental health units. Conclusions: During the pandemic years, health care utilization in both general and psychiatric services experienced a significant decrease, particularly at the beginning of the pandemic (March 2020). However, no significant trends were observed in either case throughout the pandemic period. Telemedicine consultations witnessed a significant increase overall during this period, particularly among mental health users. %M 38976320 %R 10.2196/53980 %U https://mental.jmir.org/2024/1/e53980 %U https://doi.org/10.2196/53980 %U http://www.ncbi.nlm.nih.gov/pubmed/38976320 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e53233 %T Exploring How Youth Use TikTok for Mental Health Information in British Columbia: Semistructured Interview Study With Youth %A Turuba,Roxanne %A Cormier,Willow %A Zimmerman,Rae %A Ow,Nikki %A Zenone,Marco %A Quintana,Yuri %A Jenkins,Emily %A Ben-David,Shelly %A Raimundo,Alicia %A Marcon,Alessandro R %A Mathias,Steve %A Henderson,Jo %A Barbic,Skye %+ Department of Occupational Science and Occupational Therapy, University of British Columbia, T325-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 6725155337, roxanne.turuba@ubc.ca %K youth %K adolescents %K young adults %K mental health %K TikTok %K social media %K qualitative research %D 2024 %7 5.7.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: TikTok (ByteDance) experienced a surge in popularity during the COVID-19 pandemic as a way for people to interact with others, share experiences and thoughts related to the pandemic, and cope with ongoing mental health challenges. However, few studies have explored how youth use TikTok to learn about mental health. Objective: This study aims to understand how youth used TikTok during the COVID-19 pandemic to learn about mental health and mental health support. Methods: Semistructured interviews were conducted with 21 youths (aged 12-24 years) living in British Columbia, Canada, who had accessed TikTok for mental health information during the COVID-19 pandemic. Interviews were audio-recorded, transcribed verbatim, coded, and analyzed using an inductive, data-driven approach. Results: A total of 3 overarching themes were identified describing youth’s experiences. The first theme centered on how TikTok gave youth easy access to mental health information and support, which was particularly helpful during the COVID-19 pandemic to curb the effects of social isolation and the additional challenges of accessing mental health services. The second theme described how the platform provided youth with connection, as it gave youth a safe space to talk about mental health and allowed them to feel seen by others going through similar experiences. This helped normalize and destigmatize conversations about mental health and brought awareness to various mental health conditions. Finally, the last theme focused on how this information led to action, such as trying different coping strategies, discussing mental health with peers and family, accessing mental health services, and advocating for themselves during medical appointments. Across the 3 themes, youth expressed having to be mindful of bias and misinformation, highlighting the barriers to identifying and reporting misinformation and providing individualized advice on the platform. Conclusions: Findings suggest that TikTok can be a useful tool to increase mental health awareness, reduce stigma, and encourage youth to learn and address their mental health challenges while providing a source of peer connection and support. Simultaneously, TikTok can adversely impact mental health through repetitive exposure to mentally distressing content and misleading diagnosis and treatment information. Regulations against harmful content are needed to mitigate these risks and make TikTok safer for youth. Efforts should also be made to increase media and health literacy among youth so that they can better assess the information they consume online. %M 38967966 %R 10.2196/53233 %U https://infodemiology.jmir.org/2024/1/e53233 %U https://doi.org/10.2196/53233 %U http://www.ncbi.nlm.nih.gov/pubmed/38967966 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52045 %T Bayesian Networks for Prescreening in Depression: Algorithm Development and Validation %A Maekawa,Eduardo %A Grua,Eoin Martino %A Nakamura,Carina Akemi %A Scazufca,Marcia %A Araya,Ricardo %A Peters,Tim %A van de Ven,Pepijn %+ Department of Electronic and Computer Engineering, University of Limerick, Plassey Park Road, Limerick, V94 T9PX, Ireland, 353 830150601, eduardo.maekawa@ul.ie %K Bayesian network %K target depressive symptomatology %K probabilistic machine learning %K stochastic gradient descent %K patient screening %K depressive symptom %K machine learning model %K machine learning %K survey %K prediction %K socioeconomic data sets %K utilization %K depression %K mental health %K digital mental health %K artificial intelligence %K AI %K prediction %K prediction modeling %K patient %K mood %K anxiety %K mood disorders %K mood disorder %K eHealth %K mobile health %K mHealth %K telehealth %D 2024 %7 4.7.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Identifying individuals with depressive symptomatology (DS) promptly and effectively is of paramount importance for providing timely treatment. Machine learning models have shown promise in this area; however, studies often fall short in demonstrating the practical benefits of using these models and fail to provide tangible real-world applications. Objective: This study aims to establish a novel methodology for identifying individuals likely to exhibit DS, identify the most influential features in a more explainable way via probabilistic measures, and propose tools that can be used in real-world applications. Methods: The study used 3 data sets: PROACTIVE, the Brazilian National Health Survey (Pesquisa Nacional de Saúde [PNS]) 2013, and PNS 2019, comprising sociodemographic and health-related features. A Bayesian network was used for feature selection. Selected features were then used to train machine learning models to predict DS, operationalized as a score of ≥10 on the 9-item Patient Health Questionnaire. The study also analyzed the impact of varying sensitivity rates on the reduction of screening interviews compared to a random approach. Results: The methodology allows the users to make an informed trade-off among sensitivity, specificity, and a reduction in the number of interviews. At the thresholds of 0.444, 0.412, and 0.472, determined by maximizing the Youden index, the models achieved sensitivities of 0.717, 0.741, and 0.718, and specificities of 0.644, 0.737, and 0.766 for PROACTIVE, PNS 2013, and PNS 2019, respectively. The area under the receiver operating characteristic curve was 0.736, 0.801, and 0.809 for these 3 data sets, respectively. For the PROACTIVE data set, the most influential features identified were postural balance, shortness of breath, and how old people feel they are. In the PNS 2013 data set, the features were the ability to do usual activities, chest pain, sleep problems, and chronic back problems. The PNS 2019 data set shared 3 of the most influential features with the PNS 2013 data set. However, the difference was the replacement of chronic back problems with verbal abuse. It is important to note that the features contained in the PNS data sets differ from those found in the PROACTIVE data set. An empirical analysis demonstrated that using the proposed model led to a potential reduction in screening interviews of up to 52% while maintaining a sensitivity of 0.80. Conclusions: This study developed a novel methodology for identifying individuals with DS, demonstrating the utility of using Bayesian networks to identify the most significant features. Moreover, this approach has the potential to substantially reduce the number of screening interviews while maintaining high sensitivity, thereby facilitating improved early identification and intervention strategies for individuals experiencing DS. %M 38963925 %R 10.2196/52045 %U https://mental.jmir.org/2024/1/e52045 %U https://doi.org/10.2196/52045 %U http://www.ncbi.nlm.nih.gov/pubmed/38963925 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e59198 %T Media Use and Its Associations With Paranoia in Schizophrenia and Bipolar Disorder: Ecological Momentary Assessment %A Paquin,Vincent %A Ackerman,Robert A %A Depp,Colin A %A Moore,Raeanne C %A Harvey,Philip D %A Pinkham,Amy E %K paranoia %K social media %K digital media %K technology %K psychosis %K schizophrenia %K schizoaffective %K bipolar disorder %K ecological momentary assessment %K spectrum %K sociodemographic %K linear mixed model %K media use %K mental health %K digital intervention %K adult %K adults %K medical center %K mental health clinic %K psychiatry %K psychiatrist %D 2024 %7 3.7.2024 %9 %J JMIR Ment Health %G English %X Background: Paranoia is a spectrum of fear-related experiences that spans diagnostic categories and is influenced by social and cognitive factors. The extent to which social media and other types of media use are associated with paranoia remains unclear. Objective: We aimed to examine associations between media use and paranoia at the within- and between-person levels. Methods: Participants were 409 individuals diagnosed with schizophrenia spectrum or bipolar disorder. Measures included sociodemographic and clinical characteristics at baseline, followed by ecological momentary assessments (EMAs) collected 3 times daily over 30 days. EMA evaluated paranoia and 5 types of media use: social media, television, music, reading or writing, and other internet or computer use. Generalized linear mixed models were used to examine paranoia as a function of each type of media use and vice versa at the within- and between-person levels. Results: Of the 409 participants, the following subgroups reported at least 1 instance of media use: 261 (63.8%) for using social media, 385 (94.1%) for watching TV, 292 (71.4%) for listening to music, 191 (46.7%) for reading or writing, and 280 (68.5%) for other internet or computer use. Gender, ethnoracial groups, educational attainment, and diagnosis of schizophrenia versus bipolar disorder were differentially associated with the likelihood of media use. There was a within-person association between social media use and paranoia: using social media was associated with a subsequent decrease of 5.5% (fold-change 0.945, 95% CI 0.904-0.987) in paranoia. The reverse association, from paranoia to subsequent changes in social media use, was not statistically significant. Other types of media use were not significantly associated with paranoia. Conclusions: This study shows that social media use was associated with a modest decrease in paranoia, perhaps reflecting the clinical benefits of social connection. However, structural disadvantage and individual factors may hamper the accessibility of media activities, and the mental health correlates of media use may further vary as a function of contents and contexts of use. %R 10.2196/59198 %U https://mental.jmir.org/2024/1/e59198 %U https://doi.org/10.2196/59198 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56118 %T Motivational Variables as Moderating Effects of a Web-Based Mental Health Program for University Students: Secondary Analysis of a Randomized Controlled Trial %A Hanano,Maria %A Rith-Najarian,Leslie %A Gong-Guy,Elizabeth %A Chavira,Denise %+ University of California, Los Angeles, 405 Hilgard Ave, Los Angeles, CA, 90095, United States, 1 9493501523, mariahanano@g.ucla.edu %K web-based intervention %K internal motivation %K depression %K anxiety %K self-determination theory %K mental health %K university students %K university %K students %K web-based %K analysis %K randomized controlled trial %K self-guided %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-guided web-based interventions have the potential of addressing help-seeking barriers and symptoms common among university students, such as depression and anxiety. Unfortunately, self-guided interventions are also associated with less adherence, implicating motivation as a potential moderator for adherence and improvement for such interventions. Previous studies examining motivation as a moderator or predictor of improvement on web-based interventions have defined and measured motivation variably, producing conflicting results. Objective: This secondary analysis of data from a randomized controlled trial aimed to examine constructs of motivation as moderators of improvement for a self-guided 8-week web-based intervention in university students (N=1607). Methods: Tested moderators included internal motivation, external motivation, and confidence in treatment derived from the Treatment Motivation Questionnaire. The primary outcome was an improvement in depression and anxiety measured by the Depression Anxiety Stress Scale-21. Results: Piecewise linear mixed effects models showed that internal motivation significantly moderated symptom change for the intervention group (t1504=–2.94; P=.003) at average and high (+1 SD) motivation levels (t1507=–2.28; P=.02 and t1507=–4.05; P<.001, respectively). Significant results remained even after controlling for baseline severity. The results showed that confidence in treatment did not significantly moderate symptom change for the intervention group (t1504=1.44; P=.15). In this sample, only internal motivation was positively correlated with service initiation, intervention adherence, and intervention satisfaction. Conclusions: The combination of a web-based intervention and high or moderate internal motivation resulted in greater improvement in the total Depression Anxiety Stress Scale-21 score. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. The results suggest that the combination of a web-based intervention and high or moderate internal motivation results in greater improvement. These findings highlight the importance of conceptually differentiating motivation-related constructs when examining moderators of improvement. To better understand the moderating role of internal motivation, future research is encouraged to replicate these findings in diverse samples as well as to examine related constructs such as baseline severity and adherence. Understanding these characteristics informs treatment strategies to maximize adherence and improvement when developing web-based interventions as well as allows services to be targeted to individuals likely to benefit from such interventions. Trial Registration: ClinicalTrials.gov NCT04361045; https://clinicaltrials.gov/study/NCT04361045 %M 38959024 %R 10.2196/56118 %U https://formative.jmir.org/2024/1/e56118 %U https://doi.org/10.2196/56118 %U http://www.ncbi.nlm.nih.gov/pubmed/38959024 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49879 %T News Media Framing of Suicide Circumstances and Gender: Mixed Methods Analysis %A Foriest,Jasmine C %A Mittal,Shravika %A Kim,Eugenia %A Carmichael,Andrea %A Lennon,Natalie %A Sumner,Steven A %A De Choudhury,Munmun %+ School of Interactive Computing, Georgia Institute of Technology, 225 North Ave NW, Atlanta, GA, 30332, United States, 1 7064643658, jay@gatech.edu %K suicide %K framing %K disparities %K reporting guidelines %K gender %K stigma %K glorification %K glorify %K glorifying %K suicidal %K self harm %K suicides %K stigmatizing %K stigmatization %K disparities %K reporting %K news %K journalist %K journalists %K journalism %K machine learning %K NLP %K natural language processing %K LLM %K LLMs %K language model %K language models %K linguistic %K linguistics %K reporter %K reporters %K gender %K digital mental health %K mHealth %K media %D 2024 %7 3.7.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death worldwide. Journalistic reporting guidelines were created to curb the impact of unsafe reporting; however, how suicide is framed in news reports may differ by important characteristics such as the circumstances and the decedent’s gender. Objective: This study aimed to examine the degree to which news media reports of suicides are framed using stigmatized or glorified language and differences in such framing by gender and circumstance of suicide. Methods: We analyzed 200 news articles regarding suicides and applied the validated Stigma of Suicide Scale to identify stigmatized and glorified language. We assessed linguistic similarity with 2 widely used metrics, cosine similarity and mutual information scores, using a machine learning–based large language model. Results: News reports of male suicides were framed more similarly to stigmatizing (P<.001) and glorifying (P=.005) language than reports of female suicides. Considering the circumstances of suicide, mutual information scores indicated that differences in the use of stigmatizing or glorifying language by gender were most pronounced for articles attributing legal (0.155), relationship (0.268), or mental health problems (0.251) as the cause. Conclusions: Linguistic differences, by gender, in stigmatizing or glorifying language when reporting suicide may exacerbate suicide disparities. %M 38959061 %R 10.2196/49879 %U https://mental.jmir.org/2024/1/e49879 %U https://doi.org/10.2196/49879 %U http://www.ncbi.nlm.nih.gov/pubmed/38959061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49431 %T Design of Digital Mental Health Platforms for Family Member Cocompletion: Scoping Review %A Welsh,Ellen T %A McIntosh,Jennifer E %A Vuong,An %A Cloud,Zoe C G %A Hartley,Eliza %A Boyd,James H %+ The Bouverie Centre, School of Psychology and Public Health, La Trobe University, 8 Gardiner Street, Brunswick, 3056, Australia, 61 384814800, e.welsh@latrobe.edu.au %K family therapy %K family %K couples %K eHealth %K digital health %K platform %K platforms %K e–mental health %K internet interventions %K psychosocial interventions %K psychosocial %K synthesis %K review methods %K review methodology %K scoping %K mental health %K utility %K design %K family caregiver %K caregiver %K parent %K child %K development %K cocompletion %K access %K accessibility %K engagement %K families %K dyad %K dyadic %K user engagement %K digital health %K user experience %K mobile phone %D 2024 %7 3.7.2024 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic placed an additional mental health burden on individuals and families, resulting in widespread service access problems. Digital mental health interventions suggest promise for improved accessibility. Recent reviews have shown emerging evidence for individual use and early evidence for multiusers. However, attrition rates remain high for digital mental health interventions, and additional complexities exist when engaging multiple family members together. Objective: As such, this scoping review aims to detail the reported evidence for digital mental health interventions designed for family use with a focus on the build and design characteristics that promote accessibility and engagement and enable cocompletion by families. Methods: A systematic literature search of MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL databases was conducted for articles published in the English language from January 2002 to March 2024. Eligible records included empirical studies of digital platforms containing some elements designed for cocompletion by related people as well as some components intended to be completed without therapist engagement. Platforms were included in cases in which clinical evidence had been documented. Results: Of the 9527 papers reviewed, 85 (0.89%) met the eligibility criteria. A total of 24 unique platforms designed for co-use by related parties were identified. Relationships between participants included couples, parent-child dyads, family caregiver–care recipient dyads, and families. Common platform features included the delivery of content via structured interventions with no to minimal tailoring or personalization offered. Some interventions provided live contact with therapists. User engagement indicators and findings varied and included user experience, satisfaction, completion rates, and feasibility. Our findings are more remarkable for what was absent in the literature than what was present. Contrary to expectations, few studies reported any design and build characteristics that enabled coparticipation. No studies reported on platform features for enabling cocompletion or considerations for ensuring individual privacy and safety. None examined platform build or design characteristics as moderators of intervention effect, and none offered a formative evaluation of the platform itself. Conclusions: In this early era of digital mental health platform design, this novel review demonstrates a striking absence of information about design elements associated with the successful engagement of multiple related users in any aspect of a therapeutic process. There remains a large gap in the literature detailing and evaluating platform design, highlighting a significant opportunity for future cross-disciplinary research. This review details the incentive for undertaking such research; suggests design considerations when building digital mental health platforms for use by families; and offers recommendations for future development, including platform co-design and formative evaluation. %M 38959030 %R 10.2196/49431 %U https://www.jmir.org/2024/1/e49431 %U https://doi.org/10.2196/49431 %U http://www.ncbi.nlm.nih.gov/pubmed/38959030 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e56569 %T The Role of Humanization and Robustness of Large Language Models in Conversational Artificial Intelligence for Individuals With Depression: A Critical Analysis %A Ferrario,Andrea %A Sedlakova,Jana %A Trachsel,Manuel %K generative AI %K large language models %K large language model %K LLM %K LLMs %K machine learning %K ML %K natural language processing %K NLP %K deep learning %K depression %K mental health %K mental illness %K mental disease %K mental diseases %K mental illnesses %K artificial intelligence %K AI %K digital health %K digital technology %K digital intervention %K digital interventions %K ethics %D 2024 %7 2.7.2024 %9 %J JMIR Ment Health %G English %X Large language model (LLM)–powered services are gaining popularity in various applications due to their exceptional performance in many tasks, such as sentiment analysis and answering questions. Recently, research has been exploring their potential use in digital health contexts, particularly in the mental health domain. However, implementing LLM-enhanced conversational artificial intelligence (CAI) presents significant ethical, technical, and clinical challenges. In this viewpoint paper, we discuss 2 challenges that affect the use of LLM-enhanced CAI for individuals with mental health issues, focusing on the use case of patients with depression: the tendency to humanize LLM-enhanced CAI and their lack of contextualized robustness. Our approach is interdisciplinary, relying on considerations from philosophy, psychology, and computer science. We argue that the humanization of LLM-enhanced CAI hinges on the reflection of what it means to simulate “human-like” features with LLMs and what role these systems should play in interactions with humans. Further, ensuring the contextualization of the robustness of LLMs requires considering the specificities of language production in individuals with depression, as well as its evolution over time. Finally, we provide a series of recommendations to foster the responsible design and deployment of LLM-enhanced CAI for the therapeutic support of individuals with depression. %R 10.2196/56569 %U https://mental.jmir.org/2024/1/e56569 %U https://doi.org/10.2196/56569 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58390 %T Enhancing Agency in Posttraumatic Stress Disorder Therapies Through Sensorimotor Technologies %A Adrien,Vladimir %A Bosc,Nicolas %A Peccia Galletto,Claire %A Diot,Thomas %A Claverie,Damien %A Reggente,Nicco %A Trousselard,Marion %A Bui,Eric %A Baubet,Thierry %A Schoeller,Félix %+ Department of Infectious and Tropical Diseases, Avicenne Hospital, AP-HP, Université Sorbonne Paris Nord, 125 rue de Stalingrad, Bobigny, 93000, France, 33 148955421, vladimir.adrien@aphp.fr %K posttraumatic stress disorder %K PTSD %K agency %K proprioception %K trauma %K self-control %K sensorimotor technology %K enactive perspective %K peritraumatic dissociation %K proprioceptive reafferent fibers %K gesture sonification devices %D 2024 %7 1.7.2024 %9 Viewpoint %J J Med Internet Res %G English %X Posttraumatic stress disorder (PTSD) is a significant public health concern, with only a third of patients recovering within a year of treatment. While PTSD often disrupts the sense of body ownership and sense of agency (SA), attention to the SA in trauma has been lacking. This perspective paper explores the loss of the SA in PTSD and its relevance in the development of symptoms. Trauma is viewed as a breakdown of the SA, related to a freeze response, with peritraumatic dissociation increasing the risk of PTSD. Drawing from embodied cognition, we propose an enactive perspective of PTSD, suggesting therapies that restore the SA through direct engagement with the body and environment. We discuss the potential of agency-based therapies and innovative technologies such as gesture sonification, which translates body movements into sounds to enhance the SA. Gesture sonification offers a screen-free, noninvasive approach that could complement existing trauma-focused therapies. We emphasize the need for interdisciplinary collaboration and clinical research to further explore these approaches in preventing and treating PTSD. %M 38742989 %R 10.2196/58390 %U https://www.jmir.org/2024/1/e58390 %U https://doi.org/10.2196/58390 %U http://www.ncbi.nlm.nih.gov/pubmed/38742989 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55302 %T Longitudinal Assessment of Seasonal Impacts and Depression Associations on Circadian Rhythm Using Multimodal Wearable Sensing: Retrospective Analysis %A Zhang,Yuezhou %A Folarin,Amos A %A Sun,Shaoxiong %A Cummins,Nicholas %A Ranjan,Yatharth %A Rashid,Zulqarnain %A Stewart,Callum %A Conde,Pauline %A Sankesara,Heet %A Laiou,Petroula %A Matcham,Faith %A White,Katie M %A Oetzmann,Carolin %A Lamers,Femke %A Siddi,Sara %A Simblett,Sara %A Vairavan,Srinivasan %A Myin-Germeys,Inez %A Mohr,David C %A Wykes,Til %A Haro,Josep Maria %A Annas,Peter %A Penninx,Brenda WJH %A Narayan,Vaibhav A %A Hotopf,Matthew %A Dobson,Richard JB %A , %+ Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, SGDP Centre, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom, 44 7579856617, yuezhou.zhang@kcl.ac.uk %K circadian rhythm %K biological rhythms %K mental health %K major depressive disorder %K MDD %K wearable %K mHealth %K mobile health %K digital health %K monitoring %D 2024 %7 28.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous mobile health (mHealth) studies have revealed significant links between depression and circadian rhythm features measured via wearables. However, the comprehensive impact of seasonal variations was not fully considered in these studies, potentially biasing interpretations in real-world settings. Objective: This study aims to explore the associations between depression severity and wearable-measured circadian rhythms while accounting for seasonal impacts. Methods: Data were sourced from a large longitudinal mHealth study, wherein participants’ depression severity was assessed biweekly using the 8-item Patient Health Questionnaire (PHQ-8), and participants’ behaviors, including sleep, step count, and heart rate (HR), were tracked via Fitbit devices for up to 2 years. We extracted 12 circadian rhythm features from the 14-day Fitbit data preceding each PHQ-8 assessment, including cosinor variables, such as HR peak timing (HR acrophase), and nonparametric features, such as the onset of the most active continuous 10-hour period (M10 onset). To investigate the association between depression severity and circadian rhythms while also assessing the seasonal impacts, we used three nested linear mixed-effects models for each circadian rhythm feature: (1) incorporating the PHQ-8 score as an independent variable, (2) adding seasonality, and (3) adding an interaction term between season and the PHQ-8 score. Results: Analyzing 10,018 PHQ-8 records alongside Fitbit data from 543 participants (n=414, 76.2% female; median age 48, IQR 32-58 years), we found that after adjusting for seasonal effects, higher PHQ-8 scores were associated with reduced daily steps (β=–93.61, P<.001), increased sleep variability (β=0.96, P<.001), and delayed circadian rhythms (ie, sleep onset: β=0.55, P=.001; sleep offset: β=1.12, P<.001; M10 onset: β=0.73, P=.003; HR acrophase: β=0.71, P=.001). Notably, the negative association with daily steps was more pronounced in spring (β of PHQ-8 × spring = –31.51, P=.002) and summer (β of PHQ-8 × summer = –42.61, P<.001) compared with winter. Additionally, the significant correlation with delayed M10 onset was observed solely in summer (β of PHQ-8 × summer = 1.06, P=.008). Moreover, compared with winter, participants experienced a shorter sleep duration by 16.6 minutes, an increase in daily steps by 394.5, a delay in M10 onset by 20.5 minutes, and a delay in HR peak time by 67.9 minutes during summer. Conclusions: Our findings highlight significant seasonal influences on human circadian rhythms and their associations with depression, underscoring the importance of considering seasonal variations in mHealth research for real-world applications. This study also indicates the potential of wearable-measured circadian rhythms as digital biomarkers for depression. %M 38941600 %R 10.2196/55302 %U https://www.jmir.org/2024/1/e55302 %U https://doi.org/10.2196/55302 %U http://www.ncbi.nlm.nih.gov/pubmed/38941600 %0 Journal Article %@ 2368-7959 %I JMIR Mental Health %V 11 %N %P e50535 %T The Efficacy of Web-Based Cognitive Behavioral Therapy With a Shame-Specific Intervention for Social Anxiety Disorder: Randomized Controlled Trial %A Wen,Xu %A Gou,Mengke %A Chen,Huijing %A Kishimoto,Tomoko %A Qian,Mingyi %A Margraf,Jürgen %A Berger,Thomas %K social anxiety disorder %K web-based cognitive behavioral therapy %K shame intervention %K mediating effects %K shame experience %D 2024 %7 27.6.2024 %9 %J JMIR Ment Health %G English %X Background: Social anxiety disorder (SAD) is one of the most prevalent psychological disorders and generally co-occurs with elevated shame levels. Previous shame-specific interventions could significantly improve outcomes in social anxiety treatments. Recent review suggests that integrating a more direct shame intervention could potentially increase the effectiveness of cognitive behavioral therapy. Web-based cognitive behavioral therapy (WCBT) has proven efficacy, sustaining benefits for 6 months to 4 years. Previous evidence indicated that shame predicted the reduction of social anxiety and mediated between engagements in exposure and changes in social anxiety during WCBT. Objective: This study aimed to design a shame intervention component through a longitudinal study and conduct a randomized controlled trial to investigate the effectiveness of a shame intervention component in reducing social anxiety symptoms and shame experience in a clinical sample of people with SAD. Methods: The development of a shame intervention component was informed by cognitive behavioral principles and insights from longitudinal data that measured the Experience of Shame Scale (ESS), the Coping Styles Questionnaire, and the Social Interaction Anxiety Scale (SIAS) in 153 participants. The psychoeducation, cognitive construct, and exposure sections were tailored to focus more on shame-related problem-solving and self-blame. A total of 1220 participants were recruited to complete questionnaires, including the ESS, the SIAS, the Social Phobia Scale (SPS), and diagnostic interviews. Following a 2-round screening process, 201 participants with SAD were randomly assigned into a shame WCBT group, a normal WCBT group, and a waiting group. After the 8-week WCBT intervention, the participants were asked to complete posttest evaluations, including the ESS, SIAS and SPS. Results: Participants in the shame WCBT group experienced significant reductions in shame levels after the intervention (ESS: P<.001; ηp2=0.22), and the reduction was greater in the shame intervention group compared to normal WCBT (P<.001; mean deviation −12.50). Participants in both the shame WCBT and normal WCBT groups experienced significant reductions in social anxiety symptoms (SIAS: P<.001; ηp2=0.32; SPS: P<.001; ηp2=0.19) compared to the waiting group after intervention. Furthermore, in the experience of social interaction anxiety (SIAS), the shame WCBT group showed a higher reduction compared to the normal WCBT group (P<.001; mean deviation −9.58). Problem-solving (SE 0.049, 95% CI 0.025-0.217) and self-blame (SE 0.082, 95% CI 0.024-0.339) mediated the effect between ESS and SIAS. Conclusions: This is the first study to design and incorporate a shame intervention component in WCBT and to validate its efficacy via a randomized controlled trial. The shame WCBT group showed a significant reduction in both shame and social anxiety after treatment compared to the normal WCBT and waiting groups. Problem-solving and self-blame mediated the effect of shame on social anxiety. In conclusion, this study supports previous findings that a direct shame-specific intervention component could enhance the efficacy of WCBT. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300072184; https://www.chictr.org.cn/showproj.html?proj=152757 %R 10.2196/50535 %U https://mental.jmir.org/2024/1/e50535 %U https://doi.org/10.2196/50535 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54634 %T Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study %A McCallum,Meaghan %A Baldwin,Matthew %A Thompson,Paige %A Blessing,Kelly %A Frisch,Maria %A Ho,Annabell %A Ainsworth,Matthew Cole %A Mitchell,Ellen Siobhan %A Michaelides,Andreas %A May,Christine N %+ Academic Research, Noom, Inc, 450 West 33rd Street, New York City, NY, 10001, United States, 1 8882665071, meaghanm@noom.com %K mHealth %K psychological distress %K Noom Mood %K digital mental wellness programs %K mobile phone %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app–based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. Objective: Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. Methods: A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks’ postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). Results: The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). Conclusions: This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations. %M 38935946 %R 10.2196/54634 %U https://mhealth.jmir.org/2024/1/e54634 %U https://doi.org/10.2196/54634 %U http://www.ncbi.nlm.nih.gov/pubmed/38935946 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55747 %T Insights Derived From Text-Based Digital Media, in Relation to Mental Health and Suicide Prevention, Using Data Analysis and Machine Learning: Systematic Review %A Sweeney,Colm %A Ennis,Edel %A Mulvenna,Maurice D %A Bond,Raymond %A O'Neill,Siobhan %+ Department of Psychlogy, Ulster University, Cromore Rd, Coleraine, BT52 1SA, United Kingdom, 44 02870 123 456, Sweeney-C23@ulster.ac.uk %K mental health %K machine learning %K text analysis %K digital intervention %D 2024 %7 27.6.2024 %9 Review %J JMIR Ment Health %G English %X Background: Text-based digital media platforms have revolutionized communication and information sharing, providing valuable access to knowledge and understanding in the fields of mental health and suicide prevention. Objective: This systematic review aimed to determine how machine learning and data analysis can be applied to text-based digital media data to understand mental health and aid suicide prevention. Methods: A systematic review of research papers from the following major electronic databases was conducted: Web of Science, MEDLINE, Embase (via MEDLINE), and PsycINFO (via MEDLINE). The database search was supplemented by a hand search using Google Scholar. Results: Overall, 19 studies were included, with five major themes as to how data analysis and machine learning techniques could be applied: (1) as predictors of personal mental health, (2) to understand how personal mental health and suicidal behavior are communicated, (3) to detect mental disorders and suicidal risk, (4) to identify help seeking for mental health difficulties, and (5) to determine the efficacy of interventions to support mental well-being. Conclusions: Our findings show that data analysis and machine learning can be used to gain valuable insights, such as the following: web-based conversations relating to depression vary among different ethnic groups, teenagers engage in a web-based conversation about suicide more often than adults, and people seeking support in web-based mental health communities feel better after receiving online support. Digital tools and mental health apps are being used successfully to manage mental health, particularly through the COVID-19 epidemic, during which analysis has revealed that there was increased anxiety and depression, and web-based communities played a part in reducing isolation during the pandemic. Predictive analytics were also shown to have potential, and virtual reality shows promising results in the delivery of preventive or curative care. Future research efforts could center on optimizing algorithms to enhance the potential of text-based digital media analysis in mental health and suicide prevention. In addressing depression, a crucial step involves identifying the factors that contribute to happiness and using machine learning to forecast these sources of happiness. This could extend to understanding how various activities result in improved happiness across different socioeconomic groups. Using insights gathered from such data analysis and machine learning, there is an opportunity to craft digital interventions, such as chatbots, designed to provide support and address mental health challenges and suicide prevention. %M 38935419 %R 10.2196/55747 %U https://mental.jmir.org/2024/1/e55747 %U https://doi.org/10.2196/55747 %U http://www.ncbi.nlm.nih.gov/pubmed/38935419 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e54945 %T A Chatbot-Delivered Stress Management Coaching for Students (MISHA App): Pilot Randomized Controlled Trial %A Ulrich,Sandra %A Lienhard,Natascha %A Künzli,Hansjörg %A Kowatsch,Tobias %+ School of Applied Psychology, Zurich University of Applied Sciences, Pfingstweidstrasse 96, Zurich, 8005, Switzerland, 41 58 934 ext 8451, sandra.ulrich@zhaw.ch %K conversational agent %K mobile health %K mHealth %K smartphone %K stress management %K lifestyle %K behavior change %K coaching %K mobile phone %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Globally, students face increasing mental health challenges, including elevated stress levels and declining well-being, leading to academic performance issues and mental health disorders. However, due to stigma and symptom underestimation, students rarely seek effective stress management solutions. Conversational agents in the health sector have shown promise in reducing stress, depression, and anxiety. Nevertheless, research on their effectiveness for students with stress remains limited. Objective: This study aims to develop a conversational agent–delivered stress management coaching intervention for students called MISHA and to evaluate its effectiveness, engagement, and acceptance. Methods: In an unblinded randomized controlled trial, Swiss students experiencing stress were recruited on the web. Using a 1:1 randomization ratio, participants (N=140) were allocated to either the intervention or waitlist control group. Treatment effectiveness on changes in the primary outcome, that is, perceived stress, and secondary outcomes, including depression, anxiety, psychosomatic symptoms, and active coping, were self-assessed and evaluated using ANOVA for repeated measure and general estimating equations. Results: The per-protocol analysis revealed evidence for improvement of stress, depression, and somatic symptoms with medium effect sizes (Cohen d=−0.36 to Cohen d=−0.60), while anxiety and active coping did not change (Cohen d=−0.29 and Cohen d=0.13). In the intention-to-treat analysis, similar results were found, indicating reduced stress (β estimate=−0.13, 95% CI −0.20 to −0.05; P<.001), depressive symptoms (β estimate=−0.23, 95% CI −0.38 to −0.08; P=.003), and psychosomatic symptoms (β estimate=−0.16, 95% CI −0.27 to −0.06; P=.003), while anxiety and active coping did not change. Overall, 60% (42/70) of the participants in the intervention group completed the coaching by completing the postintervention survey. They particularly appreciated the quality, quantity, credibility, and visual representation of information. While individual customization was rated the lowest, the target group fitting was perceived as high. Conclusions: Findings indicate that MISHA is feasible, acceptable, and effective in reducing perceived stress among students in Switzerland. Future research is needed with different populations, for example, in students with high stress levels or compared to active controls. Trial Registration: German Clinical Trials Register DRKS 00030004; https://drks.de/search/en/trial/DRKS00030004 %M 38922677 %R 10.2196/54945 %U https://mhealth.jmir.org/2024/1/e54945 %U https://doi.org/10.2196/54945 %U http://www.ncbi.nlm.nih.gov/pubmed/38922677 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47704 %T Effectiveness of Web-Based Mindfulness-Based Interventions for Patients With Cancer: Systematic Review and Meta-Analyses %A Wang,Ting %A Tang,Chulei %A Jiang,Xiaoman %A Guo,Yinning %A Zhu,Shuqin %A Xu,Qin %+ School of Nursing, Nanjing Medical University, 101 Longmian Avenue, Jiangning District, Nanjing, 211166, China, 86 13601587208, qinxu@njmu.edu.cn %K cancer %K mindfulness-based interventions %K mental health %K randomized controlled trial %K systematic review %K meta-analysis %K mindfulness %K web-based intervention %K oncology %K delivery mode %K efficacy %K quality of life %K program %K adherence %K mobile phone %D 2024 %7 25.6.2024 %9 Review %J J Med Internet Res %G English %X Background: Cancer has emerged as a considerable global health concern, contributing substantially to both morbidity and mortality. Recognizing the urgent need to enhance the overall well-being and quality of life (QOL) of cancer patients, a growing number of researchers have started using online mindfulness-based interventions (MBIs) in oncology. However, the effectiveness and optimal implementation methods of these interventions remain unknown. Objective: This study evaluates the effectiveness of online MBIs, encompassing both app- and website-based MBIs, for patients with cancer and provides insights into the potential implementation and sustainability of these interventions in real-world settings. Methods: Searches were conducted across 8 electronic databases, including the Cochrane Library, Web of Science, PubMed, Embase, SinoMed, CINAHL Complete, Scopus, and PsycINFO, until December 30, 2022. Randomized controlled trials involving cancer patients aged ≥18 years and using app- and website-based MBIs compared to standard care were included. Nonrandomized studies, interventions targeting health professionals or caregivers, and studies lacking sufficient data were excluded. Two independent authors screened articles, extracted data using standardized forms, and assessed the risk of bias in the studies using the Cochrane Bias Risk Assessment Tool. Meta-analyses were performed using Review Manager (version 5.4; The Cochrane Collaboration) and the meta package in R (R Foundation for Statistical Computing). Standardized mean differences (SMDs) were used to determine the effects of interventions. The Reach, Effectiveness, Adoption, Implementation, and Maintenance framework was used to assess the potential implementation and sustainability of these interventions in real-world settings. Results: Among 4349 articles screened, 15 (0.34%) were included. The total population comprised 1613 participants, of which 870 (53.9%) were in the experimental conditions and 743 (46.1%) were in the control conditions. The results of the meta-analysis showed that compared with the control group, the QOL (SMD 0.37, 95% CI 0.18-0.57; P<.001), sleep (SMD −0.36, 95% CI −0.71 to −0.01; P=.04), anxiety (SMD −0.48, 95% CI −0.75 to −0.20; P<.001), depression (SMD −0.36, 95% CI −0.61 to −0.11; P=.005), distress (SMD −0.50, 95% CI −0.75 to −0.26; P<.001), and perceived stress (SMD −0.89, 95% CI −1.33 to −0.45; P=.003) of the app- and website-based MBIs group in patients with cancer was significantly alleviated after the intervention. However, no significant differences were found in the fear of cancer recurrence (SMD −0.30, 95% CI −1.04 to 0.44; P=.39) and posttraumatic growth (SMD 0.08, 95% CI −0.26 to 0.42; P=.66). Most interventions were multicomponent, website-based health self-management programs, widely used by international and multilingual patients with cancer. Conclusions: App- and website-based MBIs show promise for improving mental health and QOL outcomes in patients with cancer, and further research is needed to optimize and customize these interventions for individual physical and mental symptoms. Trial Registration: PROSPERO CRD42022382219; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382219 %M 38917445 %R 10.2196/47704 %U https://www.jmir.org/2024/1/e47704 %U https://doi.org/10.2196/47704 %U http://www.ncbi.nlm.nih.gov/pubmed/38917445 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50253 %T Wearable Technologies for Detecting Burnout and Well-Being in Health Care Professionals: Scoping Review %A Barac,Milica %A Scaletty,Samantha %A Hassett,Leslie C %A Stillwell,Ashley %A Croarkin,Paul E %A Chauhan,Mohit %A Chesak,Sherry %A Bobo,William V %A Athreya,Arjun P %A Dyrbye,Liselotte N %+ Department of Medicine, University of Colorado School of Medicine, Mail Stop C290, Fitzsimons Bldg, 13001 E 17th Pl. Rm #E1347, Aurora, CO, 80045, United States, 1 303 724 4982, Liselotte.dyrbye@cuanschutz.edu %K wearable %K healthcare professionals %K burnout %K digital health %K mental health %D 2024 %7 25.6.2024 %9 Review %J J Med Internet Res %G English %X Background: The occupational burnout epidemic is a growing issue, and in the United States, up to 60% of medical students, residents, physicians, and registered nurses experience symptoms. Wearable technologies may provide an opportunity to predict the onset of burnout and other forms of distress using physiological markers. Objective: This study aims to identify physiological biomarkers of burnout, and establish what gaps are currently present in the use of wearable technologies for burnout prediction among health care professionals (HCPs). Methods: A comprehensive search of several databases was performed on June 7, 2022. No date limits were set for the search. The databases were Ovid: MEDLINE(R), Embase, Healthstar, APA PsycInfo, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science Core Collection via Clarivate Analytics, Scopus via Elsevier, EBSCOhost: Academic Search Premier, CINAHL with Full Text, and Business Source Premier. Studies observing anxiety, burnout, stress, and depression using a wearable device worn by an HCP were included, with HCP defined as medical students, residents, physicians, and nurses. Bias was assessed using the Newcastle Ottawa Quality Assessment Form for Cohort Studies. Results: The initial search yielded 505 papers, from which 10 (1.95%) studies were included in this review. The majority (n=9) used wrist-worn biosensors and described observational cohort studies (n=8), with a low risk of bias. While no physiological measures were reliably associated with burnout or anxiety, step count and time in bed were associated with depressive symptoms, and heart rate and heart rate variability were associated with acute stress. Studies were limited with long-term observations (eg, ≥12 months) and large sample sizes, with limited integration of wearable data with system-level information (eg, acuity) to predict burnout. Reporting standards were also insufficient, particularly in device adherence and sampling frequency used for physiological measurements. Conclusions: With wearables offering promise for digital health assessments of human functioning, it is possible to see wearables as a frontier for predicting burnout. Future digital health studies exploring the utility of wearable technologies for burnout prediction should address the limitations of data standardization and strategies to improve adherence and inclusivity in study participation. %M 38916948 %R 10.2196/50253 %U https://www.jmir.org/2024/1/e50253 %U https://doi.org/10.2196/50253 %U http://www.ncbi.nlm.nih.gov/pubmed/38916948 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55100 %T Digital and Hybrid Pediatric and Youth Mental Health Program Implementation Challenges During the Pandemic: Literature Review With a Knowledge Translation and Theoretical Lens Analysis %A Lyzwinski,Lynnette %A Mcdonald,Sheila %A Zwicker,Jennifer %A Tough,Suzanne %+ Department of Paediatrics, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr, Calgary, AB, T2N4N1, Canada, 1 403 220 6843, Lynnette.Lyzwinski@ucalgary.ca %K mental health %K knowledge translation %K KT %K flourishing %K youth %K teenagers %K mindfulness %K positive psychology %K telehealth %K implementation %K knowledge dissemination %K pandemic %K COVID-19 %K service delivery %D 2024 %7 25.6.2024 %9 Review %J JMIR Pediatr Parent %G English %X Background: The pandemic brought unprecedented challenges for child and youth mental health. There was a rise in depression, anxiety, and symptoms of suicidal ideation. Objective: The aims of this knowledge synthesis were to gain a deeper understanding of what types of mental health knowledge translation (KT) programs, mental health first aid training, and positive psychology interventions were developed and evaluated for youth mental health. Methods: We undertook a literature review of PubMed and MEDLINE for relevant studies on youth mental health including digital and hybrid programs undertaken during the pandemic (2020-2022). Results: A total of 60 studies were included in this review. A few KT programs were identified that engaged with a wide range of stakeholders during the pandemic, and a few were informed by KT theories. Key challenges during the implementation of mental health programs for youth included lack of access to technology and privacy concerns. Hybrid web-based and face-to-face KT and mental health care were recommended. Providers required adequate training in using telehealth and space. Conclusions: There is an opportunity to reduce the barriers to implementing tele–mental health in youth by providing adequate technological access, Wi-Fi and stationary internet connectivity, and privacy protection. Staff gained new knowledge and training from the pandemic experience of using telehealth, which will serve as a useful foundation for the future. Future research should aim to maximize the benefits of hybrid models of tele–mental health and face-to-face sessions while working on minimizing the potential barriers that were identified. In addition, future programs could consider combining mental health first aid training with hybrid digital and face-to-face mental health program delivery along with mindfulness and resilience building in a unified model of care, knowledge dissemination, and implementation. %M 38916946 %R 10.2196/55100 %U https://pediatrics.jmir.org/2024/1/e55100 %U https://doi.org/10.2196/55100 %U http://www.ncbi.nlm.nih.gov/pubmed/38916946 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52316 %T Leveraging Social Media to Predict COVID-19–Induced Disruptions to Mental Well-Being Among University Students: Modeling Study %A Das Swain,Vedant %A Ye,Jingjing %A Ramesh,Siva Karthik %A Mondal,Abhirup %A Abowd,Gregory D %A De Choudhury,Munmun %+ Khoury College of Computer Sciences, Northeastern University, #202, West Village Residence Complex H, 440 Huntington Ave, Boston, MA, 02115, United States, 1 (404) 894 2000, vedantswain@gmail.com %K social media %K mental health %K linguistic markers %K digital phenotyping %K COVID-19 %K disaster well-being %K well-being %K machine learning %K temporal trends %K disruption %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Large-scale crisis events such as COVID-19 often have secondary impacts on individuals’ mental well-being. University students are particularly vulnerable to such impacts. Traditional survey-based methods to identify those in need of support do not scale over large populations and they do not provide timely insights. We pursue an alternative approach through social media data and machine learning. Our models aim to complement surveys and provide early, precise, and objective predictions of students disrupted by COVID-19. Objective: This study aims to demonstrate the feasibility of language on private social media as an indicator of crisis-induced disruption to mental well-being. Methods: We modeled 4124 Facebook posts provided by 43 undergraduate students, spanning over 2 years. We extracted temporal trends in the psycholinguistic attributes of their posts and comments. These trends were used as features to predict how COVID-19 disrupted their mental well-being. Results: The social media–enabled model had an F1-score of 0.79, which was a 39% improvement over a model trained on the self-reported mental state of the participant. The features we used showed promise in predicting other mental states such as anxiety, depression, social, isolation, and suicidal behavior (F1-scores varied between 0.85 and 0.93). We also found that selecting the windows of time 7 months after the COVID-19–induced lockdown presented better results, therefore, paving the way for data minimization. Conclusions: We predicted COVID-19–induced disruptions to mental well-being by developing a machine learning model that leveraged language on private social media. The language in these posts described psycholinguistic trends in students’ online behavior. These longitudinal trends helped predict mental well-being disruption better than models trained on correlated mental health questionnaires. Our work inspires further research into the potential applications of early, precise, and automatic warnings for individuals concerned about their mental health in times of crisis. %M 38916951 %R 10.2196/52316 %U https://formative.jmir.org/2024/1/e52316 %U https://doi.org/10.2196/52316 %U http://www.ncbi.nlm.nih.gov/pubmed/38916951 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48298 %T Improvement and Maintenance of Clinical Outcomes in a Digital Mental Health Platform: Findings From a Longitudinal Observational Real-World Study %A Roos,Lydia G %A Sagui-Henson,Sara J %A Castro Sweet,Cynthia %A Welcome Chamberlain,Camille E %A Smith,Brooke J %+ Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 760 Westwood Plaza, Los Angeles, CA, 90024, United States, 1 8435446005, lroos@mednet.ucla.edu %K digital mental health %K employee health %K depression %K anxiety %K well-being %K mobile phone %D 2024 %7 24.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital mental health services are increasingly being provided by employers as health benefit programs that can improve access to and remove barriers to mental health care. Stratified care models, in particular, offer personalized care recommendations that can offer clinically effective interventions while conserving resources. Nonetheless, clinical evaluation is needed to understand their benefits for mental health and their use in a real-world setting. Objective: This study aimed to examine the changes in clinical outcomes (ie, depressive and anxiety symptoms and well-being) and to evaluate the use of stratified blended care among members of an employer-sponsored digital mental health benefit. Methods: In a large prospective observational study, we examined the changes in depressive symptoms (9-item Patient Health Questionnaire), anxiety symptoms (7-item Generalized Anxiety Disorder scale), and well-being (5-item World Health Organization Well-Being Index) for 3 months in 509 participants (mean age 33.9, SD 8.7 years; women: n=312, 61.3%; men: n=175, 34.4%; nonbinary: n=22, 4.3%) who were newly enrolled and engaged in care with an employer-sponsored digital mental health platform (Modern Health Inc). We also investigated the extent to which participants followed the recommendations provided to them through a stratified blended care model. Results: Participants with elevated baseline symptoms of depression and anxiety exhibited significant symptom improvements, with a 37% score improvement in depression and a 29% score improvement in anxiety (P values <.001). Participants with baseline scores indicative of poorer well-being also improved over the study period (90% score improvement; P=.002). Furthermore, over half exhibited clinical improvement or recovery for depressive symptoms (n=122, 65.2%), anxiety symptoms (n=127, 59.1%), and low well-being (n=82, 64.6%). Among participants with mild or no baseline symptoms, we found high rates of maintenance for low depressive (n=297, 92.2%) and anxiety (n=255, 86.7%) symptoms and high well-being (n=344, 90.1%). In total, two-thirds of the participants (n=343, 67.4%) used their recommended care, 16.9% (n=86) intensified their care beyond their initial recommendation, and 15.7% (n=80) of participants underused care by not engaging with the highest level of care recommended to them. Conclusions: Participants with elevated baseline depressive or anxiety symptoms improved their mental health significantly from baseline to follow-up, and most participants without symptoms or with mild symptoms at baseline maintained their mental health over time. In addition, engagement patterns indicate that the stratified blended care model was efficient in matching individuals with the most effective and least costly care while also allowing them to self-determine their care and use combinations of services that best fit their needs. Overall, the results of this study support the clinical effectiveness of the platform for improving and preserving mental health and support the utility and effectiveness of stratified blended care models to improve access to and use of digitally delivered mental health services. %M 38913405 %R 10.2196/48298 %U https://mhealth.jmir.org/2024/1/e48298 %U https://doi.org/10.2196/48298 %U http://www.ncbi.nlm.nih.gov/pubmed/38913405 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50503 %T Web-Based, Human-Guided, or Computer-Guided Transdiagnostic Cognitive Behavioral Therapy in University Students With Anxiety and Depression: Randomized Controlled Trial %A Koelen,Jurrijn %A Klein,Anke %A Wolters,Nine %A Bol,Eline %A De Koning,Lisa %A Roetink,Samantha %A Van Blom,Jorien %A Boutin,Bruno %A Schaaf,Jessica %A Grasman,Raoul %A Van der Heijde,Claudia Maria %A Salemink,Elske %A Riper,Heleen %A Karyotaki,Eirini %A Cuijpers,Pim %A Schneider,Silvia %A Rapee,Ronald %A Vonk,Peter %A Wiers,Reinout %+ Department of Developmental Psychology, University of Amsterdam, P.O.Box 15916, 1001 NK, Amsterdam, Netherlands, 31 20 5256842, r.w.h.j.wiers@uva.nl %K internet-based cognitive behavioral intervention %K iCBT %K university students %K transdiagnostic %K human guidance %K technological guidance %D 2024 %7 19.6.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-based cognitive behavioral interventions (iCBTs) are efficacious treatments for depression and anxiety. However, it is unknown whether adding human guidance is feasible and beneficial within a large educational setting. Objective: This study aims to potentially demonstrate the superiority of 2 variants of a transdiagnostic iCBT program (human-guided and computer-guided iCBT) over care as usual (CAU) in a large sample of university students and the superiority of human-guided iCBT over computer-guided iCBT. Methods: A total of 801 students with elevated levels of anxiety, depression, or both from a large university in the Netherlands were recruited as participants and randomized to 1 of 3 conditions: human-guided iCBT, computer-guided iCBT, and CAU. The primary outcome measures were depression (Patient Health Questionnaire) and anxiety (Generalized Anxiety Disorder scale). Secondary outcomes included substance use–related problems (Alcohol Use Disorder Identification Test and Drug Abuse Screening Test—10 items). Linear mixed models were used to estimate the effects of time, treatment group, and their interactions (slopes). The primary research question was whether the 3 conditions differed in improvement over 3 time points (baseline, midtreatment, and after treatment) in terms of depression and anxiety symptoms. Results were analyzed according to the intention-to-treat principle using multiple imputation. Patients were followed exploratively from baseline to 6 and 12 months. Results: In both short-term and long-term analyses, the slopes for the 3 conditions did not differ significantly in terms of depression and anxiety, although both web-based interventions were marginally more efficacious than CAU over 6 months (P values between .02 and .03). All groups showed significant improvement over time (P<.001). For the secondary outcomes, only significant improvements over time (across and not between groups) were found for drug use (P<.001). Significant differences were found in terms of adherence, indicating that participants in the human-guided condition did more sessions than those in the computer-guided condition (P=.002). Conclusions: The transdiagnostic iCBT program offers a practical, feasible, and efficacious alternative to usual care to tackle mental health problems in a large university setting. There is no indication that human guidance should be preferred over technological guidance. The potential preference of human support also depends on the scale of implementation and cost-effectiveness, which need to be addressed in future trials. Trial Registration: International Clinical Trials Registry Platform NL7328/NTR7544; https://trialsearch.who.int/Trial2.aspx?TrialID=NL-OMON26795 %M 38896474 %R 10.2196/50503 %U https://mental.jmir.org/2024/1/e50503 %U https://doi.org/10.2196/50503 %U http://www.ncbi.nlm.nih.gov/pubmed/38896474 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53966 %T Web-Based Mindfulness-Based Cognitive Therapy for Adults With a History of Depression: Protocol for a Randomized Controlled Trial %A Hooshmand Zaferanieh,Mohammad %A Shi,Lu %A Jindal,Meenu %A Chen,Liwei %A Zhang,Lingling %A Lopes,Snehal %A Jones,Karyn %A Wang,Yucheng %A Meggett,Kinsey %A Walker,Cari Beth %A Falgoust,Grace %A Zinzow,Heidi %+ University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, United States, 1 864 455 7992, hooshmam@email.sc.edu %K mindfulness-based cognitive therapy %K MBCT %K mindfulness-based interventions %K depression %K depressive symptoms %K virtual delivery %K mindfulness %K mental health %K depressive %K distress %K stress %K remote %K randomized %K controlled trial %K controlled trials %K RCT %K psychotherapy %K cognitive therapy %D 2024 %7 18.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression poses a major threat to public health with an increasing prevalence in the United States. Mindfulness-based interventions, such as mindfulness-based cognitive therapy (MBCT), are effective methods for managing depression symptoms and may help fortify existing efforts to address the current disease burden. The in-person group format of MBCT, however, incurs barriers to care such as expenses, childcare needs, and transportation issues. Alternate delivery modalities such as MBCT delivered via the web can be investigated for their capacity to overcome these barriers and still reduce symptoms of depression with adequate feasibility and efficacy. Objective: This study protocol aims to examine the feasibility and efficacy of MBCT delivered via the web for the treatment of depression. Methods: To attain study aims, 2 phases will be implemented using a waitlist control design. A total of 128 eligible participants will be randomized into either an 8-week MBCT intervention group plus treatment as usual (MBCT + TAU; group 1) or an 8-week waitlist control group (group 2). In phase I (8 weeks), group 1 will complete the intervention and group 2 will proceed with TAU. In phase II (8 weeks), group 2 will complete the intervention and group 1 will continue with TAU until reaching an 8-week follow-up. TAU may consist of receiving psychotherapy, pharmacotherapy, or combined treatment. Data collection will be completed at baseline, 8 weeks (postintervention for group 1 and preintervention for group 2), and 16 weeks (follow-up for group 1, postintervention for group 2). The primary outcomes will include (1) current, residual, or chronic depression symptoms and (2) psychiatric distress. Secondary outcomes will include perceived stress and facets of mindfulness. The feasibility will be measured by assessing protocol adherence, retention, attendance, and engagement. Finally, the extent of mindfulness self-practice and executive functioning skills will be assessed as mediators of intervention outcomes. Results: This study began screening and recruitment in December 2022. Data collection from the first cohort occurred in January 2023. By November 2023, a total of 30 participants were enrolled out of 224 who received screening. Data analysis began in February 2024, with an approximate publication of results by August 2024. Institutional review board approval took place on September 11, 2019. Conclusions: This trial will contribute to examining mindfulness-based interventions, delivered via the web, for improving current, residual, or chronic depression symptoms. It will (1) address the feasibility of MBCT delivered via the web; (2) contribute evidence regarding MBCT’s efficacy in reducing depression symptoms and psychiatric distress; and (3) assess the impact of MBCT on several important secondary outcomes. Findings from this study will develop the understanding of the causal pathways between MBCT delivered via the web and depression symptoms further, elucidating the potential for future larger-scale designs. Trial Registration: ClinicalTrials.gov NCT05347719; https://www.clinicaltrials.gov/ct2/show/NCT05347719 International Registered Report Identifier (IRRID): DERR1-10.2196/53966 %M 38888958 %R 10.2196/53966 %U https://www.researchprotocols.org/2024/1/e53966 %U https://doi.org/10.2196/53966 %U http://www.ncbi.nlm.nih.gov/pubmed/38888958 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55842 %T Digital Phenotyping of Geriatric Depression Using a Community-Based Digital Mental Health Monitoring Platform for Socially Vulnerable Older Adults and Their Community Caregivers: 6-Week Living Lab Single-Arm Pilot Study %A Song,Sunmi %A Seo,YoungBin %A Hwang,SeoYeon %A Kim,Hae-Young %A Kim,Junesun %+ Department of Health and Environmental Science, Undergraduate School, Korea University, 661 B-Hana Science Building, Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 2 3290 5689, junokim@korea.ac.kr %K depression %K monitoring system %K IoT %K AI %K wearable device %K digital mental health phenotyping %K living lab %K senior care %K Internet of Things %K artificial intelligence %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the increasing need for digital services to support geriatric mental health, the development and implementation of digital mental health care systems for older adults have been hindered by a lack of studies involving socially vulnerable older adult users and their caregivers in natural living environments. Objective: This study aims to determine whether digital sensing data on heart rate variability, sleep quality, and physical activity can predict same-day or next-day depressive symptoms among socially vulnerable older adults in their everyday living environments. In addition, this study tested the feasibility of a digital mental health monitoring platform designed to inform older adult users and their community caregivers about day-to-day changes in the health status of older adults. Methods: A single-arm, nonrandomized living lab pilot study was conducted with socially vulnerable older adults (n=25), their community caregivers (n=16), and a managerial social worker over a 6-week period during and after the COVID-19 pandemic. Depressive symptoms were assessed daily using the 9-item Patient Health Questionnaire via scripted verbal conversations with a mobile chatbot. Digital biomarkers for depression, including heart rate variability, sleep, and physical activity, were measured using a wearable sensor (Fitbit Sense) that was worn continuously, except during charging times. Daily individualized feedback, using traffic signal signs, on the health status of older adult users regarding stress, sleep, physical activity, and health emergency status was displayed on a mobile app for the users and on a web application for their community caregivers. Multilevel modeling was used to examine whether the digital biomarkers predicted same-day or next-day depressive symptoms. Study staff conducted pre- and postsurveys in person at the homes of older adult users to monitor changes in depressive symptoms, sleep quality, and system usability. Results: Among the 31 older adult participants, 25 provided data for the living lab and 24 provided data for the pre-post test analysis. The multilevel modeling results showed that increases in daily sleep fragmentation (P=.003) and sleep efficiency (P=.001) compared with one’s average were associated with an increased risk of daily depressive symptoms in older adults. The pre-post test results indicated improvements in depressive symptoms (P=.048) and sleep quality (P=.02), but not in the system usability (P=.18). Conclusions: The findings suggest that wearable sensors assessing sleep quality may be utilized to predict daily fluctuations in depressive symptoms among socially vulnerable older adults. The results also imply that receiving individualized health feedback and sharing it with community caregivers may help improve the mental health of older adults. However, additional in-person training may be necessary to enhance usability. Trial Registration: ClinicalTrials.gov NCT06270121; https://clinicaltrials.gov/study/NCT06270121 %M 38885033 %R 10.2196/55842 %U https://mhealth.jmir.org/2024/1/e55842 %U https://doi.org/10.2196/55842 %U http://www.ncbi.nlm.nih.gov/pubmed/38885033 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53897 %T Implementation of Anxiety UK’s Ask Anxia Chatbot Service: Lessons Learned %A Collins,Luke %A Nicholson,Niamh %A Lidbetter,Nicky %A Smithson,Dave %A Baker,Paul %+ Linguistics and English Language, Lancaster University, Economic and Social Research Council Centre for Corpus Approaches to Social Science, Bailrigg, Lancaster, LA1 4YW, United Kingdom, 44 1524 65201, l.collins3@lancaster.ac.uk %K chatbots %K anxiety disorders %K corpus linguistics %K conversational agents %K web-based care %D 2024 %7 17.6.2024 %9 Viewpoint %J JMIR Hum Factors %G English %X Chatbots are increasingly being applied in the context of health care, providing access to services when there are constraints on human resources. Simple, rule-based chatbots are suited to high-volume, repetitive tasks and can therefore be used effectively in providing users with important health information. In this Viewpoint paper, we report on the implementation of a chatbot service called Ask Anxia as part of a wider provision of information and support services offered by the UK national charity, Anxiety UK. We reflect on the changes made to the chatbot over the course of approximately 18 months as the Anxiety UK team monitored its performance and responded to recurrent themes in user queries by developing further information and services. We demonstrate how corpus linguistics can contribute to the evaluation of user queries and the optimization of responses. On the basis of these observations of how Anxiety UK has developed its own chatbot service, we offer recommendations for organizations looking to add automated conversational interfaces to their services. %M 38885016 %R 10.2196/53897 %U https://humanfactors.jmir.org/2024/1/e53897 %U https://doi.org/10.2196/53897 %U http://www.ncbi.nlm.nih.gov/pubmed/38885016 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55578 %T Effectiveness of Mobile-Based Progressive and Fixed Physical Activity on Depression, Stress, Anxiety, and Quality of Life Outcomes Among Adults in South Korea: Randomized Controlled Trial %A Lee,Ye Hoon %A Kim,Hyungsook %A Hwang,Juhee %A Noh,Sihyeon %+ Department of Data Science, Hanyang University, 222, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea, 82 222204751, khsook12@hanyang.ac.kr %K depressive symptoms %K mental health %K mobile-based exercise %K non–face-to-face physical activity %K progressive exercise %K mobile phone %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Depression acts as a significant obstacle to the overall well-being of individuals. Given the significant consequences, timely recognition and proactive steps to manage symptoms of depression become essential. Such actions not only reduce personal distress but also play a crucial role in reducing its far-reaching impact on society as a whole. Objective: In response to this concern, the objective of this study was to explore the use of mobile-based interventions as a possible remedy. More specifically, this study aimed to investigate the effectiveness of 2 types of physical activity (PA), progressive and fixed, within a mobile-based app on depression, perceived stress, anxiety, physical health, and psychological health, aiming to contribute to the optimization of mental health benefits. Methods: Participants (N=60; mean age 25.29, SD 6.10 years) were recruited using a combination of web-based and offline methods, and the study lasted for 8 weeks. The baseline and posttest questionnaires were administered to all participants. The participants were randomly assigned to 1 of the 3 groups: progressive group (n=20; performing mobile-based progressive PA), fixed group (n=20; performing mobile-based fixed intensity PA), and control group C (n=20). Data analysis involved comparing scores between the experimental and control groups using a one-way ANOVA, paired sample t tests (2-tailed), and repeated measures ANOVA with a 3 (group)×2 (time) design. Results: The findings revealed significant improvements in mental health indicators among participants engaged in both fixed and progressive PA groups compared with the control group. However, the fixed PA group demonstrated more significant reductions in symptoms. Specifically, the progressive PA group showed significant reductions in depression (F1,36=6.941; P=.01; ηp2=0.16) and perceived stress (F1,36=5.47; P=.03; ηp2=0.13), while the fixed PA group exhibited significant reductions in depression (F1,37=5.36; P=.03; ηp2=0.12), perceived stress (F1,37=7.81; P=.008; ηp2=0.17), and general anxiety disorder (F1,37=5.45; P=.03; ηp2=0.13) compared with the control group. Conclusions: This study underscores the potential of mobile-based PA in improving mental health outcomes. The findings offer significant insights for mental health professionals and researchers aiming to optimize mental well-being through innovative mobile therapies. Trial Registration: Clinical Research Information Service KCT0009100; https://tinyurl.com/mr33fmur %M 38865705 %R 10.2196/55578 %U https://mhealth.jmir.org/2024/1/e55578 %U https://doi.org/10.2196/55578 %U http://www.ncbi.nlm.nih.gov/pubmed/38865705 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55283 %T Web-Based Therapist-Guided Mindfulness-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder: Pilot Randomized Controlled Trial %A Kerry,Camrie %A Mann,Prabhdeep %A Babaei,Nazanin %A Katz,Joel %A Pirbaglou,Meysam %A Ritvo,Paul %+ School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 580 8021, camrie@yorku.ca %K body dysmorphic disorder %K BDD %K dysmorphophobia %K obsessive-compulsive and related disorders %K OCD %K internet-delivered cognitive behavior therapy %K iCBT %K cognitive behavior therapy %K mindfulness-based cognitive therapy %K mindfulness %K eMental health %K randomized controlled trial %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-based cognitive behavioral therapy (CBT) and stand-alone mindfulness meditation interventions are gaining empirical support for a wide variety of mental health conditions. In this study, we test the efficacy of web-based therapist-guided mindfulness-based cognitive behavioral therapy (CBT-M) for body dysmorphic disorder (BDD), a psychiatric disorder characterized by preoccupations with perceived defects in appearance. Objective: This study aims to determine whether CBT-M for BDD delivered on the web is feasible and acceptable and whether mindfulness meditation adds to CBT treatment effects for BDD. Methods: In this 8-week, 2-arm, parallel pilot randomized controlled trial, n=28 adults (aged between 18 and 55 years) were randomly allocated to an experimental group (web-based therapist-guided CBT-M) or a control group (web-based therapist-guided CBT). Study retention, accrual, and intervention adherence were assessed, along with self-report measures for BDD, depression, anxiety, and pain intensity taken at baseline and postintervention. Results: This study was feasible to implement and deemed acceptable by participants. After 8 weeks, significant improvements were found on all outcome measures for both treatment groups, and large between-group effect sizes favoring CBT-M were found for BDD symptom severity (d=–0.96), depression (d=–1.06), pain severity (d=–1.12), and pain interference (d=–1.28). However, linear mixed models demonstrated no significant differences between the groups over 8 weeks. Conclusions: The results suggest that mindfulness meditation may add to beneficial web-based CBT treatment effects for BDD. An adequately powered randomized control trial of web-based CBT-M is warranted. Trial Registration: ClinicalTrials.gov NCT05402475, http://clinicaltrials.gov/ct2/show/NCT05402475 %M 38865704 %R 10.2196/55283 %U https://mental.jmir.org/2024/1/e55283 %U https://doi.org/10.2196/55283 %U http://www.ncbi.nlm.nih.gov/pubmed/38865704 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e49618 %T Ad Hoc Modifications to a High Dependency Psychiatric Unit for People With Dementia During the COVID-19 Period %A Pilunthanakul,Thanita %A Tan,Giles Ming Yee %+ MOH Holdings Pte Ltd, 1 Maritime Square, Singapore, 099253, Singapore, 65 66220980, thanita.pilunthanakul@mohh.com.sg %K dementia %K COVID-19 %K high dependency psychiatric unit %K psychiatric intensive care unit %K caregiver stress %K SARS-CoV-2 %K psychiatric %K psychiatry %K mental health %K health care system %K Alzheimer %K ward %K care facility %D 2024 %7 11.6.2024 %9 Viewpoint %J Interact J Med Res %G English %X The COVID-19 pandemic led to behavioral exacerbations in people with dementia. Increased hospitalizations and lack of bed availability in specialized dementia wards at a tertiary psychiatric hospital in Singapore resulted in lodging people with dementia in the High Dependency Psychiatric Unit (HDPCU). Customizations to create a dementia-friendly environment at the HDPCU included: (1) environmental modifications to facilitate orientation and engender familiarity; (2) person-centered care to promote attachment, inclusion, identity, occupation, and comfort; (3) risk management for delirium; and (4) training core competencies. Such practical solutions can also be implemented elsewhere to help overcome resource constraints and repurpose services to accommodate increasing populations of people living with dementia. %M 38861715 %R 10.2196/49618 %U https://www.i-jmr.org/2024/1/e49618 %U https://doi.org/10.2196/49618 %U http://www.ncbi.nlm.nih.gov/pubmed/38861715 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55557 %T Online Cognitive Stimulation Therapy for Dementia in Brazil and India: Acceptability, Feasibility, and Lessons for Implementation %A Fisher,Emily %A Venkatesan,Shreenila %A Benevides,Pedro %A Bertrand,Elodie %A Brum,Paula Schimidt %A El Baou,Céline %A Ferri,Cleusa P %A Fossey,Jane %A Jelen,Maria %A Laks,Jerson %A Liu,Lisa %A Mograbi,Daniel C %A Natarajan,Nirupama %A Naylor,Renata %A Pantouli,Despina %A Ramanujam,Vaishnavi %A Rangaswamy,Thara %A Santos de Carvalho,Raquel L %A Stoner,Charlotte %A Vaitheswaran,Sridhar %A Spector,Aimee %+ University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 5770, emily.fisher@ucl.ac.uk %K psychosocial %K intervention %K technology %K COVID-19 %K LMIC %K low and middle income countries %D 2024 %7 11.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Cognitive stimulation therapy (CST) is an evidence-based, group psychosocial intervention for people with dementia, and it has a positive impact on cognition and quality of life. CST has been culturally adapted for use globally. It was developed as a face-to-face intervention but has recently been adapted for online delivery. Objective: In this study, we aimed to explore the feasibility and acceptability of online or virtual CST (vCST) delivery in India and Brazil, emphasizing barriers and facilitators to implementation. Methods: A single-group, multisite, mixed methods, feasibility study was conducted, with nested qualitative interviews. Primary feasibility outcomes were recruitment rate, attendance, attrition, acceptability, and outcome measure completion. Exploratory pre- and postintervention measures, including cognition and quality of life, were assessed. Qualitative interviews were conducted with people with dementia, family caregivers, and group and organizational leaders following intervention delivery, and the data were analyzed using the Consolidated Framework for Implementation Research. Results: A total of 17 vCST group sessions with 59 participants were conducted for 7 weeks, with 53% (31/59) of participants attending all 14 sessions. Attrition rate was 7% (4/59), and outcome measure completion rate at follow-up was 68% (40/59). Interviews took place with 36 stakeholders. vCST was acceptable to participants and group leaders and enabled vital access to services during pandemic restrictions. While online services broadened geographic access, challenges emerged concerning inadequate computer literacy, poor technology access, and establishing interpersonal connections online. Exploratory, uncontrolled analyses indicated positive trends in quality of life but negative trends in cognition and activities of daily living, but these results were not statistically significant. Conclusions: vCST demonstrated feasibility and acceptability, serving as a crucial resource during the pandemic but raised challenges related to technology access, computer literacy, and long-term implementation. The study highlights the potential of vCST while emphasizing ongoing development and solutions to address implementation challenges. %M 38861708 %R 10.2196/55557 %U https://aging.jmir.org/2024/1/e55557 %U https://doi.org/10.2196/55557 %U http://www.ncbi.nlm.nih.gov/pubmed/38861708 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56529 %T Considering the Role of Human Empathy in AI-Driven Therapy %A Rubin,Matan %A Arnon,Hadar %A Huppert,Jonathan D %A Perry,Anat %+ Psychology Department, Hebrew University of Jerusalem, Mt Scopus, Jerusalem, 91905, Israel, 972 2 588 3027, anat.perry@mail.huji.ac.il %K empathy %K empathetic %K empathic %K artificial empathy %K AI %K artificial intelligence %K mental health %K machine learning %K algorithm %K algorithms %K predictive model %K predictive models %K predictive analytics %K predictive system %K practical model %K practical models %K model %K models %K therapy %K mental illness %K mental illnesses %K mental disease %K mental diseases %K mood disorder %K mood disorders %K emotion %K emotions %K e-mental health %K digital mental health %K internet-based therapy %D 2024 %7 11.6.2024 %9 Viewpoint %J JMIR Ment Health %G English %X Recent breakthroughs in artificial intelligence (AI) language models have elevated the vision of using conversational AI support for mental health, with a growing body of literature indicating varying degrees of efficacy. In this paper, we ask when, in therapy, it will be easier to replace humans and, conversely, in what instances, human connection will still be more valued. We suggest that empathy lies at the heart of the answer to this question. First, we define different aspects of empathy and outline the potential empathic capabilities of humans versus AI. Next, we consider what determines when these aspects are needed most in therapy, both from the perspective of therapeutic methodology and from the perspective of patient objectives. Ultimately, our goal is to prompt further investigation and dialogue, urging both practitioners and scholars engaged in AI-mediated therapy to keep these questions and considerations in mind when investigating AI implementation in mental health. %M 38861302 %R 10.2196/56529 %U https://mental.jmir.org/2024/1/e56529 %U https://doi.org/10.2196/56529 %U http://www.ncbi.nlm.nih.gov/pubmed/38861302 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e57965 %T Development of Recommendations for the Digital Sharing of Notes With Adolescents in Mental Health Care: Delphi Study %A Nielsen,Martine Stecher %A Steinsbekk,Aslak %A Nøst,Torunn Hatlen %K electronic health record %K EHR %K electronic health records %K EHRs %K electronic medical record %K EMR %K electronic medical records %K EMRs %K patient record %K health record %K health records %K personal health record %K PHR %K online access to electronic health records %K open notes %K clinical notes %K adolescent mental health care %K adolescent mental health %K child mental health %K mental health %K mental illness %K mental illnesses %K mental disorder %K mental disorders %K recommendations %K Delphi study %K digital mental health %K e-health %K eHealth %K e–mental health %K health care professionals %K digital health care %D 2024 %7 6.6.2024 %9 %J JMIR Ment Health %G English %X Background: In many countries, health care professionals are legally obliged to share information from electronic health records with patients. However, concerns have been raised regarding the sharing of notes with adolescents in mental health care, and health care professionals have called for recommendations to guide this practice. Objective: The aim was to reach a consensus among authors of scientific papers on recommendations for health care professionals’ digital sharing of notes with adolescents in mental health care and to investigate whether staff at child and adolescent specialist mental health care clinics agreed with the recommendations. Methods: A Delphi study was conducted with authors of scientific papers to reach a consensus on recommendations. The process of making the recommendations involved three steps. First, scientific papers meeting the eligibility criteria were identified through a PubMed search where the references were screened. Second, the results from the included papers were coded and transformed into recommendations in an iterative process. Third, the authors of the included papers were asked to provide feedback and consider their agreement with each of the suggested recommendations in two rounds. After the Delphi process, a cross-sectional study was conducted among staff at specialist child and adolescent mental health care clinics to assess whether they agreed with the recommendations that reached a consensus. Results: Of the 84 invited authors, 27 responded. A consensus was reached on 17 recommendations on areas related to digital sharing of notes with adolescents in mental health care. The recommendations considered how to introduce digital access to notes, write notes, and support health care professionals, and when to withhold notes. Of the 41 staff members at child and adolescent specialist mental health care clinics, 60% or more agreed with the 17 recommendations. No consensus was reached regarding the age at which adolescents should receive digital access to their notes and the timing of digitally sharing notes with parents. Conclusions: A total of 17 recommendations related to key aspects of health care professionals’ digital sharing of notes with adolescents in mental health care achieved consensus. Health care professionals can use these recommendations to guide their practice of sharing notes with adolescents in mental health care. However, the effects and experiences of following these recommendations should be tested in clinical practice. %R 10.2196/57965 %U https://mental.jmir.org/2024/1/e57965 %U https://doi.org/10.2196/57965 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53406 %T Digital Lifestyle Interventions for Young People With Mental Illness: A Qualitative Study Among Mental Health Care Professionals %A Sawyer,Chelsea %A Carney,Rebekah %A Hassan,Lamiece %A Bucci,Sandra %A Sainsbury,John %A Lovell,Karina %A Torous,John %A Firth,Joseph %+ Division of Psychology and Mental Health, University of Manchester, 3.005 Jean Mcfarlane Building, Manchester, M13 9PL, United Kingdom, 44 161 306 7811, Joseph.firth@manchester.ac.uk %K digital health %K behavior change %K mental health care professionals %K physical health %K lifestyle intervention %K qualitative %K thematic analysis %K service optimization %K mobile phone %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation. Objective: Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care. Methods: Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings. Results: Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients’ readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described. Conclusions: The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks. %M 38837191 %R 10.2196/53406 %U https://humanfactors.jmir.org/2024/1/e53406 %U https://doi.org/10.2196/53406 %U http://www.ncbi.nlm.nih.gov/pubmed/38837191 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44443 %T Mental Wellness Self-Care in Singapore With mindline.sg: A Tutorial on the Development of a Digital Mental Health Platform for Behavior Change %A Weng,Janice Huiqin %A Hu,Yanyan %A Heaukulani,Creighton %A Tan,Clarence %A Chang,Julian Kuiyu %A Phang,Ye Sheng %A Rajendram,Priyanka %A Tan,Weng Mooi %A Loke,Wai Chiong %A Morris,Robert J T %+ MOH Office for Healthcare Transformation, 1 Maritime Square, Harbourfront Centre, Singapore, 099253, Singapore, 65 66793209, creighton.heaukulani@moht.com.sg %K digital mental health %K artificial intelligence %K AI %K AI chatbot %K digital therapeutics %K mental health %K mental wellness %K mobile phone %D 2024 %7 4.6.2024 %9 Tutorial %J J Med Internet Res %G English %X Background: Singapore, like the rest of Asia, faces persistent challenges to mental health promotion, including stigma around unwellness and seeking treatment and a lack of trained mental health personnel. The COVID-19 pandemic, which created a surge in mental health care needs and simultaneously accelerated the adoption of digital health solutions, revealed a new opportunity to quickly scale innovative solutions in the region. Objective: In June 2020, the Singaporean government launched mindline.sg, an anonymous digital mental health resource website that has grown to include >500 curated local mental health resources, a clinically validated self-assessment tool for depression and anxiety, an artificial intelligence (AI) chatbot from Wysa designed to deliver digital therapeutic exercises, and a tailored version of the website for working adults called mindline at work. The goal of the platform is to empower Singapore residents to take charge of their own mental health and to be able to offer basic support to those around them through the ease and convenience of a barrier-free digital solution. Methods: Website use is measured through click-level data analytics captured via Google Analytics and custom application programming interfaces, which in turn drive a customized analytics infrastructure based on the open-source platforms Titanium Database and Metabase. Unique, nonbounced (users that do not immediately navigate away from the site), engaged, and return users are reported. Results: In the 2 years following launch (July 1, 2020, through June 30, 2022), the website received >447,000 visitors (approximately 15% of the target population of 3 million), 62.02% (277,727/447,783) of whom explored the site or engaged with resources (referred to as nonbounced visitors); 10.54% (29,271/277,727) of those nonbounced visitors returned. The most popular features on the platform were the dialogue-based therapeutic exercises delivered by the chatbot and the self-assessment tool, which were used by 25.54% (67,626/264,758) and 11.69% (32,469/277,727) of nonbounced visitors. On mindline at work, the rates of nonbounced visitors who engaged extensively (ie, spent ≥40 seconds exploring resources) and who returned were 51.56% (22,474/43,588) and 13.43% (5,853/43,588) over a year, respectively, compared to 30.9% (42,829/138,626) and 9.97% (13,822/138,626), respectively, on the generic mindline.sg site in the same year. Conclusions: The site has achieved desired reach and has seen a strong growth rate in the number of visitors, which required substantial and sustained digital marketing campaigns and strategic outreach partnerships. The site was careful to preserve anonymity, limiting the detail of analytics. The good levels of overall adoption encourage us to believe that mild to moderate mental health conditions and the social factors that underly them are amenable to digital interventions. While mindline.sg was primarily used in Singapore, we believe that similar solutions with local customization are widely and globally applicable. %M 38833294 %R 10.2196/44443 %U https://www.jmir.org/2024/1/e44443 %U https://doi.org/10.2196/44443 %U http://www.ncbi.nlm.nih.gov/pubmed/38833294 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50024 %T A Web-Based Training Program for School Staff to Respond to Self-Harm: Design and Development of the Supportive Response to Self-Harm Program %A Burn,Anne-Marie %A Hall,Poppy %A Anderson,Joanna %+ Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, United Kingdom, 44 1223336961, amb278@cam.ac.uk %K self-harm %K schools %K young people %K youth %K school staff %K training %K coproduction %K qualitative %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-harm is common among adolescents and is a major public health concern. School staff may be the first adults to notice a young person’s self-harm and are well placed to provide support or signpost students to help. However, school staff often report that they do not feel equipped or confident to support students. Despite the need, there is a lack of evidence-based training about self-harm for school staff. A web-based training program would provide schools with a flexible and cost-effective method of increasing staff knowledge, skills, and confidence in how to respond to students who self-harm. Objective: The main objective of this study was to coproduce an evidence-based training program for school staff to improve their skills and confidence in responding to students who self-harm (Supportive Response to Self-Harm [SORTS]). This paper describes the design and development process of an initial prototype coproduced with stakeholders to ensure that the intervention meets their requirements. Methods: Using a user-centered design and person-based approach, the SORTS prototype was informed by (1) a review of research literature, existing guidelines, and policies; (2) coproduction discussions with the technical provider and subject matter experts (mental health, education, and self-harm); (3) findings from focus groups with young people; and (4) coproduction workshops with school staff. Thematic analysis using the framework method was applied. Results: Coproduction sessions with experts and the technical provider enabled us to produce a draft of the training content, a wireframe, and example high-fidelity user interface designs. Analysis of focus groups and workshops generated four key themes: (1) need for a training program; (2) acceptability, practicality, and implementation; (3) design, content, and navigation; and (4) adaptations and improvements. The findings showed that there is a clear need for a web-based training program about self-harm in schools, and the proposed program content and design were useful, practical, and acceptable. Consultations with stakeholders informed the iterative development of the prototype. Conclusions: SORTS is a web-based training program for school staff to appropriately respond to students who self-harm that is based on research evidence and developed in collaboration with stakeholders. The SORTS program will equip school staff with the skills and strategies to respond in a supportive way to students who self-harm and encourage schools to adopt a whole-school approach to self-harm. Further research is needed to complete the intervention development based on the feedback from this study and evaluate the program’s effectiveness. If found to be effective, the SORTS program could be implemented in schools and other youth organizations. %M 38833286 %R 10.2196/50024 %U https://formative.jmir.org/2024/1/e50024 %U https://doi.org/10.2196/50024 %U http://www.ncbi.nlm.nih.gov/pubmed/38833286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e40275 %T The Use of Text Messaging as an Adjunct to Internet-Based Cognitive Behavioral Therapy for Major Depressive Disorder in Youth: Secondary Analysis %A Walters,Clarice %A Gratzer,David %A Dang,Kevin %A Laposa,Judith %A Knyahnytska,Yuliya %A Ortiz,Abigail %A Gonzalez-Torres,Christina %A Moore,Lindsay P %A Chen,Sheng %A Ma,Clement %A Daskalakis,Zafiris %A Ritvo,Paul %+ School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, ON, M3J1P3, Canada, 1 4165808021, paul.ritvo@gmail.com %K online intervention %K randomized controlled trial %K major depressive disorder %K text message %K online %K cognitive %K behavior therapy %K treatment %K depression %K disorder %K symptoms %K young adults %K wellness %K procedure %K anxiety %K model %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As an established treatment for major depressive disorder (MDD), cognitive behavioral therapy (CBT) is now implemented and assessed in internet-based formats that, when combined with smartphone apps, enable secure text messaging. As an adjunct to such internet-based CBT (ICBT) approaches, text messaging has been associated with increased adherence and therapeutic alliance. Objective: This study analyzed data from the intervention arm of a randomized control trial evaluating 24-week ICBT for MDD (intervention arm) against standard-care psychiatry (waitlist control). The aim of this secondary analysis was to assess MDD symptom improvement in relation to the frequency and content of text messages sent by ICBT participants to Navigator-Coaches during randomized control trial participation. Higher text frequency in general and in 3 conceptual categories (appreciating alliance, alliance building disclosures, and agreement confirmation) was hypothesized to predict larger MDD symptom improvement. Methods: Participants were young adults (18-30 years) from the Centre for Addiction and Mental Health. The frequencies of categorized texts from 20 ICBT completers were analyzed with respect to MDD symptom improvement using linear regression models. Texts were coded by 2 independent coders and categorized using content analysis. MDD symptoms were measured using the Beck Depression Inventory-II (BDI-II). Results: Participants sent an average of 136 text messages. Analyses indicated that BDI-II improvement was negatively associated with text messaging frequency in general (β=–0.029, 95% CI –0.11 to 0.048) and in each of the 3 categories: appreciating alliance (β=–0.096, 95% CI –0.80 to 0.61), alliance building disclosures (β=–0.098, 95% CI –0.28 to 0.084), and agreement confirmation (β=–0.076, 95% CI –0.40 to 0.25). Altogether, the effect of text messaging on BDI-II improvement was uniformly negative across statistical models. More text messaging appeared associated with less MDD symptom improvement. Conclusions: The hypothesized positive associations between conceptually categorized text messages and MDD symptom improvement were not supported in this study. Instead, more text messaging appeared to indicate less treatment benefit. Future studies with larger samples are needed to discern the optimal use of text messaging in ICBT approaches using adjunctive modes of communication. Trial Registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052 %M 38820586 %R 10.2196/40275 %U https://formative.jmir.org/2024/1/e40275 %U https://doi.org/10.2196/40275 %U http://www.ncbi.nlm.nih.gov/pubmed/38820586 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54728 %T Daily Time-Use Patterns and Quality of Life in Parents: Protocol for a Pilot Quasi-Experimental, Nonrandomized Controlled Trial Using Ecological Momentary Assessment %A Altweck,Laura %A Schmidt,Silke %A Tomczyk,Samuel %+ Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Str 13, Greifswald, 17487, Germany, 49 3834 420 ext 3813, laura.altweck@uni-greifswald.de %K time-use %K well-being %K parents %K ecological momentary assessment %K feasibility %K health-related quality of life %K ambulatory assessment %K work-family conflict %K gender roles %K mixed-methods %K sex differences %K stress %D 2024 %7 31.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The gender gap in time use and its impact on health and well-being are still prevalent. Women work longer hours than men when considering both paid and unpaid (eg, childcare and chores) work, and this gender disparity is particularly visible among parents. Less is known about factors that could potentially mediate or moderate this relationship (eg, work-family conflict and gender role beliefs). Ecological momentary assessment (EMA) allows for the documentation of changes in momentary internal states, such as time use, stress, or mood. It has shown particular validity to measure shorter-term activities (eg, unpaid work) and is thus useful to address gender differences. Objective: The feasibility of the daily EMA surveys in a parent sample will be examined. The associations between time use, well-being, and stress will be examined, along with potential moderating and mediating factors such as gender, gender role beliefs, and work-family conflict. Finally, the act of monitoring one’s own time use, well-being, and stress will be examined in relation to, for example, the quality of life. Methods: We conducted a quasi-experimental, nonrandomized controlled trial with 3 data collection methods, namely, online questionnaires, EMA surveys, and qualitative interviews. The intervention group (n=64) will participate in the online questionnaires and EMA surveys, and a subsample of the intervention group (n=6-17) will also be invited to participate in qualitative interviews. Over a period of 1 week, participants in the intervention group will answer daily EMA surveys (4 times per day). In contrast, the control group (n=17) will only participate in the online questionnaires at baseline and after 1 week. The following constructs were surveyed: sociodemographic background (eg, age, gender, and household composition; baseline questionnaire); mediators and moderators (eg, gender role beliefs and work-family conflict; baseline and follow-up questionnaires); well-being, quality of life, and trait mindfulness (baseline and follow-up questionnaires); momentary activity and well-being, as well as state mindfulness (EMA); and feasibility (baseline and follow-up questionnaires as well as interviews). We anticipate that participants will regard the daily EMA as feasible. Particular daily time-use patterns (eg, high paid and unpaid workload) are expected to be related to lower well-being, higher stress, and health-related quality of life. These associations are expected to be moderated and mediated by factors such as gender, gender role beliefs, work-family conflict, and social support. Participants in the intervention group are expected to show higher values of mindfulness, well-being, health-related quality of life, and lower stress. Results: Patient recruitment started in November 2023 and ended in mid April 2024. Data analysis commenced in mid April 2024. Conclusions: This study aims to provide valuable insights into the feasibility of using EMAs and the potential benefits of activity tracking in various aspects of daily life. Trial Registration: Open Science Framework 8qj3d; https://osf.io/8qj3d International Registered Report Identifier (IRRID): PRR1-10.2196/54728 %M 38820576 %R 10.2196/54728 %U https://www.researchprotocols.org/2024/1/e54728 %U https://doi.org/10.2196/54728 %U http://www.ncbi.nlm.nih.gov/pubmed/38820576 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e46895 %T Characterizing Longitudinal Patterns in Cognition, Mood, And Activity in Depression With 6-Week High-Frequency Wearable Assessment: Observational Study %A Cormack,Francesca %A McCue,Maggie %A Skirrow,Caroline %A Cashdollar,Nathan %A Taptiklis,Nick %A van Schaik,Tempest %A Fehnert,Ben %A King,James %A Chrones,Lambros %A Sarkey,Sara %A Kroll,Jasmin %A Barnett,Jennifer H %+ Cambridge Cognition, Tunbridge Court, Bottisham, Cambridge, CB25 9TU, United Kingdom, 44 7961910560, jasmin.kroll@camcog.com %K cognition %K depression %K digital biomarkers %K ecological momentary assessment %K mobile health %K remote testing %D 2024 %7 31.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Cognitive symptoms are an underrecognized aspect of depression that are often untreated. High-frequency cognitive assessment holds promise for improving disease and treatment monitoring. Although we have previously found it feasible to remotely assess cognition and mood in this capacity, further work is needed to ascertain the optimal methodology to implement and synthesize these techniques. Objective: The objective of this study was to examine (1) longitudinal changes in mood, cognition, activity levels, and heart rate over 6 weeks; (2) diurnal and weekday-related changes; and (3) co-occurrence of fluctuations between mood, cognitive function, and activity. Methods: A total of 30 adults with current mild-moderate depression stabilized on antidepressant monotherapy responded to testing delivered through an Apple Watch (Apple Inc) for 6 weeks. Outcome measures included cognitive function, assessed with 3 brief n-back tasks daily; self-reported depressed mood, assessed once daily; daily total step count; and average heart rate. Change over a 6-week duration, diurnal and day-of-week variations, and covariation between outcome measures were examined using nonlinear and multilevel models. Results: Participants showed initial improvement in the Cognition Kit N-Back performance, followed by a learning plateau. Performance reached 90% of individual learning levels on average 10 days after study onset. N-back performance was typically better earlier and later in the day, and step counts were lower at the beginning and end of each week. Higher step counts overall were associated with faster n-back learning, and an increased daily step count was associated with better mood on the same (P<.001) and following day (P=.02). Daily n-back performance covaried with self-reported mood after participants reached their learning plateau (P=.01). Conclusions: The current results support the feasibility and sensitivity of high-frequency cognitive assessments for disease and treatment monitoring in patients with depression. Methods to model the individual plateau in task learning can be used as a sensitive approach to better characterize changes in behavior and improve the clinical relevance of cognitive data. Wearable technology allows assessment of activity levels, which may influence both cognition and mood. %M 38819909 %R 10.2196/46895 %U https://mental.jmir.org/2024/1/e46895 %U https://doi.org/10.2196/46895 %U http://www.ncbi.nlm.nih.gov/pubmed/38819909 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47515 %T Comparison of the Working Alliance in Blended Cognitive Behavioral Therapy and Treatment as Usual for Depression in Europe: Secondary Data Analysis of the E-COMPARED Randomized Controlled Trial %A Doukani,Asmae %A Quartagno,Matteo %A Sera,Francesco %A Free,Caroline %A Kakuma,Ritsuko %A Riper,Heleen %A Kleiboer,Annet %A Cerga-Pashoja,Arlinda %A van Schaik,Anneke %A Botella,Cristina %A Berger,Thomas %A Chevreul,Karine %A Matynia,Maria %A Krieger,Tobias %A Hazo,Jean-Baptiste %A Draisma,Stasja %A Titzler,Ingrid %A Topooco,Naira %A Mathiasen,Kim %A Vernmark,Kristofer %A Urech,Antoine %A Maj,Anna %A Andersson,Gerhard %A Berking,Matthias %A Baños,Rosa María %A Araya,Ricardo %+ Department of Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 020 7636 8636 ext 2463, asmae.doukani@lshtm.ac.uk %K blended psychotherapy %K cognitive behavioral therapy %K depression %K digital mental health interventions %K psychotherapy %K mental health %K program usability %K therapeutic alliance %K usability heuristics %K working alliance %D 2024 %7 31.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression. Objective: This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments. Methods: We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised–Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables. Results: Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=−0.12, 95% CI −0.17 to −0.06) and TAU (B=−0.06, 95% CI −0.11 to −0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=−0.030, 95% CI −0.05 to −0.01; P=.005). Conclusions: To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance. Trial Registration: ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1511-1 %M 38819882 %R 10.2196/47515 %U https://www.jmir.org/2024/1/e47515 %U https://doi.org/10.2196/47515 %U http://www.ncbi.nlm.nih.gov/pubmed/38819882 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50976 %T Tracking and Profiling Repeated Users Over Time in Text-Based Counseling: Longitudinal Observational Study With Hierarchical Clustering %A Xu,Yucan %A Chan,Christian Shaunlyn %A Chan,Evangeline %A Chen,Junyou %A Cheung,Florence %A Xu,Zhongzhi %A Liu,Joyce %A Yip,Paul Siu Fai %+ Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China (Hong Kong), 852 91401568, sfpyip@hku.hk %K web-based counseling %K text-based counseling %K repeated users %K frequent users %K hierarchical clustering %K service effectiveness %K risk profiling %K psychological profiles %K psycholinguistic analysis %D 2024 %7 30.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to their accessibility and anonymity, web-based counseling services are expanding at an unprecedented rate. One of the most prominent challenges such services face is repeated users, who represent a small fraction of total users but consume significant resources by continually returning to the system and reiterating the same narrative and issues. A deeper understanding of repeated users and tailoring interventions may help improve service efficiency and effectiveness. Previous studies on repeated users were mainly on telephone counseling, and the classification of repeated users tended to be arbitrary and failed to capture the heterogeneity in this group of users. Objective: In this study, we aimed to develop a systematic method to profile repeated users and to understand what drives their use of the service. By doing so, we aimed to provide insight and practical implications that can inform the provision of service catering to different types of users and improve service effectiveness. Methods: We extracted session data from 29,400 users from a free 24/7 web-based counseling service from 2018 to 2021. To systematically investigate the heterogeneity of repeated users, hierarchical clustering was used to classify the users based on 3 indicators of service use behaviors, including the duration of their user journey, use frequency, and intensity. We then compared the psychological profile of the identified subgroups including their suicide risks and primary concerns to gain insights into the factors driving their patterns of service use. Results: Three clusters of repeated users with clear psychological profiles were detected: episodic, intermittent, and persistent-intensive users. Generally, compared with one-time users, repeated users showed higher suicide risks and more complicated backgrounds, including more severe presenting issues such as suicide or self-harm, bullying, and addictive behaviors. Higher frequency and intensity of service use were also associated with elevated suicide risk levels and a higher proportion of users citing mental disorders as their primary concerns. Conclusions: This study presents a systematic method of identifying and classifying repeated users in web-based counseling services. The proposed bottom-up clustering method identified 3 subgroups of repeated users with distinct service behaviors and psychological profiles. The findings can facilitate frontline personnel in delivering more efficient interventions and the proposed method can also be meaningful to a wider range of services in improving service provision, resource allocation, and service effectiveness. %M 38815258 %R 10.2196/50976 %U https://www.jmir.org/2024/1/e50976 %U https://doi.org/10.2196/50976 %U http://www.ncbi.nlm.nih.gov/pubmed/38815258 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56668 %T Tablet-Based Cognitive and Eye Movement Measures as Accessible Tools for Schizophrenia Assessment: Multisite Usability Study %A Morita,Kentaro %A Miura,Kenichiro %A Toyomaki,Atsuhito %A Makinodan,Manabu %A Ohi,Kazutaka %A Hashimoto,Naoki %A Yasuda,Yuka %A Mitsudo,Takako %A Higuchi,Fumihiro %A Numata,Shusuke %A Yamada,Akiko %A Aoki,Yohei %A Honda,Hiromitsu %A Mizui,Ryo %A Honda,Masato %A Fujikane,Daisuke %A Matsumoto,Junya %A Hasegawa,Naomi %A Ito,Satsuki %A Akiyama,Hisashi %A Onitsuka,Toshiaki %A Satomura,Yoshihiro %A Kasai,Kiyoto %A Hashimoto,Ryota %+ Department of Pathology of Mental Diseases, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, 187 8553, Japan, 81 42 346 2046, ryotahashimoto55@ncnp.go.jp %K schizophrenia %K cognitive function %K eye movement %K diagnostic biomarkers %K digital health tools %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Schizophrenia is a complex mental disorder characterized by significant cognitive and neurobiological alterations. Impairments in cognitive function and eye movement have been known to be promising biomarkers for schizophrenia. However, cognitive assessment methods require specialized expertise. To date, data on simplified measurement tools for assessing both cognitive function and eye movement in patients with schizophrenia are lacking. Objective: This study aims to assess the efficacy of a novel tablet-based platform combining cognitive and eye movement measures for classifying schizophrenia. Methods: Forty-four patients with schizophrenia, 67 healthy controls, and 41 patients with other psychiatric diagnoses participated in this study from 10 sites across Japan. A free-viewing eye movement task and 2 cognitive assessment tools (Codebreaker task from the THINC-integrated tool and the CognitiveFunctionTest app) were used for conducting assessments in a 12.9-inch iPad Pro. We performed comparative group and logistic regression analyses for evaluating the diagnostic efficacy of the 3 measures of interest. Results: Cognitive and eye movement measures differed significantly between patients with schizophrenia and healthy controls (all 3 measures; P<.001). The Codebreaker task showed the highest classification effectiveness in distinguishing schizophrenia with an area under the receiver operating characteristic curve of 0.90. Combining cognitive and eye movement measures further improved accuracy with a maximum area under the receiver operating characteristic curve of 0.94. Cognitive measures were more effective in differentiating patients with schizophrenia from healthy controls, whereas eye movement measures better differentiated schizophrenia from other psychiatric conditions. Conclusions: This multisite study demonstrates the feasibility and effectiveness of a tablet-based app for assessing cognitive functioning and eye movements in patients with schizophrenia. Our results suggest the potential of tablet-based assessments of cognitive function and eye movement as simple and accessible evaluation tools, which may be useful for future clinical implementation. %M 38815257 %R 10.2196/56668 %U https://mental.jmir.org/2024/1/e56668 %U https://doi.org/10.2196/56668 %U http://www.ncbi.nlm.nih.gov/pubmed/38815257 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50025 %T Effectiveness of a Mental Health Chatbot for People With Chronic Diseases: Randomized Controlled Trial %A MacNeill,A Luke %A Doucet,Shelley %A Luke,Alison %+ Centre for Research in Integrated Care, University of New Brunswick, 355 Campus Ring Road, Saint John, NB, E2L 4L5, Canada, 1 506 648 5777, luke.macneill@unb.ca %K chatbot %K chronic disease %K arthritis %K diabetes %K mental health %K depression %K anxiety %K stress %K effectiveness %K application %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: People with chronic diseases tend to experience more mental health issues than their peers without these health conditions. Mental health chatbots offer a potential source of mental health support for people with chronic diseases. Objective: The aim of this study was to determine whether a mental health chatbot can improve mental health in people with chronic diseases. We focused on 2 chronic diseases in particular: arthritis and diabetes. Methods: Individuals with arthritis or diabetes were recruited using various web-based methods. Participants were randomly assigned to 1 of 2 groups. Those in the treatment group used a mental health chatbot app (Wysa [Wysa Inc]) over a period of 4 weeks. Those in the control group received no intervention. Participants completed measures of depression (Patient Health Questionnaire–9), anxiety (Generalized Anxiety Disorder Scale–7), and stress (Perceived Stress Scale–10) at baseline, with follow-up testing 2 and 4 weeks later. Participants in the treatment group completed feedback questions on their experiences with the app at the final assessment point. Results: A total of 68 participants (n=47, 69% women; mean age 42.87, SD 11.27 years) were included in the analysis. Participants were divided evenly between the treatment and control groups. Those in the treatment group reported decreases in depression (P<.001) and anxiety (P<.001) severity over the study period. No such changes were found among participants in the control group. No changes in stress were reported by participants in either group. Participants with arthritis reported higher levels of depression (P=.004) and anxiety (P=.004) severity than participants with diabetes over the course of the study, as well as higher levels of stress (P=.01); otherwise, patterns of results were similar across these health conditions. In response to the feedback questions, participants in the treatment group said that they liked many of the functions and features of the app, the general design of the app, and the user experience. They also disliked some aspects of the app, with most of these reports focusing on the chatbot’s conversational abilities. Conclusions: The results of this study suggest that mental health chatbots can be an effective source of mental health support for people with chronic diseases such as arthritis and diabetes. Although cost-effective and accessible, these programs have limitations and may not be well suited for all individuals. Trial Registration: ClinicalTrials.gov NCT04620668; https://www.clinicaltrials.gov/study/NCT04620668 %M 38814681 %R 10.2196/50025 %U https://formative.jmir.org/2024/1/e50025 %U https://doi.org/10.2196/50025 %U http://www.ncbi.nlm.nih.gov/pubmed/38814681 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55544 %T Cost-Effectiveness of Digital Mental Health Versus Usual Care During Humanitarian Crises in Lebanon: Pragmatic Randomized Trial %A Abi Hana,Racha %A Abi Ramia,Jinane %A Burchert,Sebastian %A Carswell,Kenneth %A Cuijpers,Pim %A Heim,Eva %A Knaevelsrud,Christine %A Noun,Philip %A Sijbrandij,Marit %A van Ommeren,Mark %A van’t Hof,Edith %A Wijnen,Ben %A Zoghbi,Edwina %A El Chammay,Rabih %A Smit,Filip %+ Clinical, Neuro- and Developmental Psychology Department, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1105 1081 HV, Netherlands, 31 3978968, rasha_abihana@hotmail.com %K depression %K internet-based intervention %K economic evaluation %K Lebanese %K Syrian %K digital mental health %K digital health %K mental health %K usual care %K Lebanon %K anxiety %K stress-related disorders %K treatment %K symptoms %K large randomized controlled trial %K effectiveness %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is evidence from meta-analyses and systematic reviews that digital mental health interventions for depression, anxiety, and stress-related disorders tend to be cost-effective. However, no such evidence exists for guided digital mental health care in low and middle-income countries (LMICs) facing humanitarian crises, where the needs are highest. Step-by-Step (SbS), a digital mental health intervention for depression, anxiety, and stress-related disorders, proved to be effective for Lebanese citizens and war-affected Syrians residing in Lebanon. Assessing the cost-effectiveness of SbS is crucial because Lebanon’s overstretched health care system must prioritize cost-effective treatment options in the face of continuing humanitarian and economic crises. Objective: This study aims to assess the cost-effectiveness of SbS in a randomized comparison with enhanced usual care (EUC). Methods: The cost-effectiveness analysis was conducted alongside a pragmatic randomized controlled trial in 2 parallel groups comparing SbS (n=614) with EUC (n=635). The primary outcome was cost (in US $ for the reference year 2019) per treatment response of depressive symptoms, defined as >50% reduction of depressive symptoms measured using the Patient Health Questionnaire (PHQ). The secondary outcome was cost per remission of depressive symptoms, defined as a PHQ score <5 at last follow-up (5 months post baseline). The evaluation was conducted first from the health care perspective then from the societal perspective. Results: Taking the health care perspective, SbS had an 80% probability to be regarded as cost-effective compared with EUC when there is a willingness to pay US $220 per additional treatment response or US $840 per additional remission. Taking the wider societal perspective, SbS had a >75% probability to be cost-saving while gaining response or remission. Conclusions: To our knowledge, this study is the first cost-effectiveness analysis based on a large randomized controlled trial (n=1249) of a guided digital mental health intervention in an LMIC. From the principal findings, 2 implications flowed, from the (1) health care perspective and (2) wider societal perspective. First, our findings suggest that SbS is associated with greater health benefits, albeit for higher costs than EUC. It is up to decision makers in health care to decide if they find the balance between additional health gains and additional health care costs acceptable. Second, as seen from the wider societal perspective, there is a substantial likelihood that SbS is not costing more than EUC but is associated with cost-savings as SBS participants become more productive, thus offsetting their health care costs. This finding may suggest to policy makers that it is in the interest of both population health and the wider Lebanese economy to implement SbS on a wide scale. In brief, SbS may offer a scalable, potentially cost-saving response to humanitarian emergencies in an LMIC. Trial Registration: ClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769 International Registered Report Identifier (IRRID): RR2-10.2196/21585 %M 38810255 %R 10.2196/55544 %U https://mental.jmir.org/2024/1/e55544 %U https://doi.org/10.2196/55544 %U http://www.ncbi.nlm.nih.gov/pubmed/38810255 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47546 %T Long-Term Emotional Impact of the COVID-19 Pandemic and Barriers and Facilitators to Digital Mental Health Tools in Long-Term Care Workers: Qualitative Study %A González-Spinoglio,Leticia %A Monistrol-Mula,Anna %A Vindrola-Padros,Cecilia %A Aguilar-Ortiz,Salvatore %A Carreras,Bernat %A Haro,Josep Maria %A Felez-Nobrega,Mireia %+ Research and Development Unit, Parc Sanitari Sant Joan de Déu, Institut Sant Joan de Déu, C/Dr Antoni Pujada 42, Sant Boi de Llobregat, Barcelona, 08830, Spain, 34 93 640 63 50, josepmaria.haro@sjd.es %K COVID-19 pandemic %K digital technology %K health care professionals %K long-term care %K mental health %K well-being %K digital mental health %K digital mental health interventions %K mobile phone %D 2024 %7 29.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The overall pandemic created enormous pressure on long-term care workers (LTCWs), making them particularly vulnerable to mental disorders. Despite this, most of the available evidence on professional well-being during COVID-19 has exclusively focused on frontline health care workers. Objective: This study aimed to identify the long-term psychological needs of LTCWs derived from the COVID-19 pandemic and to explore barriers and facilitators related to digital mental health tools. This is part of a project that seeks to develop a digital mental health intervention to reduce psychological distress in this population group. Methods: We performed a qualitative study with a rapid research approach. Participants were LTCWs of the autonomous community of Catalonia. We conducted 30 semistructured interviews between April and September 2022. We used a qualitative content analysis method with an inductive-deductive approach. Results: The period of the pandemic with the highest mental health burden was the COVID-19 outbreak, with almost all workers having experienced some form of emotional distress. Emotional distress persisted over time in more than half of the participants, with fatigue and nervousness being the main emotions expressed at the time of the interview. High workload, the feeling that pandemic times are not over, and poor working conditions that have remained since then have been the most frequently expressed determinants of such emotions. Potential barriers and facilitators to engagement with digital tools were also identified in terms of previous experience and beliefs of the target population, possibilities for the integration of a digital tool into daily life, preferences regarding the level of guidance, the possibility of social connectedness through the tool, and privacy and confidentiality. The identified factors may become especially relevant in the context of the pandemic remission phase. Conclusions: More than 2 years after the pandemic outbreak, emotional distress is still relevant. The persistent burden of psychological distress points to a need for institutions to take action to improve working conditions and promote employees’ well-being. Considering factors that act as barriers and facilitators for the use of digital mental health tools, it is important to develop tailored tools that could offer valuable support to this population during and after a pandemic. %M 38809605 %R 10.2196/47546 %U https://www.jmir.org/2024/1/e47546 %U https://doi.org/10.2196/47546 %U http://www.ncbi.nlm.nih.gov/pubmed/38809605 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50454 %T Effects of a Chatbot-Based Intervention on Stress and Health-Related Parameters in a Stressed Sample: Randomized Controlled Trial %A Schillings,Christine %A Meißner,Echo %A Erb,Benjamin %A Bendig,Eileen %A Schultchen,Dana %A Pollatos,Olga %+ Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Albert-Einstein-Allee 43, Ulm, 89081, Germany, 49 731 50 31738, christine.schillings@uni-ulm.de %K chatbot %K intervention %K stress %K interoception %K interoceptive sensibility %K mindfulness %K emotion regulation %K RCT %K randomized controlled trial %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Stress levels and the prevalence of mental disorders in the general population have been rising in recent years. Chatbot-based interventions represent novel and promising digital approaches to improve health-related parameters. However, there is a lack of research on chatbot-based interventions in the area of mental health. Objective: The aim of this study was to investigate the effects of a 3-week chatbot-based intervention guided by the chatbot ELME, specifically with respect to the ability to reduce stress and improve various health-related parameters in a stressed sample. Methods: In this multicenter two-armed randomized controlled trial, 118 individuals with medium to high stress levels were randomized to the intervention group (n=59) or the treatment-as-usual control group (n=59). The ELME chatbot guided participants of the intervention group through 3 weeks of training based on the topics stress, mindfulness, and interoception, with practical and psychoeducative elements delivered in two daily interactive intervention sessions via a smartphone (approximately 10-20 minutes each). The primary outcome (perceived stress) and secondary outcomes (mindfulness; interoception or interoceptive sensibility; subjective well-being; and emotion regulation, including the subfacets reappraisal and suppression) were assessed preintervention (T1), post intervention (T2; after 3 weeks), and at follow-up (T3; after 6 weeks). During both conditions, participants also underwent ecological momentary assessments of stress and interoceptive sensibility. Results: There were no significant changes in perceived stress (β03=–.018, SE=.329; P=.96) and momentary stress. Mindfulness and the subfacet reappraisal significantly increased in the intervention group over time, whereas there was no change in the subfacet suppression. Well-being and momentary interoceptive sensibility increased in both groups over time. Conclusions: To gain insight into how the intervention can be improved to achieve its full potential for stress reduction, besides a longer intervention duration, specific sample subgroups should be considered. The chatbot-based intervention seems to have the potential to improve mindfulness and emotion regulation in a stressed sample. Future chatbot-based studies and interventions in health care should be designed based on the latest findings on the efficacy of rule-based and artificial intelligence–based chatbots. Trial Registration: German Clinical Trials Register DRKS00027560; https://drks.de/search/en/trial/DRKS00027560 International Registered Report Identifier (IRRID): RR2-doi.org/10.3389/fdgth.2023.1046202 %M 38805259 %R 10.2196/50454 %U https://mental.jmir.org/2024/1/e50454 %U https://doi.org/10.2196/50454 %U http://www.ncbi.nlm.nih.gov/pubmed/38805259 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e54412 %T Examining the Effects of a Brief, Fully Self-Guided Mindfulness Ecological Momentary Intervention on Empathy and Theory-of-Mind for Generalized Anxiety Disorder: Randomized Controlled Trial %A Zainal,Nur Hani %A Newman,Michelle G %+ Department of Psychology, National University of Singapore, 9 Arts Link, Singapore, 117572, Singapore, 65 917 767 7088, hanizainal@nus.edu.sg %K empathy %K theory-of-mind %K mindfulness %K ecological momentary intervention %K generalized anxiety disorder %K randomized controlled trial %K mobile phone %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The utility of brief mindfulness ecological momentary interventions (EMIs) to improve empathy and theory-of-mind has been underinvestigated, particularly in generalized anxiety disorder (GAD). Objective: In this randomized controlled trial, we aimed to examine the efficacy of a 14-day, fully self-guided, mindfulness EMI on the empathy and theory-of-mind domains for GAD. Methods: Adults (aged ≥18 y) diagnosed with GAD were randomized to a mindfulness EMI (68/110, 61.8%) or self-monitoring app (42/110, 38.2%) arm. They completed the Interpersonal Reactivity Index self-report empathy measure and theory-of-mind test (Bell-Lysaker Emotion Recognition Task) at prerandomization, postintervention, and 1-month follow-up (1MFU) time points. Hierarchical linear modeling was conducted with the intent-to-treat principle to determine prerandomization to postintervention (pre-post intervention) and prerandomization to 1MFU (pre-1MFU) changes, comparing the mindfulness EMI to self-monitoring. Results: Observed effects were generally stronger from pre-1MFU than from pre-post intervention time points. From pre-post intervention time points, the mindfulness EMI was more efficacious than the self-monitoring app on fantasy (the ability to imagine being in others’ shoes; between-intervention effect size: Cohen d=0.26, P=.007; within-intervention effect size: Cohen d=0.22, P=.02 for the mindfulness EMI and Cohen d=−0.16, P=.10 for the self-monitoring app). From pre-1MFU time points, the mindfulness EMI, but not the self-monitoring app, improved theory-of-mind (a window into others’ thoughts and intentions through abstract, propositional knowledge about their mental states, encompassing the ability to decipher social cues) and the fantasy, personal distress (stress when witnessing others’ negative experiences), and perspective-taking (understanding others’ perspective) empathy domains. The effect sizes were small to moderate (Cohen d=0.15-0.36; P<.001 to P=.01) for significant between-intervention effects from pre-1MFU time points. Furthermore, the within-intervention effect sizes for these significant outcomes were stronger for the mindfulness EMI (Cohen d=0.30-0.43; P<.001 to P=.03) than the self-monitoring app (Cohen d=−0.12 to 0.21; P=.001 to P>.99) from pre-1MFU time points. No between-intervention and within-intervention effects on empathic concern (feeling affection, compassion, and care when observing others in distress, primarily attending to their emotional well-being) were observed from pre-post intervention and pre-1MFU time points. Conclusions: The brief mindfulness EMI improved specific domains of empathy (eg, fantasy, personal distress, and perspective-taking) and theory-of-mind with small to moderate effect sizes in persons with GAD. Higher-intensity, self-guided or coach-facilitated, multicomponent mindfulness EMIs targeting the optimization of social relationships are likely necessary to improve the empathic concern domain in this population. Trial Registration: ClinicalTrials.gov NCT04846777; https://clinicaltrials.gov/study/NCT04846777 %M 38787613 %R 10.2196/54412 %U https://mental.jmir.org/2024/1/e54412 %U https://doi.org/10.2196/54412 %U http://www.ncbi.nlm.nih.gov/pubmed/38787613 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e54781 %T The Artificial Third: A Broad View of the Effects of Introducing Generative Artificial Intelligence on Psychotherapy %A Haber,Yuval %A Levkovich,Inbar %A Hadar-Shoval,Dorit %A Elyoseph,Zohar %K psychoanalysis %K generative artificial intelligence %K psychotherapy %K large language models %K narcissism %K narcissist %K narcissistic %K perception %K perceptions %K critical thinking %K transparency %K autonomy %K mental health %K interpersonal %K LLM %K LLMs %K language model %K language models %K artificial intelligence %K generative %K AI %K ethic %K ethics %K ethical %D 2024 %7 23.5.2024 %9 %J JMIR Ment Health %G English %X This paper explores a significant shift in the field of mental health in general and psychotherapy in particular following generative artificial intelligence’s new capabilities in processing and generating humanlike language. Following Freud, this lingo-technological development is conceptualized as the “fourth narcissistic blow” that science inflicts on humanity. We argue that this narcissistic blow has a potentially dramatic influence on perceptions of human society, interrelationships, and the self. We should, accordingly, expect dramatic changes in perceptions of the therapeutic act following the emergence of what we term the artificial third in the field of psychotherapy. The introduction of an artificial third marks a critical juncture, prompting us to ask the following important core questions that address two basic elements of critical thinking, namely, transparency and autonomy: (1) What is this new artificial presence in therapy relationships? (2) How does it reshape our perception of ourselves and our interpersonal dynamics? and (3) What remains of the irreplaceable human elements at the core of therapy? Given the ethical implications that arise from these questions, this paper proposes that the artificial third can be a valuable asset when applied with insight and ethical consideration, enhancing but not replacing the human touch in therapy. %R 10.2196/54781 %U https://mental.jmir.org/2024/1/e54781 %U https://doi.org/10.2196/54781 %0 Journal Article %@ 2561-6722 %I %V 7 %N %P e57041 %T Social Media Use and Serious Psychological Distress Among Adolescents %A Shimkhada,Riti %A Ponce,Ninez A %K social media %K socials %K youth %K adolescents %K teens %K teenager %K mental health %K mental illness %K mental disease %K mental illnesses %K psychological distress %K psychological %K psychology %D 2024 %7 23.5.2024 %9 %J JMIR Pediatr Parent %G English %X This Research Letter describes the increasing trend of almost-constant social media use among California adolescents and the association with serious psychological distress, focusing on the influence of familial and experiential factors. %R 10.2196/57041 %U https://pediatrics.jmir.org/2024/1/e57041 %U https://doi.org/10.2196/57041 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54586 %T A Web-Based Intervention to Support the Mental Well-Being of Sexual and Gender Minority Young People: Mixed Methods Co-Design of Oneself %A Brown,Katherine %A Lucassen,Mathijs F G %A Núñez-García,Alicia %A Rimes,Katharine A %A Wallace,Louise M %A Samra,Rajvinder %+ Centre for Research in Psychology and Sports Science, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, AL109AB, United Kingdom, 44 1707 284 615, k.brown25@herts.ac.uk %K sexual minority %K gender minority %K lesbian, gay, bisexual, transgender, queer %K LGBTQ+ %K mental well-being %K support %K intervention %K resilience %K digital %K co-design %K sexual and gender minority youth %K SGMY %K mobile phone %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and gender minority youth are at greater risk of compromised mental health than their heterosexual and cisgender peers. This is considered to be due to an increased burden of stigma, discrimination, or bullying resulting in a heightened experience of daily stress. Given the increasing digital accessibility and a strong preference for web-based support among sexual and gender minority youth, digital interventions are a key means to provide support to maintain their well-being. Objective: This paper aims to explicate the co-design processes and underpinning logic of Oneself, a bespoke web-based intervention for sexual and gender minority youth. Methods: This study followed a 6-stage process set out by Hagen et al (identify, define, position, concept, create, and use), incorporating a systematic scoping review of existing evidence, focus groups with 4 stakeholder groups (ie, sexual and gender minority youth, professionals who directly support them, parents, and UK public health service commissioners), a series of co-design workshops and web-based consultations with sexual and gender minority youth, the appointment of a digital development company, and young adult sexual and gender minority contributors to create content grounded in authentic experiences. Results: Oneself features a welcome and home page, including a free accessible to all animation explaining the importance of using appropriate pronouns and the opportunity to create a user account and log-in to access further free content. Creating an account provides an opportunity (for the user and the research team) to record engagement, assess users’ well-being, and track progress through the available content. There are three sections of content in Oneself focused on the priority topics identified through co-design: (1) coming out and doing so safely; (2) managing school, including homophobic, biphobic, or transphobic bullying or similar; and (3) dealing with parents and families, especially unsupportive family members, including parents or caregivers. Oneself’s content focuses on identifying these as topic areas and providing potential resources to assist sexual and gender minority youth in coping with these areas. For instance, Oneself drew on therapeutic concepts such as cognitive reframing, stress reduction, and problem-solving techniques. There is also a section containing relaxation exercises, a section with links to other recommended support and resources, and a downloads section with more detailed techniques and strategies for improving well-being. Conclusions: This study contributes to research by opening up the black box of intervention development. It shows how Oneself is underpinned by a logic that can support future development and evaluation and includes diverse co-designers. More interactive techniques to support well-being would be beneficial for further development. Additional content specific to a wider range of intersecting identities (such as care-experienced Asian sexual and gender minority youth from a minority faith background) would also be beneficial in future Oneself developments. International Registered Report Identifier (IRRID): RR2-10.2196/31036 %M 38772025 %R 10.2196/54586 %U https://formative.jmir.org/2024/1/e54586 %U https://doi.org/10.2196/54586 %U http://www.ncbi.nlm.nih.gov/pubmed/38772025 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49050 %T A Web-Based Intervention Using "Five Ways to Wellbeing" to Promote Well-Being and Mental Health: Randomized Controlled Trial %A Prydz,Monica Beer %A Czajkowski,Nikolai Olavi %A Eilertsen,Maja %A Røysamb,Espen %A Nes,Ragnhild Bang %+ Promenta Research Centre, Department of Psychology, University of Oslo, Forskningsveien 3 a, PO Box 1020, Oslo, 0315, Norway, 47 95856400, m.b.prydz@psykologi.uio.no %K well-being %K mental health promotion %K intervention %K web based %K low cost %K broad outreach %K framework %K web-based intervention %K randomized controlled trial %K effectiveness %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Compromised well-being and mental health problems pose a significant threat to individuals and societies worldwide. Resource-intensive psychological treatments alone cannot alleviate this burden. There is a need for low-cost, evidence-based interventions aimed at preventing illness and promoting well-being. Five activity domains appear to be linked with well-being promotion across populations: connecting with others, being active, taking notice, learning, and being generous/giving. The activities mentioned are part of the Five Ways to Wellbeing framework and the web-based intervention Five Ways to Wellbeing for All (5waysA). Objective: This randomized controlled trial aims to test the effects of the 5waysA intervention, a web-based, low-cost, well-being–promoting measure targeting the general population. To date, the Five Ways to Wellbeing framework has not been tested in this specific format. The 5waysA intervention comprises 2 webinars and SMS text message reminders delivered over a 10-week period. Methods: In 2021, a total of 969 study participants from various regions across Norway were openly recruited through a web page. They were then randomly assigned to either an intervention group or 1 of 2 waiting list control groups, namely, active or passive. Self-reported life satisfaction (Satisfaction With Life Scale [SWLS]), flourishing (Flourishing Scale [FS]), positive emotions, anxiety, and depression symptoms (Hopkins Symptom Checklist-8 [HSCL-8]) were assessed before the intervention, at 4 weeks into the intervention, and 1-2 weeks after the intervention (over 10 weeks). Data analysis was conducted using linear mixed (multilevel) models. Results: After 10 weeks, 453 participants (171 in the intervention group and 282 in the waiting list control group) were assessed on outcome variables, with a dropout rate of 53.2% (516/969). Results revealed a significantly greater increase in the intervention group compared with the controls for SWLS (b=0.13, 95% CI 0.03-0.23; P=.001), FS (b=0.19, 95% CI 0.08-0.30; P=.001), positive emotions (b=0.43, 95% CI 0.27-0.60; P<.001), and these factors combined into a global well-being measure (b=0.28, CI 0.16-0.39; P<.001). Effect sizes (Cohen d) for the well-being outcomes ranged from 0.30 to 0.49. In addition, a significant decrease in anxiety and depressive symptoms was observed (b=–0.17, 95% CI –0.30 to –0.04; P=.001) with an effect size (Cohen d) of –0.20. Conclusions: The findings suggest that the web-based 5waysA intervention could serve as an effective approach for enhancing well-being and mental health within the general population. This study offers individuals, policy makers, and local stakeholders an accessible and potentially cost-effective well-being intervention that could be easily implemented. Trial Registration: ClinicalTrials.gov NCT04784871; https://clinicaltrials.gov/study/NCT04784871 %M 38767958 %R 10.2196/49050 %U https://mental.jmir.org/2024/1/e49050 %U https://doi.org/10.2196/49050 %U http://www.ncbi.nlm.nih.gov/pubmed/38767958 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53968 %T User Dynamics and Thematic Exploration in r/Depression During the COVID-19 Pandemic: Insights From Overlapping r/SuicideWatch Users %A Zhu,Jianfeng %A Jin,Ruoming %A Kenne,Deric R %A Phan,NhatHai %A Ku,Wei-Shinn %+ Department of Computer Science, Kent State University, 800 E. Summit St., Kent, OH, 44242, United States, 1 3306729980, jzhu10@kent.edu %K reddit %K natural language processing %K NLP %K suicidal ideation %K SI %K online communities %K depression symptoms %K COVID-19 pandemic %K bidirectional encoder representations from transformers %K BERT %K r/SuicideWatch %K r/Depression %D 2024 %7 20.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2023, the United States experienced its highest- recorded number of suicides, exceeding 50,000 deaths. In the realm of psychiatric disorders, major depressive disorder stands out as the most common issue, affecting 15% to 17% of the population and carrying a notable suicide risk of approximately 15%. However, not everyone with depression has suicidal thoughts. While “suicidal depression” is not a clinical diagnosis, it may be observed in daily life, emphasizing the need for awareness. Objective: This study aims to examine the dynamics, emotional tones, and topics discussed in posts within the r/Depression subreddit, with a specific focus on users who had also engaged in the r/SuicideWatch community. The objective was to use natural language processing techniques and models to better understand the complexities of depression among users with potential suicide ideation, with the goal of improving intervention and prevention strategies for suicide. Methods: Archived posts were extracted from the r/Depression and r/SuicideWatch Reddit communities in English spanning from 2019 to 2022, resulting in a final data set of over 150,000 posts contributed by approximately 25,000 unique overlapping users. A broad and comprehensive mix of methods was conducted on these posts, including trend and survival analysis, to explore the dynamic of users in the 2 subreddits. The BERT family of models extracted features from data for sentiment and thematic analysis. Results: On August 16, 2020, the post count in r/SuicideWatch surpassed that of r/Depression. The transition from r/Depression to r/SuicideWatch in 2020 was the shortest, lasting only 26 days. Sadness emerged as the most prevalent emotion among overlapping users in the r/Depression community. In addition, physical activity changes, negative self-view, and suicidal thoughts were identified as the most common depression symptoms, all showing strong positive correlations with the emotion tone of disappointment. Furthermore, the topic “struggles with depression and motivation in school and work” (12%) emerged as the most discussed topic aside from suicidal thoughts, categorizing users based on their inclination toward suicide ideation. Conclusions: Our study underscores the effectiveness of using natural language processing techniques to explore language markers and patterns associated with mental health challenges in online communities like r/Depression and r/SuicideWatch. These insights offer novel perspectives distinct from previous research. In the future, there will be potential for further refinement and optimization of machine classifications using these techniques, which could lead to more effective intervention and prevention strategies. %M 38767953 %R 10.2196/53968 %U https://www.jmir.org/2024/1/e53968 %U https://doi.org/10.2196/53968 %U http://www.ncbi.nlm.nih.gov/pubmed/38767953 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53204 %T Prospective Acceptability of Digital Therapy for Major Depressive Disorder in France: Multicentric Real-Life Study %A Amiot,Odile %A Sauvaget,Anne %A Alamome,Isabelle %A Bulteau,Samuel %A Charpeaud,Thomas %A Clair,Anne-Hélène %A Courtet,Philippe %A Drapier,Dominique %A Haffen,Emmanuel %A Fakra,Eric %A Gaudeau-Bosma,Christian %A Gaillard,Adeline %A Mouchabac,Stéphane %A Pineau,Fanny %A Narboni,Véronique %A Duburcq,Anne %A Lecardeur,Laurent %+ DueL, 8 Quai des Docks, Nice, 06300, France, 33 635568024, laurentlecardeur@gmail.com %K prospective acceptability %K digital health %K depression %K e-mental health %K deprexis %K psychotherapy %D 2024 %7 20.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Major depressive disorder is one of the leading causes of disability worldwide. Although most international guidelines recommend psychological and psychosocial interventions as first-line treatment for mild to moderate depression, access remains limited in France due to the limited availability of trained clinicians, high costs for patients in the context of nonreimbursement, and the fear of stigmatization. Therefore, online blended psychological treatment such as Deprexis could improve access to care for people with depression. It has several advantages, such as easy accessibility and scalability, and it is supported by evidence. Objective: This study aims to evaluate the real-life acceptability of Deprexis for people with depression in France outside of a reimbursement pathway. Methods: Deprexis Acceptability Study Measure in Real Life (DARE) was designed as a multicenter cross-sectional study in which Deprexis was offered to any patient meeting the inclusion criteria during the fixed inclusion period (June 2022-March 2023). Inclusion criteria were (1) depression, (2) age between 18 and 65 years, (3) sufficient French language skills, and (4) access to the internet with a device to connect to the Deprexis platform. Exclusion criteria were previous or current diagnoses of bipolar disorder, psychotic symptoms, and suicidal thoughts during the current episode. The primary objective was to measure the prospective acceptability of Deprexis, a new digital therapy. Secondary objectives were to examine differences in acceptability according to patient and clinician characteristics and to identify reasons for refusal. All investigators received video-based training on Deprexis before enrollment to ensure that they all had the same level of information and understanding of the program. Results: A total of 245 patients were eligible (n=159, 64.9% were women and n=138, 56.3% were single). The mean age was 40.7 (SD 14.1) years. A total of 78% (n=191) of the patients had moderate to severe depression (according to the Patient Health Questionnaire-9 [PHQ-9]). More than half of the population had another psychiatric comorbidity (excluding bipolar disorder, psychotic disorders, and suicidal ideation). A total of 33.9% (n=83) of patients accepted the idea of using Deprexis; the main reason for refusal was financial at 83.3% (n=135). Multivariate logistic regression identified factors that might favor the acceptability of Deprexis. Among these, being a couple, being treated with an antidepressant, or having a low severity level favored the acceptance of Deprexis. Conclusions: DARE is the first French study aiming at evaluating the prospective acceptability of digital therapy in the treatment of depression. The main reason for the refusal of Deprexis was financial. DARE will allow better identification of factors influencing acceptability in a natural setting. This study highlights the importance of investigating factors that may be associated with the acceptability of digital interventions, such as marital status, medication use, and severity of depression. %M 38568139 %R 10.2196/53204 %U https://formative.jmir.org/2024/1/e53204 %U https://doi.org/10.2196/53204 %U http://www.ncbi.nlm.nih.gov/pubmed/38568139 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49916 %T Psychometric Assessment of an Item Bank for Adaptive Testing on Patient-Reported Experience of Care Environment for Severe Mental Illness: Validation Study %A Fernandes,Sara %A Brousse,Yann %A Zendjidjian,Xavier %A Cano,Delphine %A Riedberger,Jérémie %A Llorca,Pierre-Michel %A Samalin,Ludovic %A Dassa,Daniel %A Trichard,Christian %A Laprevote,Vincent %A Sauvaget,Anne %A Abbar,Mocrane %A Misdrahi,David %A Berna,Fabrice %A Lancon,Christophe %A Coulon,Nathalie %A El-Hage,Wissam %A Rozier,Pierre-Emmanuel %A Benoit,Michel %A Giordana,Bruno %A Caqueo-Urízar,Alejandra %A Yon,Dong Keon %A Tran,Bach %A Auquier,Pascal %A Fond,Guillaume %A Boyer,Laurent %+ Assistance Publique-Hopitaux de Marseille, Aix-Marseille University, UR3279: Health Service Research and Quality of Life Center - CEReSS, 27, Boulevard Jean-Moulin, Marseille, 13385, France, 33 660185077, sarah.fernandes@ap-hm.fr %K psychiatry %K public mental health %K schizophrenia %K major depressive disorders %K bipolar disorders %K patient-reported experience measures %K quality of care %K health services research %K computerized adaptive testing %K real-world data %D 2024 %7 16.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The care environment significantly influences the experiences of patients with severe mental illness and the quality of their care. While a welcoming and stimulating environment enhances patient satisfaction and health outcomes, psychiatric facilities often prioritize staff workflow over patient needs. Addressing these challenges is crucial to improving patient experiences and outcomes in mental health care. Objective: This study is part of the Patient-Reported Experience Measure for Improving Quality of Care in Mental Health (PREMIUM) project and aims to establish an item bank (PREMIUM-CE) and to develop computerized adaptive tests (CATs) to measure the experience of the care environment of adult patients with schizophrenia, bipolar disorder, or major depressive disorder. Methods: We performed psychometric analyses including assessments of item response theory (IRT) model assumptions, IRT model fit, differential item functioning (DIF), item bank validity, and CAT simulations. Results: In this multicenter cross-sectional study, 498 patients were recruited from outpatient and inpatient settings. The final PREMIUM-CE 13-item bank was sufficiently unidimensional (root mean square error of approximation=0.082, 95% CI 0.067-0.097; comparative fit index=0.974; Tucker-Lewis index=0.968) and showed an adequate fit to the IRT model (infit mean square statistic ranging between 0.7 and 1.0). DIF analysis revealed no item biases according to gender, health care settings, diagnosis, or mode of study participation. PREMIUM-CE scores correlated strongly with satisfaction measures (r=0.69-0.78; P<.001) and weakly with quality-of-life measures (r=0.11-0.21; P<.001). CAT simulations showed a strong correlation (r=0.98) between CAT scores and those of the full item bank, and around 79.5% (396/498) of the participants obtained a reliable score with the administration of an average of 7 items. Conclusions: The PREMIUM-CE item bank and its CAT version have shown excellent psychometric properties, making them reliable measures for evaluating the patient experience of the care environment among adults with severe mental illness in both outpatient and inpatient settings. These measures are a valuable addition to the existing landscape of patient experience assessment, capturing what truly matters to patients and enhancing the understanding of their care experiences. Trial Registration: ClinicalTrials.gov NCT02491866; https://clinicaltrials.gov/study/NCT02491866 %M 38753416 %R 10.2196/49916 %U https://mental.jmir.org/2024/1/e49916 %U https://doi.org/10.2196/49916 %U http://www.ncbi.nlm.nih.gov/pubmed/38753416 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e42049 %T Rapport Building in Written Crisis Services: Qualitative Content Analysis %A Schwab-Reese,Laura %A Short,Caitlyn %A Jacobs,Larel %A Fingerman,Michelle %+ Department of Public Health, Purdue University, MTHW 214F, West Lafayette, IN, 47907, United States, 1 765 496 6723, lschwabr@purdue.edu %K empathy %K crisis hotline %K child maltreatment %K text hotline %K chat hotline %K telehealth %K digital empathy %K counseling %K child abuse %K family violence %K crisis %K hotline %K chat %K tele %K emotional dynamics %K therapeutic relationships %K therapy %K content analysis %K text %K inductive %K deductive %K emotion %K affect %K emotional dynamic %K counseling psychology %D 2024 %7 15.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Building therapeutic relationships and social presence are challenging in digital services and maybe even more difficult in written services. Despite these difficulties, in-person care may not be feasible or accessible in all situations. Objective: This study aims to categorize crisis counselors’ efforts to build rapport in written conversations by using deidentified conversation transcripts from the text and chat arms of the National Child Abuse Hotline. Using these categories, we identify the common characteristics of successful conversations. We defined success as conversations where help-seekers reported the hotline was a good way to seek help and that they were a lot more hopeful, a lot more informed, a lot more prepared to address the situation, and experiencing less stress, as reported by help-seekers. Methods: The sample consisted of transcripts from 314 purposely selected conversations from of the 1153 text and chat conversations during July 2020. Hotline users answered a preconversation survey (ie, demographics) and a postconversation survey (ie, their perceptions of the conversation). We used qualitative content analysis to process the conversations. Results: Active listening skills, including asking questions, paraphrasing, reflecting feelings, and interpreting situations, were commonly used by counselors. Validation, unconditional positive regard, and evaluation-based language, such as praise and apologies, were also often used. Compared with less successful conversations, successful conversations tended to include fewer statements that attend to the emotional dynamics. There were qualitative differences in how the counselors applied these approaches. Generally, crisis counselors in positive conversations tended to be more specific and tailor their comments to the situation. Conclusions: Building therapeutic relationships and social presence are essential to digital interventions involving mental health professionals. Prior research demonstrates that they can be challenging to develop in written conversations. Our work demonstrates characteristics associated with successful conversations that could be adopted in other written help-seeking interventions. %M 38748472 %R 10.2196/42049 %U https://www.jmir.org/2024/1/e42049 %U https://doi.org/10.2196/42049 %U http://www.ncbi.nlm.nih.gov/pubmed/38748472 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e49189 %T The Google Health Digital Well-Being Study: Protocol for a Digital Device Use and Well-Being Study %A McDuff,Daniel %A Barakat,Andrew %A Winbush,Ari %A Jiang,Allen %A Cordeiro,Felicia %A Crowley,Ryann %A Kahn,Lauren E %A Hernandez,John %A Allen,Nicholas B %+ Google, 1600 Amphitheatre Parkway, Unit D, Mountain View, CA, 94043, United States, 1 6176060531, dmcduff@google.com %K digital %K health %K well-being %K mobile %K google health %K digital health %K well-being %K mhealth %K digital device %K smartphone %D 2024 %7 14.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The impact of digital device use on health and well-being is a pressing question. However, the scientific literature on this topic, to date, is marred by small and unrepresentative samples, poor measurement of core constructs, and a limited ability to address the psychological and behavioral mechanisms that may underlie the relationships between device use and well-being. Recent authoritative reviews have made urgent calls for future research projects to address these limitations. The critical role of research is to identify which patterns of use are associated with benefits versus risks and who is more vulnerable to harmful versus beneficial outcomes, so that we can pursue evidence-based product design, education, and regulation aimed at maximizing benefits and minimizing the risks of smartphones and other digital devices. Objective: The objective of this study is to provide normative data on objective patterns of smartphone use. We aim to (1) identify how patterns of smartphone use impact well-being and identify groups of individuals who show similar patterns of covariation between smartphone use and well-being measures across time; (2) examine sociodemographic and personality or mental health predictors and which patterns of smartphone use and well-being are associated with pre-post changes in mental health and functioning; (3) discover which nondevice behavior patterns mediate the association between device use and well-being; (4) identify and explore recruitment strategies to increase and improve the representation of traditionally underrepresented populations; and (5) provide a real-world baseline of observed stress, mood, insomnia, physical activity, and sleep across a representative population. Methods: This is a prospective, nonrandomized study to investigate the patterns and relationships among digital device use, sensor-based measures (including both behavioral and physiological signals), and self-reported measures of mental health and well-being. The study duration is 4 weeks per participant and includes passive sensing based on smartphone sensors, and optionally a wearable (Fitbit), for the complete study period. The smartphone device will provide activity, location, phone unlocks and app usage, and battery status information. Results: At the time of submission, the study infrastructure and app have been designed and built, the institutional review board of the University of Oregon has approved the study protocol, and data collection is underway. Data from 4182 enrolled and consented participants have been collected as of March 27, 2023. We have made many efforts to sample a study population that matches the general population, and the demographic breakdown we have been able to achieve, to date, is not a perfect match. Conclusions: The impact of digital devices on mental health and well-being raises important questions. The Digital Well-Being Study is designed to help answer questions about the association between patterns of smartphone use and well-being. International Registered Report Identifier (IRRID): DERR1-10.2196/49189 %M 38743938 %R 10.2196/49189 %U https://www.researchprotocols.org/2024/1/e49189 %U https://doi.org/10.2196/49189 %U http://www.ncbi.nlm.nih.gov/pubmed/38743938 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e47382 %T Exploring How Virtual Reality Could Be Used to Treat Eating Disorders: Qualitative Study of People With Eating Disorders and Clinicians Who Treat Them %A Bould,Helen %A Kennedy,Mari-Rose %A Penton-Voak,Ian %A Thomas,Lisa May %A Bird,Jon %A Biddle,Lucy %+ Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom, 44 (0)117 9289000, helen.bould@bristol.ac.uk %K eating disorders %K virtual reality %K anorexia nervosa %K bulimia nervosa %K EDNOS %K treatment %K immersive %K clinicians %K qualitative data %K psychoeducation %K therapeutic %K limitations %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: Immersive virtual reality (VR) interventions are being developed and trialed for use in the treatment of eating disorders. However, little work has explored the opinions of people with eating disorders, or the clinicians who treat them, on the possible use of VR in this context. Objective: This study aims to use qualitative methodology to explore the views of people with eating disorders, and clinicians who treat them, on the possible use of VR in the treatment of eating disorders. Methods: We conducted a series of focus groups and interviews with people with lived experience of eating disorders and clinicians on their views about VR and how it could potentially be used in the treatment of eating disorders. People with lived experience of eating disorders were recruited between October and December 2020, with focus groups held online between November 2020 and February 2021; clinicians were recruited in September 2021 and interviewed between September and October 2021. We took a thematic approach to analyzing the resulting qualitative data. Results: We conducted 3 focus groups with 10 individuals with a current or previous eating disorder, 2 focus groups with 4 participants, and 1 with 2 participants. We held individual interviews with 4 clinicians experienced in treating people with eating disorders. Clinicians were all interviewed one-to-one because of difficulties in scheduling mutually convenient groups. We describe themes around representing the body in VR, potential therapeutic uses for VR, the strengths and limitations of VR in this context, and the practicalities of delivering VR therapy. Suggested therapeutic uses were to practice challenging situations around food-related and weight/appearance-related scenarios and interactions, to retrain attention, the representation of the body, to represent the eating disorder, for psychoeducation, and to enable therapeutic conversations with oneself. There was a substantial agreement between the groups on these themes. Conclusions: People with lived experience of eating disorders and clinicians with experience in treating eating disorders generated many ideas as to how VR could be used as a part of eating disorders treatment. They were also aware of potential limitations and expressed the need for caution around how bodies are represented in a VR setting. %R 10.2196/47382 %U https://xr.jmir.org/2024/1/e47382 %U https://doi.org/10.2196/47382 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e42547 %T Optimizing Outcomes in Psychotherapy for Anxiety Disorders Using Smartphone-Based and Passive Sensing Features: Protocol for a Randomized Controlled Trial %A Müller-Bardorff,Miriam %A Schulz,Ava %A Paersch,Christina %A Recher,Dominique %A Schlup,Barbara %A Seifritz,Erich %A Kolassa,Iris Tatjana %A Kowatsch,Tobias %A Fisher,Aaron %A Galatzer-Levy,Isaac %A Kleim,Birgit %+ Experimental Psychopathology and Psychotherapy, Department of Psychiatry and Psychology, University of Zurich, Lenggstrasse 31, Zurich, 8032, Switzerland, 41 0443842351, birgit.kleim@uzh.ch %K cognitive behavioral therapy %K CBT %K transdiagnostic %K anxiety %K digital %K ecological momentary assessment %K EMA %K passive sensing %D 2024 %7 14.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychotherapies, such as cognitive behavioral therapy (CBT), currently have the strongest evidence of durable symptom changes for most psychological disorders, such as anxiety disorders. Nevertheless, only about half of individuals treated with CBT benefit from it. Predictive algorithms, including digital assessments and passive sensing features, could better identify patients who would benefit from CBT, and thus, improve treatment choices. Objective: This study aims to establish predictive features that forecast responses to transdiagnostic CBT in anxiety disorders and to investigate key mechanisms underlying treatment responses. Methods: This study is a 2-armed randomized controlled clinical trial. We include patients with anxiety disorders who are randomized to either a transdiagnostic CBT group or a waitlist (referred to as WAIT). We index key features to predict responses prior to starting treatment using subjective self-report questionnaires, experimental tasks, biological samples, ecological momentary assessments, activity tracking, and smartphone-based passive sensing to derive a multimodal feature set for predictive modeling. Additional assessments take place weekly at mid- and posttreatment and at 6- and 12-month follow-ups to index anxiety and depression symptom severity. We aim to include 150 patients, randomized to CBT versus WAIT at a 3:1 ratio. The data set will be subject to full feature and important features selected by minimal redundancy and maximal relevance feature selection and then fed into machine leaning models, including eXtreme gradient boosting, pattern recognition network, and k-nearest neighbors to forecast treatment response. The performance of the developed models will be evaluated. In addition to predictive modeling, we will test specific mechanistic hypotheses (eg, association between self-efficacy, daily symptoms obtained using ecological momentary assessments, and treatment response) to elucidate mechanisms underlying treatment response. Results: The trial is now completed. It was approved by the Cantonal Ethics Committee, Zurich. The results will be disseminated through publications in scientific peer-reviewed journals and conference presentations. Conclusions: The aim of this trial is to improve current CBT treatment by precise forecasting of treatment response and by understanding and potentially augmenting underpinning mechanisms and personalizing treatment. Trial Registration: ClinicalTrials.gov NCT03945617; https://clinicaltrials.gov/ct2/show/results/NCT03945617 International Registered Report Identifier (IRRID): DERR1-10.2196/42547 %M 38743473 %R 10.2196/42547 %U https://www.researchprotocols.org/2024/1/e42547 %U https://doi.org/10.2196/42547 %U http://www.ncbi.nlm.nih.gov/pubmed/38743473 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50982 %T Predicting the Effectiveness of a Mindfulness Virtual Community Intervention for University Students: Machine Learning Model %A El Morr,Christo %A Tavangar,Farideh %A Ahmad,Farah %A Ritvo,Paul %A , %+ School of Health Policy and Management, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 426 736 2100 ext 22053, elmorr@yorku.ca %K machine learning %K virtual community %K virtual care %K mindfulness %K depression %K anxiety %K stress %K students %K online %K randomized controlled trial %K Canada %K virtual %K artificial intelligence %K symptoms %K behavioral therapy %K sociodemographic %K mindfulness video %K online video %D 2024 %7 13.5.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Students’ mental health crisis was recognized before the COVID-19 pandemic. Mindfulness virtual community (MVC), an 8-week web-based mindfulness and cognitive behavioral therapy program, has proven to be an effective web-based program to reduce symptoms of depression, anxiety, and stress. Predicting the success of MVC before a student enrolls in the program is essential to advise students accordingly. Objective: The objectives of this study were to investigate (1) whether we can predict MVC’s effectiveness using sociodemographic and self-reported features and (2) whether exposure to mindfulness videos is highly predictive of the intervention’s success. Methods: Machine learning models were developed to predict MVC’s effectiveness, defined as success in reducing symptoms of depression, anxiety, and stress as measured using the Patient Health Questionnaire-9 (PHQ-9), the Beck Anxiety Inventory (BAI), and the Perceived Stress Scale (PSS), to at least the minimal clinically important difference. A data set representing a sample of undergraduate students (N=209) who took the MVC intervention between fall 2017 and fall 2018 was used for this secondary analysis. Random forest was used to measure the features’ importance. Results: Gradient boosting achieved the best performance both in terms of area under the curve (AUC) and accuracy for predicting PHQ-9 (AUC=0.85 and accuracy=0.83) and PSS (AUC=1 and accuracy=1), and random forest had the best performance for predicting BAI (AUC=0.93 and accuracy=0.93). Exposure to online mindfulness videos was the most important predictor for the intervention’s effectiveness for PHQ-9, BAI, and PSS, followed by the number of working hours per week. Conclusions: The performance of the models to predict MVC intervention effectiveness for depression, anxiety, and stress is high. These models might be helpful for professionals to advise students early enough on taking the intervention or choosing other alternatives. The students’ exposure to online mindfulness videos is the most important predictor for the effectiveness of the MVC intervention. Trial Registration: ISRCTN Registry ISRCTN12249616; https://www.isrctn.com/ISRCTN12249616 %M 38578872 %R 10.2196/50982 %U https://www.i-jmr.org/2024/1/e50982 %U https://doi.org/10.2196/50982 %U http://www.ncbi.nlm.nih.gov/pubmed/38578872 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e41573 %T A Curriculum on Digital Psychiatry for a US-Based Psychiatry Residency Training Program: Pilot Implementation Study %A Noori,Sofia %A Khasnavis,Siddharth %A DeCroce-Movson,Eliza %A Blay-Tofey,Morkeh %A Vitiello,Evan %+ Department of Psychiatry, University of North Carolina School of Medicine, 333 S Columbia St, Chapel Hill, NC, 27514, United States, 1 9194450221, evan.vitiello@gmail.com %K digital psychiatry %K digital mental health %K didactic curriculum %K residency training %K psychiatry residency %K training classes %K trainee response %K residency curriculum %K trainee feedback %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital psychiatry, defined as the application of health technologies to the prevention, assessment, and treatment of mental health illnesses, is a growing field. Interest in the clinical use of these technologies continues to grow. However, psychiatric trainees receive limited or no formal education on the topic. Objective: This study aims to pilot a curriculum on digital psychiatry for a US-based psychiatry residency training program and examine the change in learner confidence regarding appraisal and clinical recommendation of digital mental health apps. Methods: Two 60-minute sessions were presented through a web-based platform to postgraduate year 2-4 residents training in psychiatry at a US-based adult psychiatry residency program. Learner confidence was assessed using pre- and postsession surveys. Results: Matched pre- and postsession quizzes showed improved confidence in multiple domains aligning with the course objectives. This included the structured appraisal of digital mental health apps (P=.03), assessment of a patient’s digital health literacy (P=.01), formal recommendation of digital health tools (P=.03), and prescription of digital therapeutics to patients (P=.03). Though an improvement from baseline, mean ratings for confidence did not exceed “somewhat comfortable” on any of the above measures. Conclusions: Our study shows the feasibility of implementing a digital psychiatry curriculum for residents in multiple levels of training. We also identified an opportunity to increase learner confidence in the appraisal and clinical use of digital mental health apps through the use of a formal curriculum. %M 38739423 %R 10.2196/41573 %U https://formative.jmir.org/2024/1/e41573 %U https://doi.org/10.2196/41573 %U http://www.ncbi.nlm.nih.gov/pubmed/38739423 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55569 %T A Digital Cognitive-Physical Intervention for Attention-Deficit/Hyperactivity Disorder: Randomized Controlled Trial %A Zhao,Licong %A Agazzi,Heather %A Du,Yasong %A Meng,Hongdao %A Maku,Renya %A Li,Ke %A Aspinall,Peter %A Garvan,Cynthia Wilson %A Fang,Shuanfeng %+ Department of Child Healthcare, Children’s Hospital Affiliated to Zhengzhou University, 33 Longhu Waihuan East Road, Zhengdong New District, Zhengzhou, 450018, China, 86 0371 85515939, fangshuanfeng@126.com %K school-age children %K cognitive training %K exercise therapy %K gamification %K ADHD %K attention deficit %K attention-deficit/hyperactivity disorder %K RCT %K randomized controlled trial %K executive function %K digital intervention %K AR %K augmented reality %D 2024 %7 10.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders among children. Pharmacotherapy has been the primary treatment for ADHD, supplemented by behavioral interventions. Digital and exercise interventions are promising nonpharmacologic approaches for enhancing the physical and psychological health of children with ADHD. However, the combined impact of digital and exercise therapies remains unclear. Objective: The aim of this study was to determine whether BrainFit, a novel digital intervention combining gamified cognitive and exercise training, is efficacious in reducing ADHD symptoms and executive function (EF) among school-aged children with ADHD. Methods: This 4-week prospective randomized controlled trial included 90 children (6-12 years old) who visited the ADHD outpatient clinic and met the diagnostic criteria for ADHD. The participants were randomized (1:1) to the BrainFit intervention (n=44) or a waitlist control (n=46) between March and August 2022. The intervention consisted of 12 30-minute sessions delivered on an iPad over 4 weeks with 3 sessions per week (Monday, Wednesday, and Friday after school) under the supervision of trained staff. The primary outcomes were parent-rated symptoms of attention and hyperactivity assessed according to the Swanson, Nolan, and Pelham questionnaire (SNAP-IV) rating scale and EF skills assessed by the Behavior Rating Inventory of Executive Function (BRIEF) scale, evaluated pre and post intervention. Intention-to-treat analysis was performed on 80 children after attrition. A nonparametric resampling-based permutation test was used for hypothesis testing of intervention effects. Results: Among the 145 children who met the inclusion criteria, 90 consented and were randomized; ultimately, 80 (88.9%) children completed the study and were included in the analysis. The participants’ average age was 8.4 (SD 1.3) years, including 63 (78.8%) male participants. The most common ADHD subtype was hyperactive/impulsive (54/80, 68%) and 23 (29%) children had severe symptoms. At the endpoint of the study, the BrainFit intervention group had a significantly larger improvement in total ADHD symptoms (SNAP-IV total score) as compared to those in the control group (β=–12.203, 95% CI –17.882 to –6.523; P<.001), owing to lower scores on the subscales Inattention (β=–3.966, 95% CI –6.285 to –1.647; P<.001), Hyperactivity/Impulsivity (β=–5.735, 95% CI –8.334 to –3.137; P<.001), and Oppositional Defiant Disorder (β=–2.995, 95% CI –4.857 to –1.132; P=.002). The intervention was associated with significant reduction in the Metacognition Index (β=–6.312, 95% CI –10.973 to –1.650; P=.006) and Global Executive Composite (β=–5.952, 95% CI –10.214 to –1.690; P=.003) on the BRIEF. No severe intervention-related adverse events were reported. Conclusions: This novel digital cognitive-physical intervention was efficacious in school-age children with ADHD. A larger multicenter effectiveness trial with longer follow-up is warranted to confirm these findings and to assess the durability of treatment effects. Trial Registration: Chinese Clinical Trial Register ChiCTR2300070521; https://www.chictr.org.cn/showproj.html?proj=177806 %M 38728075 %R 10.2196/55569 %U https://www.jmir.org/2024/1/e55569 %U https://doi.org/10.2196/55569 %U http://www.ncbi.nlm.nih.gov/pubmed/38728075 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52369 %T Feasibility and Acceptability of a Mobile App–Based TEAM-CBT (Testing Empathy Assessment Methods–Cognitive Behavioral Therapy) Intervention (Feeling Good) for Depression: Secondary Data Analysis %A Bisconti,Nicholas %A Odier,Mackenzie %A Becker,Matthew %A Bullock,Kim %+ PGSP-Stanford PsyD. Consortium, 401 Quarry Rd, Palo Alto, CA, 94304, United States, 1 6506449946, nbisco@stanford.edu %K depression %K mobile health %K mHealth %K cognitive behavioral therapy %K mobile phone %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The Feeling Good App is an automated stand-alone digital mobile mental health tool currently undergoing beta testing with the goal of providing evidence-informed self-help lessons and exercises to help individuals reduce depressive symptoms without guidance from a mental health provider. Users work through intensive basic training (IBT) and ongoing training models that provide education regarding cognitive behavioral therapy principles from a smartphone. Objective: The key objective of this study was to perform a nonsponsored third-party academic assessment of an industry-generated data set; this data set focused on the safety, feasibility, and accessibility of a commercial automated digital mobile mental health app that was developed to reduce feelings associated with depression. Methods: The Feeling Good App development team created a waitlist cohort crossover design and measured symptoms of depression and anxiety using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and an app-specific measure of negative feelings called the 7 Dimension Emotion Slider (7-DES). The waitlist cohort crossover design divided the participants into 2 groups, where 48.6% (141/290) of the participants were given immediate access to the apps, while 51.4% (149/290) were placed on a 2-week waitlist before being given access to the app. Data collected by the Feeling Good App development team were deidentified and provided to the authors of this paper for analysis through a nonsponsored university data use agreement. All quantitative data were analyzed using SPSS Statistics (version 28.0; IBM Corp). Descriptive statistics were calculated for demographic variables. Feasibility and acceptability were descriptively assessed. All participants included in the quantitative data were given access to the Feeling Good App; this study did not include a control group. Results: In terms of safety, there was no statistically significant change in suicidality from preintervention to postintervention time points (t288=0.0; P>.99), and there was a statistically significant decrease in hopelessness from preintervention to postintervention time points (F289=30.16; P<.01). In terms of acceptability, 72.2% (166/230) of the users who started the initial 2-day IBT went on to complete it, while 34.8% (80/230) of the users who started IBT completed the entirety of the apps’ 4-week protocol (150/230, 65.22% dropout rate over 4 weeks). Conclusions: This study is the first reported proof-of-concept evaluation of the Feeling Good App in terms of safety, feasibility, and statistical trends within the data set. It demonstrates a feasible and novel approach to industry and academic collaboration in the process of developing a digital mental health technology translated from an existing evidence-informed treatment. The results support the prototype app as safe for a select nonclinical population. The app had acceptable levels of engagement and dropouts throughout the intervention. Those who stay engaged showed reductions in symptom severity of depression warranting further investigation of the app’s efficacy. %M 38728080 %R 10.2196/52369 %U https://mental.jmir.org/2024/1/e52369 %U https://doi.org/10.2196/52369 %U http://www.ncbi.nlm.nih.gov/pubmed/38728080 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53890 %T A Mindfulness-Based App Intervention for Pregnant Women: Protocol for a Pilot Feasibility Study %A Rizzi,Silvia %A Poggianella,Stefania %A Pavesi,Maria Chiara %A Gios,Lorenzo %A Bincoletto,Giorgia %A Scolari,Isabella %A Paoli,Claudia %A Marroni,Debora %A Tassinari,Irene %A Baietti,Barbara %A Gianatti,Anna %A Albertini,Veronica %A Burlon,Barbara %A Chiodega,Vanda %A Endrizzi,Barbara %A Benini,Elena %A Guella,Chiara %A Gadotti,Erik %A Forti,Stefano %A Taddei,Fabrizio %+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu %K mindfulness %K promoting well-being %K pregnancy %K eHealth %K mobile health %K mHealth %K mobile apps %K development %K usability %K user-centered design %K mindfulness based %K intervention %K pregnant women %K pregnant %K feasibility study %K well-being %K women %K quality of life %K psychological symptoms %K digital solution %K virtual coach %K smartphone %K mobile phone %D 2024 %7 10.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pregnancy is a complex time characterized by major transformations in a woman, which impact her physical, mental, and social well-being. How a woman adapts to these changes can affect her quality of life and psychological well-being. The literature indicates that pregnant women commonly experience psychological symptoms, with anxiety, stress, and depression being among the most frequent. Hence, promoting a healthy lifestyle focused on women’s psychological well-being is crucial. Recently developed digital solutions have assumed a crucial role in supporting psychological well-being in physiologically pregnant women. Therefore, the need becomes evident for the development and implementation of digital solutions, such as a virtual coach implemented in a smartphone, as a support for the psychological well-being of pregnant women who do not present psychological and psychiatric disorders. Objective: This study aims to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. The primary objective is to explore the feasibility of using a virtual coach, Maia, developed within the TreC Mamma app to promote women’s psychological well-being during pregnancy through a psychoeducational module based on mindfulness. Finally, through the delivery of this module, the level of psychological well-being will be explored as a secondary objective. Methods: This is a proof-of-concept study in which a small sample (N=50) is sufficient to achieve the intended purposes. Recruitment will occur within the group of pregnant women belonging to the pregnancy care services of the Trento Azienda Provinciale per i Servizi Sanitari di Trento. The convenience sampling method will be used. Maia will interact with the participating women for 8 weeks, starting from weeks 24 and 26 of pregnancy. Specifically, there will be 2 sessions per week, which the woman can choose, to allow more flexibility toward her needs. Results: The psychoeducational pathway is expected to lead to significant results in terms of usability and engagement in women’s interactions with Maia. Furthermore, it is anticipated that there will be improvements in psychological well-being and overall quality of life. The analysis of the data collected in this study will be mainly descriptive, orientated toward assessing the achievement of the study objectives. Conclusions: Literature has shown that women preferred web-based support during the perinatal period, suggesting that implementing digital interventions can overcome barriers to social stigma and asking for help. Maia can be a valuable resource for regular psychoeducational support for women during pregnancy. International Registered Report Identifier (IRRID): RR1-10.2196/53890 %M 38567964 %R 10.2196/53890 %U https://www.researchprotocols.org/2024/1/e53890 %U https://doi.org/10.2196/53890 %U http://www.ncbi.nlm.nih.gov/pubmed/38567964 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51332 %T Differing Content and Language Based on Poster-Patient Relationships on the Chinese Social Media Platform Weibo: Text Classification, Sentiment Analysis, and Topic Modeling of Posts on Breast Cancer %A Zhang,Zhouqing %A Liew,Kongmeng %A Kuijer,Roeline %A She,Wan Jou %A Yada,Shuntaro %A Wakamiya,Shoko %A Aramaki,Eiji %+ School of Psychology, Speech and Hearing, University of Canterbury, Private Bag 4800, Christchurch, 8140, New Zealand, 64 3 369 4333, kongmeng.liew@canterbury.ac.nz %K cancer %K social media %K text classification %K topic modeling %K sentiment analysis %K Weibo %D 2024 %7 9.5.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer affects the lives of not only those diagnosed but also the people around them. Many of those affected share their experiences on social media. However, these narratives may differ according to who the poster is and what their relationship with the patient is; a patient posting about their experiences may post different content from someone whose friends or family has breast cancer. Weibo is 1 of the most popular social media platforms in China, and breast cancer–related posts are frequently found there. Objective: With the goal of understanding the different experiences of those affected by breast cancer in China, we aimed to explore how content and language used in relevant posts differ according to who the poster is and what their relationship with the patient is and whether there are differences in emotional expression and topic content if the patient is the poster themselves or a friend, family member, relative, or acquaintance. Methods: We used Weibo as a resource to examine how posts differ according to the different poster-patient relationships. We collected a total of 10,322 relevant Weibo posts. Using a 2-step analysis method, we fine-tuned 2 Chinese Robustly Optimized Bidirectional Encoder Representations from Transformers (BERT) Pretraining Approach models on this data set with annotated poster-patient relationships. These models were lined in sequence, first a binary classifier (no_patient or patient) and then a multiclass classifier (post_user, family_members, friends_relatives, acquaintances, heard_relation), to classify poster-patient relationships. Next, we used the Linguistic Inquiry and Word Count lexicon to conduct sentiment analysis from 5 emotion categories (positive and negative emotions, anger, sadness, and anxiety), followed by topic modeling (BERTopic). Results: Our binary model (F1-score=0.92) and multiclass model (F1-score=0.83) were largely able to classify poster-patient relationships accurately. Subsequent sentiment analysis showed significant differences in emotion categories across all poster-patient relationships. Notably, negative emotions and anger were higher for the “no_patient” class, but sadness and anxiety were higher for the “family_members” class. Focusing on the top 30 topics, we also noted that topics on fears and anger toward cancer were higher in the “no_patient” class, but topics on cancer treatment were higher in the “family_members” class. Conclusions: Chinese users post different types of content, depending on the poster- poster-patient relationships. If the patient is family, posts are sadder and more anxious but also contain more content on treatments. However, if no patient is detected, posts show higher levels of anger. We think that these may stem from rants from posters, which may help with emotion regulation and gathering social support. %M 38723250 %R 10.2196/51332 %U https://cancer.jmir.org/2024/1/e51332 %U https://doi.org/10.2196/51332 %U http://www.ncbi.nlm.nih.gov/pubmed/38723250 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e55750 %T Understanding the Impacts of Online Mental Health Peer Support Forums: Realist Synthesis %A Marshall,Paul %A Booth,Millissa %A Coole,Matthew %A Fothergill,Lauren %A Glossop,Zoe %A Haines,Jade %A Harding,Andrew %A Johnston,Rose %A Jones,Steven %A Lodge,Christopher %A Machin,Karen %A Meacock,Rachel %A Nielson,Kristi %A Puddephatt,Jo-Anne %A Rakic,Tamara %A Rayson,Paul %A Robinson,Heather %A Rycroft-Malone,Jo %A Shryane,Nick %A Swithenbank,Zoe %A Wise,Sara %A Lobban,Fiona %+ Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Health Innovation One, Lancaster, LA1 4YW, United Kingdom, 44 01524 522187, p.marshall4@lancaster.ac.uk %K digital mental health %K peer-to-peer support %K social networking %K moderation %K systematic review %D 2024 %7 9.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Online forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation. Objective: This study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users. Methods: We conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff. Results: Synthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users’ perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety. Conclusions: This is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability. Trial Registration: PROSPERO CRD42022352528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=352528 %M 38722680 %R 10.2196/55750 %U https://mental.jmir.org/2024/1/e55750 %U https://doi.org/10.2196/55750 %U http://www.ncbi.nlm.nih.gov/pubmed/38722680 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53756 %T Self-Selected Versus Assigned Target to Reduce Smartphone Use and Improve Mental Health: Protocol for a Randomized Controlled Trial %A Sharma,Kamal Kant %A Somasundaram,Jeeva %A Sachdeva,Ashish %+ Max Institute of Healthcare Management, Indian School of Business, Knowledge City, Sector 81, Sahibzada Ajit Singh Nagar, Punjab, 140306, India, 91 01724591831, ashish_sachdeva@isb.edu %K screen time %K monetary incentives %K target selection %K mental health %K mobile phone %D 2024 %7 6.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Smartphones have become integral to people’s lives, with a noticeable increase in the average screen time, both on a global scale and, notably, in India. Existing research links mobile consumption to sleep problems, poor physical and mental health, and lower subjective well-being. The comparative effectiveness of monetary incentives given for self-selected versus assigned targets on reducing screen time and thereby improving mental health remains unanswered. Objective: This study aims to assess the impact of monetary incentives and target selection on mobile screen time reduction and mental health. Methods: We designed a 3-armed randomized controlled trial conducted with employees and students at an educational institution in India. The study is conducted digitally over 12 weeks, including baseline (2 weeks), randomization (1 week), intervention (5 weeks), and postintervention (4 week) periods. We emailed the employees and students to inquire about their interest in participation. Those who expressed interest received detailed study information and consent forms. After securing consent, participants were asked to complete the initial survey and provide their mobile screen time during the baseline period. At the beginning of the intervention period, the participants were randomly allocated into 1 of 3 study groups in a 2:2:1 ratio (self-selected vs assigned vs control). Participants in the self-selected group were presented with 3 target options: 10%, 20%, and 30%, and they were asked to self-select a target to reduce their mobile screen time from their baseline average mobile screen time. Participants in the assigned group were given a target to reduce their mobile screen time from their baseline average mobile screen time. The assigned target was set as the average of the targets selected by participants in the self-selected group. During the intervention period, participants in the self-selected and assigned group were eligible to receive a monetary incentive of INR (Indian Rupee) 50 (US $0.61) per day for successfully attaining their target. Participants in the control group neither received nor selected a target for reducing their mobile screen time and did not receive any monetary incentives during the intervention period. All participants received information regarding the advantages of reducing mobile screen time. As an incentive, all participants would receive INR 500 (US $6.06) upon completion of the study and a chance to win 1 of 2 lotteries valued at INR 5000 (US $60.55) for consistently sharing their mobile screen time data. Results: Currently, the study intervention is being rolled out. Enrollment occurred between August 21, 2023, and September 2, 2023; data collection concluded in November 2023. We expect that results will be available by early 2024. Conclusions: The monetary incentives and self-selected versus assigned targets might be effective interventions in reducing mobile screen time among working professionals and students. Trial Registration: AsPredicted 142497; https://aspredicted.org/hr3nn.pdf International Registered Report Identifier (IRRID): DERR1-10.2196/53756 %M 38709546 %R 10.2196/53756 %U https://www.researchprotocols.org/2024/1/e53756 %U https://doi.org/10.2196/53756 %U http://www.ncbi.nlm.nih.gov/pubmed/38709546 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53550 %T Integrating Virtual Mindfulness-Based Stress Reduction Into Inflammatory Bowel Disease Care: Mixed Methods Feasibility Trial %A Chappell,Kaitlyn Delaney %A Meakins,Diana %A Marsh-Joyal,Melanie %A Bihari,Allison %A Goodman,Karen J %A Le Melledo,Jean-Michel %A Lim,Allen %A Peerani,Farhad %A Kroeker,Karen Ivy %+ Division of Gastroenterology, Department of Medicine, University of Alberta, 130 University Campus NW, Edmonton, AB, T6G 2X8, Canada, 1 780 492 4873, karen.kroeker@ualberta.ca %K inflammatory bowel disease %K psychosocial care %K multidisciplinary care %K quality of care %K quality of life %K mental health %K adult %K adults %K anxiety %K depression %K IBD %K virtual mindfulness %K feasibility trial %K clinic %K health facility %K Canada %K semistructured interview %K psychiatrist %K psychiatrists %K videoconferencing %K effectiveness %K v-MBSR %K coping %K coping strategy %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with inflammatory bowel disease (IBD) experience cycles of aggressive physical symptoms including abdominal pain, diarrhea, and fatigue. These acute symptoms regress and return, and chronic symptoms and complications often linger. The nature of the disease can also cause individuals to experience psychological distress including symptoms of anxiety and depression; however, unlike the physical symptoms of IBD, these psychological symptoms often remain untreated. Objective: This study aims to evaluate the feasibility, acceptability, and effectiveness of virtual mindfulness-based stress reduction (v-MBSR) for adults with IBD. Methods: IBD patients with self-reported anxiety or depression were recruited from clinics in Alberta, Canada to participate in an 8-week v-MSBR intervention. Eligible patients participated in v-MBSR delivered by psychiatrists using a videoconferencing platform. Primary feasibility outcomes included trial uptake, adherence, attendance, and attrition rates. Secondary effectiveness outcomes included measures of anxiety, depression, quality of life (QoL), and mindfulness. Effectiveness data were collected at 3 time points: baseline, at intervention completion, and 6 months after completion. To further assess feasibility and acceptability, participants were invited to participate in a semistructured interview after completing v-MBSR. Results: A total of 16 of the 64 (25%) referred patients agreed to participate in v-MBSR with the most common reason for decline being a lack of time while 7 of the 16 (43.8%) participants completed the program and experienced encouraging effects including decreased anxiety and depression symptoms and increased health-related QoL with both improvements persisting at 6-month follow-up. Participants described improved coping strategies and disease management techniques as benefits of v-MBSR. Conclusions: Patients with IBD were interested in a psychiatrist-led virtual anxiety management intervention, but results demonstrate v-MBSR may be too time intensive for some patients with IBD patients. v-MBSR was acceptable to those who completed the intervention, and improvements to anxiety, depression, and QoL were promising and sustainable. Future studies should attempt to characterize the patients with IBD who may benefit most from interventions like v-MBSR. %M 38709548 %R 10.2196/53550 %U https://formative.jmir.org/2024/1/e53550 %U https://doi.org/10.2196/53550 %U http://www.ncbi.nlm.nih.gov/pubmed/38709548 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51694 %T Group Cohesion and Necessary Adaptations in Online Hearing Voices Peer Support Groups: Qualitative Study With Group Facilitators %A Branitsky,Alison %A Longden,Eleanor %A Bucci,Sandra %A Morrison,Anthony P %A Varese,Filippo %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 07936813441, alison.branitsky@postgrad.manchester.ac.uk %K peer support %K group cohesion %K web-based delivery %K hearing voices %K Hearing Voices Movement %K self-help groups %D 2024 %7 3.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Face-to-face hearing voices peer support groups (HVGs), a survivor-led initiative that enables individuals who hear voices to engage with the support of peers, have a long-standing history in community settings. HVGs are premised on the notion that forming authentic, mutual relationships enables the exploration of one’s voice hearing experiences and, in turn, reduces subjective distress. As such, group cohesion is assumed to be a central mechanism of change in HVGs. The rise of digital mental health support, coupled with the COVID-19 pandemic, has resulted in many HVGs adapting to online delivery. However, to date no studies have examined the implementation of these online groups and the adaptations necessary to foster cohesion. Objective: This study aims to understand the experience of group cohesion among HVG facilitators in online groups compared with face-to-face groups. Specifically, we examined the ways in which the medium through which groups run (online or face-to-face) impacts group cohesion and how facilitators adapted HVGs to foster group cohesion online. Methods: Semistructured qualitative interviews were conducted with 11 facilitators with varied experience of facilitating online and face-to-face HVGs. Data were analyzed using reflexive thematic analysis. Results: The findings are organized into 3 themes and associated subthemes: nonverbal challenges to cohesion (lack of differentiation, transitional space, inability to see the whole picture, and expressions of empathy); discursive challenges to cohesion (topic-based conversation and depth of disclosure); and necessary adaptations for online groups (fostering shared experience and using the unique context to demonstrate investment in others). Despite challenges in both the setting and content of online groups, facilitators felt that group cohesion was still possible to achieve online but that it had to be facilitated intentionally. Conclusions: This study is the first to specifically investigate group cohesion in online HVGs. Participants noted numerous challenges to group cohesion when adapting groups to run online, including the unnaturally linear narrative flow of dialogue in online settings; lack of transitional spaces, and associated small talk before and after the session; ease of disengagement online; inhibited sharing; and absence of shared physical presence online. Although these challenges were significant, facilitators nevertheless emphasized that the benefits provided by the accessibility of online groups outweighed these challenges. Necessary adaptations for cultivating group cohesion online are outlined and include capitalizing on moments of humor and spontaneity, using group activities, encouraging information sharing between participants using the chat and screen-sharing features, and using objects from participants’ environments to gain deeper insight into their subjective worlds. %M 38701439 %R 10.2196/51694 %U https://formative.jmir.org/2024/1/e51694 %U https://doi.org/10.2196/51694 %U http://www.ncbi.nlm.nih.gov/pubmed/38701439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50385 %T An Exploration of the Goodness of Fit of Web-Based Tools for Māori: Qualitative Study Using Interviews and Focus Groups %A Donkin,Liesje %A Bidois-Putt,Marie-Claire %A Wilson,Holly %A Hayward,Penelope %A Chan,Amy Hai Yan %+ Department of Psychology and Neuroscience, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K Indigenous people %K Māori %K eHealth %K mental health %K web-based intervention %K digital intervention %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for Māori people who are tāngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. Objective: This study aims to explore the goodness-of-fit of WBIs of Māori individuals, the indigenous people of Aotearoa/New Zealand. Methods: We used interviews (n=3) and focus groups (n=5) with 30 Māori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. Results: Overall, there was a perception that the design of WBIs did not align with the Māori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for Māori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao Māori (the Māori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for Māori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with Māori. Conclusions: While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of Māori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations’ world views. %M 38696236 %R 10.2196/50385 %U https://formative.jmir.org/2024/1/e50385 %U https://doi.org/10.2196/50385 %U http://www.ncbi.nlm.nih.gov/pubmed/38696236 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50259 %T Digital Phenotypes for Early Detection of Internet Gaming Disorder in Adolescent Students: Explorative Data-Driven Study %A Cho,Kwangsu %A Kim,Minah %A Cho,Youngeun %A Hur,Ji-Won %A Kim,Do Hyung %A Park,Seonghyeon %A Park,Sunghyun %A Jang,Moonyoung %A Lee,Chang-Gun %A Kwon,Jun Soo %+ Department of Neuropsychiatry, Seoul National University Hospital, 101 Dahak-no, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 2972, kwonjs@snu.ac.kr %K adolescents %K digital biomarkers %K digital phenotyping %K digital psychiatry %K early detection %K IGD %K internet gaming disorder %K pediatric psychiatry %K proactive medicine %K secondary school %K universal screening %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Limited awareness, social stigma, and access to mental health professionals hinder early detection and intervention of internet gaming disorder (IGD), which has emerged as a significant concern among young individuals. Prevalence estimates vary between 0.7% and 15.6%, and its recognition in the International Classification of Diseases, 11th Revision and Diagnostic and Statistical Manual of Mental Disorders, 5th Edition underscores its impact on academic functioning, social isolation, and mental health challenges. Objective: This study aimed to uncover digital phenotypes for the early detection of IGD among adolescents in learning settings. By leveraging sensor data collected from student tablets, the overarching objective is to incorporate these digital indicators into daily school activities to establish these markers as a mental health screening tool, facilitating the early identification and intervention for IGD cases. Methods: A total of 168 voluntary participants were engaged, consisting of 85 students with IGD and 83 students without IGD. There were 53% (89/168) female and 47% (79/168) male individuals, all within the age range of 13-14 years. The individual students learned their Korean literature and mathematics lessons on their personal tablets, with sensor data being automatically collected. Multiple regression with bootstrapping and multivariate ANOVA were used, prioritizing interpretability over predictability, for cross-validation purposes. Results: A negative correlation between IGD Scale (IGDS) scores and learning outcomes emerged (r166=–0.15; P=.047), suggesting that higher IGDS scores were associated with lower learning outcomes. Multiple regression identified 5 key indicators linked to IGD, explaining 23% of the IGDS score variance: stroke acceleration (β=.33; P<.001), time interval between keys (β=–0.26; P=.01), word spacing (β=–0.25; P<.001), deletion (β=–0.24; P<.001), and horizontal length of strokes (β=0.21; P=.02). Multivariate ANOVA cross-validated these findings, revealing significant differences in digital phenotypes between potential IGD and non-IGD groups. The average effect size, measured by Cohen d, across the indicators was 0.40, indicating a moderate effect. Notable distinctions included faster stroke acceleration (Cohen d=0.68; P=<.001), reduced word spacing (Cohen d=.57; P=<.001), decreased deletion behavior (Cohen d=0.33; P=.04), and longer horizontal strokes (Cohen d=0.34; P=.03) in students with potential IGD compared to their counterparts without IGD. Conclusions: The aggregated findings show a negative correlation between IGD and learning performance, highlighting the effectiveness of digital markers in detecting IGD. This underscores the importance of digital phenotyping in advancing mental health care within educational settings. As schools adopt a 1-device-per-student framework, digital phenotyping emerges as a promising early detection method for IGD. This shift could transform clinical approaches from reactive to proactive measures. %M 38683658 %R 10.2196/50259 %U https://mental.jmir.org/2024/1/e50259 %U https://doi.org/10.2196/50259 %U http://www.ncbi.nlm.nih.gov/pubmed/38683658 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54581 %T Usability Comparison Among Healthy Participants of an Anthropomorphic Digital Human and a Text-Based Chatbot as a Responder to Questions on Mental Health: Randomized Controlled Trial %A Thunström,Almira Osmanovic %A Carlsen,Hanne Krage %A Ali,Lilas %A Larson,Tomas %A Hellström,Andreas %A Steingrimsson,Steinn %+ Region Västra Götaland, Psychiatric Department, Sahlgrenska University Hospital, Journalvägen 5, Gothenburg, 41650, Sweden, 46 313421000, steinn.steingrimsson@gu.se %K chatbot %K chatbots %K chat-bot %K chat-bots %K text-only chatbot, voice-only chatbot %K mental health %K mental illness %K mental disease %K mental diseases %K mental illnesses %K mental health service %K mental health services %K interface %K system usability %K usability %K digital health %K machine learning %K ML %K artificial intelligence %K AI %K algorithm %K algorithms %K NLP %K natural language processing %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The use of chatbots in mental health support has increased exponentially in recent years, with studies showing that they may be effective in treating mental health problems. More recently, the use of visual avatars called digital humans has been introduced. Digital humans have the capability to use facial expressions as another dimension in human-computer interactions. It is important to study the difference in emotional response and usability preferences between text-based chatbots and digital humans for interacting with mental health services. Objective: This study aims to explore to what extent a digital human interface and a text-only chatbot interface differed in usability when tested by healthy participants, using BETSY (Behavior, Emotion, Therapy System, and You) which uses 2 distinct interfaces: a digital human with anthropomorphic features and a text-only user interface. We also set out to explore how chatbot-generated conversations on mental health (specific to each interface) affected self-reported feelings and biometrics. Methods: We explored to what extent a digital human with anthropomorphic features differed from a traditional text-only chatbot regarding perception of usability through the System Usability Scale, emotional reactions through electroencephalography, and feelings of closeness. Healthy participants (n=45) were randomized to 2 groups that used a digital human with anthropomorphic features (n=25) or a text-only chatbot with no such features (n=20). The groups were compared by linear regression analysis and t tests. Results: No differences were observed between the text-only and digital human groups regarding demographic features. The mean System Usability Scale score was 75.34 (SD 10.01; range 57-90) for the text-only chatbot versus 64.80 (SD 14.14; range 40-90) for the digital human interface. Both groups scored their respective chatbot interfaces as average or above average in usability. Women were more likely to report feeling annoyed by BETSY. Conclusions: The text-only chatbot was perceived as significantly more user-friendly than the digital human, although there were no significant differences in electroencephalography measurements. Male participants exhibited lower levels of annoyance with both interfaces, contrary to previously reported findings. %M 38683664 %R 10.2196/54581 %U https://humanfactors.jmir.org/2024/1/e54581 %U https://doi.org/10.2196/54581 %U http://www.ncbi.nlm.nih.gov/pubmed/38683664 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e56056 %T Immersive Technologies for Depression Care: Scoping Review %A Reategui-Rivera,C Mahony %A Villarreal-Zegarra,David %A De La Cruz-Torralva,Kelly %A Díaz-Sánchez,Paquita %A Finkelstein,Joseph %+ Department of Biomedical Informatics, University of Utah, 421 Wakara Way, Ste 140, Salt Lake City, UT, 84108, United States, 1 801 581 4080, mahony.reategui@utah.edu %K depression %K immersive technologies %K virtual reality %K augmented reality %K mobile phone %D 2024 %7 25.4.2024 %9 Review %J JMIR Ment Health %G English %X Background: Depression significantly impacts quality of life, affecting approximately 280 million people worldwide. However, only 16.5% of those affected receive treatment, indicating a substantial treatment gap. Immersive technologies (IMTs) such as virtual reality (VR) and augmented reality offer new avenues for treating depression by creating immersive environments for therapeutic interventions. Despite their potential, significant gaps exist in the current evidence regarding the design, implementation, and use of IMTs for depression care. Objective: We aim to map the available evidence on IMT interventions targeting depression treatment. Methods: This scoping review followed a methodological framework, and we systematically searched databases for studies on IMTs and depression. The focus was on randomized clinical trials involving adults and using IMTs. The selection and charting process involved multiple reviewers to minimize bias. Results: The search identified 16 peer-reviewed articles, predominantly from Europe (n=10, 63%), with a notable emphasis on Poland (n=9, 56%), which contributed to more than half of the articles. Most of the studies (9/16, 56%) were conducted between 2020 and 2021. Regarding participant demographics, of the 16 articles, 5 (31%) exclusively involved female participants, and 7 (44%) featured participants whose mean or median age was >60 years. Regarding technical aspects, all studies focused on VR, with most using stand-alone VR headsets (14/16, 88%), and interventions typically ranging from 2 to 8 weeks, predominantly in hospital settings (11/16, 69%). Only 2 (13%) of the 16 studies mentioned using a specific VR design framework in planning their interventions. The most frequently used therapeutic approach was Ericksonian psychotherapy, used in 56% (9/16) of the studies. Notably, none of the articles reported using an implementation framework or identified barriers and enablers to implementation. Conclusions: This scoping review highlights the growing interest in using IMTs, particularly VR, for depression treatment but emphasizes the need for more inclusive and comprehensive research. Future studies should explore varied therapeutic approaches and cost-effectiveness as well as the inclusion of augmented reality to fully realize the potential of IMTs in mental health care. %M 38663004 %R 10.2196/56056 %U https://mental.jmir.org/2024/1/e56056 %U https://doi.org/10.2196/56056 %U http://www.ncbi.nlm.nih.gov/pubmed/38663004 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e57714 %T Therapeutic Uses of Gaming in Mental Health: An Untapped Potential %A Eckardt,Jens Peter %+ Bedre Psykiatri Research Unit (Videnscenter), Gammeltorv 14. 2 sal, Copenhagen, 1457, Denmark, 45 28943288, jp-mail@hotmail.com %K digital mental health interventions %K mental health %K psychiatry %K gaming %K serious games %K casual video games %K commercial games %K exergames %K adolescent %K anxiety %K teenage %K video game %K youth %D 2024 %7 25.4.2024 %9 Letter to the Editor %J JMIR Serious Games %G English %X %M 38662422 %R 10.2196/57714 %U https://games.jmir.org/2024/1/e57714 %U https://doi.org/10.2196/57714 %U http://www.ncbi.nlm.nih.gov/pubmed/38662422 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53668 %T Cancer Care Supportive Text Messaging Program (Text4Hope) for People Living With Cancer and Their Caregivers During the COVID-19 Pandemic: Longitudinal Observational Study %A Shalaby,Reham %A Vuong,Wesley %A Agyapong,Belinda %A Gusnowski,April %A Surood,Shireen %A Agyapong,Vincent %+ Department of Psychiatry, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, vn602367@dal.ca %K Text4Hope Cancer Care %K COVID-19 %K cancer %K caregivers %K mental health %K anxiety %K depression %K cancer care %K Canada %K Canadian %K treatment %K stress %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cancer is the leading cause of death in Canada, and living with cancer generates psychological demands, including depression and anxiety among cancer survivors and caregivers. Text4Hope-Cancer Care SMS text messaging–based service was provided to people with cancer and caregivers during the COVID-19 pandemic to support their mental health. Objective: The aim of this study is to examine the clinical effectiveness of and satisfaction with Text4Hope-Cancer Care in addressing mental health conditions among people living with cancer and caregivers. Methods: The study was conducted in Alberta, Canada. People who were diagnosed or receiving cancer treatment and caregivers self-subscribed to receive 3-months daily supportive cognitive behavioral therapy–based SMS text messages and a web-based survey was sent at designated time points to collect clinical and nonclinical data. The Hospital Anxiety and Depression scale (HADS) was used to examine changes in anxiety and depression symptoms after receiving the service. Satisfaction with the service was assessed using a survey with a Likert scale. Descriptive and inferential statistics were used, and test significance was considered with P≤.05. Results: Overall, 107 individuals subscribed to the service, and 93 completed the program (completion rate 93/107, 86.9%). A significant improvement in the anxiety symptoms (HADS-Anxiety [HADS-A] subscale) was reported after 3 months of Text4Hope-Cancer Care (t11=2.62; P=.02), with medium effect size (Hedges g=0.7), but not depression symptoms (HADS-Depression [HADS-D] subscale). Subscribers expressed high satisfaction and agreed that the service has helped them to cope with mental health symptoms and improve their quality of life. Most subscribers read the SMS text messages more than once (30/30, 100%); took time to reflect or took a beneficial action after reading the messages (27/30, 90%); and highly agreed (27/30, >80%) with the value of the received supportive SMS text messages as being relevant, succinct, affirmative, and positive. All subscribers recommended SMS text messaging for stress, anxiety, and depression and for cancer care support (30/30, 100%). Conclusions: Text4Hope-Cancer Care was well-perceived and effectively addressed anxiety symptoms among people living with cancer and caregivers during the peak of the COVID-19 pandemic. This study provides evidence-based support and insight for policy and stakeholders to implement similar convenient, economic, and accessible mental health services that support vulnerable populations during crises. International Registered Report Identifier (IRRID): RR2-10.2196/20240 %M 38657234 %R 10.2196/53668 %U https://formative.jmir.org/2024/1/e53668 %U https://doi.org/10.2196/53668 %U http://www.ncbi.nlm.nih.gov/pubmed/38657234 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54478 %T The Impact of Video-Based Microinterventions on Attitudes Toward Mental Health and Help Seeking in Youth: Web-Based Randomized Controlled Trial %A Lemmer,Diana %A Moessner,Markus %A Arnaud,Nicolas %A Baumeister,Harald %A Mutter,Agnes %A Klemm,Sarah-Lena %A König,Elisa %A Plener,Paul %A Rummel-Kluge,Christine %A Thomasius,Rainer %A Kaess,Michael %A Bauer,Stephanie %+ Center for Psychotherapy Research, Center for Psychosocial Medicine, University Hospital Heidelberg, Bergheimer Str. 54, Heidelberg, 69115, Germany, 49 6221 56 7345, stephanie.bauer@med.uni-heidelberg.de %K help seeking %K mental health %K stigma %K mental health literacy %K psychoeducation %K web-based experiment %K web-based randomized controlled trial %K microinterventions %K video-based interventions %D 2024 %7 24.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health (MH) problems in youth are prevalent, burdening, and frequently persistent. Despite the existence of effective treatment, the uptake of professional help is low, particularly due to attitudinal barriers. Objective: This study evaluated the effectiveness and acceptability of 2 video-based microinterventions aimed at reducing barriers to MH treatment and increasing the likelihood of seeking professional help in young people. Methods: This study was entirely web based and open access. The interventions addressed 5 MH problems: generalized anxiety disorder, depression, bulimia, nonsuicidal self-injury, and problematic alcohol use. Intervention 1 aimed to destigmatize and improve MH literacy, whereas intervention 2 aimed to induce positive outcome expectancies regarding professional help seeking. Of the 2435 participants who commenced the study, a final sample of 1394 (57.25%) participants aged 14 to 29 years with complete data and sufficient durations of stay on the video pages were randomized in a fully automated manner to 1 of the 5 MH problems and 1 of 3 conditions (control, intervention 1, and intervention 2) in a permuted block design. After the presentation of a video vignette, no further videos were shown to the control group, whereas a second, short intervention video was presented to the intervention 1 and 2 groups. Intervention effects on self-reported potential professional help seeking (primary outcome), stigma, and attitudes toward help seeking were examined using analyses of covariance across and within the 5 MH problems. Furthermore, we assessed video acceptability. Results: No significant group effects on potential professional help seeking were found in the total sample (F2,1385=0.99; P=.37). However, the groups differed significantly with regard to stigma outcomes and the likelihood of seeking informal help (F2,1385=3.75; P=.02). Furthermore, separate analyses indicated substantial differences in intervention effects among the 5 MH problems. Conclusions: Interventions to promote help seeking for MH problems may require disorder-specific approaches. The study results can inform future research and public health campaigns addressing adolescents and young adults. Trial Registration: German Clinical Trials Register DRKS00023110; https://drks.de/search/de/trial/DRKS00023110 %M 38656779 %R 10.2196/54478 %U https://www.jmir.org/2024/1/e54478 %U https://doi.org/10.2196/54478 %U http://www.ncbi.nlm.nih.gov/pubmed/38656779 %0 Journal Article %@ 2368-7959 %I %V 11 %N %P e51791 %T A Web-Based and Mobile Intervention Program Using a Spaced Education Approach for Workplace Mental Health Literacy: Cluster Randomized Controlled Trial %A Lam,Lawrence T %A Lam,Mary K P %K mHealth %K web-based intervention %K mental health literacy %K psychoeducation %K randomized controlled trial %K workplace %K performance %K worker %K intervention %K digital health %K mental wellness %K promote %K well-being %K mobile health %K technology %D 2024 %7 23.4.2024 %9 %J JMIR Ment Health %G English %X Background: Workplace mental health is an important global health concern. Objectives: This unblinded, phase-III, wait-listed cluster randomized controlled trial aimed to examine the effectiveness of a mobile health (mHealth) psychoeducation program using a spaced education approach on mental health literacy (MHL) in the workplace. The main interest of this paper was the immediate and 3-month medium-term effect of the program on the MHL of workers. The purposely built mHealth platform was also evaluated as a health-related app. Methods: The mHealth platform was designed using the principle of spaced education as a psychoeducation intervention program, with various modules of web-based and mobile materials presented to the participant in a progressive manner. Short quizzes at the end of each module ensured adequate learning, and successful completion qualified the learner to progress to the next level. The trial recruited 456 employees of specific industries with high levels of work-related stress. Participants who were nested in different offices or units were allocated into the intervention and wait-listed control groups using a block randomization process, with the office or unit as the cluster. A separate sample of 70 individual raters were used for the evaluation of the mHealth platform. The Australian National MHL and Stigma Survey and the Mobile Apps Rating Scale were completed through a web-based self-reported survey to assess MHL and evaluate the app. The trial and follow-up data were analyzed by a generalized linear latent and mixed model with adjustments for the clustering effect of work sites and repeated measures. Results: Of the 456 participants in the trial, 236 (51.8%) responded to the follow-up survey. Most MHL outcomes obtained significant results immediately after the intervention and across time. After adjusting for the clustering effect, the postintervention weighted mean scores were significantly higher in the intervention group than the control group for correct recognition of a mental health problem, help seeking, and stigmatization by 0.2 (SE 0.1; P=.003), 0.9 (SE 0.2; P<.001), and 1.8 (SE 0.4; P<.001), respectively. After adjusting for the clustering effect, significant differences across time were found in help-seeking intention (P=.01), stigmatization (P<.001), and social distancing (P<.001). The evaluation of the mHealth program resulted in average scores of the 4 major domains ranging from 3.8 to 4.2, with engagement having the lowest score. Conclusions: The mHealth psychoeducation intervention program using this platform had immediate and 3-month medium-term effects of retaining and improving MHL. The platform was evaluated to have satisfactory performance in terms of functionality, aesthetics, information content, and utility in enhancing MHL. It is anticipated that ongoing development in digital health will provide great benefits in improving the mental health of the global population. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000464167; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377176 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3748-y %R 10.2196/51791 %U https://mental.jmir.org/2024/1/e51791 %U https://doi.org/10.2196/51791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e46764 %T Empowering School Staff to Support Pupil Mental Health Through a Brief, Interactive Web-Based Training Program: Mixed Methods Study %A Soneson,Emma %A Howarth,Emma %A Weir,Alison %A Jones,Peter B %A Fazel,Mina %+ Department of Psychiatry, University of Oxford, Warneford Lane, Oxford, OX3 7JX, United Kingdom, 44 1865 613127, emma.soneson@psych.ox.ac.uk %K mental health %K children %K schools %K teachers %K training %K digital intervention %K pupil mental health %K mental health training %K intervention %K empowerment %K student %K pupil %K support %K school staff %K web-based training %D 2024 %7 23.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Schools in the United Kingdom and elsewhere are expected to protect and promote pupil mental health. However, many school staff members do not feel confident in identifying and responding to pupil mental health difficulties and report wanting additional training in this area. Objective: We aimed to explore the feasibility of Kognito’s At-Risk for Elementary School Educators, a brief, interactive web-based training program that uses a simulation-based approach to improve school staff’s knowledge and skills in supporting pupil mental health. Methods: We conducted a mixed methods, nonrandomized feasibility study of At-Risk for Elementary School Educators in 6 UK primary schools. Our outcomes were (1) school staff’s self-efficacy and preparedness to identify and respond to pupil mental health difficulties, (2) school staff’s identification of mental health difficulties and increased risk of mental health difficulties, (3) mental health support for identified pupils (including conversations about concerns, documentation of concerns, in-class and in-school support, and referral and access to specialist mental health services), and (4) the acceptability and practicality of the training. We assessed these outcomes using a series of questionnaires completed at baseline (T1), 1 week after the training (T2), and 3 months after the training (T3), as well as semistructured qualitative interviews. Following guidance for feasibility studies, we assessed quantitative outcomes across time points by comparing medians and IQRs and analyzed qualitative data using reflexive thematic analysis. Results: A total of 108 teachers and teaching assistants (TAs) completed T1 questionnaires, 89 (82.4%) completed T2 questionnaires, and 70 (64.8%) completed T3 questionnaires; 54 (50%) completed all 3. Eight school staff members, including teachers, TAs, mental health leads, and senior leaders, participated in the interviews. School staff reported greater confidence and preparedness in identifying and responding to mental health difficulties after completing the training. The proportion of pupils whom they identified as having mental health difficulties or increased risk declined slightly over time (medianT1=10%; medianT2=10%; medianT3=7.4%), but findings suggested a slight increase in accuracy compared with a validated screening measure (the Strengths and Difficulties Questionnaire). In-school mental health support outcomes for identified pupils improved after the training, with increases in formal documentation and communication of concerns as well as provision of in-class and in-school support. Referrals and access to external mental health services remained constant. The qualitative findings indicated that school staff perceived the training as useful, practical, and acceptable. Conclusions: The findings suggest that brief, interactive web-based training programs such as At-Risk for Elementary School Educators are a feasible means to improve the identification of and response to mental health difficulties in UK primary schools. Such training may help address the high prevalence of mental health difficulties in this age group by helping facilitate access to care and support. %M 38652534 %R 10.2196/46764 %U https://www.jmir.org/2024/1/e46764 %U https://doi.org/10.2196/46764 %U http://www.ncbi.nlm.nih.gov/pubmed/38652534 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51858 %T AI-Led Mental Health Support (Wysa) for Health Care Workers During COVID-19: Service Evaluation %A Chang,Christel Lynne %A Sinha,Chaitali %A Roy,Madhavi %A Wong,John Chee Meng %+ Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 6772 3481, pcmwcmj@nus.edu.sg %K AI %K app %K application %K artificial intelligence %K COVID-19 %K digital %K health care workers %K mental health %K pandemic %K Wysa %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact that the COVID-19 pandemic has had on health care workers’ mental health, in particular, cannot be ignored. Not only did the pandemic exacerbate mental health challenges through elevated stress, anxiety, risk of infection, and social isolation, but regulations to minimize infection additionally hindered the conduct of traditional in-person mental health care. Objective: This study explores the feasibility of using Wysa, an artificial intelligence–led mental health app, among health care workers. Methods: A national tertiary health care cluster in Singapore piloted the use of Wysa among its own health care workers to support the management of their mental well-being during the pandemic (July 2020-June 2022). The adoption of this digital mental health intervention circumvented the limitations of in-person contact and enabled large-scale access to evidence-based care. Rates and patterns of user engagement were evaluated. Results: Overall, the opportunity to use Wysa was well-received. Out of the 527 staff who were onboarded in the app, 80.1% (422/527) completed a minimum of 2 sessions. On average, users completed 10.9 sessions over 3.80 weeks. The interventions most used were for sleep and anxiety, with a strong repeat-use rate. In this sample, 46.2% (73/158) of health care workers reported symptoms of anxiety (Generalized Anxiety Disorder Assessment-7 [GAD-7]), and 15.2% (24/158) were likely to have symptoms of depression (Patient Health Questionnaire-2 [PHQ-2]). Conclusions: Based on the present findings, Wysa appears to strongly engage those with none to moderate symptoms of anxiety. This evaluation demonstrates the viability of implementing Wysa as a standard practice among this sample of health care workers, which may support the use of similar digital interventions across other communities. %M 38640476 %R 10.2196/51858 %U https://formative.jmir.org/2024/1/e51858 %U https://doi.org/10.2196/51858 %U http://www.ncbi.nlm.nih.gov/pubmed/38640476 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52326 %T Examining the Efficacy of Extended Reality–Enhanced Behavioral Activation for Adults With Major Depressive Disorder: Randomized Controlled Trial %A Paul,Margot %A Bullock,Kim %A Bailenson,Jeremy %A Burns,David %+ Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Rd, Stanford, CA, 94305, United States, 1 781 572 4136, mdpaul@stanford.edu %K virtual reality %K extended reality %K major depressive disorder %K behavioral activation %K depression %K Meta Quest 2 %D 2024 %7 15.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Major depressive disorder (MDD) is a global concern with increasing prevalence. While many evidence-based psychotherapies (EBPs) have been identified to treat MDD, there are numerous barriers to patients accessing them. Virtual reality (VR) has been used as a treatment enhancement for a variety of mental health disorders, but few studies have examined its clinical use in treating MDD. Behavioral activation (BA) is a simple yet effective and established first-line EBP for MDD that has the potential to be easily enhanced and adapted with VR technology. A previous report by our group explored the feasibility and acceptability of VR-enhanced BA in a small clinical proof-of-concept pilot. This study examines the clinical efficacy of a more immersive extended reality (XR)–enhanced BA (XR-BA) prototype. This is the first clinical efficacy test of an XR-BA protocol. Objective: This study examined whether XR-BA was feasible and efficacious in treating MDD in an ambulatory telemedicine clinic. Methods: A nonblinded between-subject randomized controlled trial compared XR-BA to traditional BA delivered via telehealth. The study used a previously established, brief 3-week, 4-session BA EBP intervention. The experimental XR-BA participants were directed to use a Meta Quest 2 (Reality Labs) VR headset to engage in simulated pleasant or mastery activities and were compared to a control arm, which used only real-life mastery or pleasant activities as between-session homework. The Patient Health Questionnaire (PHQ)–9 was the primary outcome measure. Independent-sample and paired-sample t tests (2-tailed) were used to determine statistical significance and confirmed using structural equation modeling. Results: Overall, 26 participants with MDD were randomized to receive either XR-BA (n=13, 50%) or traditional BA (n=13, 50%). The mean age of the 26 participants (n=6, 23% male; n=19, 73% female; n=1, 4% nonbinary or third gender) was 50.3 (SD 17.3) years. No adverse events were reported in either group, and no substantial differences in dropout rates or homework completion were observed. XR-BA was found to be statistically noninferior to traditional BA (t18.6=−0.28; P=.78). Both the XR-BA (t9=2.5; P=.04) and traditional BA (t10=2.3; P=.04) arms showed a statistically significant decrease in PHQ-9 and clinical severity from the beginning of session 1 to the beginning of session 4. There was a significant decrease in PHQ-8 to PHQ-9 scores between the phone intake and the beginning of session 1 for the XR-BA group (t11=2.6; P=.03) but not the traditional BA group (t11=1.4; P=.20). Conclusions: This study confirmed previous findings that XR-BA may be a feasible, non-inferior, and acceptable enhancement to traditional BA. Additionally, there was evidence that supports the potential of XR to enhance expectation or placebo effects. Further research is needed to examine the potential of XR to improve access, outcomes, and barriers to MDD care. Trial Registration: ClinicalTrials.gov NCT05525390; https://clinicaltrials.gov/study/NCT05525390 %M 38437873 %R 10.2196/52326 %U https://mental.jmir.org/2024/1/e52326 %U https://doi.org/10.2196/52326 %U http://www.ncbi.nlm.nih.gov/pubmed/38437873 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51428 %T The Effectiveness of a Digital App for Reduction of Clinical Symptoms in Individuals With Panic Disorder: Randomized Controlled Trial %A Kim,KunJung %A Hwang,Hyunchan %A Bae,Sujin %A Kim,Sun Mi %A Han,Doug Hyun %+ Chung Ang University Hospital, 102 Heucsock ro, Seoul, 06973, Republic of Korea, 82 2 6299 3132, hduk70@gmail.com %K digital app %K mHealth %K mobile health %K app %K apps %K application %K applications %K functional near-infrared spectroscopy %K hemodynamic %K hemodynamics %K panic disorder %K anxiety %K panic %K mental %K fear %K spectroscopy %K digital therapy %K fNIRS %K brain %K imaging %K neurology %K neuroscience %K cortex %K cortices %D 2024 %7 12.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Panic disorder is a common and important disease in clinical practice that decreases individual productivity and increases health care use. Treatments comprise medication and cognitive behavioral therapy. However, adverse medication effects and poor treatment compliance mean new therapeutic models are needed. Objective: We hypothesized that digital therapy for panic disorder may improve panic disorder symptoms and that treatment response would be associated with brain activity changes assessed with functional near-infrared spectroscopy (fNIRS). Methods: Individuals (n=50) with a history of panic attacks were recruited. Symptoms were assessed before and after the use of an app for panic disorder, which in this study was a smartphone-based app for treating the clinical symptoms of panic disorder, panic symptoms, depressive symptoms, and anxiety. The hemodynamics in the frontal cortex during the resting state were measured via fNIRS. The app had 4 parts: diary, education, quest, and serious games. The study trial was approved by the institutional review board of Chung-Ang University Hospital (1041078-202112-HR-349-01) and written informed consent was obtained from all participants. Results: The number of participants with improved panic symptoms in the app use group (20/25, 80%) was greater than that in the control group (6/21, 29%; χ21=12.3; P=.005). During treatment, the improvement in the Panic Disorder Severity Scale (PDSS) score in the app use group was greater than that in the control group (F1,44=7.03; P=.01). In the app use group, the total PDSS score declined by 42.5% (mean score 14.3, SD 6.5 at baseline and mean score 7.2, SD 3.6 after the intervention), whereas the PDSS score declined by 14.6% in the control group (mean score 12.4, SD 5.2 at baseline and mean score 9.8, SD 7.9 after the intervention). There were no significant differences in accumulated oxygenated hemoglobin (accHbO2) at baseline between the app use and control groups. During treatment, the reduction in accHbO2 in the right ventrolateral prefrontal cortex (VLPFC; F1,44=8.22; P=.006) and the right orbitofrontal cortex (OFC; F1,44=8.88; P=.005) was greater in the app use than the control group. Conclusions: Apps for panic disorder should effectively reduce symptoms and VLPFC and OFC brain activity in patients with panic disorder. The improvement of panic disorder symptoms was positively correlated with decreased VLPFC and OFC brain activity in the resting state. Trial Registration: Clinical Research Information Service KCT0007280; https://cris.nih.go.kr/cris/search/detailSearch.do?seq=21448 %M 38608270 %R 10.2196/51428 %U https://www.jmir.org/2024/1/e51428 %U https://doi.org/10.2196/51428 %U http://www.ncbi.nlm.nih.gov/pubmed/38608270 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45959 %T Mental Distress, Label Avoidance, and Use of a Mental Health Chatbot: Results From a US Survey %A Kosyluk,Kristin %A Baeder,Tanner %A Greene,Karah Yeona %A Tran,Jennifer T %A Bolton,Cassidy %A Loecher,Nele %A DiEva,Daniel %A Galea,Jerome T %+ Department of Mental Health Law & Policy, University of South Florida, 13301 Bruce B Downs Boulevard, MHC 2735, Tampa, FL, 33612, United States, 1 8139746019, kkosyluk@usf.edu %K chatbots %K conversational agents %K mental health %K resources %K screening %K resource referral %K stigma %K label avoidance %K survey %K training %K behavioral %K COVID-19 %K pilot test %K design %K users %K psychological distress %K symptoms %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: For almost two decades, researchers and clinicians have argued that certain aspects of mental health treatment can be removed from clinicians’ responsibilities and allocated to technology, preserving valuable clinician time and alleviating the burden on the behavioral health care system. The service delivery tasks that could arguably be allocated to technology without negatively impacting patient outcomes include screening, triage, and referral. Objective: We pilot-tested a chatbot for mental health screening and referral to understand the relationship between potential users’ demographics and chatbot use; the completion rate of mental health screening when delivered by a chatbot; and the acceptability of a prototype chatbot designed for mental health screening and referral. This chatbot not only screened participants for psychological distress but also referred them to appropriate resources that matched their level of distress and preferences. The goal of this study was to determine whether a mental health screening and referral chatbot would be feasible and acceptable to users. Methods: We conducted an internet-based survey among a sample of US-based adults. Our survey collected demographic data along with a battery of measures assessing behavioral health and symptoms, stigma (label avoidance and perceived stigma), attitudes toward treatment-seeking, readiness for change, and technology readiness and acceptance. Participants were then offered to engage with our chatbot. Those who engaged with the chatbot completed a mental health screening, received a distress score based on this screening, were referred to resources appropriate for their current level of distress, and were asked to rate the acceptability of the chatbot. Results: We found that mental health screening using a chatbot was feasible, with 168 (75.7%) of our 222 participants completing mental health screening within the chatbot sessions. Various demographic characteristics were associated with a willingness to use the chatbot. The participants who used the chatbot found it to be acceptable. Logistic regression produced a significant model with perceived usefulness and symptoms as significant positive predictors of chatbot use for the overall sample, and label avoidance as the only significant predictor of chatbot use for those currently experiencing distress. Conclusions: Label avoidance, the desire to avoid mental health services to avoid the stigmatized label of mental illness, is a significant negative predictor of care seeking. Therefore, our finding regarding label avoidance and chatbot use has significant public health implications in terms of facilitating access to mental health resources. Those who are high on label avoidance are not likely to seek care in a community mental health clinic, yet they are likely willing to engage with a mental health chatbot, participate in mental health screening, and receive mental health resources within the chatbot session. Chatbot technology may prove to be a way to engage those in care who have previously avoided treatment due to stigma. %M 38607665 %R 10.2196/45959 %U https://formative.jmir.org/2024/1/e45959 %U https://doi.org/10.2196/45959 %U http://www.ncbi.nlm.nih.gov/pubmed/38607665 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49780 %T Race and Socioeconomic Status as Predictors of Willingness to Use Digital Mental Health Interventions or One-On-One Psychotherapy: National Survey Study %A Lorenzo-Luaces,Lorenzo %A Wasil,Akash %A Kacmarek,Corinne N %A DeRubeis,Robert %+ Indiana University-Bloomington, 1101 E 10th St, Bloomington, IN, 47405, United States, 1 8128560866, lolorenz@indiana.edu %K digital mental health %K ethnicity %K health disparities %K internet-based CBT %K cognitive behavioral therapy %K intervention %K mental health %K mental health care %K race %K therapy %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an ongoing debate about whether digital mental health interventions (DMHIs) can reduce racial and socioeconomic inequities in access to mental health care. A key factor in this debate involves the extent to which racial and ethnic minoritized individuals and socioeconomically disadvantaged individuals are willing to use, and pay for, DMHIs. Objective: This study examined racial and ethnic as well as socioeconomic differences in participants’ willingness to pay for DMHIs versus one-on-one therapy (1:1 therapy). Methods: We conducted a national survey of people in the United States (N=423; women: n=204; mean age 45.15, SD 16.19 years; non-Hispanic White: n=293) through Prolific. After reading descriptions of DMHIs and 1:1 therapy, participants rated their willingness to use each treatment (1) for free, (2) for a small fee, (3) as a maximum dollar amount, and (4) as a percentage of their total monthly income. At the end of the study, there was a decision task to potentially receive more information about DMHIs and 1:1 therapy. Results: Race and ethnicity was associated with willingness to pay more of one’s income, as a percent or in dollar amounts, and was also associated with information-seeking for DMHIs in the behavioral task. For most outcomes, race and ethnicity was not associated with willingness to try 1:1 therapy. Greater educational attainment was associated to willingness to try DMHIs for free, the decision to learn more about DMHIs, and willingness to pay for 1:1 therapy. Income was inconsistently associated to willingness to try DMHIs or 1:1 therapy. Conclusions: If they are available for free or at very low costs, DMHIs may reduce inequities by expanding access to mental health care for racial and ethnic minoritized individuals and economically disadvantaged groups. %M 38602769 %R 10.2196/49780 %U https://formative.jmir.org/2024/1/e49780 %U https://doi.org/10.2196/49780 %U http://www.ncbi.nlm.nih.gov/pubmed/38602769 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53417 %T Moderating Effect of Coping Strategies on the Association Between the Infodemic-Driven Overuse of Health Care Services and Cyberchondria and Anxiety: Partial Least Squares Structural Equation Modeling Study %A Xu,Richard Huan %A Chen,Caiyun %+ Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, 11 Yuk Choi Rd, Hung Hom, China (Hong Kong), 852 27664199, richard.xu@polyu.edu.hk %K infodemic %K health care %K cyberchondria %K anxiety %K coping %K structural equation modeling %D 2024 %7 9.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to a substantial increase in health information, which has, in turn, caused a significant rise in cyberchondria and anxiety among individuals who search for web-based medical information. To cope with this information overload and safeguard their mental well-being, individuals may adopt various strategies. However, the effectiveness of these strategies in mitigating the negative effects of information overload and promoting overall well-being remains uncertain. Objective: This study aimed to investigate the moderating effect of coping strategies on the relationship between the infodemic-driven misuse of health care and depression and cyberchondria. The findings could add a new dimension to our understanding of the psychological impacts of the infodemic, especially in the context of a global health crisis, and the moderating effect of different coping strategies on the relationship between the overuse of health care and cyberchondria and anxiety. Methods: The data used in this study were obtained from a cross-sectional web-based survey. A professional survey company was contracted to collect the data using its web-based panel. The survey was completed by Chinese individuals aged 18 years or older without cognitive problems. Model parameters of the relationships between infodemic-driven overuse of health care, cyberchondria, and anxiety were analyzed using bootstrapped partial least squares structural equation modeling. Additionally, the moderating effects of coping strategies on the aforementioned relationships were also examined. Results: A total of 986 respondents completed the web-based survey. The mean scores of the Generalized Anxiety Disorder-7 and Cyberchondria Severity Scale-12 were 8.4 (SD 3.8) and 39.7 (SD 7.5), respectively. The mean score of problem-focused coping was higher than those of emotion- and avoidant-focused coping. There was a significantly positive relationship between a high level of infodemic and increased overuse of health care (bootstrapped mean 0.21, SD 0.03; 95% CI 0.1581-0.271). The overuse of health care resulted in more severe cyberchondria (bootstrapped mean 0.107, SD 0.032) and higher anxiety levels (bootstrapped mean 0.282, SD 0.032) in all the models. Emotion (bootstrapped mean 0.02, SD 0.008 and 0.037, SD 0.015)- and avoidant (bootstrapped mean 0.026, SD 0.009 and 0.049, SD 0.016)-focused coping strategies significantly moderated the relationship between the overuse of health care and cyberchondria and that between the overuse of health care and anxiety, respectively. Regarding the problem-based model, the moderating effect was significant for the relationship between the overuse of health care and anxiety (bootstrapped mean 0.007, SD 0.011; 95% CI 0.005-0.027). Conclusions: This study provides empirical evidence about the impact of coping strategies on the relationship between infodemic-related overuse of health care services and cyberchondria and anxiety. Future research can build on the findings of this study to further explore these relationships and develop and test interventions aimed at mitigating the negative impact of the infodemic on mental health. %M 38593427 %R 10.2196/53417 %U https://www.jmir.org/2024/1/e53417 %U https://doi.org/10.2196/53417 %U http://www.ncbi.nlm.nih.gov/pubmed/38593427 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e53998 %T Feasibility, Acceptability, and Preliminary Efficacy of a Smartphone App–Led Cognitive Behavioral Therapy for Depression Under Therapist Supervision: Open Trial %A Wilhelm,Sabine %A Bernstein,Emily E %A Bentley,Kate H %A Snorrason,Ivar %A Hoeppner,Susanne S %A Klare,Dalton %A Greenberg,Jennifer L %A Weingarden,Hilary %A McCoy,Thomas H %A Harrison,Oliver %+ Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, United States, 1 617 724 6146, swilhelm@mgh.harvard.edu %K depressive disorder %K depressive %K depression %K open trial %K open trials %K single arm %K smartphone %K cognitive behavioral therapy %K cognitive behavioural therapy %K CBT %K psychotherapy %K psychoeducation %K digital health %K mobile applications %K mHealth %K mobile health %K app %K apps %K application %K applications %K psychiatry %K psychiatric %K feasibility %K acceptability %K usability %K satisfaction %K user experience %K mental %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Major depressive disorder affects approximately 1 in 5 adults during their lifetime and is the leading cause of disability worldwide. Yet, a minority receive adequate treatment due to person-level (eg, geographical distance to providers) and systems-level (eg, shortage of trained providers) barriers. Digital tools could improve this treatment gap by reducing the time and frequency of therapy sessions needed for effective treatment through the provision of flexible, automated support. Objective: This study aimed to examine the feasibility, acceptability, and preliminary clinical effect of Mindset for Depression, a deployment-ready 8-week smartphone-based cognitive behavioral therapy (CBT) supported by brief teletherapy appointments with a therapist. Methods: This 8-week, single-arm open trial tested the Mindset for Depression app when combined with 8 brief (16-25 minutes) video conferencing visits with a licensed doctoral-level CBT therapist (n=28 participants). The app offers flexible, accessible psychoeducation, CBT skills practice, and support to patients as well as clinician guidance to promote sustained engagement, monitor safety, and tailor treatment to individual patient needs. To increase accessibility and thus generalizability, all study procedures were conducted remotely. Feasibility and acceptability were assessed via attrition, patient expectations and feedback, and treatment utilization. The primary clinical outcome measure was the clinician-rated Hamilton Depression Rating Scale, administered at pretreatment, midpoint, and posttreatment. Secondary measures of functional impairment and quality of life as well as maintenance of gains (3-month follow-up) were also collected. Results: Treatment credibility (week 4), expectancy (week 4), and satisfaction (week 8) were moderate to high, and attrition was low (n=2, 7%). Participants self-reported using the app or practicing (either on or off the app) the CBT skills taught in the app for a median of 50 (IQR 30-60; week 4) or 60 (IQR 30-90; week 8) minutes per week; participants accessed the app on an average 36.8 (SD 10.0) days and completed a median of 7 of 8 (IQR 6-8) steps by the week 8 assessment. The app was rated positively across domains of engagement, functionality, aesthetics, and information. Participants’ depression severity scores decreased from an average Hamilton Depression Rating Scale score indicating moderate depression (mean 19.1, SD 5.0) at baseline to a week 8 mean score indicating mild depression (mean 10.8, SD 6.1; d=1.47; P<.001). Improvement was also observed for functional impairment and quality of life. Gains were maintained at 3-month follow-up. Conclusions: The results show that Mindset for Depression is a feasible and acceptable treatment option for individuals with major depressive disorder. This smartphone-led treatment holds promise to be an efficacious, scalable, and cost-effective treatment option. The next steps include testing Mindset for Depression in a fully powered randomized controlled trial and real-world clinical settings. Trial Registration: ClinicalTrials.gov NCT05386329; https://clinicaltrials.gov/study/NCT05386329?term=NCT05386329 %M 38592771 %R 10.2196/53998 %U https://mental.jmir.org/2024/1/e53998 %U https://doi.org/10.2196/53998 %U http://www.ncbi.nlm.nih.gov/pubmed/38592771 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e53117 %T Evaluation of the e–Mental Health Intervention Make It Training From Patients' Perspectives: Qualitative Analysis Within the Reduct Trial %A Krakowczyk,Julia Barbara %A Truijens,Femke %A Teufel,Martin %A Lalgi,Tania %A Heinen,Jana %A Schug,Caterina %A Erim,Yesim %A Pantförder,Michael %A Graf,Johanna %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, Essen, Germany, 49 201438755216, julia.krakowczyk@uni-due.de %K psycho-oncology %K eHealth %K digital health %K cancer %K Reduct trial %K oncology %D 2024 %7 9.4.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Make It Training is an e–mental health intervention designed for individuals with cancer that aims to reduce psychological distress and improve disease-related coping and quality of life. Objective: This study evaluated the experienced usefulness and usability of the web-based Make It Training intervention using a qualitative approach. Methods: In this study, semistructured interviews were conducted with participants at different cancer stages and with different cancer entities. All participants had previously taken part in the Reduct trial, a randomized controlled trial that assessed the efficacy of the Make It Training intervention. The data were coded deductively by 2 independent researchers and analyzed iteratively using thematic codebook analysis. Results: Analysis of experienced usefulness resulted in 4 themes (developing coping strategies to reduce psychological distress, improvement in quality of life, Make It Training vs traditional psychotherapy, and integration into daily life) with 11 subthemes. Analysis of experienced usability resulted in 3 themes (efficiency and accessibility, user-friendliness, and recommendations to design the Make It Training intervention to be more appealing) with 6 subthemes. Make It Training was evaluated as a user-friendly intervention helpful for developing functional coping strategies to reduce psychological distress and improve quality of life. The consensus regarding Make It Training was that it was described as a daily companion that integrates well into daily life and that it has the potential to be routinely implemented within oncological health care either as a stand-alone intervention or in addition to psychotherapy. Conclusions: e–Mental health interventions such as Make It Training can target both the prevention of mental health issues and health promotion. Moreover, they offer a cost-efficient and low-threshold option to receive psycho-oncological support. %M 38592764 %R 10.2196/53117 %U https://cancer.jmir.org/2024/1/e53117 %U https://doi.org/10.2196/53117 %U http://www.ncbi.nlm.nih.gov/pubmed/38592764 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e46593 %T Studies of Social Anxiety Using Ambulatory Assessment: Systematic Review %A Fernández-Álvarez,Javier %A Colombo,Desirée %A Gómez Penedo,Juan Martín %A Pierantonelli,Maitena %A Baños,Rosa María %A Botella,Cristina %+ Department of Basic and Clinical Psychology and Psychobiology, Jaume I University, Avda. Vicent Sos Baynat s/n, Castellon de la Plana, 12071, Spain, 34 964 72 80 0, javferalvarez@gmail.com %K social anxiety disorder %K ambulatory assessment %K ecological momentary assessment %K intensive longitudinal methods %K systematic review %K social anxiety %K use %K qualitative synthesis %K emotional %K cognitive %K behavioral %K development %K mental disorder %K anxiety %K mental health %K mobile health %K mHealth %K monitoring %K review %K assessment %K mobile phone %D 2024 %7 4.4.2024 %9 Review %J JMIR Ment Health %G English %X Background: There has been an increased interest in understanding social anxiety (SA) and SA disorder (SAD) antecedents and consequences as they occur in real time, resulting in a proliferation of studies using ambulatory assessment (AA). Despite the exponential growth of research in this area, these studies have not been synthesized yet. Objective: This review aimed to identify and describe the latest advances in the understanding of SA and SAD through the use of AA. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic literature search was conducted in Scopus, PubMed, and Web of Science. Results: A total of 70 articles met the inclusion criteria. The qualitative synthesis of these studies showed that AA permitted the exploration of the emotional, cognitive, and behavioral dynamics associated with the experience of SA and SAD. In line with the available models of SA and SAD, emotion regulation, perseverative cognition, cognitive factors, substance use, and interactional patterns were the principal topics of the included studies. In addition, the incorporation of AA to study psychological interventions, multimodal assessment using sensors and biosensors, and transcultural differences were some of the identified emerging topics. Conclusions: AA constitutes a very powerful methodology to grasp SA from a complementary perspective to laboratory experiments and usual self-report measures, shedding light on the cognitive, emotional, and behavioral antecedents and consequences of SA and the development and maintenance of SAD as a mental disorder. %M 38574359 %R 10.2196/46593 %U https://mental.jmir.org/2024/1/e46593 %U https://doi.org/10.2196/46593 %U http://www.ncbi.nlm.nih.gov/pubmed/38574359 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50850 %T Web-Based Emotion Regulation Training for Sexual Health: Randomized Controlled Trial %A Jobim Fischer,Vinicius %A Rossato Holz,Maila %A Billieux,Joël %A Andersson,Gerhard %A Vögele,Claus %+ Institute for Health and Behaviour, Department of Behavioural and Cognitive Sciences, University of Luxembourg, 11, Porte des Sciences, Esch-sur-Alzette, L-4366, Luxembourg, 352 46 66 44 9740, viniciusjfischer@gmail.com %K emotion regulation %K internet %K sexual health %K FSFI %K randomized controlled trial %K intervention %K psychosexual intervention %K sexual disorder %K sexual dysfunction %K internet-based %D 2024 %7 3.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective emotional regulation (ER) skills are important for sexual function, as they impact emotional awareness and expression during sexual activity, and therefore, satisfaction and distress. Emotion regulation interventions may offer a promising approach to improve sexual health. Web-based emotion regulation may be a therapeutic strategy for men and women with sexual health concerns. Nevertheless, there is a scarcity of intervention trials investigating its effects in this context, much less using the internet. Objective: This study aims to investigate the effects of a web-based emotion regulation training program for sexual function in both men and women. Methods: The participants were recruited based on their self-reported sexual problems, which for men was defined by a score of <25 on the International Index Erectile Function (IIEF) and for women by a score of <26.55 on the Female Sexual Function Index (FSFI). The final sample included 60 participants who were randomized to either a web-based emotion regulation training for sexual function or to a waitlist control group. The treatment consisted of an 8-week web-based emotion regulation training for sexual function. The participants were assessed at baseline, post intervention, and the 3-month follow-up. Results: Of the 60 participants included, only 6 completed all 3 assessment points (n=5, 20% in the treatment group and n=1, 5% in the waitlist control group) after receiving the intervention. At follow-up, there were no significant differences between groups in any measure. Among the intervention completers, large-to-moderate within-group effect sizes were observed between the assessment points on measures of emotion regulation, depression, lubrication, orgasm, thoughts of sexual failure, and abuse during sexual activity. The adherence rate was very low, limiting the generalizability of the findings. Conclusions: Participants who completed the intervention showed improvements in both sexual function domains and emotion regulation. Nonetheless, due to a high dropout rate, this trial failed to collect sufficient data to allow for any conclusions to be drawn on treatment effects. Trial Registration: ClinicalTrials.gov NCT04792177; https://clinicaltrials.gov/study/NCT04792177 %M 38568720 %R 10.2196/50850 %U https://formative.jmir.org/2024/1/e50850 %U https://doi.org/10.2196/50850 %U http://www.ncbi.nlm.nih.gov/pubmed/38568720 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e58631 %T Digital Tools to Facilitate the Detection and Treatment of Bipolar Disorder: Key Developments and Future Directions %A de Azevedo Cardoso,Taiane %A Kochhar,Shruti %A Torous,John %A Morton,Emma %+ JMIR Publications, 130 Queens Quay E Suite 1100, Toronto, ON, M5A 0P6, Canada, 1 2899411482, taiane.cardoso@jmir.org %K bipolar disorder %K digital phenotyping %K machine learning %K mobile health interventions %K mobile health %K mHealth %K apps %D 2024 %7 1.4.2024 %9 Editorial %J JMIR Ment Health %G English %X Bipolar disorder (BD) impacts over 40 million people around the world, often manifesting in early adulthood and substantially impacting the quality of life and functioning of individuals. Although early interventions are associated with a better prognosis, the early detection of BD is challenging given the high degree of similarity with other psychiatric conditions, including major depressive disorder, which corroborates the high rates of misdiagnosis. Further, BD has a chronic, relapsing course, and the majority of patients will go on to experience mood relapses despite pharmacological treatment. Digital technologies present promising results to augment early detection of symptoms and enhance BD treatment. In this editorial, we will discuss current findings on the use of digital technologies in the field of BD, while debating the challenges associated with their implementation in clinical practice and the future directions. %M 38557724 %R 10.2196/58631 %U https://mental.jmir.org/2024/1/e58631 %U https://doi.org/10.2196/58631 %U http://www.ncbi.nlm.nih.gov/pubmed/38557724 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49217 %T A Novel Blended Transdiagnostic Intervention (eOrygen) for Youth Psychosis and Borderline Personality Disorder: Uncontrolled Single-Group Pilot Study %A O'Sullivan,Shaunagh %A McEnery,Carla %A Cagliarini,Daniela %A Hinton,Jordan D X %A Valentine,Lee %A Nicholas,Jennifer %A Chen,Nicola A %A Castagnini,Emily %A Lester,Jacqueline %A Kanellopoulos,Esta %A D'Alfonso,Simon %A Gleeson,John F %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Road, Parkville, Australia, 61 428282470, shaunagh.osullivan@orygen.org.au %K digital intervention %K blended care %K youth mental health %K transdiagnostic intervention %K psychotic disorders %K borderline personality disorder %K digital health %K mobile phone %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Integrating innovative digital mental health interventions within specialist services is a promising strategy to address the shortcomings of both face-to-face and web-based mental health services. However, despite young people’s preferences and calls for integration of these services, current mental health services rarely offer blended models of care. Objective: This pilot study tested an integrated digital and face-to-face transdiagnostic intervention (eOrygen) as a blended model of care for youth psychosis and borderline personality disorder. The primary aim was to evaluate the feasibility, acceptability, and safety of eOrygen. The secondary aim was to assess pre-post changes in key clinical and psychosocial outcomes. An exploratory aim was to explore the barriers and facilitators identified by young people and clinicians in implementing a blended model of care into practice. Methods: A total of 33 young people (aged 15-25 years) and 18 clinicians were recruited over 4 months from two youth mental health services in Melbourne, Victoria, Australia: (1) the Early Psychosis Prevention and Intervention Centre, an early intervention service for first-episode psychosis; and (2) the Helping Young People Early Clinic, an early intervention service for borderline personality disorder. The feasibility, acceptability, and safety of eOrygen were evaluated via an uncontrolled single-group study. Repeated measures 2-tailed t tests assessed changes in clinical and psychosocial outcomes between before and after the intervention (3 months). Eight semistructured qualitative interviews were conducted with the young people, and 3 focus groups, attended by 15 (83%) of the 18 clinicians, were conducted after the intervention. Results: eOrygen was found to be feasible, acceptable, and safe. Feasibility was established owing to a low refusal rate of 25% (15/59) and by exceeding our goal of young people recruited to the study per clinician. Acceptability was established because 93% (22/24) of the young people reported that they would recommend eOrygen to others, and safety was established because no adverse events or unlawful entries were recorded and there were no worsening of clinical and social outcome measures. Interviews with the young people identified facilitators to engagement such as peer support and personalized therapy content, as well as barriers such as low motivation, social anxiety, and privacy concerns. The clinician focus groups identified evidence-based content as an implementation facilitator, whereas a lack of familiarity with the platform was identified as a barrier owing to clinicians’ competing priorities, such as concerns related to risk and handling acute presentations, as well as the challenge of being understaffed. Conclusions: eOrygen as a blended transdiagnostic intervention has the potential to increase therapeutic continuity, engagement, alliance, and intensity. Future research will need to establish the effectiveness of blended models of care for young people with complex mental health conditions and determine how to optimize the implementation of such models into specialized services. %M 38557432 %R 10.2196/49217 %U https://mental.jmir.org/2024/1/e49217 %U https://doi.org/10.2196/49217 %U http://www.ncbi.nlm.nih.gov/pubmed/38557432 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48068 %T Development and Evaluation of a Digital App for Patient Self-Management of Opioid Use Disorder: Usability, Acceptability, and Utility Study %A King Jr,Van Lewis %A Siegel,Gregg %A Priesmeyer,Henry Richard %A Siegel,Leslie H %A Potter,Jennifer S %+ Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center San Antonio, 5109 Medical Drive, San Antonio, TX, 78229, United States, 1 210 450 8058, kingvl@uthscsa.edu %K opioid use disorder %K digital health %K behavioral medicine %K KIOS %K mHealth %K substance use disorder %K substance use treatment %K self-management %K opioid misuse %K substance use %K social support %K KIOS app %K KIOS application %K software %K patient-centered %K opioid %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-management of opioid use disorder (OUD) is an important component of treatment. Many patients receiving opioid agonist treatment in methadone maintenance treatment settings benefit from counseling treatments to help them improve their recovery skills but have insufficient access to these treatments between clinic appointments. In addition, many addiction medicine clinicians treating patients with OUD in a general medical clinic setting do not have consistent access to counseling referrals for their patients. This can lead to decreases in both treatment retention and overall progress in the patient’s recovery from substance misuse. Digital apps may help to bridge this gap by coaching, supporting, and reinforcing behavioral change that is initiated and directed by their psychosocial and medical providers. Objective: This study aimed to conduct an acceptability, usability, and utility pilot study of the KIOS app to address these clinical needs. Methods: We developed a unique, patient-centered computational software system (KIOS; Biomedical Development Corporation) to assist in managing OUD in an outpatient, methadone maintenance clinic setting. KIOS tracks interacting self-reported symptoms (craving, depressed mood, anxiety, irritability, pain, agitation or restlessness, difficulty sleeping, absenteeism, difficulty with usual activities, and conflicts with others) to determine changes in both the trajectory and severity of symptom patterns over time. KIOS then applies a proprietary algorithm to assess the individual’s patterns of symptom interaction in accordance with models previously established by OUD experts. After this analysis, KIOS provides specific behavioral advice addressing the individual’s changing trajectory of symptoms to help the person self-manage their symptoms. The KIOS software also provides analytics on the self-reported data that can be used by patients, clinicians, and researchers to track outcomes. Results: In a 4-week acceptability, usability (mean System Usability Scale-Modified score 89.5, SD 9.2, maximum of 10.0), and utility (mean KIOS utility questionnaire score 6.32, SD 0.25, maximum of 7.0) pilot study of 15 methadone-maintained participants with OUD, user experience, usability, and software-generated advice received high and positive assessment scores. The KIOS clinical variables closely correlated with craving self-report measures. Therefore, managing these variables with advice generated by the KIOS software could have an impact on craving and ultimately substance use. Conclusions: KIOS tracks key clinical variables and generates advice specifically relevant to the patient’s current and changing clinical state. Patients in this pilot study assigned high positive values to the KIOS user experience, ease of use, and the appropriateness, relevance, and usefulness of the specific behavioral guidance they received to match their evolving experiences. KIOS may therefore be useful to augment in-person treatment of opioid agonist patients and help fill treatment gaps that currently exist in the continuum of care. A National Institute on Drug Abuse–funded randomized controlled trial of KIOS to augment in-person treatment of patients with OUD is currently being conducted. %M 38557501 %R 10.2196/48068 %U https://formative.jmir.org/2024/1/e48068 %U https://doi.org/10.2196/48068 %U http://www.ncbi.nlm.nih.gov/pubmed/38557501 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52186 %T Effectiveness of Virtual Reality–Based Well-Being Interventions for Stress Reduction in Young Adults: Systematic Review %A Xu,Joy %A Khanotia,Areej %A Juni,Shmuel %A Ku,Josephine %A Sami,Hana %A Lin,Vallen %A Walterson,Roberta %A Payne,Evelyn %A Jo,Helen %A Rahimpoor-Marnani,Parmin %+ David Geffen School of Medicine at UCLA, 417 Charles E Young Drive West, Los Angeles, CA, 90024, United States, 1 3109481476, joyjxu@gmail.com %K well-being %K well-being %K virtual reality %K VR %K stress, nature %K academic %K student %K intervention %K young adults %K teens %K adolescent %K stressors %K stress management %K systematic review %K accessible %K accessibility %K students %K affordable %D 2024 %7 29.3.2024 %9 Review %J JMIR Ment Health %G English %X Background: Adolescents can be especially vulnerable to various stressors as they are still in their formative years and transitioning into adulthood. Hence, it is important for them to have effective stress management strategies. Objective: This systematic review investigates current well-being interventions that are aimed at reducing stress among young adults. In particular, interventions using the medium of virtual reality (VR) are explored. Methods: This mixed methods systematic review follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines, and papers were gathered from databases such as PsycINFO, PubMed, Science Direct, Web of Science, OpenGrey, and Edutopia. Predetermined criteria and specific keywords were used to search for the papers. Search results were screened and extracted with all article screening or extraction delegated among all authors. Any disagreements after reconciliation were settled by a third author. The quality and risk of bias of included studies were assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) Tool for Quantitative Studies. Studies were analyzed qualitatively. Results: In total, 20 studies were included, and qualitative analysis was performed to evaluate the effectiveness of VR-based interventions in 3 domains: nature, stress, and academics. Conclusions: Studies using VR interventions, overall, promoted a reduction in stress and an increase in well-being. The findings suggest that VR may serve as an accessible and affordable medium of stress reduction for students and young adults. Larger sample sizes, and a greater number of included studies, may be required in future directions. %M 38551625 %R 10.2196/52186 %U https://mental.jmir.org/2024/1/e52186 %U https://doi.org/10.2196/52186 %U http://www.ncbi.nlm.nih.gov/pubmed/38551625 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e48027 %T The Effectiveness of a Cell Phone eHealth App in Changing Knowledge, Stigmatizing Attitudes, and Intention to Seek Help Associated With Obsessive-Compulsive Disorder: Pilot Questionnaire Study %A Chaves,Antonio %A Arnáez,Sandra %A García-Soriano,Gemma %+ Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universitat de València, Avda Blasco Ibáñez, 21, Valencia, 46010, Spain, 34 963983389, gemma.garcia@uv.es %K obsessive-compulsive disorder %K OCD %K mental health literacy %K stigma %K app %K help-seeking intention %K seek help %K mobile phone %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Obsessive-compulsive disorder (OCD) is a disabling disorder associated with high interference in people’s lives. However, patients with OCD either do not seek help or delay seeking help. Research suggests that this could be explained by poor mental health literacy about the disorder and the associated stigma. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary effectiveness of a mental health mobile app, esTOCma, developed to improve knowledge about OCD and its treatment, increase help-seeking intention, and reduce stigmatizing attitudes and social distance associated with OCD. Methods: We used preintervention, postintervention, and 3-month follow-up assessments in this single-arm pilot intervention. Overall, 90 participants were recruited from the community using the snowball sampling method. We used esTOCma to defeat the “stigma monster” over the course of 10 missions. The participants completed the sociodemographic information and Obsessive-Compulsive Inventory–Revised at preassessment and an acceptability questionnaire at postassessment. All other measures were completed at the preassessment, postassessment, and 3-month follow-up (ie, the Spanish Mental Illness Stigma Attribution Questionnaire–27, the General Help-Seeking Questionnaire, the Social Distance Scale, and the Mental Health Literacy Questionnaire). Results: Of the 90 participants from the community that were assessed for eligibility, 86% (n=78) were allocated to intervention. Of these 78 participants, 79% (n=62) completed the game and answered the postintervention assessment (completer group). Overall, 69% (43/62) of the participants also completed the 3-month follow-up assessment. The participants completing the study were older (P=.003) and had a higher baseline knowledge of OCD (P=.05). The participants took an average of 13.64 (SD 10.50) days to complete the intervention, including the pre- and postassessments. The participants spent an average of 4.56 (SD 3.33) days completing the 10 missions included in the app. Each mission took a mean of between 2 (SD 3.01) and 9.35 (SD 3.06) minutes. The app was rated as useful or very useful by the vast majority of participants 90% (56/62). Moreover, 90% (56/62) of the participants reported that they had learned or learned a lot, and 98% (61/62) of the participants reported that they would recommend the app to a friend. Repeated measures ANOVA (43/62, 69%) showed that after the intervention participants showed an increased knowledge of mental health and intention to seek help as well as fewer stigmatizing attitudes and less social distance. Conclusions: Preliminary data show that esTOCma is a feasible and acceptable app, and after completing its 10 missions, there is an increase in the understanding of OCD and help-seeking intention along with a decrease in the social stigma and social distance associated with OCD that lasts for at least 3 months. The results support the potential of technology-based interventions to increase the intention to seek help and reduce the stigma associated with OCD. A larger, community-controlled study is also recommended. %M 38551629 %R 10.2196/48027 %U https://mhealth.jmir.org/2024/1/e48027 %U https://doi.org/10.2196/48027 %U http://www.ncbi.nlm.nih.gov/pubmed/38551629 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56002 %T Preferences for mHealth Intervention to Address Mental Health Challenges Among Men Who Have Sex With Men in Nepal: Qualitative Study %A Gautam,Kamal %A Aguilar,Camille %A Paudel,Kiran %A Dhakal,Manisha %A Wickersham,Jeffrey A %A Acharya,Bibhav %A Sapkota,Sabitri %A Deuba,Keshab %A Shrestha,Roman %+ Department of Allied Health Sciences, University of Connecticut, 358 Mansfield Road, Storrs, CT, 06269, United States, 1 860 486 2834, roman.shrestha@uconn.edu %K mental health %K MSM %K mHealth %K smartphone apps %K digital health %K Nepal %K gay %K homosexual %K homosexuality %K men who have sex with men %K focus group %K focus groups %K qualitative %K barrier %K barriers %K thematic %K mHealth %K mobile health %K app %K apps %K applications %K applications %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Men who have sex with men (MSM) are disproportionately burdened by poor mental health. Despite the increasing burden, evidence-based interventions for MSM are largely nonexistent in Nepal. Objective: This study explored mental health concerns, contributing factors, barriers to mental health care and support, and preferred interventions to improve access to and use of mental health support services among MSM in Nepal. Methods: We conducted focus groups with MSM in Kathmandu, Nepal, in January 2023. In total, 28 participants took part in 5 focus group sessions. Participants discussed several topics related to the mental health issues they experienced, factors contributing to these issues, and their suggestions for potential interventions to address existing barriers. The discussions were recorded, transcribed, and analyzed using Dedoose (version 9.0.54; SocioCultural Research Consultants, LLC) software for thematic analysis. Results: Participants reported substantial mental health problems, including anxiety, depression, suicidal ideation, and behaviors. Contributing factors included family rejection, isolation, bullying, stigma, discrimination, and fear of HIV and other sexually transmitted infections. Barriers to accessing services included cost, lack of lesbian, gay, bisexual, transgender, intersex, queer, and asexual (LGBTIQA+)–friendly providers, and the stigma associated with mental health and sexuality. Participants suggested a smartphone app with features such as a mental health screening tool, digital consultation, helpline number, directory of LGBTIQA+-friendly providers, mental health resources, and a discussion forum for peer support as potential solutions. Participants emphasized the importance of privacy and confidentiality to ensure mobile apps are safe and accessible. Conclusions: The findings of this study have potential transferability to other low-resource settings facing similar challenges. Intervention developers can use these findings to design tailored mobile apps to facilitate mental health care delivery and support for MSM and other marginalized groups. %M 38551632 %R 10.2196/56002 %U https://humanfactors.jmir.org/2024/1/e56002 %U https://doi.org/10.2196/56002 %U http://www.ncbi.nlm.nih.gov/pubmed/38551632 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e47699 %T The Journey of Engaging With Web-Based Self-Harm and Suicide Content: Longitudinal Qualitative Study %A Haime,Zoë %A Kennedy,Laura %A Grace,Lydia %A Cohen,Rachel %A Derges,Jane %A Biddle,Lucy %+ Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom, 44 01179289000, zoe.haime@bristol.ac.uk %K suicide %K self-harm %K online %K longitudinal %K qualitative %D 2024 %7 28.3.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Self-harm and suicide are major public health concerns worldwide, with attention focused on the web environment as a helpful or harmful influence. Longitudinal research on self-harm and suicide–related internet use is limited, highlighting a paucity of evidence on long-term patterns and effects of engaging with such content. Objective: This study explores the experiences of people engaging with self-harm or suicide content over a 6-month period. Methods: This study used qualitative and digital ethnographic methods longitudinally, including one-to-one interviews at 3 time points to explore individual narratives. A trajectory analysis approach involving 4 steps was used to interpret the data. Results: The findings from 14 participants established the web-based journey of people who engage with self-harm or suicide content. In total, 5 themes were identified: initial interactions with self-harm or suicide content, changes in what self-harm or suicide content people engage with and where, changes in experiences of self-harm or suicide behaviors associated with web-based self-harm or suicide content engagement, the disengagement-reengagement cycle, and future perspectives on web-based self-harm or suicide content engagement. Initial engagements were driven by participants seeking help, often when offline support had been unavailable. Some participants’ exposure to self-harm and suicide content led to their own self-harm and suicide behaviors, with varying patterns of change over time. Notably, disengagement from web-based self-harm and suicide spaces served as a protective measure for all participants, but the pull of familiar content resulted in only brief periods of disconnection. Participants also expressed future intentions to continue returning to these self-harm and suicide web-based spaces, acknowledging the nonlinear nature of their own recovery journey and aiming to support others in the community. Within the themes identified in this study, narratives revealed that participants’ behavior was shaped by cognitive flexibility and rigidity, metacognitive abilities, and digital expertise. Opportunities for behavior change arose during periods of cognitive flexibility prompted by life events, stressors, and shifts in mental health. Participants sought diverse and potentially harmful content during challenging times but moved toward recovery-oriented engagements in positive circumstances. Metacognitive and digital efficacy skills also played a pivotal role in participants’ control of web-based interactions, enabling more effective management of content or platforms or sites that posed potential harms. Conclusions: This study demonstrated the complexity of web-based interactions, with beneficial and harmful content intertwined. Participants who demonstrated metacognition and digital efficacy had better control over web-based engagements. Some attributed these skills to study processes, including taking part in reflective diaries, showing the potential of upskilling users. This study also highlighted how participants remained vulnerable by engaging with familiar web-based spaces, emphasizing the responsibility of web-based industry leaders to develop tools that empower users to enhance their web-based safety. %M 38546718 %R 10.2196/47699 %U https://infodemiology.jmir.org/2024/1/e47699 %U https://doi.org/10.2196/47699 %U http://www.ncbi.nlm.nih.gov/pubmed/38546718 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54287 %T Effectiveness of the Minder Mobile Mental Health and Substance Use Intervention for University Students: Randomized Controlled Trial %A Vereschagin,Melissa %A Wang,Angel Y %A Richardson,Chris G %A Xie,Hui %A Munthali,Richard J %A Hudec,Kristen L %A Leung,Calista %A Wojcik,Katharine D %A Munro,Lonna %A Halli,Priyanka %A Kessler,Ronald C %A Vigo,Daniel V %+ Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T2A1, Canada, 1 6048228048, daniel.vigo@ubc.ca %K mental health %K substance use %K college students %K mobile interventions %K digital interventions %K randomized controlled trial %K mobile phone %D 2024 %7 27.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: University attendance represents a transition period for students that often coincides with the emergence of mental health and substance use challenges. Digital interventions have been identified as a promising means of supporting students due to their scalability, adaptability, and acceptability. Minder is a mental health and substance use mobile app that was codeveloped with university students. Objective: This study aims to examine the effectiveness of the Minder mobile app in improving mental health and substance use outcomes in a general population of university students. Methods: A 2-arm, parallel-assignment, single-blinded, 30-day randomized controlled trial was used to evaluate Minder using intention-to-treat analysis. In total, 1489 participants were recruited and randomly assigned to the intervention (n=743, 49.9%) or waitlist control (n=746, 50.1%) condition. The Minder app delivers evidence-based content through an automated chatbot and connects participants with services and university social groups. Participants are also assigned a trained peer coach to support them. The primary outcomes were measured through in-app self-assessments and included changes in general anxiety symptomology, depressive symptomology, and alcohol consumption risk measured using the 7-item General Anxiety Disorder scale, 9-item Patient Health Questionnaire, and US Alcohol Use Disorders Identification Test–Consumption Scale, respectively, from baseline to 30-day follow-up. Secondary outcomes included measures related to changes in the frequency of substance use (cannabis, alcohol, opioids, and nonmedical stimulants) and mental well-being. Generalized linear mixed-effects models were used to examine each outcome. Results: In total, 79.3% (589/743) of participants in the intervention group and 83% (619/746) of participants in the control group completed the follow-up survey. The intervention group had significantly greater average reductions in anxiety symptoms measured using the 7-item General Anxiety Disorder scale (adjusted group mean difference=−0.85, 95% CI −1.27 to −0.42; P<.001; Cohen d=−0.17) and depressive symptoms measured using the 9-item Patient Health Questionnaire (adjusted group mean difference=−0.63, 95% CI −1.08 to −0.17; P=.007; Cohen d=−0.11). A reduction in the US Alcohol Use Disorders Identification Test–Consumption Scale score among intervention participants was also observed, but it was not significant (P=.23). Statistically significant differences in favor of the intervention group were found for mental well-being and reductions in the frequency of cannabis use and typical number of drinks consumed. A total of 77.1% (573/743) of participants in the intervention group accessed at least 1 app component during the study period. Conclusions: In a general population sample of university students, the Minder app was effective in reducing symptoms of anxiety and depression, with provisional support for increasing mental well-being and reducing the frequency of cannabis and alcohol use. These findings highlight the potential ability of e-tools focused on prevention and early intervention to be integrated into existing university systems to support students’ needs. Trial Registration: ClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601 International Registered Report Identifier (IRRID): RR2-10.2196/49364 %M 38536225 %R 10.2196/54287 %U https://www.jmir.org/2024/1/e54287 %U https://doi.org/10.2196/54287 %U http://www.ncbi.nlm.nih.gov/pubmed/38536225 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55517 %T Community Members’ Perceptions of a Resource-Rich Well-Being Website in California During the COVID-19 Pandemic: Qualitative Thematic Analysis %A Heilemann,MarySue V %A Lai,Jianchao %A Cadiz,Madonna P %A Meza,Jocelyn I %A Flores Romero,Daniela %A Wells,Kenneth B %+ School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Box 956919, Los Angeles, CA, 90095-6919, United States, 1 310 206 4735, mheilema@sonnet.ucla.edu %K adaptation %K humans %K pandemics %K mental health %K COVID-19 %K health resources %K California %K psychological %K stigma %K digital %K prevention %K public health %K emotions %K website %K qualitative research %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. Objective: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. Methods: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. Results: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) “Feels like home”—experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) “It’s a one-stop-shop”—judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. Conclusions: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too “professional” or “clinical.” The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma. %M 38526558 %R 10.2196/55517 %U https://formative.jmir.org/2024/1/e55517 %U https://doi.org/10.2196/55517 %U http://www.ncbi.nlm.nih.gov/pubmed/38526558 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45563 %T The Impact of COVID-19 and Exposure to Violent Media Content on Cyber Violence Victimization Among Adolescents in South Korea: National Population-Based Study %A Lee,Eugene %A Schulz,Peter J %A Lee,Hye Eun %+ Department of Communication & Media, Ewha Womans University, #403 Ewha-POSCO, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea, 82 3277 6937, hyeeunlee77@ewha.ac.kr %K cyber violence %K adolescents %K victimization %K perpetration %K COVID-19 %D 2024 %7 22.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Because of the COVID-19 pandemic and consequent stay-at-home mandates, adolescents faced isolation and a decline in mental health. With increased online activity during this period, concerns arose regarding exposure to violent media content and cyber victimization among adolescents. Yet, the precise influence of pandemic-related measures on experiences of cyber violence remains unclear. Hence, it is pertinent to investigate whether the pandemic altered the dynamics of cyber violence victimization for individuals. Objective: This study aims to investigate the effects of COVID-19 and exposure to violent media content on cyber violence victimization among adolescents in South Korea. Methods: We used national survey data from 2019 (n=4779) and 2020 (n=4958) to investigate the potential impact of COVID-19 on the prevalence of cyber violence among young adolescents. The data encompassed responses from elementary fourth-grade students to senior high school students, probing their exposure to violent media content, average internet use, as well as experiences of victimization and perpetration. Results: The analysis revealed a noteworthy decline in cyber victimization during 2020 compared with 2019 (B=–0.12, t=–3.45, P<.001). Furthermore, being a perpetrator significantly contributed to cyber victimization (B=0.57, t=48.36, P<.001). Additionally, younger adolescents (β=–.06, t=–6.09, P<.001), those spending more time online (β=.18, t=13.83, P<.001), and those exposed to violent media (β=.14, t=13.89, P<.001) were found to be more susceptible to victimization. Conclusions: Despite the widespread belief that cyber violence among adolescents surged during COVID-19 due to increased online activity, the study findings counter this assumption. Surprisingly, COVID-19 did not exacerbate cyber victimization; rather, it decreased it. Given the strong correlation between cyber victimization and offline victimization, our attention should be directed toward implementing real-life interventions aimed at curbing violence originating from in-person violence at school. %M 38517467 %R 10.2196/45563 %U https://www.jmir.org/2024/1/e45563 %U https://doi.org/10.2196/45563 %U http://www.ncbi.nlm.nih.gov/pubmed/38517467 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47960 %T Effectiveness of a Web-based and Mobile Therapy Chatbot on Anxiety and Depressive Symptoms in Subclinical Young Adults: Randomized Controlled Trial %A Karkosz,Stanisław %A Szymański,Robert %A Sanna,Katarzyna %A Michałowski,Jarosław %+ Laboratory of Affective Neuroscience in Poznan, SWPS University, Chodakowska 19/31, Warsaw, 03-815, Poland, 48 22 517 96 00, skarkosz@swps.edu.pl %K chatbots %K conversational agents %K chatbot %K conversational agent %K artificial intelligence %K mental health %K depression %K anxiety %K depressive %K cognitive distortions %K young adults %K randomized control trial %K RCT %K user experience %K CBT %K psychotherapy %K cognitive behavioral therapy %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been an increased need to provide specialized help for people with depressive and anxiety symptoms, particularly teenagers and young adults. There is evidence from a 2-week intervention that chatbots (eg, Woebot) are effective in reducing depression and anxiety, an effect that was not detected in the control group that was provided self-help materials. Although chatbots are a promising solution, there is limited scientific evidence for the efficacy of agent-guided cognitive behavioral therapy (CBT) outside the English language, especially for highly inflected languages. Objective: This study aimed to measure the efficacy of Fido, a therapy chatbot that uses the Polish language. It targets depressive and anxiety symptoms using CBT techniques. We hypothesized that participants using Fido would show a greater reduction in anxiety and depressive symptoms than the control group. Methods: We conducted a 2-arm, open-label, randomized controlled trial with 81 participants with subclinical depression or anxiety who were recruited via social media. Participants were divided into experimental (interacted with a fully automated Fido chatbot) and control (received a self-help book) groups. Both intervention methods addressed topics such as general psychoeducation and cognitive distortion identification and modification via Socratic questioning. The chatbot also featured suicidal ideation identification and redirection to suicide hotlines. We used self-assessment scales to measure primary outcomes, including the levels of depression, anxiety, worry tendencies, satisfaction with life, and loneliness at baseline, after the 2-week intervention and at the 1-month follow-up. We also controlled for secondary outcomes, including engagement and frequency of use. Results: There were no differences in anxiety and depressive symptoms between the groups at enrollment and baseline. After the intervention, depressive and anxiety symptoms were reduced in both groups (chatbot: n=36; control: n=38), which remained stable at the 1-month follow-up. Loneliness was not significantly different between the groups after the intervention, but an exploratory analysis showed a decline in loneliness among participants who used Fido more frequently. Both groups used their intervention technique with similar frequency; however, the control group spent more time (mean 117.57, SD 72.40 minutes) on the intervention than the Fido group (mean 79.44, SD 42.96 minutes). Conclusions: We did not replicate the findings from previous (eg, Woebot) studies, as both arms yielded therapeutic effects. However, such results are in line with other research of Internet interventions. Nevertheless, Fido provided sufficient help to reduce anxiety and depressive symptoms and decreased perceived loneliness among high-frequency users, which is one of the first pieces of evidence of chatbot efficacy with agents that use a highly inflected language. Further research is needed to determine the long-term, real-world effectiveness of Fido and its efficacy in a clinical sample. Trial Registration: ClinicalTrials.gov NCT05762939; https://clinicaltrials.gov/study/NCT05762939; Open Science Foundation Registry 2cqt3; https://osf.io/2cqt3 %M 38506892 %R 10.2196/47960 %U https://formative.jmir.org/2024/1/e47960 %U https://doi.org/10.2196/47960 %U http://www.ncbi.nlm.nih.gov/pubmed/38506892 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50506 %T Association of Digital Engagement With Relaxation Tools and Stress Level Reduction: Retrospective Cohort Study %A Breuer-Asher,Inbar %A Ritholz,Marilyn D %A Horwitz,David L %A Manejwala,Omar %A Behar,Ephraim %A Fundoiano-Hershcovitz,Yifat %+ DarioHealth, Ofek 8, 5 Tarshish Street, Caesarea, 3079821, Israel, 972 525296979, yifat@dariohealth.com %K mental health %K perceived stress %K stress reduction %K digital health %K video sessions %K behavioral health %K relaxation %K breathing exercises %K CBT %K anxiety %K cognitive behavioral therapy %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress is an emotional response caused by external triggers and is a high-prevalence global problem affecting mental and physical health. Several different digital therapeutic solutions are effective for stress management. However, there is limited understanding of the association between relaxation components and stress levels when using a digital app. Objective: This study investigated the contribution of relaxation tools to stress levels over time. We hypothesized that participation in breathing exercises and cognitive behavioral therapy–based video sessions would be associated with a reduction in stress levels. We also hypothesized a significant reduction specifically in participants’ perceived sense of burden and lack of productivity when engaged with breathing exercises and video sessions. Methods: Stress levels were evaluated in a real-world data cohort using a behavioral health app for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform–based treatment followed users (N=490) who started with moderate and above levels of stress and completed at least 2 stress assessments. The levels of stress were tracked throughout the first 10 weeks. A piecewise mixed effects model was applied to model the trajectories of weekly stress mean scores in 2 time segments (1-6 weeks and 6-10 weeks). Next, a simple slope analysis was used for interpreting interactions probing the moderators: breathing exercises and video sessions. Piecewise mixed-effects models were also used to model the trajectories of specific perceived stress item rates in the stress questionnaire in the 2 segments (1-6 weeks and 6-10 weeks) and whether they are moderated by the relaxation engagements. Simple slope analysis was also used here for the interpretation of the interactions. Results: Analysis revealed a significant decrease in stress symptoms (β=–.25; 95% CI –0.32 to –0.17; P<.001) during the period of 1-6 weeks of app use that was maintained during the period of 6-10 weeks. Breathing exercises significantly moderated the reduction in stress symptoms during the period of 1-6 weeks (β=–.07; 95% CI –0.13 to –0.01; P=.03), while engagement in digital video sessions did not moderate stress scores. Engagement in digital video sessions, as well as breathing exercises, significantly moderated the reduction in perceived sense of burden and lack of productivity during weeks 1-6 and remained stable during weeks 6-10 on both items. Conclusions: This study sheds light on the association between stress level reduction and specific components of engagement in a digital health app, breathing exercises, and cognitive behavioral therapy–based video sessions. Our findings provide a basis for further investigation of current and moderating factors that contribute to the personalization of digital intervention. In addition, results may aid in developing a more comprehensive understanding of how digital intervention tools work for mental health and for whom they are most effective. %M 38502164 %R 10.2196/50506 %U https://formative.jmir.org/2024/1/e50506 %U https://doi.org/10.2196/50506 %U http://www.ncbi.nlm.nih.gov/pubmed/38502164 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50283 %T The Effect of Explicit Suicide Language in Engagement With a Suicide Prevention Search Page Help-Seeking Prompt: Nonrandomized Trial %A Onie,Sandersan %A Armstrong,Susanne Oliver %A Josifovski,Natasha %A Berlinquette,Patrick %A Livingstone,Nicola %A Holland,Sarah %A Finemore,Coco %A Gale,Nyree %A Elder,Emma %A Laggis,George %A Heffernan,Cassandra %A Theobald,Adam %A Torok,Michelle %A Shand,Fiona %A Larsen,Mark %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 432359134, s.onie@blackdog.org.au %K suicide %K suicide prevention %K Google %K Google Ads %K internet search %K explicit wording %K mental health %K suicidal %K advertisement %K advertisements %K messaging %K prevention signage %K campaign %K campaigns %K distress %K engagement %K prompt %K prompts %K information seeking %K help seeking %K searching %K search %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given that signage, messaging, and advertisements (ads) are the gateway to many interventions in suicide prevention, it is important that we understand what type of messaging works best for whom. Objective: We investigated whether explicitly mentioning suicide increases engagement using internet ads by investigating engagement with campaigns with different categories of keywords searched, which may reflect different cognitive states. Methods: We ran a 2-arm study Australia-wide, with or without ads featuring explicit suicide wording. We analyzed whether there were differences in engagement for campaigns with explicit and nonexplicit ads for low-risk (distressed but not explicitly suicidal), high-risk (explicitly suicidal), and help-seeking for suicide keywords. Results: Our analyses revealed that having explicit wording has opposite effects, depending on the search terms used: explicit wording reduced the engagement rate for individuals searching for low-risk keywords but increased engagement for those using high-risk keywords. Conclusions: The findings suggest that individuals who are aware of their suicidality respond better to campaigns that explicitly use the word “suicide.” We found that individuals who search for low-risk keywords also respond to explicit ads, suggesting that some individuals who are experiencing suicidality search for low-risk keywords. %M 38502162 %R 10.2196/50283 %U https://mental.jmir.org/2024/1/e50283 %U https://doi.org/10.2196/50283 %U http://www.ncbi.nlm.nih.gov/pubmed/38502162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48504 %T The EMPOWER Occupational e–Mental Health Intervention Implementation Checklist to Foster e–Mental Health Interventions in the Workplace: Development Study %A Raggi,Alberto %A Bernard,Renaldo M %A Toppo,Claudia %A Sabariego,Carla %A Salvador Carulla,Luis %A Lukersmith,Sue %A Hakkaart-van Roijen,Leona %A Merecz-Kot,Dorota %A Olaya,Beatriz %A Antunes Lima,Rodrigo %A Gutiérrez-Marín,Desirée %A Vorstenbosch,Ellen %A Curatoli,Chiara %A Cacciatore,Martina %+ Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, Milano, 20133, Italy, 39 0223943105, alberto.raggi@istituto-besta.it %K implementation %K workplace %K mental health %K well-being %K digital health %K mobile health %K mHealth %K eHealth %K e–mental health %K stakeholder consultation %K intervention %K occupational %K stakeholders %K consultation %K barrier %K checklist %D 2024 %7 15.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Occupational e–mental health (OeMH) interventions significantly reduce the burden of mental health conditions. The successful implementation of OeMH interventions is influenced by many implementation strategies, barriers, and facilitators across contexts, which, however, are not systematically tracked. One of the reasons is that international consensus on documenting and reporting the implementation of OeMH interventions is lacking. There is a need for practical guidance on the key factors influencing the implementation of interventions that organizations should consider. Stakeholder consultations secure a valuable source of information about these key strategies, barriers, and facilitators that are relevant to successful implementation of OeMH interventions. Objective: The objective of this study was to develop a brief checklist to guide the implementation of OeMH interventions. Methods: Based on the results of a recently published systematic review, we drafted a comprehensive checklist with a wide set of strategies, barriers, and facilitators that were identified as relevant for the implementation of OeMH interventions. We then used a 2-stage stakeholder consultation process to refine the draft checklist to a brief and practical checklist comprising key implementation factors. In the first stage, stakeholders evaluated the relevance and feasibility of items on the draft checklist using a web-based survey. The list of items comprised 12 facilitators presented as statements addressing “elements that positively affect implementation” and 17 barriers presented as statements addressing “concerns toward implementation.” If a strategy was deemed relevant, respondents were asked to rate it using a 4-point Likert scale ranging from “very difficult to implement” to “very easy to implement.” In the second stage, stakeholders were interviewed to elaborate on the most relevant barriers and facilitators shortlisted from the first stage. The interview mostly focused on the relevance and priority of strategies and factors affecting OeMH intervention implementation. In the interview, the stakeholders’ responses to the open survey’s questions were further explored. The final checklist included strategies ranked as relevant and feasible and the most relevant facilitators and barriers, which were endorsed during either the survey or the interviews. Results: In total, 26 stakeholders completed the web-based survey (response rate=24.8%) and 4 stakeholders participated in individual interviews. The OeMH intervention implementation checklist comprised 28 items, including 9 (32.1%) strategies, 8 (28.6%) barriers, and 11 (39.3%) facilitators. There was widespread agreement between findings from the survey and interviews, the most outstanding exception being the idea of proposing OeMH interventions as benefits for employees. Conclusions: Through our 2-stage stakeholder consultation, we developed a brief checklist that provides organizations with a guide for the implementation of OeMH interventions. Future research should empirically validate the effectiveness and usefulness of the checklist. %M 38488846 %R 10.2196/48504 %U https://www.jmir.org/2024/1/e48504 %U https://doi.org/10.2196/48504 %U http://www.ncbi.nlm.nih.gov/pubmed/38488846 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e45860 %T Lessons and Untapped Potential of Smartphone-Based Physical Activity Interventions for Mental Health: Narrative Review %A Bernstein,Emily E %A Wolfe,Emma C %A Huguenel,Brynn M %A Wilhelm,Sabine %+ Department of Psychology, University of Virginia, Gilmer Hall, 485 McCormick Road, Charlottesville, VA, 22903, United States, 1 3014665679, rpu3zk@virginia.edu %K smartphone %K digital health %K exercise %K physical activity %K mental health %K depression %K anxiety %K mobile phone %D 2024 %7 15.3.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Physical activity has well-known and broad health benefits, including antidepressive and anxiolytic effects. However, only approximately half of Americans meet even the minimum exercise recommendations. Individuals with anxiety, depression, or related conditions are even less likely to do so. With the advent of mobile sensors and phones, experts have quickly noted the utility of technology for the enhanced measurement of and intervention for physical activity. In addition to being more accessible than in-person approaches, technology-driven interventions may uniquely engage key mechanisms of behavior change such as self-awareness. Objective: This study aims to provide a narrative overview and specific recommendations for future research on smartphone-based physical activity interventions for psychological disorders or concerns. Methods: In this paper, we summarized early efforts to adapt and test smartphone-based or smartphone-supported physical activity interventions for mental health. The included articles described or reported smartphone-delivered or smartphone-supported interventions intended to increase physical activity or reduce sedentary behavior and included an emotional disorder, concern, or symptom as an outcome measure. We attempted to extract details regarding the intervention designs, trial designs, study populations, outcome measures, and inclusion of adaptations specifically for mental health. In taking a narrative lens, we drew attention to the type of work that has been done and used these exemplars to discuss key directions to build on. Results: To date, most studies have examined mental health outcomes as secondary or exploratory variables largely in the context of managing medical concerns (eg, cancer and diabetes). Few trials have recruited psychiatric populations or explicitly aimed to target psychiatric concerns. Consequently, although there are encouraging signals that smartphone-based physical activity interventions could be feasible, acceptable, and efficacious for individuals with mental illnesses, this remains an underexplored area. Conclusions: Promising avenues for tailoring validated smartphone-based interventions include adding psychoeducation (eg, the relationship between depression, physical activity, and inactivity), offering psychosocial treatment in parallel (eg, cognitive restructuring), and adding personalized coaching. To conclude, we offer specific recommendations for future research, treatment development, and implementation in this area, which remains open and promising for flexible, highly scalable support. %M 38488834 %R 10.2196/45860 %U https://mhealth.jmir.org/2024/1/e45860 %U https://doi.org/10.2196/45860 %U http://www.ncbi.nlm.nih.gov/pubmed/38488834 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50056 %T Adapting the Number of Questions Based on Detected Psychological Distress for Cognitive Behavioral Therapy With an Embodied Conversational Agent: Comparative Study %A Shidara,Kazuhiro %A Tanaka,Hiroki %A Adachi,Hiroyoshi %A Kanayama,Daisuke %A Kudo,Takashi %A Nakamura,Satoshi %+ Nara Institute of Science and Technology, 8916-5, Takayama-cho, Ikoma, 630-0192, Japan, 81 80 4687 8116, shidara.kazuhiro.sc5@is.naist.jp %K cognitive behavioral therapy %K psychological distress detection %K embodied conversational agents %K automatic thoughts %K long short-term memory %K multitask learning %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The high prevalence of mental illness is a critical social problem. The limited availability of mental health services is a major factor that exacerbates this problem. One solution is to deliver cognitive behavioral therapy (CBT) using an embodied conversational agent (ECA). ECAs make it possible to provide health care without location or time constraints. One of the techniques used in CBT is Socratic questioning, which guides users to correct negative thoughts. The effectiveness of this approach depends on a therapist’s skill to adapt to the user’s mood or distress level. However, current ECAs do not possess this skill. Therefore, it is essential to implement this adaptation ability to the ECAs. Objective: This study aims to develop and evaluate a method that automatically adapts the number of Socratic questions based on the level of detected psychological distress during a CBT session with an ECA. We hypothesize that this adaptive approach to selecting the number of questions will lower psychological distress, reduce negative emotional states, and produce more substantial cognitive changes compared with a random number of questions. Methods: In this study, which envisions health care support in daily life, we recruited participants aged from 18 to 65 years for an experiment that involved 2 different conditions: an ECA that adapts a number of questions based on psychological distress detection or an ECA that only asked a random number of questions. The participants were assigned to 1 of the 2 conditions, experienced a single CBT session with an ECA, and completed questionnaires before and after the session. Results: The participants completed the experiment. There were slight differences in sex, age, and preexperimental psychological distress levels between the 2 conditions. The adapted number of questions condition showed significantly lower psychological distress than the random number of questions condition after the session. We also found a significant difference in the cognitive change when the number of questions was adapted based on the detected distress level, compared with when the number of questions was fewer than what was appropriate for the level of distress detected. Conclusions: The results show that an ECA adapting the number of Socratic questions based on detected distress levels increases the effectiveness of CBT. Participants who received an adaptive number of questions experienced greater reductions in distress than those who received a random number of questions. In addition, the participants showed a greater amount of cognitive change when the number of questions matched the detected distress level. This suggests that adapting the question quantity based on distress level detection can improve the results of CBT delivered by an ECA. These results illustrate the advantages of ECAs, paving the way for mental health care that is more tailored and effective. %M 38483464 %R 10.2196/50056 %U https://formative.jmir.org/2024/1/e50056 %U https://doi.org/10.2196/50056 %U http://www.ncbi.nlm.nih.gov/pubmed/38483464 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52790 %T Effectiveness of One Videoconference-Based Exposure and Response Prevention Session at Home in Adjunction to Inpatient Treatment in Persons With Obsessive-Compulsive Disorder: Nonrandomized Study %A Voderholzer,Ulrich %A Meule,Adrian %A Koch,Stefan %A Pfeuffer,Simone %A Netter,Anna-Lena %A Lehr,Dirk %A Zisler,Eva Maria %+ Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Nußbaumstraße 7, Munich, 80336, Germany, 49 15205886528, Eva.Zisler@med.uni-muenchen.de %K obsessive-compulsive disorder %K videoconference-based treatment %K therapy %K exposure %K response prevention %K OCD %K prevention %K inpatient %K video %K videoconference %K therapist %K therapists %K mood %K positive mood %K environment %K clinical setting %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Therapist-guided exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD) is frequently conducted within clinical settings but rarely at places where patients are usually confronted with OCD symptom-provoking situations in daily life (eg, at home). Objective: This study aimed to investigate patients’ views on 1 ERP session at home via videoconference and its impact on treatment outcome. Methods: A total of 64 inpatients with OCD received 1 session of therapist-guided videoconference-based ERP at home in adjunction to a multimodal inpatient treatment between 2015 and 2020. Results: Compared with 64 age- and sex-matched controls who received a multimodal inpatient treatment without 1 session of videoconference-based ERP at home, patients who received 1 session of videoconference-based ERP in adjunction to a multimodal inpatient treatment showed stronger reductions in OCD symptom severity from admission to discharge. Before the videoconference-based ERP session, patients reported high rationale credibility and treatment expectancy. After the videoconference-based ERP session, patients reported medium-to-high positive mood as well as depth and smoothness of the session, and they perceived the working alliance as high. Conclusions: Results highlight the importance of administering therapist-guided ERP sessions in patients’ natural environment to enhance treatment response in OCD. Videoconference-based ERP as add-on to treatment as usual is, therefore, a promising approach to facilitate the application of ERP in patients’ natural environment and foster the generalization of ERP conducted in clinical settings. %M 38477970 %R 10.2196/52790 %U https://mental.jmir.org/2024/1/e52790 %U https://doi.org/10.2196/52790 %U http://www.ncbi.nlm.nih.gov/pubmed/38477970 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e45987 %T A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study %A Eager,Sharon %A Killaspy,Helen %A C,Joanna %A Mezey,Gillian %A McPherson,Peter %A Downey,Megan %A Thompson,Georgina %A Lloyd-Evans,Brynmor %+ Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, 44 (0)20 7679 9428, b.lloyd-evans@ucl.ac.uk %K social inclusion %K supported accommodation %K mental health %K digital health %K care planning %D 2024 %7 13.3.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. Objective: This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. Methods: This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through “think-aloud” testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. Results: Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals’ priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users’ inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. Conclusions: The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers. %M 38477978 %R 10.2196/45987 %U https://www.i-jmr.org/2024/1/e45987 %U https://doi.org/10.2196/45987 %U http://www.ncbi.nlm.nih.gov/pubmed/38477978 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54251 %T Navigating Social Cognitive Impairments in Schizophrenia Spectrum Disorders: Protocol for a Pilot Pre-Post Quasi-Experimental Study for Remote Avatar-Assisted Cognitive Remediation Therapy %A Thibaudeau,Elisabeth %A Peyroux,Elodie %A Franck,Nicolas %A Carling,Hannah %A Lepage,Martin %+ Douglas Research Center, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada, 1 514 761 6131 ext 4393, elisabeth.thibaudeau@mail.mcgill.ca %K social cognition %K schizophrenia spectrum disorder %K psychosis %K cognitive remediation therapy %K social cognitive training %K digital relational simulation %K cultural adaptation %K feasibility %K acceptability %K mobile phone %D 2024 %7 13.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social cognitive impairments are prevalent in schizophrenia spectrum disorder (SSD) and have detrimental effects on functioning. Cognitive remediation (CR) has shown its efficacy in improving social cognitive impairments, although the transfer of these skills to daily life and the personalization of these interventions remain challenging. RC2S (Remédiation Cognitive de la Cognition Sociale dans la Schizophrénie; Cognitive remediation of social cognition in Schizophrenia) is a French CR that combines the learning of strategies and practice using paper-and-pencil exercises and digital relational simulations. This French program was designed as an in-person intervention. Objective: This project aims to culturally adapt the RC2S program, in French-Canadian and North American English and to assess the feasibility, acceptability, safety, and implementation of a remote version in people with SSD. An exploratory objective is to assess the preliminary effect of remote RC2S on goal attainment, social cognition, and psychosocial outcomes. Methods: We will use a pre-post quasi-experimental design. First, the translation and cultural adaptation in North American English and French-Canadian of RC2S is presented. Then, 20 participants aged ≥18 years with a diagnosis of SSD, presenting with a subjective or an objective impairment in social cognition, will be included to receive RC2S. In addition, 5 therapists will be included as research participants to assess their perspective on RC2S. Participants with SSD will undergo a baseline remote assessment of their social cognition, clinical symptoms, and functioning. They will then start remote RC2S for 24 biweekly individual 1-hour sessions with a therapist. Following the case formulation and goal setting, participants will complete personalized paper-and-pencil exercises to develop strategies and integrative digital relational simulations, during which they will help an avatar navigate through a variety of social contexts and relationships. The last 2 sessions are dedicated to the transfer to daily life. All participants will complete in-session questionnaires assessing therapeutic alliance, motivation, acceptability, feasibility, and implementation. Following RC2S, the participants with SSD will repeat the same assessment as the baseline. Descriptive statistics will be used to summarize the data about acceptability, feasibility, safety, and implementation. To assess the preliminary effect of RC2S, an intention-to-treat approach will be used with linear mixed models for repeated measures with fixed effects of time. Results: So far, 45% (9/20) of participants with SSD (mean age 37.9, SD 9.3 years) have completed the project. They received a mean of 20.5 out of 24 (SD 3.5) sessions of RC2S. A total of 5 therapists also completed the project. Conclusions: Improving social cognitive impairments is an important target in SSD to promote functional recovery. Using digital technologies to address these impairments and deliver the intervention is a promising approach to increase the ecological validity of CR and access to the intervention. Trial Registration: ClinicalTrials.gov NCT05017532; https://classic.clinicaltrials.gov/ct2/show/NCT05017532 International Registered Report Identifier (IRRID): DERR1-10.2196/54251 %M 38477975 %R 10.2196/54251 %U https://www.researchprotocols.org/2024/1/e54251 %U https://doi.org/10.2196/54251 %U http://www.ncbi.nlm.nih.gov/pubmed/38477975 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49462 %T User-Friendly Chatbot to Mitigate the Psychological Stress of Older Adults During the COVID-19 Pandemic: Development and Usability Study %A Chou,Ya-Hsin %A Lin,Chemin %A Lee,Shwu-Hua %A Lee,Yen-Fen %A Cheng,Li-Chen %+ Department of Information and Finance Management, National Taipei University of Technology, 1, Sec 3, Zhongxiao E Rd, Taipei, 10608, Taiwan, 886 2771 2171, lijen.cheng@gmail.com %K geriatric psychiatry %K mental health %K loneliness %K chatbot %K user experience %K health promotion %K older adults %K technology-assisted interventions %K pandemic %K lonely %K gerontology %K elderly %K develop %K design %K development %K conversational agent %K geriatric %K geriatrics %K psychiatry %D 2024 %7 13.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To safeguard the most vulnerable individuals during the COVID-19 pandemic, numerous governments enforced measures such as stay-at-home orders, social distancing, and self-isolation. These social restrictions had a particularly negative effect on older adults, as they are more vulnerable and experience increased loneliness, which has various adverse effects, including increasing the risk of mental health problems and mortality. Chatbots can potentially reduce loneliness and provide companionship during a pandemic. However, existing chatbots do not cater to the specific needs of older adult populations. Objective: We aimed to develop a user-friendly chatbot tailored to the specific needs of older adults with anxiety or depressive disorders during the COVID-19 pandemic and to examine their perspectives on mental health chatbot use. The primary research objective was to investigate whether chatbots can mitigate the psychological stress of older adults during COVID-19. Methods: Participants were older adults belonging to two age groups (≥65 years and <65 years) from a psychiatric outpatient department who had been diagnosed with depressive or anxiety disorders by certified psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. The participants were required to use mobile phones, have internet access, and possess literacy skills. The chatbot’s content includes monitoring and tracking health data and providing health information. Participants had access to the chatbot for at least 4 weeks. Self-report questionnaires for loneliness, depression, and anxiety were administered before and after chatbot use. The participants also rated their attitudes toward the chatbot. Results: A total of 35 participants (mean age 65.21, SD 7.51 years) were enrolled in the trial, comprising 74% (n=26) female and 26% (n=9) male participants. The participants demonstrated a high utilization rate during the intervention, with over 82% engaging with the chatbot daily. Loneliness significantly improved in the older group ≥65 years. This group also responded positively to the chatbot, as evidenced by changes in University of California Los Angeles Loneliness Scale scores, suggesting that this demographic can derive benefits from chatbot interaction. Conversely, the younger group, <65 years, exhibited no significant changes in loneliness after the intervention. Both the older and younger age groups provided good scores in relation to chatbot design with respect to usability (mean scores of 6.33 and 6.05, respectively) and satisfaction (mean scores of 5.33 and 5.15, respectively), rated on a 7-point Likert scale. Conclusions: The chatbot interface was found to be user-friendly and demonstrated promising results among participants 65 years and older who were receiving care at psychiatric outpatient clinics and experiencing relatively stable symptoms of depression and anxiety. The chatbot not only provided caring companionship but also showed the potential to alleviate loneliness during the challenging circumstances of a pandemic. %M 38477965 %R 10.2196/49462 %U https://formative.jmir.org/2024/1/e49462 %U https://doi.org/10.2196/49462 %U http://www.ncbi.nlm.nih.gov/pubmed/38477965 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52324 %T Development of a Multiplatform Tool for the Prevention of Prevalent Mental Health Pathologies in Adults: Protocol for a Randomized Control Trial %A Ramos,Nadia %A Besoain,Felipe %A Cancino,Natalia %A Gallardo,Ismael %A Albornoz,Paula %A Fresno,Andres %A Spencer,Rosario %A Schott,Soledad %A Núñez,Daniel %A Salgado,Carolina %A Campos,Susana %+ Center of Applied Psychology, Faculty of Psychology, University of Talca, 1 Poniente 1141, Talca, 3460000, Chile, 56 71 2 201783, susana.campos@utalca.cl %K adults %K anxiety %K depression %K eHealth %K mental health %K mobile app %K RCT %D 2024 %7 11.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The prevalence of depression and anxiety has increased in recent years, with many individuals having trouble accessing mental health support. Smartphones have become an integral part of modern life, with apps offering new ways to deliver evidence-based self-help strategies to cope with common mental health symptoms. However, most of them do not have empirical evidence of their overall effectiveness or the effectiveness of their components, which could pose a risk for users. Objective: The aim of this study is to evaluate the effectiveness of the modules of evaluation, psychoeducation, and emotional regulation strategies in a multiplatform self-help mental health mobile app in the Maule region of Chile. Methods: A sample of 196 adults will be selected, who will be randomly assigned to different components of the app for a fixed period to assess its ability to reduce symptomatology. Results: The trial is not yet recruiting and is expected to end in October 2024. The first results are expected in April 2024. Conclusions: This is the first study in Chile to develop and test the effectiveness of a mobile app to manage anxiety and depression symptoms in adults. The intervention proposed is based on evidence suggesting that the internet or remote intervention tools and self-management of prevalent symptomatology could be the future of mental health care systems in the digital era. If the effects of the intervention are positive, wide implementation in Chile and other Spanish-speaking countries could be possible in the future. International Registered Report Identifier (IRRID): PRR1-10.2196/52324 %M 38466982 %R 10.2196/52324 %U https://www.researchprotocols.org/2024/1/e52324 %U https://doi.org/10.2196/52324 %U http://www.ncbi.nlm.nih.gov/pubmed/38466982 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e40406 %T Mobile-Delivered Mindfulness Intervention on Anxiety Level Among College Athletes: Randomized Controlled Trial %A Gao,Yu %A Shi,Lu %A Fu,Ning %A Yang,Nan %A Weeks-Gariepy,Tracy %A Mao,Yuping %+ Department of Health Science, Pace University, One Pace Plaza, New York, NY, 10038, United States, 1 (866) 722 3338, lshi@pace.edu %K anxiety %K athletes %K body %K calmness %K cognition %K college students %K college %K feasibility %K feedback %K intervention %K meditation %K mHealth %K mindfulness %K mobile %K participant %K positive %K program %K relaxation %K sleep %K students %D 2024 %7 8.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: College athletes are a group often affected by anxiety. Few interventional studies have been conducted to address the anxiety issues in this population. Objective: We conducted a mobile-delivered mindfulness intervention among college athletes to study its feasibility and efficacy in lowering their anxiety level and improving their mindfulness (measured by the Five Facet Mindfulness Questionnaire [FFMQ]). Methods: In April 2019, we recruited 290 college athletes from a public university in Shanghai, China, and 288 of them were randomized into an intervention group and a control group (closed trial), with the former (n=150) receiving a therapist-guided, smartphone-delivered mindfulness-based intervention and the latter receiving mental health promotion messages (n=138). We offered in-person instructions during the orientation session for the intervention group in a classroom, with the therapist interacting with the participants on the smartphone platform later during the intervention. We used generalized linear modeling and the intent-to-treat approach to compare the 2 groups' outcomes in dispositional anxiety, precompetition anxiety, and anxiety during competition, plus the 5 dimensions of mindfulness (measured by the FFMQ). Results: Our intent-to-treat analysis and generalized linear modeling found no significant difference in dispositional anxiety, precompetition anxiety, or anxiety during competition. Only the “observation” facet of mindfulness measures had a notable difference between the changes experienced by the 2 groups, whereby the intervention group had a net gain of .214 yet fell short of reaching statistical significance (P=.09). Participants who specialized in group sports had a higher level of anxiety (β=.19; SE=.08), a lower level of “nonjudgemental inner experience” in FFMQ (β=–.07; SE=.03), and a lower level of “nonreactivity” (β=–.138; SE=.052) than those specializing in individual sports. Conclusions: No significant reduction in anxiety was detected in this study. Based on the participant feedback, the time availability for mindfulness practice and session attendance for these student athletes in an elite college could have compromised the intervention’s effectiveness. Future interventions among this population could explore a more student-friendly time schedule (eg, avoid final exam time) or attempt to improve cognitive and scholastic outcomes. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900024449; https://www.chictr.org.cn/showproj.html?proj=40865 %M 38457201 %R 10.2196/40406 %U https://www.jmir.org/2024/1/e40406 %U https://doi.org/10.2196/40406 %U http://www.ncbi.nlm.nih.gov/pubmed/38457201 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48026 %T Status and Influencing Factors of Social Media Addiction in Chinese Workers: Cross-Sectional Survey Study %A Kong,Weitao %A Li,Yuanyuan %A Luo,Aijing %A Xie,Wenzhao %+ The Second Xiangya Hospital, Central South University, 139 Renmin Middle Road, Changsha, 410000, China, 86 0731 85292212, luoaj@csu.edu.cn %K social media addiction %K job burnout %K mindfulness %K mobile phone %K technology addiction %K cross-sectional survey %D 2024 %7 6.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media addiction (SMA) caused by excessive dependence on social media is becoming a global problem. At present, most of the SMA studies recruit college students as research participants, with very few studies involving workers and other age groups, especially in China. Objective: This study aims to investigate the current status of SMA among Chinese workers and analyze its influencing factors. Methods: From November 1, 2022, to January 30, 2023, we conducted an anonymous web-based questionnaire survey in mainland China, and a total of 5176 participants completed the questionnaire. The questionnaire included the Social Networking Service Addiction Scale, Maslach Burnout Inventory–General Survey scale, Mindful Attention Awareness Scale, as well as questionnaires regarding participants’ social media use habits and demographic information. Results: Through strict screening, 3468 valid questionnaires were included in this study. The main findings of this study revealed the following: the average SMA score of workers was higher (mean 53.19, SD 12.04), and some of them (393/3468, 11.33%) relied heavily on social media; there were statistically significant differences in SMA scores among workers in different industries (F14,3453=3.98; P<.001); single workers (t3106=8.6; P<.001) and workers in a relationship (t2749=5.67; P<.001) had higher SMA scores than married workers, but some married workers (214/3468, 6.17%) were highly dependent on social media; the level of SMA among female workers was higher than that of male workers (t3466=3.65; P<.001), and the SMA score of workers negatively correlated with age (r=−0.22; P<.001) and positively correlated with education level (r=0.12; P<.001); the frequency of using social media for entertainment during work (r=0.33; P<.001) and the frequency of staying up late using social media (r=0.14; P<.001) were positively correlated with the level of SMA in workers; and the level of SMA in workers was significantly positively correlated with their level of burnout (r=0.35; P<.001), whereas it was significantly negatively correlated with their level of mindfulness (r=−0.55; P<.001). Conclusions: The results of this study suggest that SMA among Chinese workers is relatively serious and that the SMA problem among workers requires more attention from society and academia. In particular, female workers, young workers, unmarried workers, highly educated workers, workers with bad social media habits, workers with high levels of job burnout, and workers with low levels of mindfulness were highly dependent on social media. In addition, occupation is an important influencing factor in SMA. Thus, the government should strengthen the supervision of social media companies. Medical institutions should provide health education on SMA and offer intervention programs for those addicted to social media. Workers should cultivate healthy habits while using social media. %M 38446542 %R 10.2196/48026 %U https://www.jmir.org/2024/1/e48026 %U https://doi.org/10.2196/48026 %U http://www.ncbi.nlm.nih.gov/pubmed/38446542 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53001 %T Layperson-Supported, Web-Delivered Cognitive Behavioral Therapy for Depression in Older Adults: Randomized Controlled Trial %A Xiang,Xiaoling %A Kayser,Jay %A Turner,Skyla %A Ash,Samson %A Himle,Joseph A %+ School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI, 48109, United States, 1 (734) 763 6581, xiangxi@umich.edu %K internet-based cognitive behavioral therapy %K iCBT %K digital mental health interventions %K older adults %K depression %D 2024 %7 4.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is the most prevalent mental health condition in older adults. However, not all evidence-based treatments are easily accessible. Web-delivered cognitive behavioral therapy (wCBT) facilitated by laypersons is a viable treatment alternative. Objective: This randomized controlled trial aims to evaluate the efficacy of a novel wCBT program, Empower@Home, supported by trained lay coaches, against a waitlist attention control. Empower@Home is among the very few existing wCBT programs specifically designed for older adults. The primary objective was to assess the efficacy of the intervention compared with attention control. The secondary objective was to evaluate the program’s impact on secondary psychosocial outcomes and explore potential change mechanisms. Methods: Older adults (N=70) were recruited via web-based research registries, social media advertisements, and community agency referrals and randomly assigned to either the intervention or control group in a 1:1 allocation ratio. The intervention group received access to Empower@Home, which included 9 web-delivered self-help lessons and weekly telephone coaching sessions by a trained layperson over 10 weeks. The control group received weekly friendly phone calls and depressive symptom monitoring. The primary clinical outcome was the severity of depressive symptoms assessed using the Patient Health Questionnaire-9. The secondary clinical outcomes included anxiety, anger, social isolation, insomnia, pain intensity, and quality of life. Linear mixed modeling was used to determine the treatment effects on depression, and 2-tailed t tests were used to assess within-group changes and between-group differences. Results: Most participants in the intervention group completed all 9 sessions (31/35, 89%). The usability and acceptability ratings were excellent. The intervention group had a large within-group change in depressive symptoms (Cohen d=1.22; P<.001), whereas the attention control group experienced a medium change (Cohen d=0.57; P<.001). The between-group effect size was significant, favoring the intervention group over the control group (Cohen d=0.72; P<.001). In the linear mixed model, the group-by-time interaction was statistically significant (b=–0.68, 95% CI –1.00 to –0.35; P<.001). The treatment effects were mediated by improvements in cognitive behavioral therapy skills acquisition; behavioral activation; and satisfaction with the basic psychological needs of autonomy, competence, and relatedness. Furthermore, the intervention group showed significant within-group improvements in secondary psychosocial outcomes, including anxiety (P=.001), anger (P<.001), social isolation (P=.02), insomnia (P=.007), and pain (P=.03). By contrast, the control group did not experience significant changes in these outcome domains. However, the between-group differences in secondary outcomes were not statistically significant, owing to the small sample size. Conclusions: Empower@Home, a wCBT program supported by lay coaches, was more efficacious in reducing depressive symptoms than friendly telephone calls and depression symptom monitoring. Future studies should examine the effectiveness of the intervention in community and practice settings using nonclinician staff already present in these real-world settings as coaches. Trial Registration: ClinicalTrials.gov NCT05593276; https://clinicaltrials.gov/ct2/show/NCT05593276 International Registered Report Identifier (IRRID): RR2-10.2196/44210 %M 38437013 %R 10.2196/53001 %U https://www.jmir.org/2024/1/e53001 %U https://doi.org/10.2196/53001 %U http://www.ncbi.nlm.nih.gov/pubmed/38437013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e40187 %T Efficacy of Internet-Based Cognitive Behavioral Therapy for Subthreshold Depression Among Older Adults in Institutional Long-Term Care Settings: Pragmatic Randomized Controlled Trial %A Kong,Fanqian %A Yu,Libo %A Hou,Yanbin %A Zhu,Lijie %A Zhou,Jing %A Huang,Lingjie %A Lv,Yueer %A Wang,Li %A Zhang,Li %A Yang,Yiling %A Ying,Yuchen %+ Ningbo College of Health Sciences, 51 Xuefu Street, Yinzhou District, Ningbo, Zhejiang, 315100, China, 86 13685733802, 1246401741@qq.com %K internet-based cognitive behavioral therapy %K subthreshold depression %K randomized controlled trial %K older adults %K LTC setting %D 2024 %7 1.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Subthreshold depression (sD) is prevalent in older populations in long-term care (LTC) settings, but psychological therapy in LTC settings in China is not readily available. Thus, internet-based cognitive behavioral therapy (ICBT) may be suitable for this population, but research on the efficacy of ICBT for older adults with sD, especially those living in LTC settings, is limited. Objective: This study aimed to evaluate the efficacy and acceptability of ICBT treatment for sD among LTC residents in China. We also examined whether ICBT is as effective as group-based cognitive behavioral therapy (CBT) for treating sD in this population. Methods: We conducted a pragmatic randomized controlled trial, which included 18 LTC institutions. A total of 354 participants were randomized to ICBT, group-based CBT, or a waiting list and were followed up for 12 months. The primary outcome was self-reported depressive symptoms on the Center for Epidemiological Studies Depression Scale (CES-D). Secondary outcomes were the scores of the Patient Health Questionnaire–9 (PHQ-9), Generalized Anxiety Disorder 7-Item (GAD-7), and Geriatric Depression Scale (GDS). A mixed-effects model was used to assess the efficacy of ICBT. Results: The ICBT group showed a significant improvement in self-reported depressive symptoms, which was maintained at the 12-month follow-up (all P<.001). The ICBT group exhibited a significantly larger reduction in the scores of the CES-D (Cohen d=0.07, 95% CI 0.04-0.09; P=.01), PHQ-9 (d=0.30, 95% CI 0.28-0.33; P<.001), GDS (d=0.10, 95% CI 0.08-0.13; P<.001), and GAD-7 (d=0.19, 95% CI 0.17-0.22; P<.001) compared with a waiting list at postintervention. ICBT had significantly stronger effects than CBT on the PHQ-9 and GAD-7 at postintervention (d=0.15, 95% CI 0.13-0.17; P<.001 and d=0.21, 95% CI 0.19-0.23; P<.001, respectively), 6-month follow-up (d=0.18, 95% CI 0.16-0.21; P<.001 and d=0.18, 95% CI 0.15-0.21; P<.001, respectively), and 12-month follow-up (d=0.15, 95% CI 0.11-0.19; P<.001 and d=0.18, 95% CI 0.14-0.21; P<.001, respectively). Conclusions: ICBT is a relatively effective and acceptable intervention for reducing depressive symptoms among Chinese LTC residents with sD. These findings indicate the usefulness of ICBT application for sD in LTC settings. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000030697; https://www.chictr.org.cn/showproj.aspx?proj=50781 %M 38427424 %R 10.2196/40187 %U https://www.jmir.org/2024/1/e40187 %U https://doi.org/10.2196/40187 %U http://www.ncbi.nlm.nih.gov/pubmed/38427424 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48883 %T Assessing the Effectiveness of STAPP@Work, a Self-Management Mobile App, in Reducing Work Stress and Preventing Burnout: Single-Case Experimental Design Study %A Demirel,Sevda %A Roke,Yvette %A Hoogendoorn,Adriaan W %A Hoefakker,Jamie %A Hoeberichts,Kirsten %A van Harten,Peter N %+ Expertise Center for Autism Spectrum Disorder, GGz Centraal, Boomgaardweg 12, Almere, 1326 AD, Netherlands, 31 41807329, S.demirel@ggzcentraal.nl %K mental health %K stress %K coping %K burnout %K stress management %K digital intervention %K health promotion %K mobile apps %K mobile health %K mHealth %K mental health professionals %D 2024 %7 29.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. Objective: This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. Methods: The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. Results: After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=–0.38, 95% CI –0.67 to –0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=–0.31, 95% CI –0.51 to –0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. Conclusions: The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism. %M 38275128 %R 10.2196/48883 %U https://www.jmir.org/2024/1/e48883 %U https://doi.org/10.2196/48883 %U http://www.ncbi.nlm.nih.gov/pubmed/38275128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51268 %T The Effect of Digital Mental Health Literacy Interventions on Mental Health: Systematic Review and Meta-Analysis %A Yeo,GeckHong %A Reich,Stephanie M %A Liaw,Nicole A %A Chia,Elizabeth Yee Min %+ School of Education, University of California, Irvine, 3454 Education, Irvine, CA, 92697, United States, 1 (949) 824 5970, smreich@uci.edu %K review and meta-analysis %K digital mental health literacy %K digital mental health interventions %K mental health functioning %D 2024 %7 29.2.2024 %9 Review %J J Med Internet Res %G English %X Background: Accelerated by technological advancements and the recent global pandemic, there is burgeoning interest in digital mental health literacy (DMHL) interventions that can positively affect mental health. However, existing work remains inconclusive regarding the effectiveness of DMHL interventions. Objective: This systematic review and meta-analysis investigated the components and modes of DMHL interventions, their moderating factors, and their long-term impacts on mental health literacy and mental health. Methods: We used a random-effects model to conduct meta-analyses and meta-regressions on moderating effects of DMHL interventions on mental health. Results: Using 144 interventions with 206 effect sizes, we found a moderate effect of DMHL interventions in enhancing distal mental health outcomes (standardized mean difference=0.42, 95% CI −0.10 to 0.73; P<.001) and a large effect in increasing proximal mental health literacy outcomes (standardized mean difference=0.65, 95% CI 0.59-0.74; P<.001). Uptake of DMHL interventions was comparable with that of control conditions, and uptake of DMHL interventions did not moderate the effects on both proximal mental health literacy outcomes and distal mental health outcomes. DMHL interventions were as effective as face-to-face interventions and did not differ by platform type or dosage. DMHL plus interventions (DMHL psychoeducation coupled with other active treatment) produced large effects in bolstering mental health, were more effective than DMHL only interventions (self-help DMHL psychoeducation), and were comparable with non-DMHL interventions (treatment as usual). DMHL interventions demonstrated positive effects on mental health that were sustained over follow-up assessments and were most effective in enhancing the mental health of emerging and older adults. Conclusions: For theory building, our review and meta-analysis found that DMHL interventions are as effective as face-to-face interventions. DMHL interventions confer optimal effects on mental health when DMHL psychoeducation is combined with informal, nonprofessional active treatment components such as skills training and peer support, which demonstrate comparable effectiveness with that of treatment as usual (client-professional interactions and therapies). These effects, which did not differ by platform type or dosage, were sustained over time. Additionally, most DMHL interventions are found in Western cultural contexts, especially in high-income countries (Global North) such as Australia, the United States, and the United Kingdom, and limited research is conducted in low-income countries in Asia and in South American and African countries. Most of the DMHL studies did not report information on the racial or ethnic makeup of the samples. Future work on DMHL interventions that target racial or ethnic minority groups, particularly the design, adoption, and evaluation of the effects of culturally adaptive DMHL interventions on uptake and mental health functioning, is needed. Such evidence can drive the adoption and implementation of DMHL interventions at scale, which represents a key foundation for practice-changing impact in the provision of mental health resources for individuals and the community. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023363995; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023363995 %M 38421687 %R 10.2196/51268 %U https://www.jmir.org/2024/1/e51268 %U https://doi.org/10.2196/51268 %U http://www.ncbi.nlm.nih.gov/pubmed/38421687 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53659 %T Feasibility of Guided Internet-Based Cognitive Behavioral Therapy for Panic Disorder and Social Anxiety Disorder in Japan: Pilot Single-Arm Trial %A Shinno,Seina %A Matsumoto,Kazuki %A Hamatani,Sayo %A Inaba,Yosuke %A Ozawa,Yoshihito %A Kawasaki,Yohei %A Ikai,Tomoki %A Sutoh,Chihiro %A Hayashi,Hiroyuki %A Shimizu,Eiji %+ Division of Clinical Psychology, Kagoshima University Medical and Dental Hospital, 1-35-8 Sakuragaoka, Kagoshima, 8908520, Japan, 81 099 275 5707, k2782199@kadai.jp %K cognitive behavioral therapy %K internet intervention %K panic disorder %K social anxiety %K feasibility trail %K adult %K adults %K anxiety disorder %K internet-based %K e-learning %K Japan %K statistical analyses %K therapist %K therapists %K intervention %K severity %K symptoms %K therapeutic alliance %K mobile phone %D 2024 %7 29.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy (CBT) is effective in treating anxiety disorders. Accessibility to CBT has been limited in Japan due to the shortage of therapists. While an open-source e-learning system can be used to create a simple internet-based cognitive behavioral therapy (ICBT) program, the safety and outpatient acceptance of this treatment approach have not been explored in Japan. Objective: The aim of this study was to investigate whether outpatients with anxiety disorders could accept and successfully complete the ICBT program with guidance by CBT therapists when implementing therapeutic modules and CBT tasks. Due to being in the initial phase of a novel treatment in Japan, this study was intended for verification with a small sample size. Methods: In total, 6 adults, including 4 male participants and 2 female participants, were enrolled in a single-arm trial. The intervention involved guided ICBT comprising 12 sessions, including CBT text, comprehension confirmation tests, and explanatory videos about cognitive behavioral models, accessible through a website. The therapist guided the participants in accessing the ICBT program and answering their questions using a chat tool. The primary outcome was anxiety severity assessed using the State-Trait Anxiety Inventory-Trait. Secondary outcomes included the Panic Disorder Severity Scale, Liebowitz Social Anxiety Scale (LSAS), Beck Anxiety Inventory (BAI), Patient Health Questionnaire–9, Generalized Anxiety Disorder–7, and Working Alliance Inventory–Short Form (WAI-SF). Statistical analyses were performed using paired 2-tailed t tests to assess the changes in clinical symptoms. The total WAI-SF score at the final session was used to evaluate the therapeutic alliance. For statistical analyses, mean changes for total State-Trait Anxiety Inventory-Trait, BAI, Panic Disorder Severity Scale, LSAS, Patient Health Questionnaire–9, and Generalized Anxiety Disorder–7 scores were analyzed using the paired 2-tailed t test. The 2-sided significance level for hypothesis testing was set at 5%, and 2-sided 95% CIs were calculated. Results: Most participants diligently engaged with the ICBT program. No adverse events were reported. The mean total scores for the primary outcome decreased by 11.0 (SD 9.6) points (95% CI –22.2 to 0.20; Hedges g=0.95), but it was not statistically significant. The mean total scores for the secondary outcomes that assess clinical symptoms decreased, with a significant reduction observed in the BAI of 15.7 (SD 12.1) points (95% CI –28.4 to –3.0; P=.03; Hedges g=1.24). The mean total scores for PDSS and LSAS decreased significantly, by 12.0 (SD 4.24) points (95% CI –50.1 to 26.1; P=.16; Hedges g=1.79) and 32.4 (SD 11.1) points (95% CI –59.7 to –4.3; P=.04; Hedges g=1.38), respectively. Of the participants, 67% (n=4) showed treatment response, and 50% (n=3) achieved remission after the intervention. The therapeutic alliance, measured using the WAI-SF, was moderate. Conclusions: Guided ICBT may be feasible for the treatment of outpatients with panic disorder and social anxiety disorder in Japan. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN0000038118; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000043439 %M 38421717 %R 10.2196/53659 %U https://formative.jmir.org/2024/1/e53659 %U https://doi.org/10.2196/53659 %U http://www.ncbi.nlm.nih.gov/pubmed/38421717 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48168 %T Attrition in Conversational Agent–Delivered Mental Health Interventions: Systematic Review and Meta-Analysis %A Jabir,Ahmad Ishqi %A Lin,Xiaowen %A Martinengo,Laura %A Sharp,Gemma %A Theng,Yin-Leng %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road, Level 18, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K conversational agent %K chatbot %K mental health %K mHealth %K attrition %K dropout %K mobile phone %K artificial intelligence %K AI %K systematic review %K meta-analysis %K digital health interventions %D 2024 %7 27.2.2024 %9 Review %J J Med Internet Res %G English %X Background: Conversational agents (CAs) or chatbots are computer programs that mimic human conversation. They have the potential to improve access to mental health interventions through automated, scalable, and personalized delivery of psychotherapeutic content. However, digital health interventions, including those delivered by CAs, often have high attrition rates. Identifying the factors associated with attrition is critical to improving future clinical trials. Objective: This review aims to estimate the overall and differential rates of attrition in CA-delivered mental health interventions (CA interventions), evaluate the impact of study design and intervention-related aspects on attrition, and describe study design features aimed at reducing or mitigating study attrition. Methods: We searched PubMed, Embase (Ovid), PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and Web of Science, and conducted a gray literature search on Google Scholar in June 2022. We included randomized controlled trials that compared CA interventions against control groups and excluded studies that lasted for 1 session only and used Wizard of Oz interventions. We also assessed the risk of bias in the included studies using the Cochrane Risk of Bias Tool 2.0. Random-effects proportional meta-analysis was applied to calculate the pooled dropout rates in the intervention groups. Random-effects meta-analysis was used to compare the attrition rate in the intervention groups with that in the control groups. We used a narrative review to summarize the findings. Results: The systematic search retrieved 4566 records from peer-reviewed databases and citation searches, of which 41 (0.90%) randomized controlled trials met the inclusion criteria. The meta-analytic overall attrition rate in the intervention group was 21.84% (95% CI 16.74%-27.36%; I2=94%). Short-term studies that lasted ≤8 weeks showed a lower attrition rate (18.05%, 95% CI 9.91%- 27.76%; I2=94.6%) than long-term studies that lasted >8 weeks (26.59%, 95% CI 20.09%-33.63%; I2=93.89%). Intervention group participants were more likely to attrit than control group participants for short-term (log odds ratio 1.22, 95% CI 0.99-1.50; I2=21.89%) and long-term studies (log odds ratio 1.33, 95% CI 1.08-1.65; I2=49.43%). Intervention-related characteristics associated with higher attrition include stand-alone CA interventions without human support, not having a symptom tracker feature, no visual representation of the CA, and comparing CA interventions with waitlist controls. No participant-level factor reliably predicted attrition. Conclusions: Our results indicated that approximately one-fifth of the participants will drop out from CA interventions in short-term studies. High heterogeneities made it difficult to generalize the findings. Our results suggested that future CA interventions should adopt a blended design with human support, use symptom tracking, compare CA intervention groups against active controls rather than waitlist controls, and include a visual representation of the CA to reduce the attrition rate. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022341415; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022341415 %M 38412023 %R 10.2196/48168 %U https://www.jmir.org/2024/1/e48168 %U https://doi.org/10.2196/48168 %U http://www.ncbi.nlm.nih.gov/pubmed/38412023 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e55560 %T Rates of Trauma Exposure and Posttraumatic Stress in a Pediatric Digital Mental Health Intervention: Retrospective Analysis of Associations With Anxiety and Depressive Symptom Improvement Over Time %A Lawrence-Sidebottom,Darian %A Huffman,Landry Goodgame %A Beam,Aislinn Brenna %A Guerra,Rachael %A Parikh,Amit %A Roots,Monika %A Huberty,Jennifer %+ Bend Health Inc, 2801 Marshall Ct, Madison, WI, 53705, United States, 1 8005160975, darian.lawrence@bendhealth.com %K collaborative care model %K telehealth %K childhood trauma %K DMHI %K digital health %K mental health %K telemedicine %K trauma %K traumatic %K pediatric %K pediatrics %K paediatric %K paediatrics %K child %K children %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K retrospective %K anxiety %K depression %K depressive %K co-occurring %K comorbid %K comorbidity %K comorbidities %K association %K associations %K correlation %K correlations %K correlate %D 2024 %7 27.2.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths. Objective: This study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non–posttraumatic DMHI is linked to reductions in PTS symptoms. Methods: This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children’s trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments. Results: Among eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions. Conclusions: This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment. %M 38412001 %R 10.2196/55560 %U https://pediatrics.jmir.org/2024/1/e55560 %U https://doi.org/10.2196/55560 %U http://www.ncbi.nlm.nih.gov/pubmed/38412001 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e50282 %T Immersive Virtual Reality–Based Methods for Assessing Executive Functioning: Systematic Review %A Kirkham,Rebecca %A Kooijman,Lars %A Albertella,Lucy %A Myles,Dan %A Yücel,Murat %A Rotaru,Kristian %+ Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, 770 Blackburn Road, Clayton, 3168, Australia, 61 (03) 9905 0100, rebecca.kirkham@monash.edu %K virtual reality %K executive functioning %K neuropsychological assessment %K systematic review %K psychometric properties %K cybersickness %K immersion %K cognition %D 2024 %7 26.2.2024 %9 Review %J JMIR Serious Games %G English %X Background: Neuropsychological assessments traditionally include tests of executive functioning (EF) because of its critical role in daily activities and link to mental disorders. Established traditional EF assessments, although robust, lack ecological validity and are limited to single cognitive processes. These methods, which are suitable for clinical populations, are less informative regarding EF in healthy individuals. With these limitations in mind, immersive virtual reality (VR)–based assessments of EF have garnered interest because of their potential to increase test sensitivity, ecological validity, and neuropsychological assessment accessibility. Objective: This systematic review aims to explore the literature on immersive VR assessments of EF focusing on (1) EF components being assessed, (2) how these assessments are validated, and (3) strategies for monitoring potential adverse (cybersickness) and beneficial (immersion) effects. Methods: EBSCOhost, Scopus, and Web of Science were searched in July 2022 using keywords that reflected the main themes of VR, neuropsychological tests, and EF. Articles had to be peer-reviewed manuscripts written in English and published after 2013 that detailed empirical, clinical, or proof-of-concept studies in which a virtual environment using a head-mounted display was used to assess EF in an adult population. A tabular synthesis method was used in which validation details from each study, including comparative assessments and scores, were systematically organized in a table. The results were summed and qualitatively analyzed to provide a comprehensive overview of the findings. Results: The search retrieved 555 unique articles, of which 19 (3.4%) met the inclusion criteria. The reviewed studies encompassed EF and associated higher-order cognitive functions such as inhibitory control, cognitive flexibility, working memory, planning, and attention. VR assessments commonly underwent validation against gold-standard traditional tasks. However, discrepancies were observed, with some studies lacking reported a priori planned correlations, omitting detailed descriptions of the EF constructs evaluated using the VR paradigms, and frequently reporting incomplete results. Notably, only 4 of the 19 (21%) studies evaluated cybersickness, and 5 of the 19 (26%) studies included user experience assessments. Conclusions: Although it acknowledges the potential of VR paradigms for assessing EF, the evidence has limitations. The methodological and psychometric properties of the included studies were inconsistently addressed, raising concerns about their validity and reliability. Infrequent monitoring of adverse effects such as cybersickness and considerable variability in sample sizes may limit interpretation and hinder psychometric evaluation. Several recommendations are proposed to improve the theory and practice of immersive VR assessments of EF. Future studies should explore the integration of biosensors with VR systems and the capabilities of VR in the context of spatial navigation assessments. Despite considerable promise, the systematic and validated implementation of VR assessments is essential for ensuring their practical utility in real-world applications. %M 38407958 %R 10.2196/50282 %U https://games.jmir.org/2024/1/e50282 %U https://doi.org/10.2196/50282 %U http://www.ncbi.nlm.nih.gov/pubmed/38407958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48881 %T Perception of Apps for Mental Health Assessment With Recommendations for Future Design: United Kingdom Semistructured Interview Study %A Funnell,Erin L %A Spadaro,Benedetta %A Martin-Key,Nayra A %A Benacek,Jiri %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K app design %K digital health %K eHealth %K interviews %K mental health %K mHealth %K mobile phone %D 2024 %7 23.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health care provision in the United Kingdom is overwhelmed by a high demand for services. There are high rates of under-, over-, and misdiagnosis of common mental health disorders in primary care and delays in accessing secondary care. This negatively affects patient functioning and outcomes. Digital tools may offer a time-efficient avenue for the remote assessment and triage of mental health disorders that can be integrated directly into existing care pathways to support clinicians. However, despite the potential of digital tools in the field of mental health, there remain gaps in our understanding of how the intended user base, people with lived experiences of mental health concerns, perceive these technologies. Objective: This study explores the perspectives and attitudes of individuals with lived experiences of mental health concerns on mental health apps that are designed to support self-assessment and triage. Methods: A semistructured interview approach was used to explore the perspectives of the interviewees using 5 open-ended questions. Interviews were transcribed verbatim from audio data recordings. The average interview lasted 46 minutes (rounded to the nearest min; SD 12.93 min). A thematic analysis was conducted. Results: Overall, 16 individuals were interviewed in this study. The average age was 42.25 (SD 15.18) years, half of the interviewees identified as women (8/16, 50%), and all were White (16/16, 100%). The thematic analysis revealed six major themes: (1) availability and accessibility, (2) quality, (3) attitudes, (4) safety, (5) impact, and (6) functionality. Conclusions: Engaging in clear communication regarding data security and privacy policies, adopting a consent-driven approach to data sharing, and identifying gaps in the app marketplace to foster the inclusion of a range of mental health conditions and avoid oversaturation of apps for common mental health disorders (eg, depression and anxiety) were identified as priorities from interviewees’ comments. Furthermore, reputation was identified as a driver of uptake and engagement, with endorsement from a respected source (ie, health care provider, academic institution) or direct recommendation from a trusted health care professional associated with increased interest and trust. Furthermore, there was an interest in the role that co-designed digital self-assessments could play in existing care pathways, particularly in terms of facilitating informed discussions with health care professionals during appointments and by signposting individuals to the most appropriate services. In addition, interviewees discussed the potential of mental health apps to provide waiting list support to individuals awaiting treatment by providing personalized psychoeducation, self-help tips, and sources of help. However, concerns regarding the quality of care being affected because of digital delivery have been reported; therefore, frequent monitoring of patient acceptability and care outcomes is warranted. In addition, communicating the rationale and benefits of digitizing services will likely be important for securing interest and uptake from health care service users. %M 38393760 %R 10.2196/48881 %U https://formative.jmir.org/2024/1/e48881 %U https://doi.org/10.2196/48881 %U http://www.ncbi.nlm.nih.gov/pubmed/38393760 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52338 %T Group, Blended and Individual, Unguided Online Delivery of Mindfulness-Based Cognitive Therapy for People With Cancer: Feasibility Uncontrolled Trial %A Badaghi,Nasim %A van Kruijsbergen,Mette %A Speckens,Anne %A Vilé,Joëlle %A Prins,Judith %A Kelders,Saskia %A Kwakkenbos,Linda %+ Department of Psychiatry, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, 6525 GA, Netherlands, 31 0624835397, nasim.badaghimoreno@radboudumc.nl %K cancer %K eHeath %K online interventions %K mindfulness %K psycho-oncology %K qualitative research %K oncology %K CBT %K blended %K eMBCT %K iCBT %K cognitive therapy %K unguided %K psychotherapy %K MBCT %K co-creation %K therapist %K self-guided %K peer-support %K co-design %K participatory %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Online mindfulness based cognitive therapy (eMBCT) has been shown to reduce psychological distress in people with cancer. However, this population has reported lack of support and asynchronous communication as barriers to eMBCT, resulting in higher nonadherence rates than with face-to-face MBCT. Using a co-creation process, we developed 2 formats of eMBCT: group, blended (combination of therapist-guided group and individual online sessions) and individual, unguided (individual, unguided online sessions only). Group, blended eMBCT offers peer support and guidance, whereas individual, unguided eMBCT offers flexibility and the possibility of large-scale implementation. Objective: The objective of this nonrandomized feasibility study was to assess aspects of feasibility of the group, blended and individual, unguided eMBCT interventions. Methods: Participants were people with cancer who chose between group, blended and individual, unguided eMBCT. Both intervention conditions followed the same 8-week eMBCT program, including an introductory session and a silent day (10 sessions total). All sessions for individual, unguided eMBCT occurred via the platform Minddistrict, whereas group, blended eMBCT consisted of 3 online videoconference sessions guided by a mindfulness teacher and 5 sessions via Minddistrict. We assessed the feasibility of the intervention quantitatively and qualitatively by evaluating its acceptability among participants. Additionally, we assessed limited efficacy by looking at the number of questionnaires participants completed pre- and postintervention. Results: We included 12 participants for each eMBCT condition. Participants in group, blended eMBCT completed, on average, 9.7 of 10 sessions, compared with an average 8.3 sessions for individual, unguided eMBCT (excluding dropouts). Of the 24 participants, 13 (54%) agreed to be interviewed (5 unguided and 8 blended). Participants in both conditions reported positive experiences, including the convenience of not having to travel and the flexibility to choose when and where to participate. However, among the barriers for participation, participants in the group, blended condition reported a preference for more group sessions, and participants in the individual, unguided condition reported a lack of guidance. Additionally, for the group, blended condition, the effect sizes were small for all outcome measures (Hedges g range=0.01-0.36), except for fatigue, which had a moderate effect size (Hedges g=0.57). For the individual, unguided condition, the effect sizes were small for all outcome measures (Hedges g range=0.24-0.46), except for mindfulness skills (Hedges g=0.52) and engagement with the intervention (Hedges g=1.53). Conclusions: Participants in this study had a positive experience with group, blended and individual, unguided eMBCT. Based on the results from this study, we will adjust the intervention prior to conducting a full-scale randomized controlled trial to evaluate effectiveness; we will add 1 group session to the group, blended eMBCT using Zoom as the platform for the group sessions; and we will send reminders to participants to complete questionnaires. Trial Registration: ClinicalTrials.gov NCT05336916; https://clinicaltrials.gov/ct2/show/NCT05336916 %M 38381493 %R 10.2196/52338 %U https://formative.jmir.org/2024/1/e52338 %U https://doi.org/10.2196/52338 %U http://www.ncbi.nlm.nih.gov/pubmed/38381493 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e46697 %T A Novel Casual Video Game With Simple Mental Health and Well-Being Concepts (Match Emoji): Mixed Methods Feasibility Study %A Pine,Russell %A Mbinta,James %A Te Morenga,Lisa %A Fleming,Theresa %+ School of Health, Victoria University of Wellington, Kelburn Parade, Kelburn, Wellington, 6012, New Zealand, 64 4 472 1000, russell.pine@vuw.ac.nz %K adolescent %K anxiety %K casual video games %K digital mental health interventions %K gaming %K mental health %K micro interventions %K serious game %K teenage %K video game %K youth %D 2024 %7 12.2.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Adolescence is a crucial phase for early intervention and prevention of mental health problems. Casual video games are popular and have promise as a novel mechanism for reaching young people, but this potential has seldom been explored. Objective: This study aimed to explore the acceptability, feasibility, and possible indicators of therapeutic changes after playing a purpose-built novel casual video game (Match Emoji) with simple mental health and well-being content among young adolescents. Methods: We conducted a single-arm, nonrandomized trial of Match Emoji with 12- to 14-year-old school students (N=45; 26 [57%] New Zealand European, 12 [26%] Māori; 7 [15%] Asian or Pacific; 27 [60%] boys, 3 [6%] non-binary). Participants were invited to play Match Emoji for 15 minutes, 2-3 times a week over 2 weeks (a total of 60 minutes). Acceptability was assessed through the frequency and duration of use (analytics analyzed at the end of the 2-week intervention period and at weeks 4 and 6) and through participant reports. The Child and Adolescent Mindfulness Measure (CAMM), General Help-Seeking Questionnaire (GHSQ), Flourishing Scale (FS), and Revised Children’s Anxiety and Depression Scale (RCADS) were assessed at baseline and week 2 to indicate possible effects. Focus groups were held in week 4. Results: Most participants (n=39, 87%) used Match Emoji for at least 60 minutes over the 2-week intervention, with 80% (36/45) continuing to play the game after the intervention period. Mean change (from baseline to 2 weeks) on each measure was 1.38 (95% CI –0.03 to 2.79; P=.06) for CAMM; 0.8 (95% CI –2.71 to 4.31; P=.64) for GHSQ; –1.09 (95% CI –2.83 to 0.66; P=.21) for FS; and –3.42 (95% CI –6.84 to –0.001; P=0.49) for RCADS. Focus group feedback suggested that Match Emoji was enjoyable and helpful. Conclusions: The casual video game with mental health content appeared to be acceptable and provided a promising indication of possible therapeutic effects. This approach is worthy of further investigation. International Registered Report Identifier (IRRID): RR2-10.2196/31588 %M 38345848 %R 10.2196/46697 %U https://games.jmir.org/2024/1/e46697 %U https://doi.org/10.2196/46697 %U http://www.ncbi.nlm.nih.gov/pubmed/38345848 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e51704 %T Incorporating a Stepped Care Approach Into Internet-Based Cognitive Behavioral Therapy for Depression: Randomized Controlled Trial %A Jagayat,Jasleen Kaur %A Kumar,Anchan %A Shao,Yijia %A Pannu,Amrita %A Patel,Charmy %A Shirazi,Amirhossein %A Omrani,Mohsen %A Alavi,Nazanin %+ Centre for Neuroscience Studies, Queen's University, 18 Stuart Street, Kingston, ON, K7L 3N6, Canada, 1 613 533 2600, jasleenjagayat@gmail.com %K internet-based cognitive behavioral therapy %K i-CBT %K major depressive disorder %K MDD %K stepped care %K digital mental health care %K mobile phone %D 2024 %7 9.2.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression is a hidden burden, yet it is a leading cause of disability worldwide. Despite the adverse effects of depression, fewer than one-third of patients receive care. Internet-based cognitive behavioral therapy (i-CBT) is an effective treatment for depression, and combining i-CBT with supervised care could make the therapy scalable and effective. A stepped care model is a framework for beginning treatment with an effective and low-intensity intervention while adapting care based on the patient’s needs. Objective: This study investigated the efficacy of a stepped care i-CBT model for depression based on changes in self-reported depressive symptoms. Methods: In this single-blinded, randomized controlled trial, participants were allocated to either the i-CBT–only group (28/56, 50%) or the i-CBT with stepped care group (28/56, 50%). Both groups received a 13-week i-CBT program tailored for depression. The i-CBT program was provided through a secure, online mental health clinic called the Online Psychotherapy Tool. Participants read through the sessions and completed the assignments related to each session. Participants in the stepped care group received additional interventions from their care provider based on standard questionnaire scores (ie, Patient Health Questionnaire–9 [PHQ-9], Quick Inventory of Depressive Symptomatology [QIDS], and Quality of Life Enjoyment and Satisfaction Questionnaire–Short Form) and their assignment responses. From lowest to highest intensity, the additional interventions included SMS text messages, phone calls, video calls, or a video call with a psychiatrist. Results: For this study, 56 participants were recruited to complete an i-CBT program (n=28, 50%; mean age 37.9; SD 13.08 y; 7/28, 27% were men) or an i-CBT with stepped care program (n=28, 50%; mean age 40.6; SD 14.28 y; 11/28, 42% were men). The results of this study indicate that the i-CBT program was effective in significantly reducing depressive symptoms, as measured by the PHQ-9 (F4,80=9.95; P<.001) and QIDS (F2,28=5.73; P=.008); however, there were no significant differences in the reduction of depressive symptoms between the 2 groups (PHQ-9: F4,80=0.43; P=.78; QIDS: F2,28=3.05; P=.06). The stepped care group was not significantly better in reducing depressive symptoms than the i-CBT group (PHQ-9, P=.79; QIDS, P=.06). Although there were no significant differences observed between the number of participants who completed the program between the groups (χ21=2.6; P=.10), participants in the stepped care group, on average, participated in more sessions than those who prematurely terminated participation in the i-CBT group (t55=−2; P=.03; 95% CI –4.83 to –0.002). Conclusions: Implementing a stepped care approach in i-CBT is an effective treatment for depression, and the stepped care model can assist patients to complete more sessions in their treatment. Trial Registration: Clinicaltrials.gov NCT04747873; https://clinicaltrials.gov/study/NCT04747873 %M 38173167 %R 10.2196/51704 %U https://mental.jmir.org/2024/1/e51704 %U https://doi.org/10.2196/51704 %U http://www.ncbi.nlm.nih.gov/pubmed/38173167 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47360 %T Exploring User Perspectives on Brief Reflective Questioning Activities for Stress Management: Mixed Methods Study %A Bhattacharjee,Ananya %A Chen,Pan %A Mandal,Abhijoy %A Hsu,Anne %A O'Leary,Katie %A Mariakakis,Alex %A Williams,Joseph Jay %+ Department of Computer Science, University of Toronto, 40 St George St, Toronto, ON, M5S 2E4, Canada, 1 647 619 6982, ananya@cs.toronto.edu %K reflection %K mental health %K stress %K reflective questioning activity %K RQA %K brief intervention %K computer-mediated communication %K email %K SMS text messaging %K mobile phone %D 2024 %7 8.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Current online interventions dedicated to assisting individuals in managing stress and negative emotions often necessitate substantial time commitments. This can be burdensome for users, leading to high dropout rates and reducing the effectiveness of these interventions. This highlights an urgent need for concise digital activities that individuals can swiftly access during instances of negative emotions or stress in their daily lives. Objective: The primary aim of this study was to investigate the viability of using a brief digital exercise, specifically a reflective questioning activity (RQA), to help people reflect on their thoughts and emotions about a troubling situation. The RQA is designed to be quick, applicable to the general public, and scalable without requiring a significant support structure. Methods: We conducted 3 simultaneous studies. In the first study, we recruited 48 participants who completed the RQA and provided qualitative feedback on its design through surveys and semistructured interviews. In the second study, which involved 215 participants from Amazon Mechanical Turk, we used a between-participants design to compare the RQA with a single-question activity. Our hypotheses posited that the RQA would yield greater immediate stress relief and higher perceived utility, while not significantly altering the perception of time commitment. To assess these, we measured survey completion times and gathered multiple self-reported scores. In the third study, we assessed the RQA’s real-world impact as a periodic intervention, exploring engagement via platforms such as email and SMS text messaging, complemented by follow-up interviews with participants. Results: In our first study, participants appreciated the RQA for facilitating structured reflection, enabling expression through writing, and promoting problem-solving. However, some of the participants experienced confusion and frustration, particularly when they were unable to find solutions or alternative perspectives on their thoughts. In the second study, the RQA condition resulted in significantly higher ratings (P=.003) for the utility of the activity and a statistically significant decrease (P<.001) in perceived stress rating compared with the single-question activity. Although the RQA required significantly more time to be completed (P<.001), there was no statistically significant difference in participants’ subjective perceived time commitment (P=.37). Deploying the RQA over 2 weeks in the third study identified some potential challenges to consider for such activities, such as the monotony of doing the same activity several times, the limited affordances of mobile phones, and the importance of having the prompts align with the occurrence of new troubling situations. Conclusions: This paper describes the design and evaluation of a brief online self-reflection activity based on cognitive behavioral therapy principles. Our findings can inform practitioners and researchers in the design and exploration of formats for brief interventions to help people with everyday struggles. %M 38329800 %R 10.2196/47360 %U https://formative.jmir.org/2024/1/e47360 %U https://doi.org/10.2196/47360 %U http://www.ncbi.nlm.nih.gov/pubmed/38329800 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48467 %T Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial %A Peake,Emily %A Miller,Ian %A Flannery,Jessica %A Chen,Lang %A Lake,Jessica %A Padmanabhan,Aarthi %+ Limbix Health Inc, 548 Market St, PMB 91609, San Francisco, CA, 94104, United States, 1 888 546 2495, aarthi.padmanabhan@bighealth.com %K adolescent %K depression %K randomized controlled trial %K mobile phone %K digital therapeutics %K mobile app %K cognitive behavioral therapy %K behavioral activation %K mobile health %D 2024 %7 7.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescent depression is a significant public health concern; however, access to effective mental health care is limited. Digital therapeutics (DTx) can improve access to evidence-based interventions; however, their efficacy in adolescents is sparsely documented. Objective: This study aims to examine the efficacy of a mobile app DTx versus an active control as an adjunct treatment for adolescent depression symptoms. Methods: An internet-based open-label randomized control trial was conducted nationwide with a partial crossover design, and 168 adolescents aged 13 to 21 years with symptoms of depression were recruited between November 2020 and September 2021. Participants were randomized (1:1) to the cognitive behavioral therapy–based treatment app (Spark) or to a psychoeducational control app (control), which they would use for a duration of 5 weeks. The primary outcome was a between-group (Spark vs control) difference in the change in depression symptoms from baseline to postintervention, as measured by the Patient Health Questionnaire-8 (PHQ-8) using a linear mixed-effects analysis. The PHQ-8 ranges from 0 to 24, with scores of 5 to 9 indicating mild depression symptoms, scores of 10 to 14 indicating moderate symptoms, scores of 15 to 19 indicating moderately severe symptoms, and scores of 20 to 24 indicating severe symptoms. A minimal clinically important difference (5-point reduction between baseline and postintervention) in the Spark arm and group differences in remission and treatment response rates based on the PHQ-8 at postintervention were also investigated. Results: A total of 160 participants were randomized, 80 in the Spark arm (mean age 16.89, SD 2.5 y) and 80 in the control arm (mean age 16.79, SD 2.59 y). Data from 121 participants (Spark: n=63; control: n=58) with moderate to severe (PHQ-8≥10) symptoms at baseline were included in the primary analyses following a modified intention-to-treat principle. A linear mixed-effect analysis revealed a nonsignificant difference between the study arms in depression symptom change over the intervention period. The Spark arm met a minimal clinically important difference threshold (mean −5.08, 95% CI −6.72 to −3.42). The remission rate in the Spark arm was significantly higher than that in the control arm (11/63, 17% vs 2/58, 3%; χ21=6.2; P=.01; false discovery rate–adjusted P=.03). The treatment response rates were not significantly different between the study arms (P=.07; false discovery rate–adjusted P=.16). Post hoc analyses including participants with mild to severe (PHQ-8 score ≥5) symptoms at baseline revealed promising evidence that Spark is effective in those with mild to severe symptoms. Conclusions: There is initial evidence that a self-guided, cognitive behavioral therapy–based DTx intervention may effectively treat mild to severe depression symptoms in adolescents. DTx may improve access to mental health care for adolescents or serve as an important adjunct to the standard of care. Trial Registration: ClinicalTrials.gov NCT04524598; https://clinicaltrials.gov/study/NCT04524598 %M 38324367 %R 10.2196/48467 %U https://www.jmir.org/2024/1/e48467 %U https://doi.org/10.2196/48467 %U http://www.ncbi.nlm.nih.gov/pubmed/38324367 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45114 %T Depression and Anxiety in Adolescents During the COVID-19 Pandemic in Relation to the Use of Digital Technologies: Longitudinal Cohort Study %A Shen,Chen %A Smith,Rachel B %A Heller,Joel %A Spiers,Alexander D V %A Thompson,Rhiannon %A Ward,Helen %A Roiser,Jonathan P %A Nicholls,Dasha %A Toledano,Mireille B %+ MRC Centre for Environment and Health, School of Public Health, Imperial College London, School of Medicine Building, Norfolk Place, London, W21PG, United Kingdom, 44 02075943298, m.toledano@imperial.ac.uk %K COVID-19 %K depression %K anxiety %K public health %K adolescence %K digital technology use %K sleep %K mobile phone %D 2024 %7 7.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescents are susceptible to mental illness and have experienced substantial disruption owing to the COVID-19 pandemic. The digital environment is increasingly important in the context of a pandemic when in-person social connection is restricted. Objective: This study aims to estimate whether depression and anxiety had worsened compared with the prepandemic period and examine potential associations with sociodemographic characteristics and behavioral factors, particularly digital behaviors. Methods: We analyzed cross-sectional and longitudinal data from a large, representative Greater London adolescent cohort study: the Study of Cognition, Adolescents and Mobile Phones (SCAMP). Participants completed surveys at T1 between November 2016 and July 2018 (N=4978; aged 13 to 15 years) and at T2 between July 2020 and June 2021 (N=1328; aged 16 to 18 years). Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder scale, respectively. Information on the duration of total mobile phone use, social network site use, and video gaming was also collected using questionnaires. Multivariable logistic regression was used to assess the cross-sectional and longitudinal associations of sociodemographic characteristics, digital technology use, and sleep duration with clinically significant depression and anxiety. Results: The proportion of adolescents who had clinical depression and anxiety significantly increased at T2 (depression: 140/421, 33.3%; anxiety: 125/425, 29.4%) compared with the proportion of adolescents at T1 (depression: 57/421, 13.5%; anxiety: 58/425, 13.6%; P for 2-proportion z test <.001 for both depression and anxiety). Depression and anxiety levels were similar between the summer holiday, school opening, and school closures. Female participants had higher odds of new incident depression (odds ratio [OR] 2.5, 95% CI 1.5-4.18) and anxiety (OR 2.11, 95% CI 1.23-3.61) at T2. A high level of total mobile phone use at T1 was associated with developing depression at T2 (OR 1.89, 95% CI 1.02-3.49). Social network site use was associated with depression and anxiety cross-sectionally at T1 and T2 but did not appear to be associated with developing depression or anxiety longitudinally. Insufficient sleep at T1 was associated with developing depression at T2 (OR 2.26, 95% CI 1.31-3.91). Conclusions: The mental health of this large sample of adolescents from London deteriorated during the pandemic without noticeable variations relating to public health measures. The deterioration was exacerbated in girls, those with preexisting high total mobile phone use, and those with preexisting disrupted sleep. Our findings suggest the necessity for allocating resources to address these modifiable factors and target high-risk groups. %M 38324379 %R 10.2196/45114 %U https://www.jmir.org/2024/1/e45114 %U https://doi.org/10.2196/45114 %U http://www.ncbi.nlm.nih.gov/pubmed/38324379 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e48929 %T Digital Methods for the Spiritual and Mental Health of Generation Z: Scoping Review %A Park,Susanna Y %A Do,Bridgette %A Yourell,Jacqlyn %A Hermer,Janice %A Huberty,Jennifer %+ Skylight, Radiant Foundation, 55 N 300 W Suite 800, Salt Lake City, UT, 84101, United States, 1 (720) 675 7228, susanna@skylight.org %K Generation Z %K Gen Z %K spiritual health %K digital mental health %K spirituality %D 2024 %7 6.2.2024 %9 Review %J Interact J Med Res %G English %X Background: Generation Z (Gen Z) includes individuals born between 1995 and 2012. These individuals experience high rates of anxiety and depression. Most Gen Z individuals identify with being spiritual, and aspects from religion and spirituality can be integrated into mental health treatment and care as both are related to lower levels of depression. However, research on the spiritual and mental health of Gen Z is sparse. To date, there are no systematic or scoping reviews on digital methods to address the spiritual and mental health of Gen Z. Objective: This scoping review aimed to describe the current state of digital methods to address spiritual and mental health among Gen Z, identify the knowledge gaps, and make suggestions for how to leverage digital spiritual and mental health interventions for Gen Z. Methods: A comprehensive literature search was conducted in PubMed, Scopus, PsycInfo, CINAHL, Education Full Text, Google Scholar, SocIndex, and Sociological Abstracts. The inclusion criteria were as follows: (1) study population born between 1995 and 2012 (ie, Gen Z); (2) reporting on spiritual health or well-being, spirituality or religion, and mental health or well-being; (3) reporting on using digital methods; (4) publication in 1996 or beyond; (5) human subject research; (6) full text availability in English; (7) primary research study design; and (8) peer-reviewed article. Two authors screened articles and subsequently extracted data from the included articles to describe the available evidence. Results: A total of 413 articles were screened at the title and abstract levels, of which 27 were further assessed with full text for eligibility. Five studies met the inclusion criteria, and data were extracted to summarize study characteristics and findings. The studies were performed across 4 different countries. There were 2 mixed-methods studies (South Africa and Canada), 2 cross-sectional studies (China and United States), and 1 randomized controlled trial (United States). Of these studies, only 2 discussed digital interventions (a text messaging–based intervention to improve spiritual and mental health, and a feasibility study for a mental health app). Other studies had a digital component with minor or unclear spiritual and mental health measures. Overall, there was a lack of consistency in how spiritual and mental health were measured. Conclusions: Few studies have focused on assessing the spiritual and mental health of Gen Z in the digital context, and no research to date has examined a digital spiritual and mental health application among Gen Z. Research is needed to inform the development and evaluation of approaches to address the spiritual and mental health of Gen Z via digital means (eg, mobile apps). %M 38261532 %R 10.2196/48929 %U https://www.i-jmr.org/2024/1/e48929 %U https://doi.org/10.2196/48929 %U http://www.ncbi.nlm.nih.gov/pubmed/38261532 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e51126 %T Reasons for Acceptance or Rejection of Online Record Access Among Patients Affected by a Severe Mental Illness: Mixed Methods Study %A Schwarz,Julian %A Meier-Diedrich,Eva %A Neumann,Katharina %A Heinze,Martin %A Eisenmann,Yvonne %A Thoma,Samuel %+ Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, 15562, Germany, 49 33638 83 5, julian.schwarz@mhb-fontane.de %K open notes %K patient-clinician relations %K electronic health record %K clinical notes %K visit notes %K patient participation %K online record access %K mental illness %K patient portal %K mental health %K qualitative interview %K patient education %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Over the past few years, online record access (ORA) has been established through secure patient portals in various countries, allowing patients to access their health data, including clinical notes (“open notes”). Previous research indicates that ORA in mental health, particularly among patients with severe mental illness (SMI), has been rarely offered. Little is known about the expectations and motivations of patients with SMI when reading what their clinicians share via ORA. Objective: The aim of this study is to explore the reasons why patients with SMI consider or reject ORA and whether sociodemographic characteristics may influence patient decisions. Methods: ORA was offered to randomly selected patients at 3 university outpatient clinics in Brandenburg, Germany, which exclusively treat patients with SMI. Within the framework of a mixed methods evaluation, qualitative interviews were conducted with patients who chose to participate in ORA and those who declined, aiming to explore the underlying reasons for their decisions. The interviews were transcribed and analyzed using thematic analysis. Sociodemographic characteristics of patients were examined using descriptive statistics to identify predictors of acceptance or rejection of ORA. Results: Out of 103 included patients, 58% (n=60) wished to read their clinical notes. The reasons varied, ranging from a desire to engage more actively in their treatment to critically monitoring it and using the accessible data for third-party purposes. Conversely, 42% (n=43) chose not to use ORA, voicing concerns about possibly harming the trustful relationship with their clinicians as well as potential personal distress or uncertainty arising from reading the notes. Practical barriers such as a lack of digital literacy or suspected difficult-to-understand medical language were also named as contributing factors. Correlation analysis revealed that the majority of patients with depressive disorder desired to read the clinical notes (P<.001), while individuals with psychotic disorders showed a higher tendency to decline ORA (P<.05). No significant group differences were observed for other patient groups or characteristics. Conclusions: The adoption of ORA is influenced by a wide range of motivational factors, while patients also present a similar variety of reasons for declining its use. The results emphasize the urgent need for knowledge and patient education regarding factors that may hinder the decision to use ORA, including its practical usage, its application possibilities, and concerns related to data privacy. Further research is needed to explore approaches for adequately preparing individuals with SMI to transition from their inherent interest to active engagement with ORA. Trial Registration: German Clinical Trial Register DRKS00030188; https://drks.de/search/en/trial/DRKS00030188 %M 38315523 %R 10.2196/51126 %U https://mental.jmir.org/2024/1/e51126 %U https://doi.org/10.2196/51126 %U http://www.ncbi.nlm.nih.gov/pubmed/38315523 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e46637 %T Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis %A Fischer-Grote,Linda %A Fössing,Vera %A Aigner,Martin %A Fehrmann,Elisabeth %A Boeckle,Markus %+ Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems, 3500, Austria, 43 6503032923, elisabeth.fehrmann@kl.ac.at %K COVID-19 pandemic %K online/digital mental health intervention %K e-mental health %K anxiety %K social functioning %K depression %K well-being %K psychological distress %K eating disorder %K COVID-19 symptoms %D 2024 %7 5.2.2024 %9 Review %J JMIR Ment Health %G English %X Background: The prevalence of mental illness increased in children, adolescents, and young adults during the COVID-19 pandemic, while at the same time, access to treatment facilities has been restricted, resulting in a need for the quick implementation of remote or online interventions. Objective: This study aimed to give an overview of randomized controlled studies examining remote or online interventions for mental health in children, adolescents, and young adults and to explore the overall effectiveness of these interventions regarding different symptoms. Methods: A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, PsycInfo, Psyndex, Embase, and Google Scholar. A meta-analysis was conducted using a random effects model to calculate overall effect sizes for interventions using standardized mean differences (SMDs) for postintervention scores. Results: We identified 17 articles with 8732 participants in the final sample, and 13 were included in the quantitative analysis. The studies examined different digital interventions for several outcomes, showing better outcomes than the control in some studies. Meta-analyses revealed significant medium overall effects for anxiety (SMD=0.44, 95% CI 0.20 to 0.67) and social functioning (SMD=0.42, 95% CI –0.68 to –0.17) and a large significant effect for depression (SMD=1.31, 95% CI 0.34 to 2.95). In contrast, no significant overall treatment effects for well-being, psychological distress, disordered eating, and COVID-19–related symptoms were found. Conclusions: The qualitative and quantitative analyses of the included studies show promising results regarding the effectiveness of online interventions, especially for symptoms of anxiety and depression and for training of social functioning. However, the effectiveness needs to be further investigated for other groups of symptoms in the future. All in all, more research with high-quality studies is required. %M 38315524 %R 10.2196/46637 %U https://mental.jmir.org/2024/1/e46637 %U https://doi.org/10.2196/46637 %U http://www.ncbi.nlm.nih.gov/pubmed/38315524 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e46116 %T Digital Health Psychosocial Intervention in Adult Patients With Cancer and Their Families: Systematic Review and Meta-Analysis %A Zhang,Yingzi %A Flannery,Marie %A Zhang,Zhihong %A Underhill-Blazey,Meghan %A Bobry,Melanie %A Leblanc,Natalie %A Rodriguez,Darcey %A Zhang,Chen %+ Magnet Program and Nursing Research Department, UT Southwestern Medical Center, 8200 Brookriver Dr, Dallas, TX, 75247, United States, 1 469 291 4808, yingzi.zhang@utsouthwestern.edu %K cancer %K anxiety %K decision-making %K depression %K digital health %K distress %K family %K mental health %K mortality %K psychosocial intervention %K quality of life %D 2024 %7 5.2.2024 %9 Review %J JMIR Cancer %G English %X Background: Patients with cancer and their families often experience significant distress and deterioration in their quality of life. Psychosocial interventions were used to address patients’ and families’ psychosocial needs. Digital technology is increasingly being used to deliver psychosocial interventions to patients with cancer and their families. Objective: A systematic review and meta-analysis were conducted to review the characteristics and effectiveness of digital health interventions on psychosocial outcomes in adult patients with cancer and their family members. Methods: Databases (PubMed, Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, ProQuest Dissertations and Theses Global, and ClinicalTrials.gov) were searched for randomized controlled trials (RCTs) or quasi-experimental studies that tested the effects of a digital intervention on psychosocial outcomes. The Joanna Briggs Institute’s critical appraisal checklists for RCTs and quasi-experimental studies were used to assess quality. Standardized mean differences (ie, Hedges g) were calculated to compare intervention effectiveness. Subgroup analysis was planned to examine the effect of delivery mode, duration of the intervention, type of control, and dosage on outcomes using a random-effects modeling approach. Results: A total of 65 studies involving 10,361 patients (mean 159, SD 166; range 9-803 patients per study) and 1045 caregivers or partners (mean 16, SD 54; range 9-244 caregivers or partners per study) were included in the systematic review. Of these, 32 studies were included in a meta-analysis of the effects of digital health interventions on quality of life, anxiety, depression, distress, and self-efficacy. Overall, the RCT studies’ general quality was mixed (applicable scores: mean 0.61, SD 0.12; range 0.38-0.91). Quasi-experimental studies were generally of moderate to high quality (applicable scores: mean 0.75, SD 0.08; range 0.63-0.89). Psychoeducation and cognitive-behavioral strategies were commonly used. More than half (n=38, 59%) did not identify a conceptual or theoretical framework. Most interventions were delivered through the internet (n=40, 62%). The median number of intervention sessions was 6 (range 1-56). The frequency of the intervention was highly variable, with self-paced (n=26, 40%) being the most common. The median duration was 8 weeks. The meta-analysis results showed that digital psychosocial interventions were effective in improving patients’ quality of life with a small effect size (Hedges g=0.05, 95% CI –0.01 to 0.10; I2=42.7%; P=.01). The interventions effectively reduced anxiety and depression symptoms in patients, as shown by moderate effect sizes on Hospital Anxiety and Depression Scale total scores (Hedges g=–0.72, 95% CI –1.89 to 0.46; I2=97.6%; P<.001). Conclusions: This study demonstrated the effectiveness of digital health interventions on quality of life, anxiety, and depression in patients. Future research with a clear description of the methodology to enhance the ability to perform meta-analysis is needed. Moreover, this study provides preliminary evidence to support the integration of existing digital health psychosocial interventions in clinical practice. Trial Registration: PROSPERO CRD42020189698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=189698 %M 38315546 %R 10.2196/46116 %U https://cancer.jmir.org/2024/1/e46116 %U https://doi.org/10.2196/46116 %U http://www.ncbi.nlm.nih.gov/pubmed/38315546 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50977 %T Patient Satisfaction With a Coach-Guided, Technology-Based Mental Health Treatment: Qualitative Interview Study and Theme Analysis %A Smith,Ashley Helm %A Touchett,Hilary %A Chen,Patricia %A Fletcher,Terri %A Arney,Jennifer %A Hogan,Julianna %A Wassef,Miryam %A Cloitre,Marylene %A Lindsay,Jan A %+ Houston Veteran Affairs Health Services Research and Development Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veteran Affairs Medical Center, 2002 Holcombe Blvd. (152), Houston, TX, 77030, United States, 1 713 794 8601, ashley.smith30@va.gov %K coaching %K digital treatment %K interview %K mental health %K patient satisfaction %K PTSD %K qualitative assessment %K qualitative methods %K sentiment analysis %K technology-based %K telehealth %K trauma %K veterans %K video telehealth %K web-based treatment %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Technology-based mental health interventions address barriers rural veterans face in accessing care, including provider scarcity and distance from the hospital or clinic. webSTAIR is a 10-module, web-based treatment based on Skills Training in Affective and Interpersonal Regulation, designed to treat posttraumatic stress disorder and depression in individuals exposed to trauma. Previous work has demonstrated that webSTAIR is acceptable to participants and effective at reducing symptoms of posttraumatic stress disorder and depression when delivered synchronously or asynchronously (over 5 or 10 sessions). Objective: This study explored factors that lead to greater patient satisfaction with webSTAIR, a web-based, coach-guided intervention. Methods: We analyzed qualitative interview data to identify themes related to patient satisfaction with webSTAIR delivered with synchronous video-based coaching. Results: Four themes emerged from the data: (1) coaching provides accountability and support, (2) self-pacing offers value that meets individual needs, (3) participants like the comfort and convenience of the web-based format, and (4) technical issues were common but not insurmountable. Conclusions: We conclude that participants valued the accountability, flexibility, and convenience of tech-based interventions with video-delivered coaching. %M 38306167 %R 10.2196/50977 %U https://mental.jmir.org/2024/1/e50977 %U https://doi.org/10.2196/50977 %U http://www.ncbi.nlm.nih.gov/pubmed/38306167 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52560 %T Mental Health and Well-Being in Racial or Ethnic Minority Individuals After Using a Faith and Prayer Mobile App (Pray.com): Feasibility and Preliminary Efficacy Trial %A Laird,Breanne %A Zuniga,Sabrina %A Hook,Joshua N %A Van Tongeren,Daryl R %A Joeman,Lynda %A Huberty,Jennifer %+ Pray, Inc, 4607 Lakeview Canyon Rd #456, Westlack Village, CA, 91361, United States, 1 9095574002, breanne.laird@pray.com %K religion %K spirituality %K mobile apps %K mental health %K well-being %K app %K ethnic %K technology %K engagement %K stress %K depression %K anxiety %K quality of life %K spiritual well-being %K racial %K spiritual practices %K spiritual practice %K mobile phone %K mobile health %K mHealth %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research is needed on how faith and prayer apps fit within the values of racial and ethnic minority (REM) groups, as well as whether such apps are effective in promoting mental health and well-being. Objective: This study aims to determine the feasibility and preliminary effectiveness of using the mobile app Pray.com on mental health and well-being among REM participants. Methods: This study was a single-group (N=77), 4-week feasibility trial in REM groups (65/77, 84% Black or African American). Participants were asked to use the Pray.com app at no cost for at least 5 times per week for 5 minutes per day. Participants completed questionnaires at the baseline and postintervention time points. Feasibility questionnaires were only completed at the postintervention time point, including qualitative interviews (n=15). The feasibility questions included acceptability (ie, satisfaction, intent to continue use, perceived appropriateness, and fit within culture), demand (ie, self-reported app use, expressed interest, and perceived demand), and practicality (ie, ease or difficulty of use, ability to use the app, and cost-effectiveness). Frequency and descriptive statistics were used to analyze feasibility outcomes. Changes in dependent variables were analyzed using paired-sample 2-tailed t tests. Partial correlations were conducted to explore the association between app use and outcomes, controlling for baseline scores. Results: Participants reported (54/72, 75% responded with “very likely” or “likely” to the feasibility questions) that they perceived the Pray.com app as acceptable. These findings were supported by qualitative interviews (n=15). Most participants (62/72, 86%) did not meet the app use prescription but expressed interest in using the app in the future and perceived demand for it in their communities. In addition, participants reported that the app was easy to use and perceived it to be inexpensive (US $7.99). Participants reported improved mental health (ie, stress and depressive and anxiety symptoms) and well-being (ie, satisfaction with life, spiritual well-being, religious commitment, and racial or ethnic identity development) at postintervention despite relatively low average levels and high variability of app use (average total of 45.83, SD 111.90 min over the course of the study). Greater app use was significantly associated with improvements in mental health and spiritual well-being. However, app use and study methodology limitations suggest that the study results may not accurately capture the full impact of Pray.com use. Conclusions: This is the first study to assess the feasibility of a faith and prayer app for mental health and well-being in a sample of REM individuals. Our findings suggest that the use of a faith and prayer app (ie, Pray.com) could be feasible and significantly impactful for the improvement of mental health symptoms and well-being in REM individuals and their communities, especially Black and African American individuals with a Christian affiliation. Further research is warranted. %M 38306173 %R 10.2196/52560 %U https://formative.jmir.org/2024/1/e52560 %U https://doi.org/10.2196/52560 %U http://www.ncbi.nlm.nih.gov/pubmed/38306173 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51066 %T Acceptability and Utility of a Digital Group Intervention to Prevent Perinatal Depression in Youths via Interactive Maternal Group for Information and Emotional Support (IMAGINE): Pilot Cohort Study %A Ronen,Keshet %A Gewali,Anupa %A Dachelet,Kristin %A White,Erica %A Jean-Baptiste,Marimirca %A Evans,Yolanda N %A Unger,Jennifer A %A Tandon,S Darius %A Bhat,Amritha %+ Department of Global Health, University of Washington, 3980 15th Avenue North East, Seattle, WA, 98195, United States, 1 2066854363, keshet@uw.edu %K perinatal depression %K youth %K mHealth %K digital health %K acceptability %K utility %K depression %K pilot study %K pregnancy %K postpartum %K prevention %K cognitive behavioral therapy %K psychoeducation %K mixed methods %K manage %K mood %K mobile phone %D 2024 %7 2.2.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Perinatal depression (depression during pregnancy or the first year postpartum) affects 10%-25% of perinatal individuals, with a higher risk among youths aged <25 years. The Mothers and Babies Course (MB) is an evidence-based intervention for the prevention of perinatal depression, grounded in cognitive behavioral therapy, attachment theory, and psychoeducation. Objective: We developed a digital adaptation of MB (Interactive Maternal Group for Information and Emotional Support [IMAGINE]) and evaluated it in a pre-post mixed methods pilot among young perinatal people in the United States. Methods: IMAGINE was a structured digital group of up to 7 participants, with scheduled MB content and open discussion for 12 weeks, facilitated by a social worker. Scheduled content included asynchronous SMS text messages, graphics, prerecorded videos, mood polls, and optional weekly synchronous video calls. Eligible participants were pregnant or ≤80 days postpartum, aged 16 to 24 years, had access to a smartphone, spoke English, and had a Patient Health Questionnaire score <10. Participants were recruited throughout the United States from August 2020 to January 2021 through paid social media ads, in-person outreach at clinics, and respondent-driven sampling. Participants completed quantitative questionnaires at enrollment and 3 months, and qualitative interviews at 3 months. We determined uptake, acceptability (by Acceptability of Intervention Measure score), and utility (by use of cognitive behavioral therapy skills). We compared depression symptoms (by Patient Health Questionnaire score), social support (by abbreviated Social Support Behavior score), and perceived stress (by Perceived Stress Score) between enrollment and follow-up by paired 2-tailed t test. Results: Among 68 individuals who contacted this study, 22 were screened, 13 were eligible, and 10 enrolled, for an uptake of 76.9%. Furthermore, 4 (40%) participants were pregnant at enrollment. Participants had a median age of 17.9 (IQR 17.4-21.7) years, 6 (67%) identified as Black, 5 (56%) Latinx, and 6 (67%) using Medicaid health insurance. Further, 9 (90%) participants completed follow-up. Among these, the mean acceptability score was 4.3 out of 5 (SD 0.6) and all participants said they would recommend IMAGINE to a friend. Participants reported using a median of 7 of 11 skills (IQR 5-7 skills) at least half the days. We found no significant changes in depression symptoms, perceived stress, or social support. Qualitatively, participants reported one-to-one support from the facilitator, connection with other parents, and regular mood reflection were especially helpful aspects of the intervention. Additionally, participants reported that the intervention normalized their mental health challenges, improved their ability to manage their mood, and increased their openness to mental health care. Conclusions: This pilot study provides promising evidence of the acceptability and utility of IMAGINE among perinatal youths. Our study’s small sample size did not detect changes in clinical outcomes; our findings suggest IMAGINE warrants larger-scale evaluation. %M 38306159 %R 10.2196/51066 %U https://formative.jmir.org/2024/1/e51066 %U https://doi.org/10.2196/51066 %U http://www.ncbi.nlm.nih.gov/pubmed/38306159 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e42976 %T The Evaluation of the GET.ON Nationwide Web-Only Treatment Service for Depression- and Stress-Related Symptoms: Naturalistic Trial %A Etzelmueller,Anne %A Heber,Elena %A Horvath,Hanne %A Radkovsky,Anna %A Lehr,Dirk %A Ebert,David Daniel %+ Department of Sports and Health Sciences, Professorship Psychology and Digital Mental Health Care, Technical University of Munich, Georg-Brauchle-Ring 60, Munich, 80992, Germany, 49 621345167, anneetzelmueller@gmail.com %K depression %K stress %K digital %K internet %K effectiveness %K routine care %D 2024 %7 1.2.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: GET.ON (HelloBetter) treatment interventions have been shown to be efficacious in multiple randomized controlled trials. Objective: This study evaluated the effectiveness of 2 GET.ON interventions, GET.ON Mood Enhancer and GET.ON Stress, in a national digital mental health service implemented across Germany. Methods: Following an initial web-based questionnaire, participants were allocated to either intervention based on their baseline symptom severity and personal choice and received a semistandardized guided, feedback-on-demand guided, or self-guided version of the treatment. Uncontrolled routine care data from 851 participants were analyzed using a pretest-posttest design. Half of the participants (461/851, 54.2%) were allocated to the stress intervention (189/461, 41% semistandardized; 240/461, 52% feedback on demand; and 32/461, 6.9% self-guided), and almost all participants in the mood intervention (349/352, 99.2%) received semistandardized guidance. Results: Results on depression-related symptom severity indicated a reduction in reported symptoms, with a large effect size of d=−0.92 (95% CI −1.21 to −0.63). Results on perceived stress and insomnia indicated a reduction in symptom severity, with large effect sizes of d=1.02 (95% CI −1.46 to −0.58) and d=−0.75 (95% CI −1.10 to −0.40), respectively. A small percentage of participants experienced deterioration in depression-related symptoms (11/289, 3.8%), perceived stress (6/296, 2%), and insomnia (5/252, 2%). After completing treatment, 51.9% (150/289) of participants showed a clinically reliable change in depression-related symptoms, whereas 20.4% (59/289) achieved a close to symptom-free status. Similar improvements were observed in perceived stress and insomnia severity. Guidance moderated the effectiveness of and adherence to the interventions in reducing depressive symptom severity. Effect sizes on depression-related symptom severity were d=−1.20 (95% CI −1.45 to −0.93) for the semistandardized group, d=−0.36 (95% CI −0.68 to −0.04) for the feedback-on-demand group, and d=−0.83 (95% CI −1.03 to −0.63) for the self-guided group. Furthermore, 47.6% (405/851) of the participants completed all modules of the intervention. Participant satisfaction was high across all patient groups and both interventions; 89.3% (242/271) of participants would recommend it to a friend in need of similar help. Limitations include the assignment to treatments and guidance formats based on symptom severity. Furthermore, part of the differences in symptom change between groups must be assumed to be due to this baseline difference in the measures. Conclusions: Future digital health implementation and routine care research should focus on monitoring symptom deterioration and other negative effects, as well as possible predictors of deterioration and the investigation of individual patient trajectories. In conclusion, this study supports the effectiveness of tailored digital mental health services in routine care for depression- and stress-related symptoms in Germany. The results highlight the importance of guidance in delivering internet-based cognitive behavioral therapy interventions and provide further evidence for its potential delivered as web-only solutions for increasing access to and use of psychological treatments. %M 38300701 %R 10.2196/42976 %U https://www.jmir.org/2024/1/e42976 %U https://doi.org/10.2196/42976 %U http://www.ncbi.nlm.nih.gov/pubmed/38300701 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54253 %T Improvements in Adolescents’ Disordered Eating Behaviors in a Collaborative Care Digital Mental Health Intervention: Retrospective Observational Study %A Huffman,Landry Goodgame %A Lawrence-Sidebottom,Darian %A Beam,Aislinn Brenna %A Parikh,Amit %A Guerra,Rachael %A Roots,Monika %A Huberty,Jennifer %+ Bend Health Inc, 2810 Marshall Ct, Madison, WI, 53705, United States, 1 8005160975, darian.lawrence@bendhealth.com %K behavioral care %K mental health %K web-based coaching %K web-based therapy %K eating disorders %K eating %K anorexia %K coach %K coaching %K pediatric %K pediatrics %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K digital mental health intervention %K DMHI %K collaborative %K digital health %D 2024 %7 31.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people today are exhibiting increasing rates of disordered eating behaviors, as well as eating disorders (EDs), alongside other mental and behavioral problems such as anxiety and depression. However, limited access to mental health care means that EDs, disordered eating behaviors, and comorbid mental health problems are often underdiagnosed and undertreated. Digital mental health interventions (DMHIs) offer accessible and scalable alternatives to traditional treatment modalities, but their effectiveness has not been well established among adolescents with EDs and disordered eating behaviors. Objective: This study uses data from a collaborative care pediatric DMHI to determine whether participation in a DMHI is associated with a reduction in adolescents’ disordered eating behaviors. Methods: Adolescent members in care with Bend Health Inc completed the SCOFF questionnaire at baseline (before the start of care) and approximately every month during care to assess disordered eating behaviors. They also completed assessments of mental health symptoms at baseline. Member characteristics, mental health symptoms, and disordered eating behaviors of adolescents with elevated SCOFF scores at baseline (before the start of care) were compared to those of adolescents with nonelevated SCOFF scores at baseline. Members participated in web-based coaching or therapy sessions throughout the duration of mental health care. Results: Compared to adolescents with nonelevated SCOFF scores (n=520), adolescents with elevated SCOFF scores (n=169) were predominantly female and exhibited higher rates of elevated anxiety and depressive symptoms. SCOFF scores decreased over time in care with the DMHI for 61.4% (n=70) of adolescents with elevated SCOFF scores, and each additional month of participation was associated with greater improvements in disordered eating behaviors (F1,233=72.82; P<.001). Conclusions: Our findings offer promising preliminary evidence that participation in mental health care with a collaborative care DMHI may be beneficial in the reduction of disordered eating symptoms in adolescents, including those who are experiencing comorbid anxiety and depressive symptoms. %M 38294855 %R 10.2196/54253 %U https://formative.jmir.org/2024/1/e54253 %U https://doi.org/10.2196/54253 %U http://www.ncbi.nlm.nih.gov/pubmed/38294855 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51069 %T Efficacy of ChatGPT in Cantonese Sentiment Analysis: Comparative Study %A Fu,Ziru %A Hsu,Yu Cheng %A Chan,Christian S %A Lau,Chaak Ming %A Liu,Joyce %A Yip,Paul Siu Fai %+ The Hong Kong Jockey Club Centre for Suicide Research and Prevention, Faculty of Social Sciences, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong SAR, China (Hong Kong), 852 28315232, sfpyip@hku.hk %K Cantonese %K ChatGPT %K counseling %K natural language processing %K NLP %K sentiment analysis %D 2024 %7 30.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Sentiment analysis is a significant yet difficult task in natural language processing. The linguistic peculiarities of Cantonese, including its high similarity with Standard Chinese, its grammatical and lexical uniqueness, and its colloquialism and multilingualism, make it different from other languages and pose additional challenges to sentiment analysis. Recent advances in models such as ChatGPT offer potential viable solutions. Objective: This study investigated the efficacy of GPT-3.5 and GPT-4 in Cantonese sentiment analysis in the context of web-based counseling and compared their performance with other mainstream methods, including lexicon-based methods and machine learning approaches. Methods: We analyzed transcripts from a web-based, text-based counseling service in Hong Kong, including a total of 131 individual counseling sessions and 6169 messages between counselors and help-seekers. First, a codebook was developed for human annotation. A simple prompt (“Is the sentiment of this Cantonese text positive, neutral, or negative? Respond with the sentiment label only.”) was then given to GPT-3.5 and GPT-4 to label each message’s sentiment. GPT-3.5 and GPT-4’s performance was compared with a lexicon-based method and 3 state-of-the-art models, including linear regression, support vector machines, and long short-term memory neural networks. Results: Our findings revealed ChatGPT’s remarkable accuracy in sentiment classification, with GPT-3.5 and GPT-4, respectively, achieving 92.1% (5682/6169) and 95.3% (5880/6169) accuracy in identifying positive, neutral, and negative sentiment, thereby outperforming the traditional lexicon-based method, which had an accuracy of 37.2% (2295/6169), and the 3 machine learning models, which had accuracies ranging from 66% (4072/6169) to 70.9% (4374/6169). Conclusions: Among many text analysis techniques, ChatGPT demonstrates superior accuracy and emerges as a promising tool for Cantonese sentiment analysis. This study also highlights ChatGPT’s applicability in real-world scenarios, such as monitoring the quality of text-based counseling services and detecting message-level sentiments in vivo. The insights derived from this study pave the way for further exploration into the capabilities of ChatGPT in the context of underresourced languages and specialized domains like psychotherapy and natural language processing. %M 38289662 %R 10.2196/51069 %U https://www.jmir.org/2024/1/e51069 %U https://doi.org/10.2196/51069 %U http://www.ncbi.nlm.nih.gov/pubmed/38289662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54132 %T Web-Based Mindfulness Meditation as an Adjunct to Internet-Delivered Cognitive Behavioral Therapy for Public Safety Personnel: Mixed Methods Feasibility Evaluation Study %A Landry,Caeleigh A %A McCall,Hugh C %A Beahm,Janine D %A Titov,Nickolai %A Dear,Blake %A Carleton,R Nicholas %A Hadjistavropoulos,Heather D %+ Department of Psychology, University of Regina, Administration-Humanities, AH 345, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada, 1 306 585 5133, heather.hadjistavropoulos@uregina.ca %K public safety personnel %K PSP %K internet therapy %K mindfulness %K meditation %K internet-delivered cognitive behavioral therapy %K iCBT %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Public safety personnel (PSP) are individuals who work to ensure the safety and security of communities (eg, correctional workers, firefighters, paramedics, and police officers). PSP have a high risk of developing mental disorders and face unique barriers to traditional mental health treatments. The PSP Wellbeing Course is a transdiagnostic, internet-delivered cognitive behavioral therapy (iCBT) course tailored to assist PSP with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). The initial course outcomes are promising, but some clients report some challenges with learning skills and recommend adding additional resources. Mindfulness meditations, which help people to experience the world and their reactions to the world in open and nonjudgmental ways, may complement the existing PSP Wellbeing Course. Objective: This study aims to examine the feasibility of mindfulness meditations in iCBT tailored for PSP. Information was gathered to evaluate engagement and client experiences with mindfulness meditations, symptom change, and the relationship between mindfulness meditation use and symptom change. Methods: A mixed methods study was conducted on PSP enrolled in the PSP Wellbeing Course who were offered 5 mindfulness meditations during the program (ie, 1/lesson). Clients completed questionnaires on depression, anxiety, PTSD, anger, insomnia, resilience, and mindfulness at pretreatment and at 8 weeks; an 8-week treatment satisfaction questionnaire; and brief weekly measures of mindfulness meditation engagement. We used paired sample t tests (2-tailed) to assess changes in outcomes over time and partial correlations to assess whether mindfulness meditation use predicted outcomes at posttreatment. A total of 12 clients were interviewed about their perceptions of the mindfulness meditations, and interviews were analyzed using directed content analysis. Results: Among the 40 clients enrolled, 27 (68%) reported using the mindfulness meditations, practicing for an average of 4.8 (SD 8.1) minutes each week. Most interviewees described the mindfulness meditations as beneficial but also reported challenges, such as discomfort while sitting with their feelings. Clients provided suggestions for better integration of mindfulness into iCBT. Overall, clients who completed the PSP Wellbeing Course with mindfulness meditations experienced statistically significant improvements in symptoms of anxiety (P=.001), depression (P=.001), PTSD (P=.001), and anger (P=.001) but not insomnia (P=.02). Clients also experienced improvements in resilience (P=.01) and mindfulness (P=.001). Self-reported time spent meditating was not associated with changes in symptoms over time. Conclusions: This study provides new insight into the integration of mindfulness meditations with iCBT for PSP. It demonstrates the partial feasibility of adding mindfulness meditations to iCBT, revealing that some, but not all, PSP engaged with the meditations and reported benefits. PSP reported using the mindfulness meditations inconsistently and described challenges with the meditations. Improvements can be made to better integrate mindfulness meditation into iCBT, including offering mindfulness meditation as an optional resource, providing more psychoeducation on managing challenges, and offering shorter meditations. %M 38289655 %R 10.2196/54132 %U https://formative.jmir.org/2024/1/e54132 %U https://doi.org/10.2196/54132 %U http://www.ncbi.nlm.nih.gov/pubmed/38289655 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51245 %T Addressing Cyberscams and Acquired Brain Injury (“I Desperately Need to Know What to Do”): Qualitative Exploration of Clinicians’ and Service Providers’ Perspectives %A Chew,Kimberly Ann %A Ponsford,Jennie %A Gould,Kate Rachel %+ Monash-Epworth Rehabilitation Research Centre, 185-187 Hoddle Street, Richmond, Victoria, 3121, Australia, 61 03 9426 8923, kimberly.chew@monash.edu %K cyberscam %K cyberscams %K fraud %K cybercrime %K cybersafety %K brain injury %K disability %K neurorehabilitation %K interventions %K treatment %K qualitative %D 2024 %7 29.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: People with acquired brain injury (ABI) may be more susceptible to scams owing to postinjury cognitive and psychosocial consequences. Cyberscams result in financial loss and debilitating psychological impacts such as shame and mistrust, interference with neurorehabilitation, and reduced independence. Despite these significant consequences, there are no psychological treatments to support cyberscam survivors. There is limited evidence regarding how the current workforce is addressing post-ABI cyberscams. Objective: This study aims to understand the perspectives and needs of clinicians and service providers in addressing post-ABI cyberscams. Methods: Overall, 20 multidisciplinary clinicians and service providers were recruited through purposive sampling across Australia. Semistructured interviews explored post-ABI scam experiences and vulnerabilities, treatments and their efficacy, and recommendations for future cybersafety recovery interventions. Reflexive thematic analysis was used. Results: In total, 8 themes encompassing a biopsychosocial understanding of scam vulnerabilities and impacts were identified: “genuine lack of awareness: cognitive-executive difficulties”; “not coping with the loss of it all”; “needing trust and connection”; “strong reactions of trusted others”; “nothing structured to do”; “financial stress and independence”; “cyberability”; and “scammer persuasion.” Each theme informed clinical recommendations including the need to provide psychological and cognitive support, enhance financial and cybersafety skills, promote meaningful social engagement, and foster collaboration between families and clinical support teams. Conclusions: The multifaceted range of scam vulnerabilities and impacts highlighted the need for individualized, comprehensive, and targeted treatments using a biopsychosocial approach to enable cyberscam recovery among people with ABI. These findings will guide the development of a co-designed intervention. %M 38285489 %R 10.2196/51245 %U https://www.jmir.org/2024/1/e51245 %U https://doi.org/10.2196/51245 %U http://www.ncbi.nlm.nih.gov/pubmed/38285489 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48880 %T Acceptance of a Web-Based Intervention in Individuals Who Committed Sexual Offenses Against Children: Cross-Sectional Study %A Schröder,Sonja %A Buntrock,Claudia %A Neumann,Louisa %A Müller,Jürgen L %A Fromberger,Peter %+ Clinic for Psychiatry and Psychotherapy – Forensic Psychiatry, University Medical Center Göttingen, Rosdorfer Weg 70, Göttingen, 37081, Germany, 49 5514022114, sonja.schroeder@med.uni-goettingen.de %K mHealth %K web-based intervention %K acceptance %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K sexual offenses against children %K child abuse %K child pornography %K children %K sexual offense %K cross-sectional study %K community %K anxiety %K psychiatry %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals who have committed sexual offenses against children often have difficulties finding treatment, despite its potential effectiveness. Although the development of web-based interventions could enhance therapeutic supply, up to now the acceptance thereof among this target group is unknown. Objective: For the first time, this study assesses the acceptance of a web-based intervention among individuals who committed sexual offenses against children and analyzes variables that predict acceptance. Following the Unified Theory of Acceptance and Use of Technology (UTAUT), it is assumed that acceptance of web-based interventions in individuals who have committed sexual offenses against children follows the same mechanisms as for individuals in general psychiatry. Methods: This cross-sectional study is based on the data from an ongoing clinical trial (@myTabu) evaluating the effectiveness of a web-based intervention in individuals who committed sexual offenses against children (N=113). Acceptance level was measured using a questionnaire based on the UTAUT and modified for the target group. Furthermore, predictors of acceptance from the UTAUT (performance expectancy, effort expectancy, and social influence [SI]), attitudes toward web-based interventions, and internet anxiety were assessed at baseline. Results: Most participants (61.1%, 69/113), reported high acceptance, while 36.3% (41/113) of them indicated moderate acceptance, and 2.7% (3/113) of them expressed low acceptance. In a linear regression model, the predictors explained 41.2% of the variance (F11,101=9.055; P=.01). Attitudes toward web-based interventions (B=0.398, 95% CI 0.16-0.64; P=.001) and SI (B=0.183, 95% CI 0.03-0.38; P=.04) significantly predicted acceptance. Post hoc explorative analysis showed that the participants’ belief that people close to them would recommend the use of a web-based intervention is a predictor of acceptance. In contrast, the belief that their community supervisor would recommend the use thereof was not predictive in this respect. Conclusions: For the participants of this study, we identified high acceptance of web-based interventions for the majority of participants. SI and the participants’ attitudes toward web-based interventions were important in predicting acceptance. Trial Registration: German Clinical Trial Registration (DRKS, Deutsches Register Klinischer Studien) DRKS 00021256; https://drks.de/search/de/trial/DRKS00021256 %M 38277200 %R 10.2196/48880 %U https://formative.jmir.org/2024/1/e48880 %U https://doi.org/10.2196/48880 %U http://www.ncbi.nlm.nih.gov/pubmed/38277200 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44029 %T Testing a Behavioral Activation Gaming App for Depression During Pregnancy: Multimethod Pilot Study %A Vanderkruik,Rachel C %A Ferguson,Craig %A Kobylski,Lauren A %A Locascio,Joseph J %A Hamlett,Gabriella E %A Killenberg,Parker C %A Lewis,Robert %A Jones,Noah %A Rossa,Ella T %A Dineen,Hannah %A Picard,Rosalind %A Cohen,Lee S %+ Center for Women's Mental Health, Massachusetts General Hospital, 185 Cambridge St, Ste 2200, Boston, MA, 02114, United States, 1 781 691 9071, rvanderkruik@mgh.harvard.edu %K perinatal depression %K pregnancy %K behavioral activation %K mobile app %K digital intervention %K mobile phone %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression during pregnancy is increasingly recognized as a worldwide public health problem. If untreated, there can be detrimental outcomes for the mother and child. Anxiety is also often comorbid with depression. Although effective treatments exist, most women do not receive treatment. Technology is a mechanism to increase access to and engagement in mental health services. Objective: The Guardians is a mobile app, grounded in behavioral activation principles, which seeks to leverage mobile game mechanics and in-game rewards to encourage user engagement. This study seeks to assess app satisfaction and engagement and to explore changes in clinical symptoms of depression and anxiety among a sample of pregnant women with elevated depressive symptoms. Methods: This multimethod pilot test consisted of a single-arm, proof-of-concept trial to examine the feasibility and acceptability of The Guardians among a pregnant sample with depression (N=18). Participation included two web-based study visits: (1) a baseline assessment to collect demographic and obstetric information and to assess clinical symptoms and (2) an exit interview to administer follow-up measures and explore user experience. Participants completed biweekly questionnaires (ie, Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7) during the trial to assess depression and anxiety symptom severity. App satisfaction was measured using 2 self-report scales (ie, Mobile Application Rating Scale and Player Experience of Needs Satisfaction scale). Engagement with The Guardians was captured using game interaction metric data. We used backward-eliminated mixed effects longitudinal models to examine the effects of app engagement and satisfaction and length of time in the study on symptoms of depression and anxiety. Content analysis was conducted on qualitative data from exit interviews. Results: The 15-day and 30-day overall app retention rates were 26.6% and 15.1%, respectively. Mixed effects models found significant negative main effects of week in study (β=−.35; t61=−3.05; P=.003), number of activities completed (β=−.12; t61=−2.05; P=.04), days played (β=−.12; t58=−2.9; P=.005), and satisfaction, according to the Mobile Application Rating Scale (β=−3.05; t45=−2.19; P=.03) on depressive symptoms. We have reported about similar analyses for anxiety. There is preliminary evidence suggesting harder activities are associated with greater mood improvement than easier activities. Qualitative content analysis resulted in feedback falling under the following themes: activities, app design, engagement, fit of the app with lifestyle, perceived impact of the app on mood, and suggestions for app modifications. Conclusions: Preliminary results from this multimethod study of The Guardians indicate feasibility and acceptability among pregnant women with depression. Retention and engagement levels were more than double those of previous public mental health apps, and use of the app was associated with significant decrease in depressive symptom scores over the 10-week trial. The Guardians shows promise as an effective and scalable digital intervention to support women experiencing depression. %M 38277191 %R 10.2196/44029 %U https://formative.jmir.org/2024/1/e44029 %U https://doi.org/10.2196/44029 %U http://www.ncbi.nlm.nih.gov/pubmed/38277191 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50132 %T Development and Evaluation of a Smartphone-Based Chatbot Coach to Facilitate a Balanced Lifestyle in Individuals With Headaches (BalanceUP App): Randomized Controlled Trial %A Ulrich,Sandra %A Gantenbein,Andreas R %A Zuber,Viktor %A Von Wyl,Agnes %A Kowatsch,Tobias %A Künzli,Hansjörg %+ School of Applied Psychology, Zurich University of Applied Sciences, Pfingstweidstrasse 96, 2, Zurich, 8005, Switzerland, 41 58 934 ext 8451, sandra.ulrich@zhaw.ch %K chatbot %K mobile health %K mHealth %K smartphone %K headache management %K psychoeducation %K behavior change %K stress management %K mental well-being %K lifestyle %K mindfulness %K relaxation %K mobile phone %D 2024 %7 24.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Primary headaches, including migraine and tension-type headaches, are widespread and have a social, physical, mental, and economic impact. Among the key components of treatment are behavior interventions such as lifestyle modification. Scalable conversational agents (CAs) have the potential to deliver behavior interventions at a low threshold. To our knowledge, there is no evidence of behavioral interventions delivered by CAs for the treatment of headaches. Objective: This study has 2 aims. The first aim was to develop and test a smartphone-based coaching intervention (BalanceUP) for people experiencing frequent headaches, delivered by a CA and designed to improve mental well-being using various behavior change techniques. The second aim was to evaluate the effectiveness of BalanceUP by comparing the intervention and waitlist control groups and assess the engagement and acceptance of participants using BalanceUP. Methods: In an unblinded randomized controlled trial, adults with frequent headaches were recruited on the web and in collaboration with experts and allocated to either a CA intervention (BalanceUP) or a control condition. The effects of the treatment on changes in the primary outcome of the study, that is, mental well-being (as measured by the Patient Health Questionnaire Anxiety and Depression Scale), and secondary outcomes (eg, psychosomatic symptoms, stress, headache-related self-efficacy, intention to change behavior, presenteeism and absenteeism, and pain coping) were analyzed using linear mixed models and Cohen d. Primary and secondary outcomes were self-assessed before and after the intervention, and acceptance was assessed after the intervention. Engagement was measured during the intervention using self-reports and usage data. Results: A total of 198 participants (mean age 38.7, SD 12.14 y; n=172, 86.9% women) participated in the study (intervention group: n=110; waitlist control group: n=88). After the intervention, the intention-to-treat analysis revealed evidence for improved well-being (treatment: β estimate=–3.28, 95% CI –5.07 to –1.48) with moderate between-group effects (Cohen d=–0.66, 95% CI –0.99 to –0.33) in favor of the intervention group. We also found evidence of reduced somatic symptoms, perceived stress, and absenteeism and presenteeism, as well as improved headache management self-efficacy, application of behavior change techniques, and pain coping skills, with effects ranging from medium to large (Cohen d=0.43-1.05). Overall, 64.8% (118/182) of the participants used coaching as intended by engaging throughout the coaching and completing the outro. Conclusions: BalanceUP was well accepted, and the results suggest that coaching delivered by a CA can be effective in reducing the burden of people who experience headaches by improving their well-being. Trial Registration: German Clinical Trials Register DRKS00017422; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00017422 %M 38265863 %R 10.2196/50132 %U https://www.jmir.org/2024/1/e50132 %U https://doi.org/10.2196/50132 %U http://www.ncbi.nlm.nih.gov/pubmed/38265863 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49577 %T Health Care Professionals’ Views on the Use of Passive Sensing, AI, and Machine Learning in Mental Health Care: Systematic Review With Meta-Synthesis %A Rogan,Jessica %A Bucci,Sandra %A Firth,Joseph %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences, The University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom, 44 161 306 0422, sandra.bucci@manchester.ac.uk %K artificial intelligence %K machine learning %K passive sensing %K mental health care %K clinicians %K views %K meta-synthesis %K review %K mental health %K health care %K health care professionals %K psychology %K psychiatry %K mental health professionals %K mobile phone %D 2024 %7 23.1.2024 %9 Review %J JMIR Ment Health %G English %X Background: Mental health difficulties are highly prevalent worldwide. Passive sensing technologies and applied artificial intelligence (AI) methods can provide an innovative means of supporting the management of mental health problems and enhancing the quality of care. However, the views of stakeholders are important in understanding the potential barriers to and facilitators of their implementation. Objective: This study aims to review, critically appraise, and synthesize qualitative findings relating to the views of mental health care professionals on the use of passive sensing and AI in mental health care. Methods: A systematic search of qualitative studies was performed using 4 databases. A meta-synthesis approach was used, whereby studies were analyzed using an inductive thematic analysis approach within a critical realist epistemological framework. Results: Overall, 10 studies met the eligibility criteria. The 3 main themes were uses of passive sensing and AI in clinical practice, barriers to and facilitators of use in practice, and consequences for service users. A total of 5 subthemes were identified: barriers, facilitators, empowerment, risk to well-being, and data privacy and protection issues. Conclusions: Although clinicians are open-minded about the use of passive sensing and AI in mental health care, important factors to consider are service user well-being, clinician workloads, and therapeutic relationships. Service users and clinicians must be involved in the development of digital technologies and systems to ensure ease of use. The development of, and training in, clear policies and guidelines on the use of passive sensing and AI in mental health care, including risk management and data security procedures, will also be key to facilitating clinician engagement. The means for clinicians and service users to provide feedback on how the use of passive sensing and AI in practice is being received should also be considered. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022331698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331698 %M 38261403 %R 10.2196/49577 %U https://mental.jmir.org/2024/1/e49577 %U https://doi.org/10.2196/49577 %U http://www.ncbi.nlm.nih.gov/pubmed/38261403 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52816 %T eHealth in the Management of Depressive Episodes in Catalonia’s Primary Care From 2017 to 2022: Retrospective Observational Study %A Fuster-Casanovas,Aïna %A Miró Catalina,Queralt %A Vidal-Alaball,Josep %A Escalé-Besa,Anna %A Carrión,Carme %+ Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Carrer Pica d'Estats, 13-15, Sant Fruitós de Bages, 08272, Spain, 34 936 93 00 40, jvidal.cc.ics@gencat.cat %K eHealth %K depression %K depressive disorder %K primary health care %K mental health patient %K patient %K patients %K healthcare system %K digital transformation %K mental disorder %K mental disorders %K diagnostic %K clinical practice %K clinical practices %K retrospective %K observational %K regression %K digital tool %K digital tools %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: The reasons for mental health consultations are becoming increasingly relevant in primary care. The Catalan health care system is undergoing a process of digital transformation, where eHealth is becoming increasingly relevant in routine clinical practice. Objective: This study aimed to analyze the approach to depressive episodes and the role of eHealth in the Catalan health care system from 2017 to 2022. Methods: A retrospective observational study was conducted on diagnostic codes related to depressive episodes and mood disorders between 2017 and 2022 using data from the Catalan Institute of Health. The sociodemographic evolution and prevalence of depression and mood disorders in Catalonia were analyzed between 2017 and 2022. Sociodemographic variables were analyzed using absolute frequency and percentage. The prevalence of depressive episodes was calculated, highlighting the year-to-year changes. The use of eHealth for related consultations was assessed by comparing the percentages of eHealth and face-to-face consultations. A comparison of sociodemographic variables based on attendance type was conducted. Additionally, a logistic regression model was used to explore factors influencing face-to-face attendance. The analysis used R software (version 4.2.1), with all differences examined using 95% CIs. Results: From 2017 to 2022, there was an 86.6% increase in the prevalence of depression and mood disorders, with women consistently more affected (20,950/31,197, 67.2% in 2017 and 22,078/33,169, 66.6% in 2022). In 2022, a significant rise in depression diagnoses was observed in rural areas (difference 0.71%, 95% CI 0.04%-1.43%), contrasting with a significant decrease in urban settings (difference –0.7%, 95% CI –1.35% to –0.05%). There was a significant increase in antidepressant use in 2022 compared to 2017 (difference 2.4%, 95% CI 1.87%-3.06%) and the proportion of eHealth visits rose from 4.34% (1240/28,561) in 2017 to 26.3% (8501/32,267) in 2022. Logistic regression analysis indicated that men (odds ratio [OR] 1.06, 95% CI 1.04-1.09) and younger individuals had a higher likelihood of eHealth consultations in 2022. Furthermore, individuals using eHealth consultations were more likely to use antidepressants (OR 1.54, 95% CI 1.50-1.57) and anxiolytics (OR 1.06, 95% CI 1.03-1.09). Conclusions: The prevalence of depression in Catalonia has significantly increased in the last 6 years, likely influenced by the COVID-19 pandemic. Despite ongoing digital transformation since 2011, eHealth usage remained limited as of 2017. During the lockdown period, eHealth accounted for nearly half of all health care consultations, representing a quarter of consultations by 2022. In the immediate aftermath of the COVID-19 pandemic, emerging evidence suggests a significant role of eHealth in managing depression-related consultations, along with an apparent likelihood of patients being prescribed antidepressants and anxiolytics. Further research is needed to understand the long-term impact of eHealth on diagnostic practices and medication use. %M 38236631 %R 10.2196/52816 %U https://mental.jmir.org/2024/1/e52816 %U https://doi.org/10.2196/52816 %U http://www.ncbi.nlm.nih.gov/pubmed/38236631 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48175 %T Information and Communication Technology for Managing Social Isolation and Loneliness Among People Living With Parkinson Disease: Qualitative Study of Barriers and Facilitators %A Thangavel,Gomathi %A Memedi,Mevludin %A Hedström,Karin %+ Centre for Empirical Research on Information Systems, Örebro University School of Business, Fakultetsgatan 1, Örebro, 70281, Sweden, 46 19302471, gomathi.thangavel@oru.se %K social isolation %K loneliness %K Parkinson disease %K ICT %K information and communication technology %D 2024 %7 17.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Parkinson disease (PD) is a complex, noncurable, and progressive neurological disease affecting different areas of the human nervous system. PD is associated with both motor and nonmotor symptoms, which negatively affect patients’ quality of life and may cause changes in socialization such as intentional social withdrawal. This may further lead to social isolation and loneliness. The use of information and communication technology (ICT) plays an important role in managing social isolation and loneliness. Currently, there is a lack of research focusing on designing and developing ICT solutions that specifically address social isolation and loneliness among people living with PD. Objective: This study addresses this gap by investigating barriers and social needs in the context of social isolation, loneliness, and technology use among people living with PD. The insights gained can inform the development of effective ICT solutions, which can address social isolation and loneliness and improve the quality of life for people living with PD. Methods: A qualitative study with 2 phases of data collection were conducted. During the first phase, 9 health care professionals and 16 people living with PD were interviewed to understand how PD affects social life and technology use. During the second phase, 2 focus groups were conducted with 4 people living with PD in each group to gather insights into their needs and identify ways to manage social isolation and loneliness. Thematic analysis was used to analyze both data sets and identify key themes. Results: The results showed that the barriers experienced by people living with PD due to PD such as “fatigue,” “psychological conditions,” “social stigma,” and “medication side effects” affect their social life. People living with PD also experience difficulties using a keyboard and mouse, remembering passwords, and navigating complex applications due to their PD-related physical and cognitive limitations. To manage their social isolation and loneliness, people living with PD suggested having a simple and easy-to-use solution, allowing them to participate in a digital community based on their interests, communicate with others, and receive recommendations for social events. Conclusions: The new ICT solutions focusing on social isolation and loneliness among people living with PD should consider the barriers restricting user’s social activities and technology use. Given the wide range of needs and barriers experienced by people living with PD, it is more suitable to adopt user-centered design approaches that emphasize the active participation of end users in the design process. Importantly, any ICT solution designed for people living with PD should not encourage internet addiction, which will further contribute to the person’s withdrawal from society. %M 38231548 %R 10.2196/48175 %U https://www.jmir.org/2024/1/e48175 %U https://doi.org/10.2196/48175 %U http://www.ncbi.nlm.nih.gov/pubmed/38231548 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52197 %T Predictors of Use and Drop Out From a Web-Based Cognitive Behavioral Therapy Program and Health Community for Depression and Anxiety in Primary Care Patients: Secondary Analysis of a Randomized Controlled Trial %A Rotondi,Armando J %A Belnap,Bea Herbeck %A Rothenberger,Scott %A Feldman,Robert %A Hanusa,Barbara %A Rollman,Bruce L %+ Mental Illness Research Education and Clinical Center, VA Pittsburgh Healthcare System, Veterans Administration, Research Office Building (151R-U), University Drive C, Pittsburgh, PA, 15240, United States, 1 412 360 2494, armandorotondi1@gmail.com %K e-mental health %K user engagement %K initiation %K discontinue %K depression %K anxiety %K cognitive behavioral therapy %K computerized CBT %K online health community %K collaborative care %K internet support group %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: A previously reported study examined the treatment of primary care patients with at least moderate severity depressive or anxiety symptoms via an evidence-based computerized cognitive behavioral therapy (CCBT) program (Beating the Blues) and an online health community (OHC) that included a moderated internet support group. The 2 treatment arms proved to be equally successful at 6-month follow-up. Objective: Although highly promising, e-mental health treatment programs have encountered high rates of noninitiation, poor adherence, and discontinuation. Identifying ways to counter these tendencies is critical for their success. To further explore these issues, this study identified the primary care patient characteristics that increased the chances patients would not initiate the use of an intervention, (ie, not try it even once), initiate use, and go on to discontinue or continue to use an intervention. Methods: The study had 3 arms: one received access to CCBT (n=301); another received CCBT plus OHC (n=302), which included a moderated internet support group; and the third received usual care (n=101). Participants in the 2 active intervention arms of the study were grouped together for analyses of CCBT use (n=603) because both arms had access to CCBT, and there were no differences in outcomes between the 2 arms. Analyses of OHC use were based on 302 participants who were randomized to that arm. Results: Several baseline patient characteristics were associated with failure to initiate the use of CCBT, including having worse physical health (measured by the Short Form Health Survey Physical Components Score, P=.01), more interference from pain (by the Patient-Reported Outcomes Measurement Information System Pain Interference score, P=.048), less formal education (P=.02), and being African American or another US minority group (P=.006). Characteristics associated with failure to initiate use of the OHC were better mental health (by the Short Form Health Survey Mental Components Score, P=.04), lower use of the internet (P=.005), and less formal education (P=.001). Those who initiated the use of the CCBT program but went on to complete less of the program had less formal education (P=.01) and lower severity of anxiety symptoms (P=.03). Conclusions: This study found that several patient characteristics predicted whether a patient was likely to not initiate use or discontinue the use of CCBT or OHC. These findings have clear implications for actionable areas that can be targeted during initial and ongoing engagement activities designed to increase patient buy-in, as well as increase subsequent use and the resulting success of eHealth programs. Trial Registration: ClinicalTrials.gov NCT01482806; https://clinicaltrials.gov/study/NCT01482806 %M 38231552 %R 10.2196/52197 %U https://mental.jmir.org/2024/1/e52197 %U https://doi.org/10.2196/52197 %U http://www.ncbi.nlm.nih.gov/pubmed/38231552 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e49099 %T Implementation of an Electronic Mental Health Platform for Youth and Young Adults in a School Context Across Alberta, Canada: Thematic Analysis of the Perspectives of Stakeholders %A Dimitropoulos,Gina %A Bassi,Emilie M %A Bright,Katherine S %A Gondziola,Jason %A Bradley,Jessica %A Fersovitch,Melanie %A Stamp,Leanne %A LaMonica,Haley M %A Iorfino,Frank %A Gaskell,Tanya %A Tomlinson,Sara %A Johnson,David Wyatt %+ Faculty of Social Work, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 7332, gdimit@ucalgary.ca %K electronic mental health %K eMH %K digital mental health %K youth and young adult mental health %K secondary schools %K implementation science %K qualitative descriptive methods %K mental health platform %K mental health %K mobile phone %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Youth, aged 15 to 24 years, are more likely to experience mental health (MH) or substance use issues than other age groups. This is a critical period for intervention because MH disorders, if left unattended, may become chronic and serious and negatively affect many aspects of a young person’s life. Even among those who are treated, poor outcomes will still occur for a percentage of youth. Electronic MH (eMH) tools have been implemented in traditional MH settings to reach youth requiring assistance with MH and substance use issues. However, the utility of eMH tools in school settings has yet to be investigated. Objective: The objective of this study was to gain an understanding of the perspectives of key school staff stakeholders regarding barriers and facilitators to the implementation of the Innowell eMH platform in secondary schools across the province of Alberta, Canada. Methods: Guided by a qualitative descriptive approach, focus groups were conducted to elicit stakeholder perspectives on the perceived implementation challenges and opportunities of embedding the Innowell eMH platform in secondary school MH services. In total, 8 focus groups were conducted with 52 key school staff stakeholders. Results: Themes related to barriers and facilitators to youth and school MH care professional (MHCP) capacity in implementing and using eMH tools were identified. With respect to youth capacity barriers, the following themes were inductively generated: (1) concerns about some students not being suitable for eMH services, (2) minors requiring consent from parents or caregivers to use eMH services as well as confidentiality and privacy concerns, and (3) limited access to technology and internet service among youth. A second theme related to school MHCP barriers to implementation, which included (1) feeling stretched with high caseloads and change fatigue, (2) concerns with risk and liability, and (3) unmasking MH issues in the face of limited resources. In contrast to the barriers to youth and MHCP capacity, many facilitators to implementation were discussed. Youth capacity facilitators included (1) the potential for youth to be empowered using eMH tools, (2) the platform fostering therapeutic relationships with school personnel, and (3) enhancing access to needed services and resources. MHCP capacity facilitators to implementation were (1) system transformation through flexibility and problem-solving, (2) opportunities for collaboration with youth and MHCPs and across different systems, and (3) an opportunity for the continuity of services. Conclusions: Our findings highlight nuanced school MHCP perspectives that demonstrate critical youth and MHCP capacity concerns, with consideration for organizational factors that may impede or enhance the implementation processes for embedding eMH in a school context. The barriers and facilitators to implementation provide future researchers and decision makers with challenges and opportunities that could be addressed in the preimplementation phase. %M 38231558 %R 10.2196/49099 %U https://mental.jmir.org/2024/1/e49099 %U https://doi.org/10.2196/49099 %U http://www.ncbi.nlm.nih.gov/pubmed/38231558 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53931 %T A Blended Intervention Targeting Emotion Dysregulation in Adults With Attention-Deficit/Hyperactivity Disorder: Development and Feasibility Study %A Nordby,Emilie S %A Guribye,Frode %A Schønning,Viktor %A Andersen,Sander Lindholm %A Kuntsi,Jonna %A Lundervold,Astri J %+ Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, Bergen, 5036, Norway, 47 45440197, emilie.nordby@uib.no %K ADHD %K adult %K adults %K app %K applications %K apps %K attention deficit %K blended intervention %K blended %K develop %K development %K digital %K emotion regulation %K emotion %K emotional %K emotions %K feasibility %K group session %K group sessions %K hybrid %K hyperactivity %K inattention %K mental health %K neurodevelopmental %K psychotherapy %K satisfaction %K skill %K training %D 2024 %7 17.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many adults with attention-deficit/hyperactivity disorder (ADHD) experience difficulties related to emotion regulation. Such difficulties are known to substantially impact quality of life and overall functioning. Yet, there is a lack of treatment interventions specifically designed to address these challenges. Objective: This study aimed to describe the development and assess the feasibility, along with the initial clinical outcomes, of a novel blended intervention for adults with ADHD. The blended intervention combines both face-to-face and digital components and is specifically designed to address emotion dysregulation in ADHD. Methods: This intervention was an 8-week blended intervention combining weekly face-to-face group sessions with a supplementary digital companion app. The intervention is based on elements from dialectic behavioral therapy skills training and positive psychology. To evaluate its feasibility, we performed a 10-week feasibility study with an uncontrolled pre-post study design, including 16 adults with ADHD and co-occurring emotion dysregulation. The feasibility measures encompassed adherence, satisfaction, and perceived credibility of the intervention. Clinical outcomes were evaluated by self-reported symptoms of emotion dysregulation, inattention, hyperactivity-impulsivity, executive function, depression, anxiety, and a measure of quality of life. Paired sample 2-tailed t tests were used to analyze clinical outcomes with a Bonferroni-corrected significance level. Results: Both treatment credibility and treatment satisfaction were rated favorably by the majority of the participants. In particular, the participants emphasized meeting others with ADHD as beneficial. In terms of adherence, 3 participants withdrew before initiating the intervention, while another 4 participants did not complete the intervention. On average, the participants who enrolled in the intervention attended 6.2 of the 8 group sessions and completed 6.7 of the 8 skills training modules in the companion app. In terms of clinical outcomes, there was a reduction in symptoms of emotion dysregulation from before to after the intervention (d=2.0). Significant improvements were also observed in measures of inattention (d=1.1) and hyperactivity-impulsivity (d=0.9). However, no significant improvements were found in the domains of depression, anxiety, quality of life, and executive functioning. Conclusions: The results are encouraging, both in terms of feasibility and the preliminary clinical results on emotion dysregulation. The blended format, combining digital and face-to-face elements, may also seem to offer some advantages: the group-based format was valued as it facilitated peer interaction, while a rather high completion of modules in the companion app highlights its potential to enhance skills training between the group sessions. Future randomized controlled trials are called for to further evaluate the clinical effectiveness of the intervention. Trial Registration: ClinicalTrials.gov NCT05644028; https://clinicaltrials.gov/study/NCT05644028 %M 38231536 %R 10.2196/53931 %U https://formative.jmir.org/2024/1/e53931 %U https://doi.org/10.2196/53931 %U http://www.ncbi.nlm.nih.gov/pubmed/38231536 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50399 %T Feasibility, Acceptability, and Potential Efficacy of a Self-Guided Internet-Delivered Dialectical Behavior Therapy Intervention for Substance Use Disorders: Randomized Controlled Trial %A Daros,Alexander R %A Guimond,Timothy H %A Yager,Christina %A Palermo,Emma H %A Wilks,Chelsey R %A Quilty,Lena C %+ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, ON, M6J1H1, Canada, 1 5192533000 ext 2236, daros.alexander@gmail.com %K depression %K anxiety %K emotion dysregulation %K digital interventions %K dialectical behavior therapy %K substance use disorder %K alcohol use disorder %K randomized controlled trial %K eHealth %K mobile phone %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: People with alcohol and substance use disorders (SUDs) often have underlying difficulties in regulating emotions. Although dialectical behavioral therapy is effective for SUDs, it is often difficult to access. Self-guided, internet-delivered dialectical behavioral therapy (iDBT) allows for expanded availability, but few studies have rigorously evaluated it in individuals with SUDs. Objective: This study examines the feasibility, acceptability, and potential efficacy of an iDBT intervention in treatment-seeking adults with SUDs. We hypothesized that iDBT would be feasible, credible, acceptable, and engaging to people with SUDs. We also hypothesized that the immediate versus delayed iDBT group would show comparatively greater improvements and that both groups would show significant improvements over time. Methods: A 12-week, single-blinded, parallel-arm, randomized controlled trial was implemented, with assessments at baseline and at 4 (acute), 8, and 12 weeks (follow-up). A total of 72 community adults aged 18 to 64 years were randomized. The immediate group (n=38) received access to iDBT at baseline, and the delayed group (n=34) received access after 4 weeks. The intervention (Pocket Skills 2.0) was a self-guided iDBT via a website, with immediate access to all content, additional text and email reminders, and additional support meetings as requested. Our primary outcome was substance dependence, with secondary outcomes pertaining to feasibility, clinical outcomes, functional disability, and emotion dysregulation, among other measures. All outcomes were assessed using self-report questionnaires. Results: iDBT was perceived as a credible and acceptable treatment. In terms of feasibility, 94% (68/72) of the participants started iDBT, 13% (9/68) were early dropouts, 35% (24/68) used it for the recommended 8 days in the first month, and 50% (34/68) were still active 4 weeks later. On average, the participants used iDBT for 2 hours and 24 minutes across 10 separate days. In the acute period, no greater benefit was found for the immediate group on substance dependence, although we did find lower depression (b=−2.46; P=.02) and anxiety (b=−2.22; P=.02). At follow-up, there were greater benefits in terms of reduced alcohol (b=−2.00; P=.02) and nonalcoholic substance (b=−3.74; P=.01) consumption in the immediate access group. Both groups demonstrated improvements in substance dependence in the acute (b=−1.73; P<.001) and follow-up period (b=−2.09; P<.001). At follow-up, both groups reported reduced depression, anxiety, suicidal behaviors, emotional dysregulation, and functional disability. Conclusions: iDBT is a feasible and acceptable intervention for patients with SUDs, although methods for improving engagement are warranted. Although results did not support efficacy for the primary outcome at 4 weeks, findings support reductions in substance dependence and other mental health concerns at 12 weeks. Notwithstanding the limitations of this study, the results suggest the potential value of iDBT in the treatment of SUDs and other mental health conditions. Trial Registration: ClinicalTrials.gov NCT05094440; https://clinicaltrials.gov/show/NCT05094440 %M 38227362 %R 10.2196/50399 %U https://mental.jmir.org/2024/1/e50399 %U https://doi.org/10.2196/50399 %U http://www.ncbi.nlm.nih.gov/pubmed/38227362 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e44923 %T The Impact of Social Media Use on Mental Health and Family Functioning Within Web-Based Communities in Saudi Arabia: Ethnographic Correlational Study %A Alwuqaysi,Bdour %A Abdul-Rahman,Alfie %A Borgo,Rita %+ King's College London, 155 Wandsworth Road, Apt 3004, Sky Gardns, London, SW8 2FZ, United Kingdom, 44 07470334344, bdour.alwuqaysi@hotmail.com %K social media use %K mental health %K family functioning %D 2024 %7 16.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, increasing numbers of parents, activists, and decision-makers have raised concerns about the potential adverse effects of social media use on both mental health and family functioning. Although some studies have indicated associations between social media use and negative mental health outcomes, others have found no evidence of mental health harm. Objective: This correlation study investigated the interplay between social media use, mental health, and family functioning. Analyzing data from 314 users, this study explores diverse mental health outcomes. The study places particular emphasis on the Saudi Arabian sample, providing valuable insights into the cultural context and shedding light on the specific dynamics of social media’s impact on mental well-being and family dynamics in this demographic context. Methods: We collected data through a subsection of an anonymous web-based survey titled “The Effect of COVID-19 on Social Media Usage, Mental Health, and Family Functioning.” The survey was distributed through diverse web-based platforms in Saudi Arabia, emphasizing the Saudi sample. The participants indicated their social media accounts and estimated their daily use. Mental health was assessed using the General Health Questionnaire and family functioning was evaluated using the Family Assessment Device Questionnaire. In addition, 6 mental health conditions (anxiety, self-esteem, depression, body dysmorphia, social media addiction, and eating disorders) were self-reported by participants. Results: The study demonstrates a pattern of frequent social media use, with a significant portion dedicating 3-5 hours daily for web-based activities, and most of the sample accessed platforms multiple times a day. Despite concerns about social media addiction and perceived unhealthiness, participants cited staying connected with friends and family as their primary motivation for social media use. WhatsApp was perceived as the most positively impactful, whereas TikTok was considered the most negative for our Saudi sample. YouTube, Instagram, and Snapchat users reported poorer mental health compared with nonusers of these platforms. Mental health effects encompassed anxiety and addiction, with age and gender emerging as significant factors. Associations between social media use and family functioning were evident, with higher social media quartiles correlating with a greater likelihood of mental health and unhealthy family functioning. Logistic regression identified age and gender as factors linked to affected mental health, particularly noting that female participants aged 25-34 years were found to be more susceptible to affected mental health. In addition, multivariable analysis identified age and social media use quartiles as factors associated with poor family functioning. Conclusions: This study examined how social media affects mental health and family functioning in Saudi Arabia. These findings underscore the need for culturally tailored interventions to address these challenges, considering diverse demographic needs. Recognizing these nuances can guide the development of interventions to promote digital well-being, acknowledging the importance of familial connections in Saudi society. %M 38227352 %R 10.2196/44923 %U https://formative.jmir.org/2024/1/e44923 %U https://doi.org/10.2196/44923 %U http://www.ncbi.nlm.nih.gov/pubmed/38227352 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50222 %T Exploring Adolescents’ Attitudes Toward Mental Health Apps: Concurrent Mixed Methods Study %A Høgsdal,Helene %A Kyrrestad,Henriette %A Rye,Marte %A Kaiser,Sabine %+ Regional Centre for Child and Youth Mental Health and Child Welfare - North, Faculty of Health Sciences, UiT The Arctic University of Norway, Campus Tromsø, Tromsø, 9019, Norway, 47 77646619, helene.hogsdal@uit.no %K mental health applications %K mental health %K adolescents %K adolescent %K youth %K mobile health %K app %K apps %K application %K applications %K opinion %K opinions %K cross sectional %K survey %K surveys %K questionnaire %D 2024 %7 15.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescence is a critical time in which many psychological disorders develop. Mental health promotion is important, especially during this period. In recent years, an increasing number of mobile apps geared toward mental health promotion and preventing mental illness have been developed specifically for adolescents, with the goal of strengthening their mental health and well-being. Objective: This study aims to explore adolescents’ attitudes toward mental health apps, as well as the perceived usefulness of mental health apps. Methods: In this mixed methods study, a total of 183 adolescents (mean age 15.62, SD 3.21 years) answered a cross-sectional questionnaire, with 10 questions (eg, “What do you think about mental health apps in general?”). To complement the quantitative findings, individual interviews were conducted with 9 adolescents, during which they could elaborate on their opinions about mental health apps. Results: A total of 30% (56/183) of the adolescents in the quantitative study had used a mental health app. Over half of the respondents (77/126, 61.1%) reported that they would use a mental health app if they had a mental health problem as well as that they thought mental health apps were somewhat or very useful (114/183, 62.3%). Availability was the most frequently reported advantage of mental health apps (107/183, 58.8%). Possible associated costs of mental health apps were the most frequently mentioned barrier to their use (87/183, 47.5%). Findings from the interviews also pointed to the importance of the availability of mental health apps as well as their credibility and potential to provide adolescents with autonomy when seeking mental health advice and help. Conclusions: Overall, the results indicate that adolescents have a positive attitude toward and an interest in mental health apps. However, adolescents are also more or less unaware of such apps, which might be one reason why they are often not used. The findings of this study have important implications for future research on mental health apps and for developers of mental health apps that target young people. The insights gained from this study can inform the development of more effective mental health apps that better meet the needs and preferences of adolescents. %M 38224474 %R 10.2196/50222 %U https://formative.jmir.org/2024/1/e50222 %U https://doi.org/10.2196/50222 %U http://www.ncbi.nlm.nih.gov/pubmed/38224474 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e48537 %T Understanding Public Perceptions of Virtual Reality Psychological Therapy Using the Attitudes Towards Virtual Reality Therapy (AVRT) Scale: Mixed Methods Development Study %A Gomez Bergin,Aislinn D %A Allison,Aoife M %A Hazell,Cassie M %+ National Institute of Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Jubilee Campus, Triumph Rd, Nottingham, NG7 2TU, United Kingdom, 44 115 82 30431, aislinn.bergin@nottingham.ac.uk %K psychological interventions %K digital %K virtual reality %K virtual agent %K mental health %K presence %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Virtual reality (VR) psychological therapy has the potential to increase access to evidence-based mental health interventions by automating their delivery while maintaining outcomes. However, it is unclear whether these more automated therapies are acceptable to potential users of mental health services. Objective: The main aim of this study was to develop a new, validated questionnaire to measure public perceptions of VR therapy (VRT) guided by a virtual coach. We also aimed to explore these perceptions in depth and test how aspects such as familiarity with VR and mental health are associated with these perceptions, using both quantitative and qualitative approaches. Methods: We used a cross-sectional mixed methods design and conducted an exploratory factor analysis of a questionnaire that we developed, the Attitudes Towards Virtual Reality Therapy (AVRT) Scale, and a qualitative content analysis of the data collected through free-text responses during completion of the questionnaire. Results: We received 295 responses and identified 4 factors within the AVRT Scale, including attitudes toward VRT, expectation of presence, preference for VRT, and cost-effectiveness. We found that being more familiar with VR was correlated with more positive attitudes toward VRT (factor 1), a higher expectation of presence (factor 2), a preference for VRT over face-to-face therapy (factor 3), and a belief that VRT is cost-effective (factor 4). Qualitative data supported the factors we identified and indicated that VRT is acceptable when delivered at home and guided by a virtual coach. Conclusions: This study is the first to validate a scale to explore attitudes toward VRT guided by a virtual coach. Our findings indicate that people are willing to try VRT, particularly because it offers increased access and choice, and that as VR becomes ubiquitous, they will also have positive attitudes toward VRT. Future research should further validate the AVRT Scale. %M 38214958 %R 10.2196/48537 %U https://mental.jmir.org/2024/1/e48537 %U https://doi.org/10.2196/48537 %U http://www.ncbi.nlm.nih.gov/pubmed/38214958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51795 %T Linguistic Variables and Gender Differences Within a Messenger-Based Psychosocial Chat Counseling Service for Children and Adolescents: Cross-Sectional Study %A Efe,Zeki %A Baldofski,Sabrina %A Kohls,Elisabeth %A Eckert,Melanie %A Saee,Shadi %A Thomas,Julia %A Wundrack,Richard %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Semmelweisstr 10, Haus 13, Leipzig, 04103, Germany, 49 341 9724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K e-mental health %K chat counseling %K crisis %K helpline %K linguistic %K language %K Linguistic Inquiry and Word Count %K LIWC %K psychiatric symptoms %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Text messaging is widely used by young people for communicating and seeking mental health support through chat-based helplines. However, written communication lacks nonverbal cues, and language usage is an important source of information about a person’s mental health state and is known to be a marker for psychopathology. Objective: The aim of the study was to investigate language usage, and its gender differences and associations with the presence of psychiatric symptoms within a chat counseling service for adolescents and young adults. Methods: For this study, the anonymized chat content of a German messenger–based psychosocial chat counseling service for children and adolescents (“krisenchat”) between May 2020 and July 2021 was analyzed. In total, 661,131 messages from 6962 users were evaluated using Linguistic Inquiry and Word Count, considering the following linguistic variables: first-person singular and plural pronouns, negations, positive and negative emotion words, insight words, and causation words. Descriptive analyses were performed, and gender differences of those variables were evaluated. Finally, a binary logistic regression analysis examined the predictive value of linguistic variables on the presence of psychiatric symptoms. Results: Across all analyzed chats, first-person singular pronouns were used most frequently (965,542/8,328,309, 11.6%), followed by positive emotion words (408,087/8,328,309, 4.9%), insight words (341,460/8,328,309, 4.1%), negations (316,475/8,328,309, 3.8%), negative emotion words (266,505/8,328,309, 3.2%), causation words (241,520/8,328,309, 2.9%), and first-person plural pronouns (499,698/8,328,309, 0.6%). Female users and users identifying as diverse used significantly more first-person singular pronouns and insight words than male users (both P<.001). Negations were significantly more used by female users than male users or users identifying as diverse (P=.007). Similar findings were noted for negative emotion words (P=.01). The regression model of predicting psychiatric symptoms by linguistic variables was significant and indicated that increased use of first-person singular pronouns (odds ratio [OR] 1.05), negations (OR 1.11), and negative emotion words (OR 1.15) was positively associated with the presence of psychiatric symptoms, whereas increased use of first-person plural pronouns (OR 0.39) and causation words (OR 0.90) was negatively associated with the presence of psychiatric symptoms. Suicidality, self-harm, and depression showed the most significant correlations with linguistic variables. Conclusions: This study highlights the importance of examining linguistic features in chat counseling contexts. By integrating psycholinguistic findings into counseling practice, counselors may better understand users’ psychological processes and provide more targeted support. For instance, certain linguistic features, such as high use of first-person singular pronouns, negations, or negative emotion words, may indicate the presence of psychiatric symptoms, particularly among female users and users identifying as diverse. Further research is needed to provide an in-depth look into language processes within chat counseling services. %M 38214955 %R 10.2196/51795 %U https://formative.jmir.org/2024/1/e51795 %U https://doi.org/10.2196/51795 %U http://www.ncbi.nlm.nih.gov/pubmed/38214955 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52969 %T Remote Delivery of the Cuidándome Telehealth Intervention for Self-Management of Depression and Anxiety Among Latina Immigrant Women: Randomized Controlled Trial %A Alvarez,Carmen %A Aryal,Subhash %A Vrany,Elizabeth %A Sanchez R,Maria Jose %A Quiles,Rosalphie %A Escobar-Acosta,Lia %A Hill-Briggs,Felicia %+ School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, United States, 1 2158980715, alcarmen@nursing.upenn.edu %K Latina immigrant %K mental health %K depression %K anxiety %K problem-solving %K intervention study %K trauma-informed %K depressive %K Latinx %K Latin %K Latino %K Latina %K Hispanic %K Spanish %K immigrant %K immigrants %K survivor %K child %K children %K childhood %K trauma %K traumatic %K adverse %K telehealth %K telemedicine %K eHealth %K digital health %K feasibility %K acceptability %K randomized %K controlled trial %K controlled trials %K mobile phone %D 2024 %7 8.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Growing evidence suggests that Latina immigrant survivors of adverse childhood experiences (ACEs) are at increased risk for developing and remaining with either depression or anxiety or both symptoms. This study examined the feasibility and acceptability of a telehealth intervention—Cuidándome (quee-DAN-doh-meh, “taking care of myself”). Cuidándome is a 10-week, patient-centered, trauma-informed intervention delivered by a trained facilitator that promotes self-management of depression and anxiety symptoms through improved problem-solving skills and strategies. Objective: The aim of this study was to examine the feasibility and acceptability of Cuidándome delivered remotely (via Zoom) with Latina immigrant ACE survivors with either depression or anxiety or both symptoms. We also estimated the effect sizes associated with the intervention on decreasing depression and anxiety symptoms and improving social problem–solving styles. Methods: We evaluated Cuidándome using a randomized controlled trial design. Latina immigrants (N=47) who had experienced at least 1 ACE and had at least mild depression or anxiety symptoms were randomized to Cuidándome or a comparison group delivered by trained facilitators. We assessed for changes in depression and anxiety symptoms as well as social problem–solving styles at baseline, post intervention, and 3- and 6-month follow-up. Results: Analyses indicated significant decreases over time within both Cuidándome and comparison groups for depression and anxiety symptoms and maladaptive problem-solving. The intervention effect was largest for anxiety; at 6-month follow-up, Cuidándome participants had significantly lower anxiety scores than the comparison group. In addition, we observed a greater average point reduction in depression symptoms at 6 months among Cuidándome participants (5.7 points) than in the comparison group (3.7 points). Conclusions: A mental health program delivered via Zoom by a trained facilitator was feasible and acceptable to Latina immigrant women and can be beneficial for reducing anxiety and depression symptoms. More research is needed to assess the effectiveness of Cuidándome among a powered sample size of Latina immigrants. Trial Registration: ISRCTN Registry ISRCTN16668518; https://www.isrctn.com/ISRCTN16668518 %M 38190239 %R 10.2196/52969 %U https://formative.jmir.org/2024/1/e52969 %U https://doi.org/10.2196/52969 %U http://www.ncbi.nlm.nih.gov/pubmed/38190239 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47006 %T Digital Phenotyping for Mood Disorders: Methodology-Oriented Pilot Feasibility Study %A Breitinger,Scott %A Gardea-Resendez,Manuel %A Langholm,Carsten %A Xiong,Ashley %A Laivell,Joseph %A Stoppel,Cynthia %A Harper,Laura %A Volety,Rama %A Walker,Alex %A D'Mello,Ryan %A Byun,Andrew Jin Soo %A Zandi,Peter %A Goes,Fernando S %A Frye,Mark %A Torous,John %+ Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 5072845233, breitinger.scott@mayo.edu %K mood disorders %K depression %K bipolar disorder %K digital health %K digital phenotyping %K mobile apps %K patient-generated health data %K wearable devices %D 2023 %7 29.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In the burgeoning area of clinical digital phenotyping research, there is a dearth of literature that details methodology, including the key challenges and dilemmas in developing and implementing a successful architecture for technological infrastructure, patient engagement, longitudinal study participation, and successful reporting and analysis of diverse passive and active digital data streams. Objective: This article provides a narrative rationale for our study design in the context of the current evidence base and best practices, with an emphasis on our initial lessons learned from the implementation challenges and successes of this digital phenotyping study. Methods: We describe the design and implementation approach for a digital phenotyping pilot feasibility study with attention to synthesizing key literature and the reasoning for pragmatic adaptations in implementing a multisite study encompassing distinct geographic and population settings. This methodology was used to recruit patients as study participants with a clinician-validated diagnostic history of unipolar depression, bipolar I disorder, or bipolar II disorder, or healthy controls in 2 geographically distinct health care systems for a longitudinal digital phenotyping study of mood disorders. Results: We describe the feasibility of a multisite digital phenotyping pilot study for patients with mood disorders in terms of passively and actively collected phenotyping data quality and enrollment of patients. Overall data quality (assessed as the amount of sensor data obtained vs expected) was high compared to that in related studies. Results were reported on the relevant demographic features of study participants, revealing recruitment properties of age (mean subgroup age ranged from 31 years in the healthy control subgroup to 38 years in the bipolar I disorder subgroup), sex (predominance of female participants, with 7/11, 64% females in the bipolar II disorder subgroup), and smartphone operating system (iOS vs Android; iOS ranged from 7/11, 64% in the bipolar II disorder subgroup to 29/32, 91% in the healthy control subgroup). We also described implementation considerations around digital phenotyping research for mood disorders and other psychiatric conditions. Conclusions: Digital phenotyping in affective disorders is feasible on both Android and iOS smartphones, and the resulting data quality using an open-source platform is higher than that in comparable studies. While the digital phenotyping data quality was independent of gender and race, the reported demographic features of study participants revealed important information on possible selection biases that may result from naturalistic research in this domain. We believe that the methodology described will be readily reproducible and generalizable to other study settings and patient populations given our data on deployment at 2 unique sites. %M 38157233 %R 10.2196/47006 %U https://www.jmir.org/2023/1/e47006 %U https://doi.org/10.2196/47006 %U http://www.ncbi.nlm.nih.gov/pubmed/38157233 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45905 %T Implementation Considerations for Family-Based Telehealth Interventions for Youth in Foster Care: Focus Group Study With Child Welfare System Professionals %A Leo,Hannah P %A Folk,Johanna B %A Rodriguez,Christopher %A Tolou-Shams,Marina %+ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 675 18th St., San Francisco, CA, 94143, United States, 1 4154767000, Marina.Tolou-Shams@ucsf.edu %K foster youth %K telehealth %K family-based interventions %K mental health %D 2023 %7 29.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Between 2016 and 2020, over 600,000 youth were served annually by the foster care system. Despite approximately half of foster youth struggling with emotional or behavioral challenges, few receive much-needed services to address their mental health concerns. Family-based interventions are efficacious in addressing both youth and caregiver mental health needs; however, foster youth participation in these family-based interventions is limited by many barriers, including out-of-home placement far from their family of origin. Telehealth is a promising tool for mitigating barriers to access to treatment interventions for foster youth and their families. Objective: This study aims to understand child welfare system professionals’ perspectives on enabling factors and barriers to providing family-based interventions via telehealth to youth in out-of-county foster care placement. Methods: This qualitative study derived themes from 3 semistructured focus groups with child welfare system professionals. Participants were asked to discuss how family-based interventions are delivered to foster youth and their caregivers in their jurisdictions, as well as to share their thoughts about how to use telehealth to improve access to family-based interventions for families with youth in out-of-home placement. Data were analyzed using constant comparative analysis and inductive thematic analysis, with the Behavioral Model for Vulnerable Populations as the theoretical framework. Results: Participants were 19 child welfare system professionals (eg, social workers, residential treatment staff, and supervisors) who participated in 1 of the 3 focus groups (6-7/group). Most participants were women (n=13, 68%), White individuals (n=10, 53%), and social workers (n=8, 42%). On average, participants worked in the child welfare system for 16.6 (SD 8.3) years. Participants identified multilevel factors impacting family-based intervention delivery including environmental factors (eg, Medicare billing and presumptive transfer), predisposing characteristics (eg, psychological resources), enabling factors (eg, transportation and team-based youth-centered care), and need factors (eg, motivation to engage). Participants expressed optimism that telehealth could increase access to needed mental health care, diverse providers, and longevity of care while also expressing some concerns regarding telehealth access and literacy. Conclusions: Child welfare system professionals highlight the need to develop policies and telehealth interventions that are youth versus placement centered, include resources that limit barriers and bolster motivation for engagement, and follow a team-based care model. Findings from this study inform how telehealth can be used to increase access to and engagement with family-based interventions for youth in out-of-home placements and their caregivers of origin. %M 38157238 %R 10.2196/45905 %U https://formative.jmir.org/2023/1/e45905 %U https://doi.org/10.2196/45905 %U http://www.ncbi.nlm.nih.gov/pubmed/38157238 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43882 %T Feasibility, Adherence, and Effectiveness of Blended Psychotherapy for Severe Mental Illnesses: Scoping Review %A Ehrt-Schäfer,Yamina %A Rusmir,Milan %A Vetter,Johannes %A Seifritz,Erich %A Müller,Mario %A Kleim,Birgit %+ Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Lenggstrasse 31, Zurich, 8032, Switzerland, 41 +41583842817, yamina.ehrt@pukzh.ch %K blended psychotherapy %K severe mental illnesses %K digital health intervention %K e-mental health %K scoping review %D 2023 %7 26.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: Blended psychotherapy (bPT) combines face-to-face psychotherapy with digital interventions to enhance the effectiveness of mental health treatment. The feasibility and effectiveness of bPT have been demonstrated for various mental health issues, although primarily for patients with higher levels of functioning. Objective: This scoping review aims to investigate the feasibility, adherence, and effectiveness of bPT for the treatment of patients with severe mental illnesses (SMIs). Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, we conducted searches in PubMed, MEDLINE, Embase, PsycINFO, and PsycArticles for studies published until March 23, 2023. Results: Out of 587 screened papers, we incorporated 25 studies encompassing 23 bPT interventions, involving a total of 2554 patients with SMI. The intervention formats and research designs exhibited significant variation. Our findings offer preliminary evidence supporting the feasibility of bPT for SMI, although there is limited research on adherence. Nevertheless, the summarized studies indicated promising attrition rates, spanning from 0% to 37%, implying a potential beneficial impact of bPT on adherence to SMI treatment. The quantity of evidence on the effects of bPT for SMI was limited and challenging to generalize. Among the 15 controlled trials, 4 concluded that bPT interventions were effective compared with controls. However, it is noteworthy that 2 of these studies used the same study population, and the control groups exhibited significant variations. Conclusions: Overall, our review suggests that while bPT appears promising as a treatment method, further research is necessary to establish its effectiveness for SMI. We discuss considerations for clinical implementation, directions, and future research. %M 38147373 %R 10.2196/43882 %U https://mental.jmir.org/2023/1/e43882 %U https://doi.org/10.2196/43882 %U http://www.ncbi.nlm.nih.gov/pubmed/38147373 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e53935 %T Teaching Adolescents With Type 1 Diabetes Self-Compassion (TADS) to Reduce Diabetes Distress: Protocol for a Randomized Controlled Trial %A Dover,Saunya %A Ahmet,Alexandra %A Bluth,Karen %A Feldman,Brian M %A Goldbloom,Ellen B %A Goldfield,Gary S %A Hamilton,Sarah %A Imran,Omar %A Khalif,Adam %A Khatchadourian,Karine %A Lawrence,Sarah %A Leonard,Andrew %A Liu,Kuan %A Ouyang,Yongdong %A Peeters,Corien %A Shah,Jai %A Spector,Noah %A Zuijdwijk,Caroline %A Robinson,Marie-Eve %+ Children's Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON, K1H8L1, Canada, 1 6137377600, mrobinson@cheo.on.ca %K anxiety %K depression %K diabetes distress %K disordered eating %K mental health %K mindful self-compassion %K pediatrics %K randomized controlled trial %K type 1 diabetes %D 2023 %7 26.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents living with type 1 diabetes (T1D) often experience diabetes distress (DD), a construct distinct from depression or anxiety that refers to the negative emotions that arise from living with and managing diabetes. Self-compassion, which involves being open to one’s own suffering and treating oneself with the same care one would show to loved ones, is associated with better psychological and clinical outcomes among individuals with T1D. Self-compassion is a skill that can be taught and therefore represents an opportunity for intervention. Objective: The overall aim of this study is to assess the effectiveness of a web-based mindful self-compassion for teens (MSC-T) intervention on improving DD, anxiety, depression, diabetes-related disordered eating, and suicidal ideation experienced by youth with T1D (aged between 12 and 17 years) compared with a waitlist control group (standard of care). We will also explore (1) if the effect of the MSC-T intervention changes over time, (2) if the MSC-T intervention has a positive impact on measures of glycemic control, and (3) if the effect of the MSC-T intervention differs based on self-reported gender. Methods: We will conduct a single-center, parallel-group randomized controlled trial of 140 adolescents with T1D followed for 12 months. Participants will be randomly allocated (using hidden allocation) in a 1:1 ratio to either the MSC-T intervention or the waitlist control group. Our primary outcome is DD, as measured by the Problem Areas in Diabetes-Teen (PAID-T) version at 3 months. Secondary outcomes, assessed at 3 and 12 months, include anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale), depression (Patient Health Questionnaire-9 [PHQ-9]), diabetes-related disordered eating (Diabetes Eating Problem Survey-Revised [DEPS-R] version), and suicidal ideation (using 1 question from the PHQ-9). Results: Study recruitment began in October 2022 and was completed in March 2023, with a total of 141 participants enrolling. Data collection will be ongoing until March 2024. The first results are expected in June 2024. Conclusions: This study will be the first randomized trial to assess the effectiveness of the web-based MSC-T intervention on adolescents with T1D. Given that adolescence is a period where individuals are typically required to assume more responsibility for their diabetes care, providing adolescents with the tools they need to better manage the stress that often accompanies T1D management is paramount. Trial Registration: ClinicalTrials.gov NCT05463874; https://clinicaltrials.gov/study/NCT05463874 International Registered Report Identifier (IRRID): DERR1-10.2196/53935 %M 38048480 %R 10.2196/53935 %U https://www.researchprotocols.org/2023/1/e53935 %U https://doi.org/10.2196/53935 %U http://www.ncbi.nlm.nih.gov/pubmed/38048480 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e51102 %T Efficacy of an Electronic Cognitive Behavioral Therapy Program Delivered via the Online Psychotherapy Tool for Depression and Anxiety Related to the COVID-19 Pandemic: Pre-Post Pilot Study %A Moghimi,Elnaz %A Stephenson,Callum %A Agarwal,Anika %A Nikjoo,Niloofar %A Malakouti,Niloufar %A Layzell,Gina %A O'Riordan,Anne %A Jagayat,Jasleen %A Shirazi,Amirhossein %A Gutierrez,Gilmar %A Khan,Ferwa %A Patel,Charmy %A Yang,Megan %A Omrani,Mohsen %A Alavi,Nazanin %+ Department of Psychiatry, Faculty of Health Sciences, Queen's University, 166 Brock Street, Kingston, ON, K7L 5G23, Canada, 1 6135443310, nazanin.alavitabari@kingstonhsc.ca %K mental health %K depression %K anxiety %K cognitive behavioral therapy %K online %K COVID-19 %K efficacy %K electronic cognitive behavioral therapy %K online psychotherapy tool %K pandemic %K evidence-based treatment %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Lockdowns and social distancing resulting from the COVID-19 pandemic have worsened the population’s mental health and made it more difficult for individuals to receive care. Electronic cognitive behavioral therapy (e-CBT) is a cost-effective and evidence-based treatment for anxiety and depression and can be accessed remotely. Objective: The objective of the study was to investigate the efficacy of online psychotherapy tailored to depression and anxiety symptoms during the pandemic. Methods: The pilot study used a pre-post design to evaluate the efficacy of a 9-week e-CBT program designed for individuals with depression and anxiety affected by the pandemic. Participants were adults (N=59) diagnosed with major depressive disorder and generalized anxiety disorder, whose mental health symptoms initiated or worsened during the COVID-19 pandemic. The online psychotherapy program focused on teaching coping, mindfulness, and problem-solving skills. Symptoms of anxiety and depression, resilience, and quality of life were assessed. Results: Participants demonstrated significant improvements in symptoms of anxiety (P=.02) and depression (P=.03) after the intervention. Similar trends were observed in the intention-to-treat analysis. No significant differences were observed in resilience and quality-of-life measures. The sample comprised mostly females, making it challenging to discern the benefits of the intervention in males. Although a pre-post design is less rigorous than a controlled trial, this design was selected to observe changes in scores during a critical period. Conclusions: e-CBT for COVID-19 is an effective and accessible treatment option. Improvements in clinical symptoms of anxiety and depression can be observed in individuals whose mental health is affected by the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/study/NCT04476667 International Registered Report Identifier (IRRID): RR2-10.2196/24913 %M 37993984 %R 10.2196/51102 %U https://mental.jmir.org/2023/1/e51102 %U https://doi.org/10.2196/51102 %U http://www.ncbi.nlm.nih.gov/pubmed/37993984 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46579 %T Exploring Counselor Practices and Risk Assessment in a Proactive Digital Intervention Through Instagram in Young People: Qualitative Study %A Peart,Natalie %A Hetrick,Sarah %A Gibson,Kerry %A Stasiak,Karolina %+ Department of Psychology, University of Auckland, 23 Symonds Street, Auckland, 1023, New Zealand, 64 276758552, nnatalie.peart@auckland.ac.nz %K counseling %K distress %K empathize %K internet %K mental health %K online text %K proactive %K qualitative study %K risk assessment %K self-harm %K social media %K suicide %K validation %K youth %D 2023 %7 25.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is one of the leading causes of preventable death in young people, and the way young people are communicating suicidality has evolved to include web-based disclosures and help-seeking. To date, mental health intervention services, both on the web and in person, have been conceived in the traditional model, whereby support is provided if a young person (or their family) actively seeks out that support when distressed. On the other hand, proactive outreach is an innovative approach to intervention that has been shown to be effective in other areas of health care. Live for Tomorrow chat was delivered on Instagram and comprised of counselors who reach out to provide brief person-centered intervention to young people who post content indicating distress or suicidality. Objective: Our aim was to explore how counselors engaged young people in a proactive digital intervention and how risk assessment was conducted in this context. Methods: We analyzed 35 transcripts of conversations between counselors and young people aged 13-25 years using the 6-step approach of Braun and Clarke’s reflexive thematic analysis. These transcripts included a counseling intervention and a follow-up chat that was aimed at collecting feedback about the counseling intervention. Results: A total of 7 themes emerged: using microskills to facilitate conversations, building confidence and capacity to cope with change, seeking permission when approaching conversations about suicidality or self-harm, conversations about suicidality following a structured approach, providing assurances of confidentiality, validation of the experience of suicidality, and using conversations about suicidality to identify interventions. Counselors were able to translate counseling microskills and structured questioning regarding suicidality into a digital context. In particular, in the digital context, counselors would use the young person’s post and emojis to further conversations and build rapport. Conclusions: The findings highlight the importance of the counselor’s role to listen, empathize, validate, and empower young people and that all these skills can be transferred to a digital text counseling intervention. Counselors used a structured approach to understanding suicidality in a permission-seeking, validating, and confidential manner to identify interventions with the young person. These practices allowed the conversation to move beyond traditional risk assessment practices to meaningful conversations about suicidality. Moving beyond traditional risk assessment practices and into conversations about suicidality allowed for the validation of the young person’s experience and exploration of interventions and support that made sense and were seen to be helpful to the young person. This study highlighted the benefits of a proactive digital chat-based intervention, which is a novel approach to engaging with young people experiencing psychological distress and suicidality. Furthermore, this research demonstrates the feasibility and benefit of moving mental health intervention and support to a medium where young people are currently disclosing distress and intervening proactively. %M 38145477 %R 10.2196/46579 %U https://formative.jmir.org/2023/1/e46579 %U https://doi.org/10.2196/46579 %U http://www.ncbi.nlm.nih.gov/pubmed/38145477 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e52901 %T Assessing the Impact of Evidence-Based Mental Health Guidance During the COVID-19 Pandemic: Systematic Review and Qualitative Evaluation %A Smith,Katharine A %A Ostinelli,Edoardo G %A Ede,Roger %A Allard,Lisa %A Thomson,Michaela %A Hewitt,Kiran %A Brown,Petra %A Zangani,Caroline %A Jenkins,Matthew %A Hinze,Verena %A Ma,George %A Pothulu,Prajnesh %A Henshall,Catherine %A Malhi,Gin S %A Every-Palmer,Susanna %A Cipriani,Andrea %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Headington, Oxford, OX3 7JX, United Kingdom, 44 1865902135, katharine.smith@psych.ox.ac.uk %K evidence synthesis %K guidelines %K mental health %K systematic review %K focus group %K survey %K COVID-19 %K pandemic %K digital health %K eHealth %K mobile phone %D 2023 %7 22.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, the Oxford Precision Psychiatry Lab (OxPPL) developed open-access web-based summaries of mental health care guidelines (OxPPL guidance) in key areas such as digital approaches and telepsychiatry, suicide and self-harm, domestic violence and abuse, perinatal care, and vaccine hesitancy and prioritization in the context of mental illness, to inform timely clinical decision-making. Objective: This study aimed to evaluate the practice of creating evidence-based health guidelines during health emergencies using the OxPPL guidance as an example. An international network of clinical sites and colleagues (in Australia, New Zealand, and the United Kingdom) including clinicians, researchers, and experts by experience aimed to (1) evaluate the clinical impact of the OxPPL guidance, as an example of an evidence-based summary of guidelines; (2) review the literature for other evidence-based summaries of COVID-19 guidelines regarding mental health care; and (3) produce a framework for response to future global health emergencies. Methods: The impact and clinical utility of the OxPPL guidance were assessed using clinicians’ feedback via an international survey and focus groups. A systematic review (protocol registered on Open Science Framework) identified summaries or syntheses of guidelines for mental health care during and after the COVID-19 pandemic and assessed the accuracy of the methods used in the OxPPL guidance by identifying any resources that the guidance had not included. Results: Overall, 80.2% (146/182) of the clinicians agreed or strongly agreed that the OxPPL guidance answered important clinical questions, 73.1% (133/182) stated that the guidance was relevant to their service, 59.3% (108/182) said that the guidelines had or would have a positive impact on their clinical practice, 42.9% (78/182) that they had shared or would share the guidance, and 80.2% (146/182) stated that the methodology could be used during future health crises. The focus groups found that the combination of evidence-based knowledge, clinical viewpoint, and visibility was crucial for clinical implementation. The systematic review identified 2543 records, of which 2 syntheses of guidelines met all the inclusion criteria, but only 1 (the OxPPL guidance) used evidence-based methodology. The review showed that the OxPPL guidance had included the majority of eligible guidelines, but 6 were identified that had not been included. Conclusions: The study identified an unmet need for web-based, evidence-based mental health care guidance during the COVID-19 pandemic. The OxPPL guidance was evaluated by clinicians as having a real-world clinical impact. Robust evidence-based methodology and expertise in mental health are necessary, but easy accessibility is also needed, and digital technology can materially help. Further health emergencies are inevitable and now is the ideal time to prepare, including addressing the training needs of clinicians, patients, and carers, especially in areas such as telepsychiatry and digital mental health. For future planning, guidance should be widely disseminated on an international platform, with allocated resources to support adaptive updates. %M 38133912 %R 10.2196/52901 %U https://mental.jmir.org/2023/1/e52901 %U https://doi.org/10.2196/52901 %U http://www.ncbi.nlm.nih.gov/pubmed/38133912 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42510 %T Comparing Web-Based and Blended Training for Coping With Challenges of Flexible Work Designs: Randomized Controlled Trial %A Althammer,Sarah Elena %A Wöhrmann,Anne Marit %A Michel,Alexandra %+ Federal Institute for Occupational Safety and Health, Friedrich-Henkel-Weg 1-25, Dortmund, 44149, Germany, 49 23190712071, sarah.althammer@alumni.uni-heidelberg.de %K blended training %K web-based training %K psychological detachment %K well-being %K work-life balance %D 2023 %7 19.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Workers with flexible work designs (FWDs) face specific challenges, such as difficulties in detaching from work, setting boundaries between work and private life, and recovering from work. Objective: This study evaluated the effectiveness of an intervention in improving the recovery, work-life balance, and well-being of workers with FWDs compared with a waitlist control group. It also compares the effectiveness of a web-based training format and blended training format. Methods: In the web-based training format, participants individually completed 6 web-based modules and daily tasks over 6 weeks, learning self-regulation strategies to meet the particular challenges of FWDs. In the blended training format, participants attended 3 group sessions in addition to completing the 6 web-based modules. In a randomized controlled trial, participants were assigned to a web-based intervention group (196/575, 34.1%), blended intervention group (198/575, 34.4%), or waitlist control group (181/575, 31.5%). Study participants self-assessed their levels of primary outcomes (psychological detachment, satisfaction with work-life balance, and well-being) before the intervention, after the intervention, at a 4-week follow-up, and at a 6-month follow-up. The final sample included 373 participants (web-based intervention group: n=107, 28.7%; blended intervention group: n=129, 34.6%; and control group: n=137, 36.7%). Compliance was assessed as a secondary outcome. Results: The results of multilevel analyses were in line with our hypothesis that both training formats would improve psychological detachment, satisfaction with work-life balance, and well-being. We expected blended training to reinforce these effects, but blended training participants did not profit more from the intervention than web-based training participants. However, they reported to have had more social exchange, and blended training participants were more likely to adhere to the training. Conclusions: Both web-based and blended training are effective tools for improving the recovery, work-life balance, and well-being of workers with FWDs. Group sessions can increase the likelihood of participants actively participating in web-based modules and exercises. Trial Registration: German Clinical Trials Register DRKS00032721; https://drks.de/search/en/trial/DRKS00032721 %M 38113084 %R 10.2196/42510 %U https://www.jmir.org/2023/1/e42510 %U https://doi.org/10.2196/42510 %U http://www.ncbi.nlm.nih.gov/pubmed/38113084 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e52804 %T Exploring the Number of Web-Based Behavioral Health Coaching Sessions Associated With Symptom Improvement in Youth: Observational Retrospective Analysis %A Lawrence-Sidebottom,Darian %A Huffman,Landry Goodgame %A Beam,Aislinn %A Guerra,Rachael %A Parikh,Amit %A Roots,Monika %A Huberty,Jennifer %+ Bend Health, Inc, 9450 SW Gemini Drive #58509, Beaverton, OR, 97008, United States, 1 7708619131, landry.huffman@bendhealth.com %K adolescents %K anxiety %K children %K depression %K digital mental health intervention %K reliable change %D 2023 %7 18.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Rates of anxiety and depression have been increasing among children and adolescents for the past decade; however, many young people do not receive adequate mental health care. Digital mental health interventions (DMHIs) that include web-based behavioral health coaching are widely accessible and can confer significant improvements in youth anxiety and depressive symptoms. However, more research is necessary to determine the number of web-based coaching sessions that confer clinically significant improvements in anxiety and depressive symptoms in youth. Objective: This study uses data from a pediatric DMHI to explore the number of web-based coaching sessions required to confer symptom improvements among children and adolescents with moderate or moderately severe symptoms of anxiety and depression. Methods: We used retrospective data from a pediatric DMHI that offered web-based behavioral health coaching in tandem with self-guided access to asynchronous chat with practitioners, digital mental health resources, and web-based mental health symptom assessments. Children and adolescents who engaged in 3 or more sessions of exclusive behavioral health coaching for moderate to moderately severe symptoms of anxiety (n=66) and depression (n=59) were included in the analyses. Analyses explored whether participants showed reliable change (a decrease in symptom scores that exceeds a clinically established threshold) and stable reliable change (at least 2 successive assessments of reliable change). Kaplan-Meier survival analyses were performed to determine the median number of coaching sessions when the first reliable change and stable reliable change occurred for anxiety and depressive symptoms. Results: Reliable change in anxiety symptoms was observed after a median of 2 (95% CI 2-3) sessions, and stable reliable change in anxiety symptoms was observed after a median of 6 (95% CI 5-8) sessions. A reliable change in depressive symptoms was observed after a median of 2 (95% CI 1-3) sessions, and a stable reliable change in depressive symptoms was observed after a median of 6 (95% CI 5-7) sessions. Children improved 1-2 sessions earlier than adolescents. Conclusions: Findings from this study will inform caregivers and youth seeking mental health care by characterizing the typical time frame in which current participants show improvements in symptoms. Moreover, by suggesting that meaningful symptom improvement can occur within a relatively short time frame, these results bolster the growing body of research that indicates web-based behavioral health coaching is an effective form of mental health care for young people. %M 38109174 %R 10.2196/52804 %U https://formative.jmir.org/2023/1/e52804 %U https://doi.org/10.2196/52804 %U http://www.ncbi.nlm.nih.gov/pubmed/38109174 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e50806 %T Efficacy of a Smartphone App in Enhancing Medication Adherence and Accuracy in Individuals With Schizophrenia During the COVID-19 Pandemic: Randomized Controlled Trial %A Chen,Huan Hwa %A Hsu,Hsin Tien %A Lin,Pei Chao %A Chen,Chin-Yin %A Hsieh,Hsiu Fen %A Ko,Chih Hung %+ College of Nursing, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd., Sanmin District, Kaohsiung, 80708, Taiwan, 886 7 3121101 ext 2626, hsiufen96@kmu.edu.tw %K cognitive functions %K medication adherence %K psychiatric symptoms %K schizophrenia %K smartphone app %D 2023 %7 14.12.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Poor medication adherence or inaccuracy in taking prescribed medications plays an important role in the recurrence or worsening of psychiatric symptoms in patients with schizophrenia, and the COVID-19 pandemic impacted their medication adherence with exacerbated symptoms or relapse. The use of mobile health services increased during the COVID-19 pandemic, and their role in improving mental health is becoming clearer. Objective: This study aimed to explore the effectiveness of a smartphone app (MedAdhere) on medication adherence and accuracy among patients with schizophrenia and to measure their psychiatric symptoms and cognitive functions. Methods: In this 12-week experimental study, participants were provided interventions with the MedAdhere app, and data were collected between June 2021 and September 2022. A total of 105 participants were randomly assigned to either the experimental or control groups. We used the Positive and Negative Syndrome Scale and Mini-Mental State Examination to measure the participants’ psychiatric symptoms and cognitive functions. Generalized estimating equations were used for data analysis. Results: A total of 94 participants met the inclusion criteria and completed the protocol, and the medication adherence rate of the experimental group was 94.72% (2785/2940) during the intervention. Psychotic symptoms (positive, negative, and general psychopathology symptoms) and cognitive functions (memory, language, and executive function) were significantly improved in the experimental group compared to the control group after the intervention. Conclusions: The MedAdhere app effectively and significantly improved medication adherence and, thereby, the psychiatric symptoms of patients with schizophrenia. This artificial intelligence assisted app could be extended to all patients who need to be reminded to take medication on schedule. Trial Registration: ClinicalTrials.gov NCT05892120; https://clinicaltrials.gov/study/NCT05892120 %M 38096017 %R 10.2196/50806 %U https://mental.jmir.org/2023/1/e50806 %U https://doi.org/10.2196/50806 %U http://www.ncbi.nlm.nih.gov/pubmed/38096017 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e47250 %T Phone-Based Text Therapy for Youth Mental Health: Rapid Review %A Karnik,Varun %A Henderson,Hamish %A Khan,Urooj Raza %A Boyd,James %+ La Trobe University, 360 Collins Street, Melbourne, 3086, Australia, 61 3 9479 6000, varun.karnik@griffithuni.edu.au %K text therapy %K mHealth %K adolescent health %K distance counseling %K mental illness %K mobile health intervention %K adolescent %K health promotion %K digital mental health intervention %D 2023 %7 14.12.2023 %9 Review %J Interact J Med Res %G English %X Background: Mental illness has become a prevalent issue impacting adolescents worldwide. Many barriers, including stigma and poor health literacy, prevent this population group from accessing reliable mental health care services. Synchronous text–therapy counseling is an underused therapeutic approach in combating adolescent mental illness. Phone-based text therapy is uniquely placed to offer personalized counseling to adolescents through a familiar and engaging treatment modality. Objective: This rapid review aims to understand the clinical effectiveness, usability, and accessibility of phone-based text therapy for youth mental health. Methods: Cochrane CENTRAL, Embase, PubMed, and PsycINFO were used to search for suitable literature. Five groups of keywords were used: those related to (1) “therapy,” (2) “text,” (3) “phone,” (4) “youth,” and (5) “mental health.” Eligibility criteria were formed through the PICO (Population, Intervention, Control, and Outcome) framework. Studies were included if a synchronous phone-based text therapy intervention was used in an adolescent population, with an age range of 12-24 years. Only literature available in full-text, English, and a peer-reviewed journal was considered. Furthermore, a date limit of 5 years was set to reflect the recent development of digital interventions for mental health. Pertinent information from each study was tabulated, and a narrative synthesis was used to assess, describe, and organize the included studies comprehensively and concisely. Results: Of the 771 studies dual screened, 7 studies were included in this rapid review. Most of the exclusions occurred due to the use of the wrong intervention, such as asynchronous messaging. The selected studies had a low risk of bias and were suitable for the review. All interventional trials demonstrated reductions in mental health symptoms, primarily depression and anxiety. Most studies displayed high usability among participants, while data were unclear regarding accessibility. Conclusions: This review reveals the high potential of phone-based text therapy as an intervention for adolescents experiencing mental illness. We hope that this review promotes further refinement of text-based phone therapies and encourages future research on this subject matter. %M 38096012 %R 10.2196/47250 %U https://www.i-jmr.org/2023/1/e47250 %U https://doi.org/10.2196/47250 %U http://www.ncbi.nlm.nih.gov/pubmed/38096012 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47860 %T A Personalized, Transdiagnostic Smartphone Intervention (Mello) Targeting Repetitive Negative Thinking in Young People With Depression and Anxiety: Pilot Randomized Controlled Trial %A Bell,Imogen %A Arnold,Chelsea %A Gilbertson,Tamsyn %A D’Alfonso,Simon %A Castagnini,Emily %A Chen,Nicola %A Nicholas,Jennifer %A O’Sullivan,Shaunagh %A Valentine,Lee %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Rd, Melbourne, 3052, Australia, 61 3 99669177, imogen.bell@orygen.org.au %K repetitive negative thinking %K rumination %K anxiety %K depression %K mobile app %K just-in-time adaptive interventions %K youth mental health %K adolescent %K mobile phone %D 2023 %7 13.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Repetitive negative thinking (RNT) is a key transdiagnostic mechanism underpinning depression and anxiety. Using “just-in-time adaptive interventions” via smartphones may disrupt RNT in real time, providing targeted and personalized intervention. Objective: This pilot randomized controlled trial evaluates the feasibility, acceptability, and preliminary clinical outcomes and mechanisms of Mello—a fully automated, personalized, transdiagnostic, and mechanistic smartphone intervention targeting RNT in young people with depression and anxiety. Methods: Participants with heightened depression, anxiety, and RNT were recruited via social media and randomized to receive Mello or a nonactive control over a 6-week intervention period. Assessments were completed via Zoom sessions at baseline and at 3 and 6 weeks after baseline. Results: The findings supported feasibility and acceptability, with high rates of recruitment (N=55), uptake (55/64, 86% of eligible participants), and retention (52/55, 95% at 6 weeks). Engagement was high, with 90% (26/29) and 59% (17/29) of the participants in the Mello condition still using the app during the third and sixth weeks, respectively. Greater reductions in depression (Cohen d=0.50), anxiety (Cohen d=0.61), and RNT (Cohen d=0.87) were observed for Mello users versus controls. Mediation analyses suggested that changes in depression and anxiety were accounted for by changes in RNT. Conclusions: The results indicate that mechanistic, targeted, and real-time technology-based solutions may provide scalable and effective interventions that advance the treatment of youth mental ill health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621001701819; http://tinyurl.com/4d3jfj9f %M 38090786 %R 10.2196/47860 %U https://www.jmir.org/2023/1/e47860 %U https://doi.org/10.2196/47860 %U http://www.ncbi.nlm.nih.gov/pubmed/38090786 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46778 %T Digital Phenotyping for Monitoring Mental Disorders: Systematic Review %A Bufano,Pasquale %A Laurino,Marco %A Said,Sara %A Tognetti,Alessandro %A Menicucci,Danilo %+ Institute of Clinical Physiology, National Research Council, via Giuseppe Moruzzi,1, Pisa, 56124, Italy, 39 0503152181, marco.laurino@cnr.it %K digital phenotyping %K mobile %K mental health %K smartphone %K mobile sensing %K passive sensing %K active sensing %K digital phenotype %K digital biomarker %K mobile phone %D 2023 %7 13.12.2023 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased the impact and spread of mental illness and made health services difficult to access; therefore, there is a need for remote, pervasive forms of mental health monitoring. Digital phenotyping is a new approach that uses measures extracted from spontaneous interactions with smartphones (eg, screen touches or movements) or other digital devices as markers of mental status. Objective: This review aimed to evaluate the feasibility of using digital phenotyping for predicting relapse or exacerbation of symptoms in patients with mental disorders through a systematic review of the scientific literature. Methods: Our research was carried out using 2 bibliographic databases (PubMed and Scopus) by searching articles published up to January 2023. By following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines, we started from an initial pool of 1150 scientific papers and screened and extracted a final sample of 29 papers, including studies concerning clinical populations in the field of mental health, which were aimed at predicting relapse or exacerbation of symptoms. The systematic review has been registered on the web registry Open Science Framework. Results: We divided the results into 4 groups according to mental disorder: schizophrenia (9/29, 31%), mood disorders (15/29, 52%), anxiety disorders (4/29, 14%), and substance use disorder (1/29, 3%). The results for the first 3 groups showed that several features (ie, mobility, location, phone use, call log, heart rate, sleep, head movements, facial and vocal characteristics, sociability, social rhythms, conversations, number of steps, screen on or screen off status, SMS text message logs, peripheral skin temperature, electrodermal activity, light exposure, and physical activity), extracted from data collected via the smartphone and wearable wristbands, can be used to create digital phenotypes that could support gold-standard assessment and could be used to predict relapse or symptom exacerbations. Conclusions: Thus, as the data were consistent for almost all the mental disorders considered (mood disorders, anxiety disorders, and schizophrenia), the feasibility of this approach was confirmed. In the future, a new model of health care management using digital devices should be integrated with the digital phenotyping approach and tailored mobile interventions (managing crises during relapse or exacerbation). %M 38090800 %R 10.2196/46778 %U https://www.jmir.org/2023/1/e46778 %U https://doi.org/10.2196/46778 %U http://www.ncbi.nlm.nih.gov/pubmed/38090800 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e50636 %T The Effects of a Digital, Transdiagnostic, Clinically and Peer-Moderated Treatment Platform for Young People With Emerging Mental Health Complaints: Repeated Measures Within-Subjects Study %A van Doorn,Marilon %A Monsanto,Anne %A Wang,Chen Lu %A Verfaillie,Sander C J %A van Amelsvoort,Thérèse A M J %A Popma,Arne %A Jaspers,Monique W M %A Öry,Ferko %A Alvarez-Jimenez,Mario %A Gleeson,John F %A Nieman,Dorien H %+ Amsterdam University Medical Centers (Location AMC), 5 Meibergdreef 9, Amsterdam, 1105AZ, Netherlands, 31 208913747, m.vandoorn@amsterdamumc.nl %K indicative prevention %K youth mental health %K Moderated Online Social Therapy %K MOST+ %K eHealth %K well-being %K early detection and intervention %K Engage Young People Early %K ENYOY %D 2023 %7 13.12.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To address the growing prevalence of youth mental health problems, early intervention is crucial to minimize individual, societal, and economic impacts. Indicative prevention aims to target emerging mental health complaints before the onset of a full-blown disorder. When intervening at this early stage, individuals are more responsive to treatment, resulting in cost-effective outcomes. The Moderated Online Social Therapy platform, which was successfully implemented and proven effective in Australia, is a digital, peer- and clinically moderated treatment platform designed for young people. The Netherlands was the first country outside Australia to implement this platform, under the name Engage Young People Early (ENYOY). It has the potential to reduce the likelihood of young people developing serious mental health disorders. Objective: This study aims to investigate the effects on young people using the ENYOY-platform in relation to psychological distress, psychosocial functioning, and positive health parameters. Methods: Dutch-speaking young people with emerging mental health complaints (N=131) participated in the ENYOY-platform for 6 months in a repeated measures within-subjects study. Psychological distress, psychosocial functioning, and positive health parameters were assessed at baseline and 3, 6, and 12 months. Repeated measures ANOVA was conducted and adjusted for age, sex, therapy, and community activity. The Reliable Change Index and Clinically Significant Index were computed to compare the baseline with the 6- and 12-month measurements. The missing data rate was 22.54% and the dropout rate 62.6% (82/131). Results: The primary analysis (77/131, 58.8%) showed that psychological distress decreased and psychosocial functioning improved over time with large effect sizes (P<.001 in both cases; ηp2=0.239 and 0.318, respectively) independent of age (P=.76 for psychological distress and P=.48 for psychosocial functioning), sex (P=.24 and P=.88, respectively), therapy activity (P=.49 and P=.80, respectively), or community activity (P=.59 and P=.48, respectively). Similarly, secondary analyses (51/131, 38.9%) showed significant effects of time on the quality of life, well-being, and meaningfulness positive health parameters (P<.05; ηp2=0.062, 0.140, and 0.121, respectively). Improvements in all outcome measures were found between baseline and 3 and 6 months (P≤.001-.01; d=0.23-0.62) and sustained at follow-up (P=.18-.97; d=0.01-0.16). The Reliable Change Index indicated psychological distress improvements in 38% (39/102) of cases, no change in 54.9% (56/102) of cases, and worsening in 5.9% (6/102) of cases. Regarding psychosocial functioning, the percentages were 50% (51/102), 43.1% (44/102), and 6.9% (7/102), respectively. The Clinically Significant Index demonstrated clinically significant changes in 75.5% (77/102) of cases for distress and 89.2% (91/102) for functioning. Conclusions: This trial demonstrated that the ENYOY-platform holds promise as a transdiagnostic intervention for addressing emerging mental health complaints among young people in the Netherlands and laid the groundwork for further clinical research. It would be of great relevance to expand the population on and service delivery of the platform. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03315-x %M 38090802 %R 10.2196/50636 %U https://mhealth.jmir.org/2023/1/e50636 %U https://doi.org/10.2196/50636 %U http://www.ncbi.nlm.nih.gov/pubmed/38090802 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48689 %T Exposure Versus Cognitive Restructuring Techniques in Brief Internet-Based Cognitive Behavioral Treatment for Arabic-Speaking People With Posttraumatic Stress Disorder: Randomized Clinical Trial %A Stein,Jana %A Vöhringer,Max %A Wagner,Birgit %A Stammel,Nadine %A Nesterko,Yuriy %A Böttche,Maria %A Knaevelsrud,Christine %+ Clinical Psychological Intervention, Department of Education and Psychology, Freie Universität Berlin, Schloßstr. 1, Berlin, 12163, Germany, 49 30 303906 76, j.stein@ueberleben.org %K posttraumatic stress %K posttraumatic stress disorder %K PTSD %K Middle East %K North Africa %K Arabic %K Arabic-speaking people %K internet %K internet-based %K exposure %K cognitive restructuring %K randomized clinical trial %K RCT %K cognitive behavioral therapy %K CBT %K cognitive behavioral treatment %D 2023 %7 13.12.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa. Objective: This study aims to evaluate 2 brief internet-based treatments in terms of efficacy, including change in PTSD symptom severity during treatment. Both treatments were developed in line with Interapy, an internet-based, therapist-assisted cognitive behavioral therapy protocol for PTSD and adapted to the specific research question. The first treatment comprised self-confrontation and social sharing (exposure treatment; 6 sessions); the second comprised cognitive restructuring and social sharing (cognitive restructuring treatment; 6 sessions). The 2 treatments were compared with each other and with a waitlist control group. Methods: In total, 365 Arabic-speaking participants from the Middle East and North Africa (mean age 25.49, SD 6.68 y) with PTSD were allocated to cognitive restructuring treatment (n=118, 32.3%), exposure treatment (n=122, 33.4%), or a waitlist control group (n=125, 34.2%) between February 2021 and December 2022. PTSD symptom severity, posttraumatic maladaptive cognitions, anxiety, depressive and somatoform symptom severity, and quality of life were assessed via self-report at baseline and after treatment or waiting time. PTSD symptom severity was also measured throughout treatment or waiting time. Treatment satisfaction was assessed after treatment completion. Treatment use and satisfaction were compared between the 2 treatment conditions using appropriate statistical tests (eg, chi-square and Welch tests). Multiple imputation was performed to address missing data and evaluate treatment-associated changes. These changes were analyzed using multigroup change modeling in the completer and intention-to-treat samples. Results: Overall, 200 (N=240, 83.3%) participants started any of the treatments, of whom 123 (61.5%) completed the treatment. Treatment condition was not significantly associated with the proportion of participants who started versus did not start treatment (P=.20) or with treatment completion versus treatment dropout (P=.71). High treatment satisfaction was reported, with no significant differences between the treatment conditions (P=.48). In both treatment conditions, PTSD, anxiety, depressive and somatoform symptom severity, and posttraumatic maladaptive cognitions decreased, and quality of life improved significantly from baseline to the posttreatment time point (P≤.001 in all cases). Compared with the baseline assessment, overall PTSD symptom severity decreased significantly after 4 sessions in both treatment conditions (P<.001). Moreover, both treatment conditions were significantly superior to the waitlist control group regarding overall PTSD symptom severity (P<.001) and most other comorbid mental health symptoms (P<.001 to P=.03). Differences between the 2 conditions in the magnitude of change for all outcome measures were nonsignificant. Conclusions: Internet-based cognitive behavioral treatments for PTSD focusing primarily on either self-confrontation or cognitive restructuring are applicable and efficacious for Arabic-speaking participants. Trial Registration: German Clinical Trials Register DRKS00010245; https://drks.de/search/de/trial/DRKS00010245 %M 38090792 %R 10.2196/48689 %U https://mental.jmir.org/2023/1/e48689 %U https://doi.org/10.2196/48689 %U http://www.ncbi.nlm.nih.gov/pubmed/38090792 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47487 %T Digital Cognitive Assessment Tests for Older Adults: Systematic Literature Review %A Cubillos,Claudio %A Rienzo,Antonio %+ Escuela de Ingeniería Biomédica, Universidad de Valparaiso, General Cruz 222, Valparaíso, 2362905, Chile, 56 998291207, antonio.rienzo@uv.cl %K cognitive digital test %K systematic review %K cognitive screening %K digital interventions %K older adults %D 2023 %7 8.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: The global health pandemic has affected the increasing older adult population, especially those with mental illnesses. It is necessary to prevent cases of cognitive impairment in adults early on, and this requires the support of information and communication technologies for evaluating and training cognitive functions. This can be achieved through computer applications designed for cognitive assessment. Objective: In this review, we aimed to assess the state of the art of the current platforms and digital test applications for cognitive evaluation, with a focus on older adults. Methods: A systematic literature search was conducted on 3 databases (Web of Science, PubMed, and Scopus) to retrieve recent articles on the applications of digital tests for cognitive assessment and analyze them based on the methodology used. Four research questions were considered. Through the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, following the application of inclusion and exclusion criteria, a total of 20 articles were finally reviewed. Results: Some gaps and trends were identified regarding the types of digital applications and technologies used, the evaluated effects on cognitive domains, and the psychometric parameters and personal characteristics considered for validation. Conclusions: Computerized tests (similar to paper-and-pencil tests) and test batteries (on computers, tablets, or web platforms) were the predominant types of assessments. Initial studies with simulators, virtual environments, and daily-life activity games were also conducted. Diverse validation methods and psychometric properties were observed; however, there was a lack of evaluations that involved specific populations with diverse education levels, cultures, and degrees of technology acceptance. In addition, these evaluations should consider emotional and usability aspects. %M 38064247 %R 10.2196/47487 %U https://mental.jmir.org/2023/1/e47487 %U https://doi.org/10.2196/47487 %U http://www.ncbi.nlm.nih.gov/pubmed/38064247 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e46419 %T The Role of Daily Steps in the Treatment of Major Depressive Disorder: Secondary Analysis of a Randomized Controlled Trial of a 6-Month Internet-Based, Mindfulness-Based Cognitive Behavioral Therapy Intervention for Youth %A Dang,Kevin %A Ritvo,Paul %A Katz,Joel %A Gratzer,David %A Knyahnytska,Yuliya %A Ortiz,Abigail %A Walters,Clarice %A Attia,Mohamed %A Gonzalez-Torres,Christina %A Lustig,Andrew %A Daskalakis,Zafiris %+ School of Kinesiology and Health Sciences, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 580 8021, pritvo@yorku.ca %K accelerometer %K anxiety %K CBT %K chronic pain %K cognitive behavioral therapy %K controlled trials %K depression %K depressive symptoms %K digital health %K eHealth %K exercise %K fitbit %K intervention study %K longitudinal study %K major depressive disorder %K mHealth %K mindfulness %K mindfulness-based CBT %K objectively measured activity %K online health %K online intervention %K online therapy %K pain %K physical activity %K prospective study %K randomized controlled trial %K RCT %K step %K steps %D 2023 %7 8.12.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Current evidence supports physical activity (PA) as an adjunctive treatment for major depressive disorder (MDD). Few studies, however, have examined the relationship between objectively measured PA and MDD treatment outcomes using prospective data. Objective: This study is a secondary analysis of data from a 24-week internet-based, mindfulness-based cognitive behavioral therapy program for MDD. The purpose of this analysis was twofold: (1) to examine average daily step counts in relation to MDD symptom improvement, and whether pain moderated this relationship; and (2) to examine whether changes in step activity (ie, step trajectories) during treatment were associated with baseline symptoms and symptom improvement. Methods: Patients from the Centre for Addiction and Mental Health were part of a randomized controlled trial evaluating the effects of internet-based, mindfulness-based cognitive behavioral therapy for young adults (aged 18-30 years old) with MDD. Data from 20 participants who had completed the intervention were analyzed. PA, in the form of objectively measured steps, was measured using the Fitbit-HR Charge 2 (Fitbit Inc), and self-reported depression severity was measured with the Beck Depression Inventory-II (BDI-II). Linear regression analysis was used to test PA’s relationship with depression improvement and the moderating effect of pain severity and pain interference. Growth curve and multivariable regression models were used to test longitudinal associations. Results: Participants walked an average of 8269 steps per day, and each additional +1000-step difference between participants was significantly associated with a 2.66-point greater improvement (reduction) in BDI-II, controlling for anxiety, pain interference, and adherence to Fitbit monitoring (P=.02). Pain severity appeared to moderate (reduce) the positive effect of average daily steps on BDI-II improvement (P=.03). Higher baseline depression and anxiety symptoms predicted less positive step trajectories throughout treatment (Ps≤.001), and more positive step trajectories early in the trial predicted greater MDD improvement at the end of the trial (Ps<.04). However, step trajectories across the full duration of the trial did not significantly predict MDD improvement (Ps=.40). Conclusions: This study used objective measurements to demonstrate positive associations between PA and depression improvement in the context of cognitive behavioral treatment. Pain appeared to moderate this relationship, and baseline symptoms of anxiety and depression predicted PA trajectories. The findings inform future interventions for major depression. Future research with larger samples should consider additional moderators of PA-related treatment success and the extent to which outcomes are related to PA change in multimodal interventions. Trial Registration: Clinical Trials.gov NCT03406052; https://www.clinicaltrials.gov/ct2/show/NCT03406052 International Registered Report Identifier (IRRID): RR2-10.2196/11591 %M 38064262 %R 10.2196/46419 %U https://www.i-jmr.org/2023/1/e46419 %U https://doi.org/10.2196/46419 %U http://www.ncbi.nlm.nih.gov/pubmed/38064262 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46309 %T Social Media Use and Its Concurrent and Subsequent Relation to a Biological Marker of Inflammation: Short-Term Longitudinal Study %A Lee,David %A Jiang,Tao %A Crocker,Jennifer %A Way,Baldwin %+ Department of Communication, University at Buffalo, The State University of New York, 327 Baldy Hall, Buffalo, NY, 14260, United States, 1 716 645 1167, dslee9@buffalo.edu %K social media use %K inflammation %K physical health %K well-being %K screen time %K mental health %K social media %K biomarker %K chronic disease %D 2023 %7 8.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Although many studies have examined the impact of social media use (SMU) on mental health, very few studies have examined the association of SMU with health-relevant biomarkers. Objective: Addressing this gap, we conducted a short-term longitudinal study examining the link between SMU and C-reactive protein (CRP), a biological marker of systemic inflammation predictive of major depression, chronic diseases, and mortality. Methods: We measured college students’ weekly amount of SMU for 5 consecutive weeks objectively via the Screen Time app and collected blood samples at baseline and 5 weeks later. Results: In separate cross-sectional analyses conducted at phase 1 (baseline) and at phase 2 (5 weeks after baseline), objective SMU had a positive, concurrent association with CRP at both time points. Critically, in a longitudinal analysis, more SMU between phase 1 and phase 2 predicted increased CRP between these time points, suggesting that increased SMU led to heightened inflammation during that period. Conclusions: Although more research is needed to understand why SMU led to higher inflammation, the association between objective SMU and a marker of a biological process critical to physical health presents an intriguing opportunity for future research on social media effects. %M 38064253 %R 10.2196/46309 %U https://www.jmir.org/2023/1/e46309 %U https://doi.org/10.2196/46309 %U http://www.ncbi.nlm.nih.gov/pubmed/38064253 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e45453 %T User-Centered Development of STOP (Successful Treatment for Paranoia): Material Development and Usability Testing for a Digital Therapeutic for Paranoia %A Hsu,Che-Wei %A Stahl,Daniel %A Mouchlianitis,Elias %A Peters,Emmanuelle %A Vamvakas,George %A Keppens,Jeroen %A Watson,Miles %A Schmidt,Nora %A Jacobsen,Pamela %A McGuire,Philip %A Shergill,Sukhi %A Kabir,Thomas %A Hirani,Tia %A Yang,Ziyang %A Yiend,Jenny %+ Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 07977978655, jenny.yiend@kcl.ac.uk %K cognitive bias modification %K paranoia %K content specificity %K mental health %K mobile app %K mhealth %K digital therapeutic %K user-centered development %K user %K user-friendly app %K paranoid %K persecution %K persecution complex %K delusions %K obsession %K megalomania %K monomania %K psychosis %K psychotic %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Paranoia is a highly debilitating mental health condition. One novel intervention for paranoia is cognitive bias modification for paranoia (CBM-pa). CBM-pa comes from a class of interventions that focus on manipulating interpretation bias. Here, we aimed to develop and evaluate new therapy content for CBM-pa for later use in a self-administered digital therapeutic for paranoia called STOP (“Successful Treatment of Paranoia”). Objective: This study aimed to (1) take a user-centered approach with input from living experts, clinicians, and academics to create and evaluate paranoia-relevant item content to be used in STOP and (2) engage with living experts and the design team from a digital health care solutions company to cocreate and pilot-test the STOP mobile app prototype. Methods: We invited 18 people with living or lived experiences of paranoia to create text exemplars of personal, everyday emotionally ambiguous scenarios that could provoke paranoid thoughts. Researchers then adapted 240 suitable exemplars into corresponding intervention items in the format commonly used for CBM training and created 240 control items for the purpose of testing STOP. Each item included newly developed, visually enriching graphics content to increase the engagement and realism of the basic text scenarios. All items were then evaluated for their paranoia severity and readability by living experts (n=8) and clinicians (n=7) and for their item length by the research team. Items were evenly distributed into six 40-item sessions based on these evaluations. Finalized items were presented in the STOP mobile app, which was co-designed with a digital health care solutions company, living or lived experts, and the academic team; user acceptance was evaluated across 2 pilot tests involving living or lived experts. Results: All materials reached predefined acceptable thresholds on all rating criteria: paranoia severity (intervention items: ≥1; control items: ≤1, readability: ≥3, and length of the scenarios), and there was no systematic difference between the intervention and control group materials overall or between individual sessions within each group. For item graphics, we also found no systematic differences in users’ ratings of complexity (P=.68), attractiveness (P=.15), and interest (P=.14) between intervention and control group materials. User acceptance testing of the mobile app found that it is easy to use and navigate, interactive, and helpful. Conclusions: Material development for any new digital therapeutic requires an iterative and rigorous process of testing involving multiple contributing groups. Appropriate user-centered development can create user-friendly mobile health apps, which may improve face validity and have a greater chance of being engaging and acceptable to the target end users. %M 38064256 %R 10.2196/45453 %U https://humanfactors.jmir.org/2023/1/e45453 %U https://doi.org/10.2196/45453 %U http://www.ncbi.nlm.nih.gov/pubmed/38064256 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e53293 %T Evaluating Clinical Outcomes in Patients Being Treated Exclusively via Telepsychiatry: Retrospective Data Analysis %A Person,Cheryl %A O'Connor,Nicola %A Koehler,Lucy %A Venkatachalam,Kartik %A Gaveras,Georgia %+ Talkiatry, 109 W 27th Street Suite 5S, New York, NY, 10001, United States, 1 833 351 8255, cheryl.person@talkiatry.com %K telepsychiatry %K PHQ-8 %K GAD-7 %K clinical outcomes %K rural %K commercial insurance %K telehealth %K depression %K anxiety %K telemental health %K psychiatry %K Generalized Anxiety Disorder-7 %K Patient Health Questionnaire-8 %D 2023 %7 8.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression and anxiety are highly prevalent conditions in the United States. Despite the availability of suitable therapeutic options, limited access to high-quality psychiatrists represents a major barrier to treatment. Although telepsychiatry has the potential to improve access to psychiatrists, treatment efficacy in the telepsychiatry model remains unclear. Objective: Our primary objective was to determine whether there was a clinically meaningful change in 1 of 2 validated outcome measures of depression and anxiety—the Patient Health Questionnaire–8 (PHQ-8) or the Generalized Anxiety Disorder–7 (GAD-7)—after receiving at least 8 weeks of treatment in an outpatient telepsychiatry setting. Methods: We included treatment-seeking patients enrolled in a large outpatient telepsychiatry service that accepts commercial insurance. All analyzed patients completed the GAD-7 and PHQ-8 prior to their first appointment and at least once after 8 weeks of treatment. Treatments included comprehensive diagnostic evaluation, supportive psychotherapy, and medication management. Results: In total, 1826 treatment-seeking patients were evaluated for clinically meaningful changes in GAD-7 and PHQ-8 scores during treatment. Mean treatment duration was 103 (SD 34) days. At baseline, 58.8% (1074/1826) and 60.1% (1097/1826) of patients exhibited at least moderate anxiety and depression, respectively. In response to treatment, mean change for GAD-7 was –6.71 (95% CI –7.03 to –6.40) and for PHQ-8 was –6.85 (95% CI –7.18 to –6.52). Patients with at least moderate symptoms at baseline showed a 45.7% reduction in GAD-7 scores and a 43.1% reduction in PHQ-8 scores. Effect sizes for GAD-7 and PHQ-8, as measured by Cohen d for paired samples, were d=1.30 (P<.001) and d=1.23 (P<.001), respectively. Changes in GAD-7 and PHQ-8 scores correlated with the type of insurance held by the patients. Greatest reductions in scores were observed among patients with commercial insurance (45% and 43.9% reductions in GAD-7 and PHQ-8 scores, respectively). Although patients with Medicare did exhibit statistically significant reductions in GAD-7 and PHQ-8 scores from baseline (P<.001), these improvements were attenuated compared to those in patients with commercial insurance (29.2% and 27.6% reduction in GAD-7 and PHQ-8 scores, respectively). Pairwise comparison tests revealed significant differences in treatment responses in patients with Medicare versus commercial insurance (P<.001). Responses were independent of patient geographic classification (urban vs rural; P=.48 for GAD-7 and P=.07 for PHQ-8). The finding that treatment efficacy was comparable among rural and urban patients indicated that telepsychiatry is a promising approach to overcome treatment disparities that stem from geographical constraints. Conclusions: In this large retrospective data analysis of treatment-seeking patients using a telepsychiatry platform, we found robust and clinically significant improvement in depression and anxiety symptoms during treatment. The results provide further evidence that telepsychiatry is highly effective and has the potential to improve access to psychiatric care. %M 37991899 %R 10.2196/53293 %U https://formative.jmir.org/2023/1/e53293 %U https://doi.org/10.2196/53293 %U http://www.ncbi.nlm.nih.gov/pubmed/37991899 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47847 %T The Adoption of AI in Mental Health Care–Perspectives From Mental Health Professionals: Qualitative Descriptive Study %A Zhang,Melody %A Scandiffio,Jillian %A Younus,Sarah %A Jeyakumar,Tharshini %A Karsan,Inaara %A Charow,Rebecca %A Salhia,Mohammad %A Wiljer,David %+ University Health Network, 190 Elizabeth Street, R Fraser Elliot Building RFE 3S-441, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 6322, David.wiljer@uhn.ca %K artificial intelligence %K education %K mental health %K behavioral health %K educators %K curriculum %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence (AI) is transforming the mental health care environment. AI tools are increasingly accessed by clients and service users. Mental health professionals must be prepared not only to use AI but also to have conversations about it when delivering care. Despite the potential for AI to enable more efficient and reliable and higher-quality care delivery, there is a persistent gap among mental health professionals in the adoption of AI. Objective: A needs assessment was conducted among mental health professionals to (1) understand the learning needs of the workforce and their attitudes toward AI and (2) inform the development of AI education curricula and knowledge translation products. Methods: A qualitative descriptive approach was taken to explore the needs of mental health professionals regarding their adoption of AI through semistructured interviews. To reach maximum variation sampling, mental health professionals (eg, psychiatrists, mental health nurses, educators, scientists, and social workers) in various settings across Ontario (eg, urban and rural, public and private sector, and clinical and research) were recruited. Results: A total of 20 individuals were recruited. Participants included practitioners (9/20, 45% social workers and 1/20, 5% mental health nurses), educator scientists (5/20, 25% with dual roles as professors/lecturers and researchers), and practitioner scientists (3/20, 15% with dual roles as researchers and psychiatrists and 2/20, 10% with dual roles as researchers and mental health nurses). Four major themes emerged: (1) fostering practice change and building self-efficacy to integrate AI into patient care; (2) promoting system-level change to accelerate the adoption of AI in mental health; (3) addressing the importance of organizational readiness as a catalyst for AI adoption; and (4) ensuring that mental health professionals have the education, knowledge, and skills to harness AI in optimizing patient care. Conclusions: AI technologies are starting to emerge in mental health care. Although many digital tools, web-based services, and mobile apps are designed using AI algorithms, mental health professionals have generally been slower in the adoption of AI. As indicated by this study’s findings, the implications are 3-fold. At the individual level, digital professionals must see the value in digitally compassionate tools that retain a humanistic approach to care. For mental health professionals, resistance toward AI adoption must be acknowledged through educational initiatives to raise awareness about the relevance, practicality, and benefits of AI. At the organizational level, digital professionals and leaders must collaborate on governance and funding structures to promote employee buy-in. At the societal level, digital and mental health professionals should collaborate in the creation of formal AI training programs specific to mental health to address knowledge gaps. This study promotes the design of relevant and sustainable education programs to support the adoption of AI within the mental health care sphere. %M 38060307 %R 10.2196/47847 %U https://formative.jmir.org/2023/1/e47847 %U https://doi.org/10.2196/47847 %U http://www.ncbi.nlm.nih.gov/pubmed/38060307 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46830 %T Repetitive Transcranial Magnetic Stimulation With and Without Text4Support for the Treatment of Resistant Depression: Protocol for a Patient-Centered Multicenter Randomized Controlled Pilot Trial %A Adu,Medard Kofi %A Dias,Raquel da Luz %A Agyapong,Belinda %A Eboreime,Ejemai %A Sapara,Adegboyega O %A Lawal,Mobolaji A %A Chew,Corina %A Diamond Frost,Karen %A Li,Daniel %A Flynn,Michael %A Hassan,Sameh %A Saleh,Ahmed %A Sridharan,Sanjana %A White,Matt %A Agyapong,Vincent IO %+ Department of Psychiatry, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 780 215 7771, vn602367@dal.ca %K repetitive transcranial magnetic stimulation %K treatment-resistant depression %K cognitive behavioral therapy %K Text4Support %K text messaging %K major depressive disorder %D 2023 %7 7.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Treatment-resistant depression (TRD) is the inability of a patient with major depressive disorder (MDD) to accomplish or achieve remission after an adequate trial of antidepressant treatments. Several combinations and augmentation treatment strategies for TRD exist, including the use of repetitive transcranial magnetic stimulation (rTMS), and new therapeutic options are being introduced. Text4Support, a text message–based form of cognitive behavioral therapy that allows patients with MDD to receive daily supportive text messages for correcting or altering negative thought patterns through positive reinforcement, may be a useful augmentation treatment strategy for patients with TRD. It is however currently unknown if adding the Text4Support intervention will enhance the response of patients with TRD to rTMS treatment. Objective: This study aims to assess the initial comparative clinical effectiveness of rTMS with and without the Text4Support program as an innovative patient-centered intervention for the management of patients diagnosed with TRD. Methods: This study is a multicenter, prospective, parallel-design, 2-arm, rater-blinded randomized controlled pilot trial. The recruitment process is scheduled to last 12 months. It will involve active treatment for 6 weeks, observation, and a follow-up period of 6 months for participants in the study arms. In total, 200 participants diagnosed with TRD at rTMS care clinics in Edmonton, Alberta, and rTMS clinics in Halifax, Nova Scotia will be randomized to 1 of 2 treatment arms (rTMS sessions alone or rTMS sessions plus Text4Support intervention). Participants in each group will be made to complete evaluation measures at baseline, and 1, 3, and 6 months. The primary outcome measure will be the mean change in the scores of the Patient Health Questionnaire-9 (PHQ-9). The secondary outcome measures will involve the scores of the 7-item Generalized Anxiety Disorders Scale (GAD-7), Columbia-Suicide Severity Rating Scale (CSSRS), and World Health Organization-Five Well-Being Index (WHO-5). Patient data will be analyzed with descriptive statistics, repeated measures, and correlational analyses. Qualitative data will be analyzed using the thematic analysis framework. Results: The results of the study are expected to be available 18 months from the start of recruitment. We hypothesize that participants enrolled in the rTMS plus Text4Support intervention treatment arm of the study will achieve superior outcomes compared with the outcomes of participants enrolled in the rTMS alone arm. Conclusions: The application of the combination of rTMS and Text4Support has not been investigated previously. Therefore, we hope that this study will provide a concrete base of data to evaluate the practical application and efficacy of using the novel combination of these 2 treatment modalities. International Registered Report Identifier (IRRID): PRR1-10.2196/46830 %M 38060308 %R 10.2196/46830 %U https://www.researchprotocols.org/2023/1/e46830 %U https://doi.org/10.2196/46830 %U http://www.ncbi.nlm.nih.gov/pubmed/38060308 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e52091 %T The Impact of Generative Conversational Artificial Intelligence on the Lesbian, Gay, Bisexual, Transgender, and Queer Community: Scoping Review %A Bragazzi,Nicola Luigi %A Crapanzano,Andrea %A Converti,Manlio %A Zerbetto,Riccardo %A Khamisy-Farah,Rola %+ Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100, robertobragazzi@gmail.com %K generative conversational artificial intelligence %K chatbot %K lesbian, gay, bisexual, transgender, and queer community %K LGBTQ %K scoping review %K mobile phone %D 2023 %7 6.12.2023 %9 Review %J J Med Internet Res %G English %X Background: Despite recent significant strides toward acceptance, inclusion, and equality, members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community still face alarming mental health disparities, being almost 3 times more likely to experience depression, anxiety, and suicidal thoughts than their heterosexual counterparts. These unique psychological challenges are due to discrimination, stigmatization, and identity-related struggles and can potentially benefit from generative conversational artificial intelligence (AI). As the latest advancement in AI, conversational agents and chatbots can imitate human conversation and support mental health, fostering diversity and inclusivity, combating stigma, and countering discrimination. In contrast, if not properly designed, they can perpetuate exclusion and inequities. Objective: This study aims to examine the impact of generative conversational AI on the LGBTQ community. Methods: This study was designed as a scoping review. Four electronic scholarly databases (Scopus, Embase, Web of Science, and MEDLINE via PubMed) and gray literature (Google Scholar) were consulted from inception without any language restrictions. Original studies focusing on the LGBTQ community or counselors working with this community exposed to chatbots and AI-enhanced internet-based platforms and exploring the feasibility, acceptance, or effectiveness of AI-enhanced tools were deemed eligible. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Results: Seven applications (HIVST-Chatbot, TelePrEP Navigator, Amanda Selfie, Crisis Contact Simulator, REALbot, Tough Talks, and Queer AI) were included and reviewed. The chatbots and internet-based assistants identified served various purposes: (1) to identify LGBTQ individuals at risk of suicide or contracting HIV or other sexually transmitted infections, (2) to provide resources to LGBTQ youth from underserved areas, (3) facilitate HIV status disclosure to sex partners, and (4) develop training role-play personas encompassing the diverse experiences and intersecting identities of LGBTQ youth to educate counselors. The use of generative conversational AI for the LGBTQ community is still in its early stages. Initial studies have found that deploying chatbots is feasible and well received, with high ratings for usability and user satisfaction. However, there is room for improvement in terms of the content provided and making conversations more engaging and interactive. Many of these studies used small sample sizes and short-term interventions measuring limited outcomes. Conclusions: Generative conversational AI holds promise, but further development and formal evaluation are needed, including studies with larger samples, longer interventions, and randomized trials to compare different content, delivery methods, and dissemination platforms. In addition, a focus on engagement with behavioral objectives is essential to advance this field. The findings have broad practical implications, highlighting that AI’s impact spans various aspects of people’s lives. Assessing AI’s impact on diverse communities and adopting diversity-aware and intersectional approaches can help shape AI’s positive impact on society as a whole. %M 37864350 %R 10.2196/52091 %U https://www.jmir.org/2023/1/e52091 %U https://doi.org/10.2196/52091 %U http://www.ncbi.nlm.nih.gov/pubmed/37864350 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48991 %T Self-Guided Mental Health Apps Targeting Racial and Ethnic Minority Groups: Scoping Review %A Saad,Fiby %A Eisenstadt,Mia %A Liverpool,Shaun %A Carlsson,Courtney %A Vainieri,Isabella %+ Clinical, Educational and Health Psychology, Division of Psychology and Language Sciences, University College London, Faculty of Brain Sciences, Gower Street, London, WC1E 6BT, United Kingdom, 44 2039872684 ext 2684, ucjuiva@ucl.ac.uk %K mental health apps %K racial and ethnic minority groups %K self-guided %K mental health %K culturally appropriate technology %D 2023 %7 6.12.2023 %9 Review %J JMIR Ment Health %G English %X Background: The use of mental health apps (MHAs) is increasing rapidly. However, little is known about the use of MHAs by racial and ethnic minority groups. Objective: In this review, we aimed to examine the acceptability and effectiveness of MHAs among racial and ethnic minority groups, describe the purposes of using MHAs, identify the barriers to MHA use in racial and ethnic minority groups, and identify the gaps in the literature. Methods: A systematic search was conducted on August 25, 2023, using Web of Science, Embase, PsycINFO, PsycArticles, PsycExtra, and MEDLINE. Articles were quality appraised using the Mixed Methods Appraisal Tool, and data were extracted and summarized to form a narrative synthesis. Results: A total of 15 studies met the inclusion criteria. Studies were primarily conducted in the United States, and the MHAs designed for racial and ethnic minority groups included ¡Aptívate!, iBobbly, AIMhi- Y, BRAVE, Build Your Own Theme Song, Mindful You, Sanadak, and 12 more MHAs used in 1 study. The MHAs were predominantly informed by cognitive behavioral therapy and focused on reducing depressive symptoms. MHAs were considered acceptable for racial and ethnic minority groups; however, engagement rates dropped over time. Only 2 studies quantitatively reported the effectiveness of MHAs among racial and ethnic minority groups. Barriers to use included the repetitiveness of the MHAs, stigma, lack of personalization, and technical issues. Conclusions: Considering the growing interest in MHAs, the available evidence for MHAs for racial and ethnic minority groups appears limited. Although the acceptability seems consistent, more research is needed to support the effectiveness of MHAs. Future research should also prioritize studies to explore the specific needs of racial and ethnic minority groups if MHAs are to be successfully adopted. %M 38055315 %R 10.2196/48991 %U https://mental.jmir.org/2023/1/e48991 %U https://doi.org/10.2196/48991 %U http://www.ncbi.nlm.nih.gov/pubmed/38055315 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47630 %T Improving Social Isolation and Loneliness Among Adolescents With Physical Disabilities Through Group-Based Virtual Reality Gaming: Feasibility Pre-Post Trial Study %A Lai,Byron %A Young,Raven %A Craig,Mary %A Chaviano,Kelli %A Swanson-Kimani,Erin %A Wozow,Cynthia %A Davis,Drew %A Rimmer,James H %+ Division of Pediatric Rehabilitation Medicine, Department of Pediatrics, University of Alabama at Birmingham, 1600 7th Avenue South, 5 Dearth, McWane 5601, Birmingham, AL, 35233, United States, 1 2056389790 ext 8 9725, blai@uabmc.edu %K therapy %K mindfulness %K play %K friend %K friends %K friendship %K lonely %K loneliness %K psychotherapy %K peer %K peers %K recreation %K disability %K adolescent %K adolescents %K disability %K disabled %K physical disability %K digital mental health intervention %K youth %K young adult %K virtual reality %K VR %K gaming %K depression %K depressive %K mental health %K social %K isolated %K isolation %K socialize %K socializing %K socialization %K interaction %K interactions %K acceptability %K game %K games %K gaming %K exergame %K exergames %K exergaming %D 2023 %7 6.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents with disabilities experience alarmingly higher rates of depression and isolation than peers without disabilities. There is a need to identify interventions that can improve mental health and isolation among this underserved population. Innovations in virtual reality (VR) gaming “standalone” headsets allow greater access to immersive high-quality digital experiences, due to their relatively low cost. Objective: This study had three purposes, which were to (1) examine the preliminary effects of a low-cost, home-based VR multiplayer recreation and socialization on depression, socialization, and loneliness; (2) quantify the acceptability of the program as measured by participant adherence, total play time, and exercise time; and (3) identify and describe behavioral mechanisms that affected participant engagement. Methods: This was a single-group, pre- to postdesign trial. The intervention was conducted at home. Participants were recruited from a children’s hospital. The intervention lasted 4 weeks and included 2×1-hour sessions per week of supervised peer-to-peer gaming. Participants used the Meta Quest 2 headset to meet peers and 2 coaches in a private party held digitally. Aim 1 was evaluated with the Children’s Depression Inventory 2 Short Form and the University of California, Los Angeles Loneliness Scale 20 items, which are measures of social isolation and loneliness, respectively. Aim 2 was evaluated through the following metrics: participant adherence, the types of games played, friendship building and playtime, and program satisfaction and enjoyment. Results: In total, 12 people enrolled (mean age 16.6, SD 1.8 years; male: n=9 and female: n=3), and 8 people completed the program. Mean attendance for the 8 participants was 77% (49 sessions of 64 total possible sessions; mean 6, SD 2 sessions). A trend was observed for improved Children’s Depression Inventory 2 Short Form scores (mean preintervention score 7.25, SD 4.2; mean postintervention score 5.38, SD 4.1; P=.06; effect size=0.45, 95% CI –0.15 to 3.9), but this was not statistically significant; no difference was observed for University of California, Los Angeles Loneliness Scale 20 items scores. Most participants (7/8, 88%) stated that they became friends with a peer in class; 50% (4/8) reported that they played with other people. Participants reported high levels of enjoyment and satisfaction with how the program was implemented. Qualitative analysis resulted in 4 qualitative themes that explained behavioral mechanisms that determined engagement in the program. Conclusions: The study findings demonstrated that a brief VR group program could be valuable for potentially improving mental health among adolescents with physical disabilities. Participants built friendships with peers and other players on the web, using low-cost consumer equipment that provided easy access and strong scale-up potential. Study findings identified factors that can be addressed to enhance the program within a larger clinical trial. Trial Registration: ClinicalTrials.gov NCT05259462; https://clinicaltrials.gov/study/NCT05259462 International Registered Report Identifier (IRRID): RR2-10.2196/42651 %M 38055309 %R 10.2196/47630 %U https://formative.jmir.org/2023/1/e47630 %U https://doi.org/10.2196/47630 %U http://www.ncbi.nlm.nih.gov/pubmed/38055309 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49074 %T Understanding Mental Health Issues in Different Subdomains of Social Networking Services: Computational Analysis of Text-Based Reddit Posts %A Kim,Seoyun %A Cha,Junyeop %A Kim,Dongjae %A Park,Eunil %+ Department of Applied Artificial Intelligence, Sungkyunkwan University, 310, Sungkyunkwan-ro 25-2, Seoul, 03063, Republic of Korea, 82 27401864, eunilpark@skku.edu %K mental health %K sentiment analysis %K mental disorder %K text analysis %K NLP %K natural language processing %K clustering %D 2023 %7 30.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Users increasingly use social networking services (SNSs) to share their feelings and emotions. For those with mental disorders, SNSs can also be used to seek advice on mental health issues. One available SNS is Reddit, in which users can freely discuss such matters on relevant health diagnostic subreddits. Objective: In this study, we analyzed the distinctive linguistic characteristics in users’ posts on specific mental disorder subreddits (depression, anxiety, bipolar disorder, borderline personality disorder, schizophrenia, autism, and mental health) and further validated their distinctiveness externally by comparing them with posts of subreddits not related to mental illness. We also confirmed that these differences in linguistic formulations can be learned through a machine learning process. Methods: Reddit posts uploaded by users were collected for our research. We used various statistical analysis methods in Linguistic Inquiry and Word Count (LIWC) software, including 1-way ANOVA and subsequent post hoc tests, to see sentiment differences in various lexical features within mental health–related subreddits and against unrelated ones. We also applied 3 supervised and unsupervised clustering methods for both cases after extracting textual features from posts on each subreddit using bidirectional encoder representations from transformers (BERT) to ensure that our data set is suitable for further machine learning or deep learning tasks. Results: We collected 3,133,509 posts of 919,722 Reddit users. The results using the data indicated that there are notable linguistic differences among the subreddits, consistent with the findings of prior research. The findings from LIWC analyses revealed that patients with each mental health issue show significantly different lexical and semantic patterns, such as word count or emotion, throughout their online social networking activities, with P<.001 for all cases. Furthermore, distinctive features of each subreddit group were successfully identified through supervised and unsupervised clustering methods, using the BERT embeddings extracted from textual posts. This distinctiveness was reflected in the Davies-Bouldin scores ranging from 0.222 to 0.397 and the silhouette scores ranging from 0.639 to 0.803 in the former case, with scores of 1.638 and 0.729, respectively, in the latter case. Conclusions: By taking a multifaceted approach, analyzing textual posts related to mental health issues using statistical, natural language processing, and machine learning techniques, our approach provides insights into aspects of recent lexical usage and information about the linguistic characteristics of patients with specific mental health issues, which can inform clinicians about patients’ mental health in diagnostic terms to aid online intervention. Our findings can further promote research areas involving linguistic analysis and machine learning approaches for patients with mental health issues by identifying and detecting mentally vulnerable groups of people online. %M 38032730 %R 10.2196/49074 %U https://www.jmir.org/2023/1/e49074 %U https://doi.org/10.2196/49074 %U http://www.ncbi.nlm.nih.gov/pubmed/38032730 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e50522 %T User-Centered Development of Bolster, an mHealth Intervention for Early Psychosis Caregivers: Needs Assessment, Prototyping, and Field Trial %A Buck,Benjamin %A Wingerson,Mary %A Whiting,Erica %A Snyder,Jaime %A Monroe-DeVita,Maria %A Ben-Zeev,Dror %+ Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Box 356560, 1959 NE Pacific Street, Seattle, WA, 98105, United States, 1 206 221 8518, buckbe@uw.edu %K caregiving %K psychosis %K mobile health %K mHealth %K user-centered design %K mobile phone %K artificial intelligence %K AI %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Caregivers play a critical role in the treatment and recovery of youth and young adults at risk for psychosis. Caregivers often report feeling isolated, overwhelmed, and lacking in resources. Mobile health (mHealth) has the potential to provide scalable, accessible, and in-the-moment support to caregivers. To date, few if any mHealth resources have been developed specifically for this population. Objective: The aim of this study was to conduct user-centered design and testing of an mHealth intervention to support early psychosis caregivers. Methods: We conducted a multiphase user-centered development process to develop the Bolster mobile app. In phase 1, a total of 21 caregivers were recruited to participate in a qualitative needs assessment and respond to an initial prototype of the Bolster platform. Content analysis was used to identify key needs and design objectives, which guided the development of the Bolster mobile app. In phase 2, a total of 11 caregivers were recruited to participate in a 1-week field trial wherein they provided qualitative and quantitative feedback regarding the usability and acceptability of Bolster; in addition, they provided baseline and posttest assessments of the measures of distress, illness appraisals, and family communication. Results: In phase 1, participants identified psychoeducation, communication coaching, a guide to seeking services, and support for coping as areas to address. Live prototype interaction sessions led to multiple design objectives, including ensuring that messages from the platform were actionable and tailored to the caregiver experience, delivering messages in multiple modalities (eg, video and text), and eliminating a messaging-style interface. These conclusions were used to develop the final version of Bolster tested in the field trial. In phase 2, of the 11 caregivers, 10 (91%) reported that they would use Bolster if they had access to it and would recommend it to another caregiver. They also reported marked changes in their appraisals of illness (Cohen d=0.55-0.68), distress (Cohen d=1.77), and expressed emotion (Cohen d=0.52). Conclusions: To our knowledge, this study is the first to design an mHealth intervention specifically for early psychosis caregivers. Preliminary data suggest that Bolster is usable, acceptable, and promising to improve key targets and outcomes. A future fully powered clinical trial will help determine whether mHealth can reduce caregiver burdens and increase engagement in services among individuals affected by psychosis. %M 38032692 %R 10.2196/50522 %U https://mental.jmir.org/2023/1/e50522 %U https://doi.org/10.2196/50522 %U http://www.ncbi.nlm.nih.gov/pubmed/38032692 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e51318 %T The Efficacy and Therapeutic Alliance of Augmented Reality Exposure Therapy in Treating Adults With Phobic Disorders: Systematic Review %A Hasan,Safa %A Alhaj,Hamid %A Hassoulas,Athanasios %+ University of Sharjah, College of Medicine, University of Shajah, Sharjah, United Arab Emirates, 971 65057239, halhaj@sharjah.ac.ae %K augmented reality %K virtual reality %K anxiety disorders %K phobic disorders %K exposure therapy %K augmented reality exposure %K phobia %K excessive fear %K prevalence %K technology %K cost-effectiveness %K fear %K phobia %K phobic %D 2023 %7 30.11.2023 %9 Review %J JMIR Ment Health %G English %X Background: Phobic disorders are characterized by excessive fear of a stimulus that can affect the quality of a patient’s life. The lifetime prevalence in adults is 7.7% to 12.5%. The current literature provides evidence-based inferences about the effectiveness of in-vivo exposure therapy (IVET) in treating phobia. However, this method can put the therapist and the client in danger, with high drop out and refusal rates. A newer approach for exposure therapy using augmented reality technology is under assessment. Objective: This systematic review investigated the novel technology’s efficacy, cost-efficacy, and therapeutic alliance in treating adults with phobia. Methods: An extensive search was conducted using 4 major databases (MEDLINE, PsycINFO, Embase, and Scopus) using a comprehensive list of synonyms for augmented reality exposure therapy (ARET) and phobic disorders. The search targeted any randomized control trial testing ARET in adults with phobic disorders up to August 8, 2022. Results: A total of 6 studies were included, with 208 participants providing results. Studies investigating the efficacy of ARET compared to no intervention showed significant results (P<.05) in the ARET group improvement. Head-to-head comparative studies comparing ARET to IVET showed no significant difference (P>.05) in the effectiveness and therapeutic alliance between both therapies. Further, the results demonstrated that the ARET group had a better long-term effect than IVET, with the ability to put the patients in more situations to face the feared object. Conclusions: The current data suggest clinically significant efficacy and a promising therapeutic alliance of ARET. However, no data are available investigating the cost-effectiveness of ARET. Further research is warranted to ascertain ARET’s cost-effectiveness and examine its efficacy in other populations and anxiety conditions. %M 38032710 %R 10.2196/51318 %U https://mental.jmir.org/2023/1/e51318 %U https://doi.org/10.2196/51318 %U http://www.ncbi.nlm.nih.gov/pubmed/38032710 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46928 %T Facilitating In-House Mobile App Development Within Psychiatric Outpatient Services for Patients Diagnosed With Borderline Personality Disorder: Rapid Application Development Approach %A Shaker,Ali Abbas %A Austin,Stephen F %A Jørgensen,Mie Sedoc %A Sørensen,John Aasted %A Bechmann,Henrik %A Kinnerup,Henriette E %A Petersen,Charlotte Juul %A Olsen,Ragnar Klein %A Simonsen,Erik %+ Psychiatric Research Unit, Psychiatric Department, Region Zealand Psychiatry, Fælledvej 6, Bygning 3, 4. sal, Slagelse, 4200, Denmark, 45 58536070, ashak@regionsjaelland.dk %K software models %K in-house development %K psychiatric services %K borderline personality disorder %K mobile application %K development %K mental health %K user design %K design %K psychiatric %K implementation %K innovation %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile app development within mental health is often time- and resource-consuming, challenging the development of mobile apps for psychiatry. There is a continuum of software development methods ranging from linear (waterfall model) to continuous adaption (Scrum). Rapid application development (RAD) is a model that so far has not been applied to psychiatric settings and may have some advantages over other models. Objective: This study aims to explore the utility of the RAD model in developing a mobile app for patients with borderline personality disorder (BPD) in a psychiatric outpatient setting. Methods: The 4 phases of the RAD model: (1) requirements planning, (2) user design, (3) construction, and (4) cutover, were applied to develop a mobile app within psychiatric outpatient services for patients diagnosed with BPD. Results: For the requirements planning phase, a short time frame was selected to minimize the time between product conceptualization and access within a clinical setting. Evidenced-based interactive content already developed was provided by current staff to enhance usability and trustworthiness. For the user design phase, activity with video themes and a discrete number of functions were used to improve the app functionality and graphical user interface. For the construction phase, close collaboration between clinicians, researchers, and software developers yielded a fully functional, in-house–developed app ready to be tested in clinical practice. For the cutover phase, the mobile app was tested successfully with a small number (n=5) of patients with a BPD. Conclusions: The RAD model could be meaningfully applied in a psychiatric setting to develop an app for BPD within a relatively short time period from conceptualization to implementation in the clinic. Short time frames and identifying a limited number of stakeholders with relevant skills in-house facilitated the use of this model. Despite some limitations, RAD could be a useful model in the development of apps for clinical populations to enable development and access to evidence-based technology. %M 38032709 %R 10.2196/46928 %U https://humanfactors.jmir.org/2023/1/e46928 %U https://doi.org/10.2196/46928 %U http://www.ncbi.nlm.nih.gov/pubmed/38032709 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50324 %T Sadness-Based Approach-Avoidance Modification Training for Subjective Stress in Adults: Pilot Randomized Controlled Trial %A Rupp,Lydia Helene %A Keinert,Marie %A Böhme,Stephanie %A Schindler-Gmelch,Lena %A Eskofier,Bjoern %A Schuller,Björn %A Berking,Matthias %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nägelsbachstr. 25a, Erlangen, 91052, Germany, 49 91318567560, lydia.rupp@fau.de %K stress %K emotion %K eHealth %K approach-avoidance %K mental health %K somatic health %K chronic stress %K intervention %K stress-related illness %K app-based %K stress management %K belief %K training %K mobile phone %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A key vulnerability factor in mental health problems is chronic stress. There is a need for easy-to-disseminate and effective interventions to advance the prevention of stress-related illnesses. App-based stress management trainings can fulfill this need. As subjectively experienced stress may be influenced by dysfunctional beliefs, modifying their evaluations might reduce subjective stress. Approach-avoidance modification trainings (AAMT) can be used to modify stimulus evaluations and are promising candidates for a mobile stress intervention. As the standard training reactions of the AAMT (swiping and joystick motion) have little valence, emotions could be incorporated as approach and avoidance reactions to enhance the effectiveness of AAMTs. Objective: We aimed to evaluate the feasibility of a mobile emotion-enhanced AAMT that engages users to display sadness to move stress-enhancing beliefs away and display positive emotions to move stress-reducing beliefs toward themselves (emotion-based AAMT using sadness and positive emotions [eAAMT-SP]). We explored the clinical efficacy of this novel intervention. Methods: We allocated 30 adult individuals with elevated stress randomly to 1 of 3 conditions (eAAMT-SP, a swipe control condition, and an inactive control condition). We evaluated the feasibility of the intervention (technical problems, adherence, usability, and acceptability). To explore the clinical efficacy of the intervention, we compared pretest-posttest differences in perceived stress (primary clinical outcome) and 3 secondary clinical outcomes (agreement with and perceived helpfulness of dysfunctional beliefs, emotion regulation, and depressive symptoms) among the conditions. Results: The predetermined benchmarks of 50% for intervention completion and 75% for feasibility of the study design (completion of the study design) were met, whereas the cutoff for technical feasibility of the study design (95% of trials without technical errors) was not met. Effect sizes for usability and acceptability were in favor of the eAAMT-SP condition (compared with the swipe control condition; intelligibility of the instructions: g=−0.86, distancing from dysfunctional beliefs: g=0.22, and approaching functional beliefs: g=0.55). Regarding clinical efficacy, the pretest-posttest effect sizes for changes in perceived stress were g=0.80 for the comparison between the eAAMT-SP and inactive control conditions and g=0.76 for the comparison between the eAAMT-SP and swipe control conditions. Effect sizes for the secondary clinical outcomes indicated greater pretest-posttest changes in the eAAMT-SP condition than in the inactive control condition and comparable changes in the swipe control condition. Conclusions: The findings regarding the feasibility of the intervention were satisfactory except for the technical feasibility of the intervention, which should be improved. The effect sizes for the clinical outcomes provide preliminary evidence for the therapeutic potential of the intervention. The findings suggest that extending the AAMT paradigm through the use of emotions may increase its efficacy. Future research should evaluate the eAAMT-SP in sufficiently powered randomized controlled trials. Trial Registration: German Clinical Trials Registry DRKS00023007; https://drks.de/search/en/trial/DRKS00023007 %M 38032725 %R 10.2196/50324 %U https://formative.jmir.org/2023/1/e50324 %U https://doi.org/10.2196/50324 %U http://www.ncbi.nlm.nih.gov/pubmed/38032725 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45128 %T User-Guided Enhancements to a Technology-Facilitated Resilience Program to Address Opioid Risks Following Traumatic Injury in Youth: Qualitative Interview Study %A Adams,Zachary W %A Marriott,Brigid R %A Karra,Swathi %A Linhart-Musikant,Elizabeth %A Raymond,Jodi L %A Fischer,Lydia J %A Bixler,Kristina A %A Bell,Teresa M %A Bryan,Eric A %A Hulvershorn,Leslie A %+ Department of Psychiatry, Indiana University School of Medicine, 410 West 10th Street, Indianapolis, IN, 46202, United States, 1 3172780591, zwadams@iu.edu %K access-to-care %K addiction %K adolescent %K behavior %K health disorder %K opioid use disorder %K opioid %K personalized care %K telehealth %K telemedicine %K trauma %K user %K youth %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth with traumatic injury experience elevated risk for behavioral health disorders, yet posthospital monitoring of patients’ behavioral health is rare. The Telehealth Resilience and Recovery Program (TRRP), a technology-facilitated and stepped access-to-care program initiated in hospitals and designed to be integrated seamlessly into trauma center operations, is a program that can potentially address this treatment gap. However, the TRRP was originally developed to address this gap for mental health recovery but not substance use. Given the high rates of substance and opioid use disorders among youth with traumatic injury, there is a need to monitor substance use and related symptoms alongside other mental health concerns. Objective: This study aimed to use an iterative, user-guided approach to inform substance use adaptations to TRRP content and procedures. Methods: We conducted individual semistructured interviews with adolescents (aged 12-17 years) and young adults (aged 18-25 years) who were recently discharged from trauma centers (n=20) and health care providers from two level 1 trauma centers (n=15). Interviews inquired about reactions to and recommendations for expanding TRRP content, features, and functionality; factors related to TRRP implementation and acceptability; and current strategies for monitoring patients’ postinjury physical and emotional recovery and opioid and substance use. Interview responses were transcribed and analyzed using thematic analysis to guide new TRRP substance use content and procedures. Results: Themes identified in interviews included gaps in care, task automation, user personalization, privacy concerns, and in-person preferences. Based on these results, a multimedia, web-based mobile education app was developed that included 8 discrete interactive education modules and 6 videos on opioid use disorder, and TRRP procedures were adapted to target opioid and other substance use disorder risk. Substance use adaptations included the development of a set of SMS text messaging–delivered questions that monitor both mental health symptoms and substance use and related symptoms (eg, pain and sleep) and the identification of validated mental health and substance use screening tools to monitor patients’ behavioral health in the months after discharge. Conclusions: Patients and health care providers found the TRRP and its expansion to address substance use acceptable. This iterative, user-guided approach yielded novel content and procedures that will be evaluated in a future trial. %M 38032728 %R 10.2196/45128 %U https://formative.jmir.org/2023/1/e45128 %U https://doi.org/10.2196/45128 %U http://www.ncbi.nlm.nih.gov/pubmed/38032728 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51549 %T Effects and Mechanisms of a Web- and Mobile-Based Acceptance and Commitment Therapy Intervention for Anxiety and Depression Symptoms in Nurses: Fully Decentralized Randomized Controlled Trial %A Lu,Yan'e %A Li,Yang %A Huang,Yongqi %A Zhang,Xuan %A Wang,Juan %A Wu,Liuliu %A Cao,Fenglin %+ Department of Nursing Psychology, School of Nursing and Rehabilitation, Shandong University, 44 Wenhua West Road, Lixia District, Jinan, 250012, China, 86 13065093172, caofenglin2008@126.com %K acceptance and commitment therapy %K anxiety %K depression %K internet-based intervention %K nurse %K randomized controlled trial %D 2023 %7 27.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Acceptance and commitment therapy (ACT) is a promising intervention for improving mental health. However, there is limited evidence on its effectiveness for nurses, particularly in web- and mobile-based intervention forms, in mitigating anxiety and depression symptoms. Objective: In this study, we aimed to examine the effect and underlying psychological mechanisms of a web- and mobile-based ACT intervention on nurses’ anxiety and depression symptoms. Methods: In this fully decentralized randomized controlled trial, nurses were recruited nationwide across China through advertisements and posters. They were randomly assigned to either the 5-week fully automated intervention or the waiting group. Primary outcomes (anxiety and depression symptoms); secondary outcomes (sleep quality, burnout, and work performance); and mediators (psychological flexibility, cognitive defusion, mindfulness, and values) were assessed using the Wenjuanxing platform. Data collectors were blinded to the group assignments throughout the study period. Results: A total of 145 nurses with anxiety or depression symptoms were randomly assigned to either the intervention group (n=72, 49.7%) or the control group (n=73, 50.3%); 97.2% (n=141) were female. During the study, 36 (24.8%) nurses were lost to follow-up, and 53 (73.6%) completed the entire intervention. Nurses in the intervention group showed significant improvement in anxiety (d=0.67, 95% CI 0.33-1.00) and depression symptoms (d=0.58, 95% CI 0.25-0.91), and the effects were sustained for 3 months after the intervention (anxiety: d=0.55, 95% CI 0.22-0.89; depression: d=0.66, 95% CI 0.33-1.00). Changes in psychological flexibility, cognitive defusion, and values mediated the effect of the intervention on anxiety and depression symptoms, while mindfulness did not have a mediating effect. Conclusions: The web- and mobile-based ACT intervention used in this study significantly improved nurses’ anxiety and depression symptoms by improving psychological flexibility, cognitive defusion, and values. The results provide new ideas for hospital administrators to prevent and intervene in nurses’ psychological issues. Trial Registration: Chinese Clinical Trial Register ChiCTR2200059218; https://tinyurl.com/4mb4t5y9 %M 38010787 %R 10.2196/51549 %U https://www.jmir.org/2023/1/e51549 %U https://doi.org/10.2196/51549 %U http://www.ncbi.nlm.nih.gov/pubmed/38010787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43584 %T Predictors of Dropout Among Psychosomatic Rehabilitation Patients During the COVID-19 Pandemic: Secondary Analysis of a Longitudinal Study of Digital Training %A Gao,Lingling %A Keller,Franziska Maria %A Becker,Petra %A Dahmen,Alina %A Lippke,Sonia %+ Health Psychology and Behavioural Medicine, Constructor University Bremen, Campus Ring 1, Bremen, 28759, Germany, 49 4212004730, slippke@constructor.university %K dropout %K web-based study %K digital therapy %K medical rehabilitation %K digital training %K mental disorder %K psychosomatic rehabilitation %K COVID-19 %D 2023 %7 27.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: High dropout rates are a common problem reported in web-based studies. Understanding which risk factors interrelate with dropping out from the studies provides the option to prevent dropout by tailoring effective strategies. Objective: This study aims to contribute an understanding of the predictors of web-based study dropout among psychosomatic rehabilitation patients. We investigated whether sociodemographics, voluntary interventions, physical and mental health, digital use for health and rehabilitation, and COVID-19 pandemic–related variables determine study dropout. Methods: Patients (N=2155) recruited from 4 psychosomatic rehabilitation clinics in Germany filled in a web-based questionnaire at T1, which was before their rehabilitation stay. Approximately half of the patients (1082/2155, 50.21%) dropped out at T2, which was after the rehabilitation stay, before and during which 3 voluntary digital trainings were provided to them. According to the number of trainings that the patients participated in, they were categorized into a comparison group or 1 of 3 intervention groups. Chi-square tests were performed to examine the differences between dropout patients and retained patients in terms of sociodemographic variables and to compare the dropout rate differences between the comparison and intervention groups. Logistic regression analyses were used to assess what factors were related to study dropout. Results: The comparison group had the highest dropout rate of 68.4% (173/253) compared with the intervention groups’ dropout rates of 47.98% (749/1561), 50% (96/192), and 42.9% (64/149). Patients with a diagnosis of combined anxiety and depressive disorder had the highest dropout rate of 64% (47/74). Younger patients (those aged <50 y) and patients who were less educated were more likely to drop out of the study. Patients who used health-related apps and the internet less were more likely to drop out of the study. Patients who remained in their jobs and patients who were infected by COVID-19 were more likely to drop out of the study. Conclusions: This study investigated the predictors of dropout in web-based studies. Different factors such as patient sociodemographics, physical and mental health, digital use, COVID-19 pandemic correlates, and study design can correlate with the dropout rate. For web-based studies with a focus on mental health, it is suggested to consider these possible dropout predictors and take appropriate steps to help patients with a high risk of dropping out overcome difficulties in completing the study. %M 37903289 %R 10.2196/43584 %U https://www.jmir.org/2023/1/e43584 %U https://doi.org/10.2196/43584 %U http://www.ncbi.nlm.nih.gov/pubmed/37903289 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e50072 %T Circadian Reinforcement Therapy in Combination With Electronic Self-Monitoring to Facilitate a Safe Postdischarge Period for Patients With Major Depression: Randomized Controlled Trial %A Aggestrup,Anne Sofie %A Svendsen,Signe Dunker %A Præstegaard,Anne %A Løventoft,Philip %A Nørregaard,Lasse %A Knorr,Ulla %A Dam,Henrik %A Frøkjær,Erik %A Danilenko,Konstantin %A Hageman,Ida %A Faurholt-Jepsen,Maria %A Kessing,Lars Vedel %A Martiny,Klaus %+ Mental Health Centre Copenhagen, Copenhagen University Hospital, Frederiksberg Hospital, Nordre Fasanvej 57, Hovedvejen 17, 1st floor, Frederiksberg, 2000, Denmark, 45 38647102, klaus.martiny@regionh.dk %K major depression %K internet interventions %K self-monitoring %K sleep %K circadian %K chronobiology %K chronotherapy %K clinician assisted %D 2023 %7 27.11.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Patients with major depression exhibit circadian disturbance of sleep and mood, and when they are discharged from inpatient wards, this disturbance poses a risk of relapse. We developed a circadian reinforcement therapy (CRT) intervention to facilitate the transition from the inpatient ward to the home for these patients. CRT focuses on increasing the zeitgeber strength for the circadian clock through social contact, physical activity, diet, daylight exposure, and sleep timing. Objective: In this study, we aimed to prevent the worsening of depression after discharge by using CRT, supported by an electronic self-monitoring system, to advance and stabilize sleep and improve mood. The primary outcome, which was assessed by a blinded rater, was the change in the Hamilton Depression Rating Scale scores from baseline to the end point. Methods: Participants were contacted while in the inpatient ward and randomized 1:1 to the CRT or the treatment-as-usual (TAU) group. For 4 weeks, participants in both groups electronically self-monitored their daily mood, physical activity, sleep, and medication using the Monsenso Daybuilder (MDB) system. The MDB allowed investigators and participants to simultaneously view a graphical display of registrations. An investigator phoned all participants weekly to coinspect data entry. In the CRT group, participants were additionally phoned between the scheduled calls if specific predefined trigger points for mood and sleep were observed during the daily inspection. Participants in the CRT group were provided with specialized CRT psychoeducation sessions immediately after inclusion, focusing on increasing the zeitgeber input to the circadian system; a PowerPoint presentation was presented; paper-based informative materials and leaflets were reviewed with the participants; and the CRT principles were used during all telephone consultations. In the TAU group, phone calls focused on data entry in the MDB system. When discharged, all patients were treated at a specialized affective disorders service. Results: Overall, 103 participants were included. Participants in the CRT group had a significantly larger reduction in Hamilton Depression Scale score (P=.04) than those in the TAU group. The self-monitored MDB data showed significantly improved evening mood (P=.02) and sleep quality (P=.04), earlier sleep onset (P=.009), and longer sleep duration (P=.005) in the CRT group than in the TAU group. The day-to-day variability of the daily and evening mood, sleep offset, sleep onset, and sleep quality were significantly lower in the CRT group (all P<.001) than in the TAU group. The user evaluation was positive for the CRT method and the MDB system. Conclusions: We found significantly lower depression levels and improved sleep quality in the CRT group than in the TAU group. We also found significantly lower day-to-day variability in daily sleep, mood parameters, and activity parameters in the CRT group than in the TAU group. The delivery of the CRT intervention should be further refined and tested. Trial Registration: ClinicalTrials.gov NCT02679768; https://clinicaltrials.gov/study/NCT02679768 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-019-2101-z %M 37800194 %R 10.2196/50072 %U https://mental.jmir.org/2023/1/e50072 %U https://doi.org/10.2196/50072 %U http://www.ncbi.nlm.nih.gov/pubmed/37800194 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e50516 %T Efficacy of an Internet-Delivered Intervention for Improving Insomnia Severity and Functioning in Veterans: Randomized Controlled Trial %A Nazem,Sarra %A Barnes,Sean M %A Forster,Jeri E %A Hostetter,Trisha A %A Monteith,Lindsey L %A Kramer,Emily B %A Gaeddert,Laurel A %A Brenner,Lisa A %+ Dissemination & Training Division, National Center for Posttraumatic Stress Disorder, 795 Willow Road, Building 334, Menlo Park, CA, 94025, United States, 1 650 796 8208, Sarra.Nazem@va.gov %K cognitive behavioral therapy %K insomnia %K internet intervention %K online intervention %K randomized controlled trial %K RCT %K RCTs %K sleep %K treatment %K veteran %K veterans %K veterans’ health %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite a growing evidence base that internet-delivered cognitive behavioral therapy for insomnia (iCBT-I) is associated with decreased insomnia severity, its efficacy has been minimally examined in veterans. Objective: The objective of this study was to evaluate the efficacy of an unguided iCBT-I (Sleep Healthy Using the Internet [SHUTi]) among veterans. Methods: We conducted a single-blind, randomized controlled trial in Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn veterans eligible for Veterans Health Administration care. Participants were randomly assigned (1:1) to receive SHUTi (a self-guided and interactive program) or an Insomnia Education Website (IEW) that provided nontailored and fixed insomnia information. Web-based assessments were administered at baseline, postintervention, 6 months postintervention, and 1 year postintervention. The primary outcome was self-reported insomnia severity (Insomnia Severity Index [ISI]). Secondary outcomes were self-reported mental and physical health functioning (Veterans RAND 36-item Health Survey). Exploratory outcomes comprised sleep diary parameters. Results: Of the 231 randomized participants (mean age 39.3, SD 7.8 years; 170/231, 73.5% male sex; 26/231, 11.3% Black; 172/231, 74.5% White; 10/231, 4.3% multiracial; and 17/231, 7.4% other; 36/231, 15.6% Hispanic) randomized between April 2018 and January 2019, a total of 116 (50.2%) were randomly assigned to SHUTi and 115 (49.8%) to the IEW. In intent-to-treat analyses, SHUTi participants experienced significantly larger ISI decreases compared with IEW participants at all time points (generalized η2 values of 0.13, 0.12, and 0.10, respectively; all P<.0001). These corresponded to estimated larger differences in changes of –3.47 (95% CI –4.78 to –2.16), –3.80 (95% CI –5.34 to –2.27), and –3.42 (95% CI –4.97 to 1.88) points on the ISI for the SHUTi group. SHUTi participants experienced significant improvements in physical (6-month generalized η2=0.04; P=.004) and mental health functioning (6-month and 1-year generalized η2=0.04; P=.009 and P=.005, respectively). Significant sleep parameter improvements were noted for SHUTi (all P<.05), though the pattern and magnitude of these reductions varied by parameter. No adverse events were reported. Conclusions: Self-administered iCBT-I was associated with immediate and long-term improvements in insomnia severity. Findings suggest that leveraging technology to meet insomnia treatment demands among veterans may be a promising approach. Trial Registration: ClinicalTrials.gov NCT03366870; https://clinicaltrials.gov/ct2/show/NCT03366870 %M 37999953 %R 10.2196/50516 %U https://mental.jmir.org/2023/1/e50516 %U https://doi.org/10.2196/50516 %U http://www.ncbi.nlm.nih.gov/pubmed/37999953 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e47729 %T The Indirect Impact of Educational Attainment as a Distal Resource for Older Adults on Loneliness, Social Isolation, Psychological Resilience, and Technology Use During the COVID-19 Pandemic: Cross-Sectional Quantitative Study %A Balki,Eric %A Hayes,Niall %A Holland,Carol %+ Department of Health Research, Faculty of Health and Medicine, Lancaster University, Bailrigg Campus, Lancaster, LA1 4YW, United Kingdom, 44 1524 65201, e.balkhi@lancaster.ac.uk %K pandemic %K educational attainment %K isolation %K loneliness %K socioemotional needs %K social engagement %K technology use %K older adults %K psychological resilience %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Aging %G English %X Background: During the COVID-19 pandemic, government-mandated social distancing prevented the spread of the disease but potentially exacerbated social isolation and loneliness for older people, especially those already vulnerable to isolation. Older adults may have been able to draw from their personal resources such as psychological resilience (PR) and technology use (TU) to combat such effects. Educational attainment (EA) or early-life EA may potentially shape later-life personal resources and their impact on the effects of the pandemic lockdown on outcomes such as loneliness. The developmental adaptation model allows for the supposition that social isolation, TU, and PR may be affected by early EA in older adults. Objective: This study examined the indirect impact of EA on pandemic-linked loneliness in a sample of older adults. The developmental adaptation model was used as the conceptual framework to view EA as a distal influence on loneliness, social isolation, PR, and TU. We hypothesized that EA would predict TU and PR and have a moderating impact on social isolation and loneliness. We also hypothesized that PR and TU would mediate the effect of EA on loneliness. Methods: This was a cross-sectional observational study, in which data were gathered from 92 older adults aged ≥65 years in the United Kingdom from March 2020 to June 2021, when the country was under various pandemic-linked social mobility restrictions. The data captured demographic information including age, gender, ethnicity, and the highest degree of education achieved. The University of California Los Angeles Loneliness Scale, Connor–Davidson Resilience Scale, Lubben Social Network Index, and Technology Experience Questionnaire were used as standardized measures. Pearson correlation, moderation, and mediation regression analyses were conducted to investigate the hypotheses. Results: We found a higher prevalence of loneliness in older adults than in prepandemic norms. EA was correlated with greater TU and PR and moderated the impact of social isolation on loneliness. PR mediated and TU partially mediated the relationship between EA and loneliness. Conclusions: Early-life EA was confirmed as a distal resource for older adults and played an indirect role in affecting loneliness levels during the pandemic. It has an impact on present-day personal resources, such as PR and TU, which affect loneliness and also moderate the impact of social isolation on loneliness. Policymakers should be aware that older adults with low levels of EA may be more vulnerable to the harmful impacts of loneliness when isolated by choice. %M 37999938 %R 10.2196/47729 %U https://aging.jmir.org/2023/1/e47729 %U https://doi.org/10.2196/47729 %U http://www.ncbi.nlm.nih.gov/pubmed/37999938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e53268 %T A Brief, Digital Music-Based Mindfulness Intervention for Black Americans With Elevated Race-Based Anxiety and Little-to-No Meditation Experience (“healing attempt"): Replication and Extension Study %A Jones,Grant %A Castro-Ramirez,Franchesca %A Al-Suwaidi,Maha %A McGuire,Taylor %A Herrmann,Felipe %+ Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, United States, gmj005@g.harvard.edu %K Black music %K mindfulness %K meditation %K music %K song %K psychotherapy %K self-compassion %K ethnic %K cultural %K single-case experiment %K race %K anxiety %K digital health intervention %K Black %K digital health %K low income %K racial disparity %K mental health %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Race-based anxiety is a critical health issue within the Black community. Mindfulness interventions hold promise for treating race-based anxiety in Black Americans; however, there are many barriers that prevent Black Americans from using these treatments, such as low cultural relevance, significant time burdens, and excessive costs. Objective: This study is a replication and extension of findings that “healing attempt”—a brief (<60-minute), digital, music-based mindfulness intervention—is a feasible and acceptable intervention for race-based anxiety in Black Americans. In this study, we tested this research question among those with little-to-no meditation experience. Methods: The participants were 4 Black American adults with elevated race-based trait anxiety and little-to-no meditation experience. We used a series of multiple-baseline single-case experiments and conducted study visits on Zoom (Zoom Video Communications) to assess whether the intervention can decrease state anxiety and increase mindfulness and self-compassion in Black Americans. We also assessed feasibility and acceptability using quantitative and qualitative scales. Results: In line with our hypotheses, “healing attempt” increased mindfulness/self-compassion (Tau-U range: 0.57-0.86; P<.001) and decreased state anxiety (Tau-U range: –0.93 to –0.66; P<.001), with high feasibility and acceptability (the average likelihood of recommending “healing attempt” was 88 out of 100). Conclusions: “healing attempt” may represent a feasible intervention for race-based anxiety in Black Americans with elevated race-based anxiety and little or no mindfulness experience. Future between-subjects randomized feasibility trials can assess whether the intervention can give rise to lasting improvements in race-based anxiety, mindfulness, and self-compassion. Trial Registration: OSF Registries osf.io/k5m93; https://osf.io/k5m93 %M 37999941 %R 10.2196/53268 %U https://formative.jmir.org/2023/1/e53268 %U https://doi.org/10.2196/53268 %U http://www.ncbi.nlm.nih.gov/pubmed/37999941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46253 %T Individually Tailored and Culturally Adapted Internet-Based Cognitive Behavioral Therapy for Arabic-Speaking Youths With Mental Health Problems in Sweden: Qualitative Feasibility Study %A Demetry,Youstina %A Wasteson,Elisabet %A Lindegaard,Tomas %A Abuleil,Amjad %A Geranmayeh,Anahita %A Andersson,Gerhard %A Shahnavaz,Shervin %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Norra stationsgatan 69, Stockholm, Sweden, 46 739522332, youstina.demetry@ki.se %K internet-based interventions %K cultural adaptation %K Arabic %K youth %K depression %K anxiety %K refugees %K mental health %K Arabic-speaking youth %K mental disorder %K psychological intervention %D 2023 %7 24.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Most forcibly displaced refugees in Sweden originate from the Arab Republic of Syria and Iraq. Approximately half of all refugees are aged between 15 and 26 years. This particular group of youths is at a higher risk for developing various mental disorders. However, low use of mental health services across Europe has been reported. Previous research indicates that culturally adapted psychological interventions may be suitable for refugee youths. However, little is known about the feasibility, acceptability, and efficacy of such psychological interventions. Objective: This study aimed to explore the feasibility, acceptability, and preliminary efficacy of an individually tailored and culturally adapted internet-based cognitive behavioral therapy for Arabic-speaking refugees and immigrant youths in Sweden. Methods: A total of 17 participants were included to participate in an open trial study of an individually tailored and culturally adapted internet-based cognitive behavioral therapy targeting common mental health problems. To assess the intervention outcome, the Hopkins Symptom Checklist was used. To explore the acceptability of the intervention, in-depth interviews were conducted with 12 participants using thematic analysis. Feasibility was assessed by measuring treatment adherence and by calculating recruitment and retention rates. Results: The intervention had a high dropout rate and low feasibility. Quantitative analyses of the treatment efficacy were not possible because of the high dropout rate. The qualitative analysis resulted in 3 overarching categories: experiences with SahaUng (the treatment), attitudes toward psychological interventions, and personal factors important for adherence. Conclusions: The findings from this study indicate that the feasibility and acceptability of the current intervention were low and, based on the qualitative analysis, could be increased by a refinement of recruitment strategies, further simplification of the treatment content, and modifications to the cultural adaptation. %M 37999955 %R 10.2196/46253 %U https://formative.jmir.org/2023/1/e46253 %U https://doi.org/10.2196/46253 %U http://www.ncbi.nlm.nih.gov/pubmed/37999955 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46927 %T Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study %A Ingeman,Katrine %A Frostholm,Lisbeth %A Wellnitz,Kaare Bro %A Wright,Kristi %A Frydendal,Ditte Hoffmann %A Onghena,Patrick %A Rask,Charlotte Ulrikka %+ Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Palle Juul-Jensens Boulevard 175, entrence K, Aarhus, 8200, Denmark, 45 20542556, katbec@rm.dk %K health anxiety by proxy %K health anxiety %K internet-delivered treatment %K single-case experimental design %K SCED %K protocol %D 2023 %7 24.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health anxiety (HA) by proxy is described as parents’ obsessive worries that their child is severely ill although this is not medically confirmed. Research on HA by proxy suggests that it is highly distressing for the parent and that the child may be at risk of developing maladaptive symptom coping strategies. No targeted treatment for this group exists. We developed PROXY, an 8-week psychological internet-delivered treatment for parents with HA by proxy. The treatment components of PROXY are informed by cognitive behavioral therapy as well as acceptance and commitment therapy, and it was developed in collaboration with parents experiencing HA by proxy and clinical experts. Objective: This paper describes the protocol for a study investigating the potential effects of PROXY on parents’ worries about their children’s health using a single-case experimental design (SCED). Methods: Five parents clinically evaluated as experiencing HA by proxy will be included. A replicated randomized SCED study will be conducted in which each participant will be randomized to receive treatment after a baseline period of between 7 and 26 days (phase A). The treatment phase duration is 8 weeks for all participants (phase B), followed by a follow-up phase lasting between 14 and 33 days (phase C), ensuring that all participants remain in the study for 96 days. Participants will report daily anxiety level by SMS text message throughout the study. They will also answer self-report questionnaires, including questions on HA by proxy and own HA, 4 times during the study. Data will be submitted to structured visual analysis to inspect anxiety level, the variability of anxiety, trends, the overlap of data points among phases, when effects occur, and the consistency of data patterns across participants. Furthermore, randomization tests will be conducted for each participant to test the null hypothesis that PROXY will have no effect on participants’ anxiety. Results: The recruitment of parents began in June 2022. As of March 2, 2023, a total of 4 parents have been included in the study. Data collection was expected to cease in April 2023. Conclusions: To the best of our knowledge, this protocol describes the only study of treatment for HA by proxy. As the prevalence of this condition is still unknown, a SCED was chosen because this method allows the inclusion of very few participants while still providing information on effects and treatment courses. Conducting the study with a replicated randomized phase design enables methodologically sound testing despite the inclusion of very few participants. The results will inform researchers on individual treatment courses and effects, which may direct future research in terms of the possible mechanisms of change, ideas for how to refine the treatment content, and how the treatment may be offered to patients in the future. Trial Registration: ClinicalTrials.gov NCT04830605; https://clinicaltrials.gov/study/NCT04830605 International Registered Report Identifier (IRRID): DERR1-10.2196/46927 %M 37999936 %R 10.2196/46927 %U https://www.researchprotocols.org/2023/1/e46927 %U https://doi.org/10.2196/46927 %U http://www.ncbi.nlm.nih.gov/pubmed/37999936 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45021 %T Internet-Based Inquiries From Users With the Intention to Overdose With Over-the-Counter Drugs: Qualitative Analysis of Yahoo! Chiebukuro %A Kariya,Azusa %A Okada,Hiroshi %A Suzuki,Shota %A Dote,Satoshi %A Nishikawa,Yoshitaka %A Araki,Kazuo %A Takahashi,Yoshimitsu %A Nakayama,Takeo %+ Department of Health Informatics, Graduate School of Medicine & School of Public Health, Kyoto University, Yoshidakonoecho, Sakyo-ku, Kyoto, 606-8501, Japan, 81 75 753 9477, kariya.azusa.57m@st.kyoto-u.ac.jp %K abuse %K consumer-generated media %K CGM %K overdose %K over-the-counter drug %K OTC drug %K question and answer site %K Q and A site %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Public concern with regard to over-the-counter (OTC) drug abuse is growing rapidly across countries. OTC drug abuse has serious effects on the mind and body, such as poisoning symptoms, and often requires specialized treatments. In contrast, there is concern about people who potentially abuse OTC drugs whose symptoms are not serious enough to consult medical institutions or drug addiction rehabilitation centers yet are at high risk of becoming drug dependent in the future. Objective: Consumer-generated media (CGM), which allows users to disseminate information, is being used by people who abuse (and those who are trying to abuse) OTC drugs to obtain information about OTC drug abuse. This study aims to analyze the content of CGM to explore the questions of people who potentially abuse OTC drugs. Methods: The subject of this research was Yahoo! Chiebukuro, the largest question and answer website in Japan. A search was performed using the names of drugs commonly used in OTC drug abuse and the keywords overdose and OD, and the number of questions posted on the content of OTC drug abuse was counted. Furthermore, a thematic analysis was conducted by extracting text data on the most abused antitussive and expectorant drug, BRON. Results: The number of questions about the content of overdose medications containing the keyword BRON has increased sharply as compared with other product names. Furthermore, 467 items of question data that met the eligibility criteria were obtained from 528 items of text data on BRON; 26 codes, 6 categories, and 3 themes were generated from the 578 questions contained in these items. Questions were asked about the effects they would gain from abusing OTC drugs and the information they needed to obtain the effects they sought, as well as about the effects of abuse on their bodies. Moreover, there were questions on how to stop abusing and what is needed when seeking help from a health care provider if they become dependent. It has become clear that people who abuse OTC drugs have difficulty in consulting face-to-face with others, and CGM is used as a means to obtain the necessary information anonymously. Conclusions: On CGM, people who abused or tried to abuse OTC drugs were asking questions about their abuse expectations and anxieties. In addition, when they became dependent, they sought advice to quit their abuse. CGM was used to exchange information about OTC drug abuse, and many questions on anxieties and hesitations were posted. This study suggests that it is necessary to produce and disseminate information on OTC drug abuse, considering the situation of those who abuse or are willing to abuse OTC drugs. Support from pharmacies and drugstores would also be essential to reduce opportunities for OTC drug abuse. %M 37991829 %R 10.2196/45021 %U https://formative.jmir.org/2023/1/e45021 %U https://doi.org/10.2196/45021 %U http://www.ncbi.nlm.nih.gov/pubmed/37991829 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43260 %T Self-Guided Digital Intervention for Depression in Adolescents: Feasibility and Preliminary Efficacy Study %A Miller,Ian %A Peake,Emily %A Strauss,Gabriel %A Vierra,Elise %A Koepsell,Xin %A Shalchi,Brandon %A Padmanabhan,Aarthi %A Lake,Jessica %+ Big Health Inc, 461 Bush St #200, San Francisco, CA, 94108, United States, 1 415 971 2900, jessica.lake@bighealth.com %K depression %K adolescents %K young adults %K cognitive behavioral therapy %K behavioral activation %K digital health %K mobile interventions %K mobile phone %D 2023 %7 22.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression in adolescents is a large and growing problem; however, access to effective mental health care continues to be a challenge. Digitally based interventions may serve to bridge this access gap for adolescents in need of care. Digital interventions that deliver components of cognitive behavioral therapy (CBT) have been shown to reduce symptoms of depression, and virtual reality (VR) may be a promising adjunctive component. However, research on these types of treatments in adolescents and young adults is limited. Objective: This study aims to evaluate the feasibility, acceptability, and preliminary efficacy of Spark (v1.0), a 5-week, self-guided, CBT-based digital program using a mobile app and VR experiences to target symptoms of depression in adolescents. Methods: A single-arm, open-label study of the Spark program was conducted with a community sample of 30 adolescents and young adults aged 12 to 21 years with self-reported moderate to severe depression symptoms. Participants completed a weekly depression assessment (Patient Health Questionnaire-8) in the app during the 5-week intervention period as well as web-based baseline, postintervention, and 1-month follow-up self-report assessments. The participants also completed a qualitative postintervention interview. For participants aged <18 years, caregivers completed assessments at baseline and postintervention time points. Feasibility outcomes included recruitment rate (the proportion of participants who enrolled in the study divided by the total number of participants screened for eligibility) and retention rate (the proportion of participants who completed postintervention assessments divided by the total number of participants who received the intervention). Acceptability outcomes included engagement with the program and quantitative and qualitative feedback about the program. Preliminary efficacy was evaluated based on the Patient Health Questionnaire-8. Results: The study recruitment (31/66, 47%) and retention (29/30, 97%) rates were high. Participants provided higher ratings for the ease of use of the Spark program (8.76 out of 10) and their enjoyment of both the mobile app (7.00 out of 10) and VR components (7.48 out of 10) of the program, whereas they provided lower ratings for the program’s ability to improve mood (4.38 out of 10) or fit into their daily routines (5.69 out of 10). We observed a clinically and statistically significant reduction in depression scores at postintervention (mean difference 5.36; P<.001) and 1-month follow-up (mean difference 6.44; P<.001) time points. Conclusions: The Spark program was found to be a feasible and acceptable way to deliver a self-guided CBT-focused intervention to adolescents and young adults with symptoms of depression. Preliminary data also indicated that the Spark program reduced the symptoms of depression in adolescents and young adults. Future studies should evaluate the efficacy of this intervention in an adequately powered randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04165681; https://classic.clinicaltrials.gov/ct2/show/NCT04165681 %M 37991839 %R 10.2196/43260 %U https://formative.jmir.org/2023/1/e43260 %U https://doi.org/10.2196/43260 %U http://www.ncbi.nlm.nih.gov/pubmed/37991839 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e51459 %T Effectiveness of Technology-Based Interventions for School-Age Children With Attention-Deficit/Hyperactivity Disorder: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Wong,Ka Po %A Qin,Jing %A Xie,Yao Jie %A Zhang,Bohan %+ Department of Applied Social Sciences, The Hong Kong Polytechnic University, 11 Yuk Choi Road, Hong Kong, China (Hong Kong), 852 64860214, portia.wong@polyu.edu.hk %K attention-deficit/hyperactivity disorder %K school-age children %K computer-assisted training program %K ADHD %K neurofeedback training %K virtual reality %K cognitive functions %D 2023 %7 21.11.2023 %9 Review %J JMIR Ment Health %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) is relatively common among school-age children. Technology-based interventions, such as computer-assisted training programs, neurofeedback training, and virtual reality, show promise in regulating the behaviors and cognitive functions of children with ADHD. An increasing number of randomized controlled trials have been conducted to evaluate the effectiveness of these technologies in improving the conditions of children with ADHD. Objective: This study aims to conduct a systematic review of technological interventions for school-age children with ADHD and perform a meta-analysis of the outcomes of technology-based interventions. Methods: A total of 19 randomized controlled studies involving 1843 participants were selected from a pool of 2404 articles across 7 electronic databases spanning from their inception to April 2022. ADHD behaviors, cognitive functions, learning ability, and quality of life were addressed in this study. Results: Random effects meta-analyses found that children with ADHD receiving technology-based intervention showed small and significant effect sizes in computer-rated inattention (standardized mean difference [SMD] −0.35; P<.04), parent-rated overall executive function measured by the Behavior Rating Inventory of Executive Function (SMD −0.35; P<.04), parent-rated disruptive behavior disorder measured by the Child Behavior Checklist (SMD −0.50; P<.001) and Disruptive Behavior Disorder Rating Scale (SMD −0.31; P<.02), and computer-rated visual attention measured by the Continuous Performance Test (SMD −0.42; P<.001) and Reaction Time (SMD −0.43; P<.02). Conclusions: Technology-based interventions are promising treatments for improving certain ADHD behaviors and cognitive functions among school-age children with ADHD. Trial Registration: PROSPERO CRD42023446924; https://tinyurl.com/7ee5t24n %M 37988139 %R 10.2196/51459 %U https://mental.jmir.org/2023/1/e51459 %U https://doi.org/10.2196/51459 %U http://www.ncbi.nlm.nih.gov/pubmed/37988139 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e51461 %T Potential Implementers’ Perspectives on the Development and Implementation of an e–Mental Health Intervention for Caregivers of Adults With Chronic Kidney Disease: Qualitative Interview Study %A Coumoundouros,Chelsea %A El Arab,Rabie Adel %A Farrand,Paul %A Hamilton,Alexander %A Sanderman,Robbert %A von Essen,Louise %A Woodford,Joanne %+ Healthcare Sciences and e-Health, Department of Women’s and Children’s Health, Uppsala University, Dag Hammarskjölds väg 14B, Uppsala, 751 85, Sweden, 46 729 999 211, joanne.woodford@kbh.uu.se %K health care professional %K implementation %K informal caregiver %K chronic kidney disease %K e–mental health %K Consolidated Framework for Implementation Research %D 2023 %7 17.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: e–Mental health interventions can improve access to mental health support for caregivers of people living with chronic kidney disease (CKD). However, implementation challenges often prevent effective interventions from being put into practice. To develop an e–mental health intervention for caregivers of people living with CKD that is optimized for future implementation, it is important to engage professionals that may endorse or deliver the intervention (ie, potential implementers) during intervention development. Objective: This study aims to explore the perspectives of potential implementers working in kidney care, in mental health care, or at nonprofit organizations regarding the design and implementation of an e–mental health intervention for caregivers of people living with CKD. Methods: Potential implementers (N=18) were recruited via National Health Service Trusts, email, and social media advertisements to participate in semistructured video interviews. Interview questions were informed by the Consolidated Framework for Implementation Research (CFIR). Data were analyzed using a deductive analysis approach using the CFIR, with inductive coding applied to relevant data not captured by the framework. Results: A total of 29 generic categories, related to 17 CFIR constructs, were identified. The perceived fit between the intervention and implementation context (ie, existing service delivery models and work routines) and existing social networks among potential implementers were perceived as important factors in enhancing implementation potential. However, a need for capacity building among potential implementers to create systems to support the identification and referral of caregivers to an e–mental health intervention was identified. Equity concerns were raised regarding the intervention, highlighting the importance of incorporating an equity lens during intervention design to enhance accessibility and adoption. Conclusions: Potential implementers provided valuable insights into key design and implementation factors to help inform the development of an e–mental health intervention for caregivers of people living with CKD. Incorporating their feedback can help ensure the intervention is acceptable and inform the selection of future implementation strategies to enhance the implementation potential of the intervention. Potential implementers should continue to be engaged throughout intervention development. %M 37792676 %R 10.2196/51461 %U https://humanfactors.jmir.org/2023/1/e51461 %U https://doi.org/10.2196/51461 %U http://www.ncbi.nlm.nih.gov/pubmed/37792676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51422 %T Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study %A Cheng,Abby L %A Agarwal,Mansi %A Armbrecht,Melissa A %A Abraham,Joanna %A Calfee,Ryan P %A Goss,Charles W %+ Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University School of Medicine, Campus Box 8233, 660 South Euclid Avenue, St Louis, MO, 63110, United States, 1 3147472823, chengal@wustl.edu %K digital mental health intervention %K chronic musculoskeletal pain %K anxiety %K depression %K pain interference %K physical function %K behavioral activation %K pain acceptance %K sleep quality %K mediation analysis %K behavioral mechanism %K chronic pain %K digital health intervention %K mobile phone %D 2023 %7 17.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Preliminary evidence suggests that digital mental health intervention (Wysa for Chronic Pain) can improve mental and physical health in people with chronic musculoskeletal pain and coexisting symptoms of depression or anxiety. However, the behavioral mechanisms through which this intervention acts are not fully understood. Objective: The purpose of this study was to identify behavioral mechanisms that may mediate changes in mental and physical health associated with use of Wysa for Chronic Pain during orthopedic management of chronic musculoskeletal pain. We hypothesized that improved behavioral activation, pain acceptance, and sleep quality mediate improvements in self-reported mental and physical health. Methods: In this prospective cohort, pilot mediation analysis, adults with chronic (≥3 months) neck or back pain received the Wysa for Chronic Pain digital intervention, which uses a conversational agent and text-based access to human counselors to deliver cognitive behavioral therapy and related therapeutic content. Patient-reported outcomes and proposed mediators were collected at baseline and 1 month. The exposure of interest was participants’ engagement (ie, total interactions) with the digital intervention. Proposed mediators were assessed using the Behavioral Activation for Depression Scale–Short Form, Chronic Pain Acceptance Questionnaire, and Athens Insomnia Scale. Outcomes included Patient-Reported Outcomes Measurement Information System Anxiety, Depression, Pain Interference, and Physical Function scores. A mediation analysis was conducted using the Baron and Kenny method, adjusting for age, sex, and baseline mediators and outcome values. P<.20 was considered significant for this pilot study. Results: Among 30 patients (mean age 59, SD 14, years; 21 [70%] female), the mediation effect of behavioral activation on the relationship between increased intervention engagement and improved anxiety symptoms met predefined statistical significance thresholds (indirect effect –0.4, 80% CI –0.7 to –0.1; P=.13, 45% of the total effect). The direction of mediation effect was generally consistent with our hypothesis for all other proposed mediator or outcome relationships, as well. Conclusions: In a full-sized randomized controlled trial of patients with chronic musculoskeletal pain, behavioral activation, pain acceptance, and sleep quality may play an important role in mediating the relationship between use of a digital mental health intervention (Wysa for Chronic Pain) and improved mental and physical health. Trial Registration: ClinicalTrials.gov NCT05194722; https://clinicaltrials.gov/ct2/show/NCT05194722 %M 37976097 %R 10.2196/51422 %U https://formative.jmir.org/2023/1/e51422 %U https://doi.org/10.2196/51422 %U http://www.ncbi.nlm.nih.gov/pubmed/37976097 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e49936 %T The Potential Influence of AI on Population Mental Health %A Ettman,Catherine K %A Galea,Sandro %+ Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N Broadway Street, Baltimore, MD, 21205, United States, 1 410 516 8000, cettman1@jhu.edu %K mental health %K artificial intelligence %K AI %K policy %K policies %K population health %K population %K ChatGPT %K generative %K tools %K digital mental health %D 2023 %7 16.11.2023 %9 Viewpoint %J JMIR Ment Health %G English %X The integration of artificial intelligence (AI) into everyday life has galvanized a global conversation on the possibilities and perils of AI on human health. In particular, there is a growing need to anticipate and address the potential impact of widely accessible, enhanced, and conversational AI on mental health. We propose 3 considerations to frame how AI may influence population mental health: through the advancement of mental health care; by altering social and economic contexts; and through the policies that shape the adoption, use, and potential abuse of AI-enhanced tools. %M 37971803 %R 10.2196/49936 %U https://mental.jmir.org/2023/1/e49936 %U https://doi.org/10.2196/49936 %U http://www.ncbi.nlm.nih.gov/pubmed/37971803 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48740 %T Assessing the Efficacy and Safety of a Digital Therapeutic for Symptoms of Depression in Adolescents: Protocol for a Randomized Controlled Trial %A Furman,Daniella J %A Hall,Shana A %A Avina,Claudia %A Kulikov,Vera N %A Lake,Jessica I %A Padmanabhan,Aarthi %+ Big Health, Inc, 461 Bush St #200, San Francisco, CA, 94108, United States, 1 707 563 1049, daniella.furman@bighealth.com %K randomized controlled trial %K depression %K adolescent %K youth %K mental health %K digital therapeutic %K behavioral activation %K cognitive behavioral therapy %K virtual trial %K efficacy %K treatment %K digital health %K intervention %K mental illness %D 2023 %7 16.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression is a serious, prevalent, recurrent, and undertreated disorder in adolescents. Low levels of treatment seeking and treatment adherence in this age group, combined with a growing national crisis in access to mental health care, have increased efforts to identify effective treatment alternatives for this demographic. Digital health interventions for mental illness can provide cost-effective, engaging, and accessible means of delivering psychotherapy to adolescents. Objective: This protocol describes a virtual randomized controlled trial designed to evaluate the efficacy and safety of a self-guided, mobile app–based implementation of behavioral activation therapy, SparkRx, for the adjunct treatment of symptoms of depression in adolescents. Methods: Participants are recruited directly through web-based and print advertisements. Following eligibility screening and consenting, participants are randomly assigned to a treatment arm (SparkRx) or a control arm (assessment-enhanced usual care) for 5 weeks. The primary efficacy outcome, total score on the 8-item Patient Health Questionnaire (PHQ-8), is assessed at the end of the 5-week intervention period. Additional participant-reported outcomes are assessed at baseline, the postintervention time point, and 1-month follow-up. The safety of the intervention is assessed by participant report (and legal guardian report, if the participant is younger than 18 years) and by patterns of symptom deterioration on the PHQ-8, as part of a larger clinical safety monitoring protocol. The primary efficacy outcome, total PHQ-8 score at the postintervention time point, will be compared between SparkRx and enhanced usual care arms using mixed effect modeling, with baseline PHQ-8 and current antidepressant medication status included as covariates. Secondary efficacy outcomes, including the proportion of participants exhibiting treatment response, remission, and minimal clinically significant improvement (all derived from total PHQ-8 scores), will be compared between groups using chi-square tests. Symptom severity at 1-month follow-up will also be compared between arms. Planned subgroup analyses will examine the robustness of treatment effects to differences in baseline symptom severity (PHQ-8 score <15 or ≥ 15) and age (younger than 18 years and older than 18 years). The primary safety outcome, the number of psychiatric serious adverse events, will be compared between trial arms using the Fisher exact test. All other adverse events will be presented descriptively. Results: As of May 2023, enrollment into the study has concluded; 223 participants were randomized. The analysis of the efficacy and safety data is expected to be completed by Fall 2023. Conclusions: We hypothesize that the results of this trial will support the efficacy and safety of SparkRx in attenuating symptoms of depression in adolescents. Positive results would more broadly support the prospect of using accessible, scientifically validated, digital therapeutics in the adjunct treatment of mental health disorders in this age range. Trial Registration: ClinicalTrials.gov NCT05462652; https://clinicaltrials.gov/study/NCT05462652 International Registered Report Identifier (IRRID): DERR1-10.2196/48740 %M 37971800 %R 10.2196/48740 %U https://www.researchprotocols.org/2023/1/e48740 %U https://doi.org/10.2196/48740 %U http://www.ncbi.nlm.nih.gov/pubmed/37971800 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41127 %T Behavioral Activation for Comorbid Depression in People With Noncommunicable Disease in India: Protocol for a Randomized Controlled Feasibility Trial %A Zainab,Rayeesa %A Kandasamy,Arun %A Bhat,Naseer Ahmad %A Dsouza,Chrishma Violla %A Jennings,Hannah %A Jackson,Cath %A Mazumdar,Papiya %A Hewitt,Catherine Elizabeth %A Ekers,David %A Narayanan,Gitanjali %A Rao,Girish N %A Coales,Karen %A Muliyala,Krishna Prasad %A Chaturvedi,Santosh K %A Murthy,Pratima %A Siddiqi,Najma %+ National Institute of Mental Health and Neuro Sciences, Hosur Rd, near Bangalore Milk Dairy, Hombegowda Nagar, Bangalore, 560029, India, 91 08026995250 ext 360, arunnimhans05@gmail.com %K adaption %K behavioral activation %K cancer %K cardiovascular disease %K cultural %K culture %K depression %K diabetes %K feasibility %K India %K language %K linguistic %K mental disorder %K mental health care %K mental health %K non-communicable disease %K Patient Health Questionnaire %K PHQ %K randomized controlled feasibility trial %K respiratory %K retention %K social %K stroke %K therapy %K treatment %D 2023 %7 16.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increasing burden of depression and noncommunicable disease (NCD) is a global challenge, especially in low- and middle-income countries, considering the resource constraints and lack of trained human resources in these settings. Effective treatment of depression in people with NCDs has the potential to enhance both the mental and physical well-being of this population. It will also result in the effective use of the available health care resources. Brief psychological therapies, such as behavioral activation (BA), are effective for the treatment of depression. BA has not been adapted in the community health care services of India, and the feasibility of using BA as an intervention for depression in NCD and its effectiveness in these settings have not been systematically evaluated. Objective: Our objective is to adapt BA for the Indian NCD context and test the acceptability, feasibility, and implementation of the adapted BA intervention (BEACON intervention package [BIP]). Additionally, we aim to test the feasibility of a randomized controlled trial evaluation of BIP for the treatment of depression compared with enhanced usual care. Methods: Following well-established frameworks for intervention adaptation, we first adapted BA (to fit the linguistic, cultural, and resource context) for delivery in India. The intervention was also adapted for potential remote delivery by telephone. In a randomized controlled trial, we will be testing the acceptability, feasibility, and implementation of the adapted BA intervention (BIP). We shall also test if a randomized controlled feasibility trial can be delivered effectively and estimate important parameters (eg, recruitment and retention rates and completeness of follow-up) needed to design a future definitive trial. Results: Following the receipt of approval from all the relevant agencies, the development of the BIP was started on November 28, 2020, and completed on August 18, 2021, and the quantitative data collection was started on August 23, 2021, and completed on December 10, 2021. Process evaluation (qualitative data) collection is ongoing. Both the qualitative and quantitative data analyses are ongoing. Conclusions: This study may offer insights that could help in closing the gap in the treatment of common mental illness, particularly in nations with limited resources, infrastructure, and systems such as India. To close this gap, BEACON tries to provide BA for depression in NCDs through qualified NCD (BA) counselors integrated within the state-run NCD clinics. The results of this study may aid in understanding whether BA as an intervention is acceptable for the population and how feasible it will be to deliver such interventions for depression in NCD in South Asian countries such as India. The BIP may also be used in the future by Indian community clinics as a brief intervention program. Trial Registration: Clinical Trials Registry of India CTRI/2020/05/025048; https://tinyurl.com/mpt33jv5 International Registered Report Identifier (IRRID): DERR1-10.2196/41127 %M 37971791 %R 10.2196/41127 %U https://www.researchprotocols.org/2023/1/e41127 %U https://doi.org/10.2196/41127 %U http://www.ncbi.nlm.nih.gov/pubmed/37971791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48634 %T The Effects of Remote Cognitive Training Combined With a Mobile App Intervention on Psychosis: Double-Blind Randomized Controlled Trial %A Fisher,Melissa %A Etter,Kevin %A Murray,Aimee %A Ghiasi,Neelu %A LaCross,Kristin %A Ramsay,Ian %A Currie,Ariel %A Fitzpatrick,Karrie %A Biagianti,Bruno %A Schlosser,Danielle %A Loewy,Rachel %A Vinogradov,Sophia %+ Department of Psychiatry & Behavioral Sciences, University of Minnesota, F299/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, United States, 1 612 273 9835, mafisher@umn.edu %K schizophrenia %K psychosis %K cognitive training %K motivation %K mobile intervention %K mobile phone %D 2023 %7 13.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Impairments in cognition and motivation are core features of psychosis and strong predictors of social and occupational functioning. Accumulating evidence indicates that cognitive deficits in psychosis can be improved by computer-based cognitive training programs; however, barriers include access and adherence to cognitive training exercises. Limited evidence-based methods have been established to enhance motivated behavior. In this study, we tested the effects of web-based targeted cognitive and social cognitive training (TCT) delivered in conjunction with an innovative digital smartphone app called Personalized Real-Time Intervention for Motivational Enhancement (PRIME). The PRIME app provides users with a motivational coach to set personalized goals and secure social networking for peer support. Objective: This study investigated whether deficits in cognition and motivation in people with a psychosis spectrum disorder (N=100) can be successfully addressed with 30 hours of TCT+PRIME as compared with 30 hours of a computer games control condition (CG) plus PRIME (CG+PRIME). Here, we describe our study procedures, the feasibility and acceptability of the intervention, and the results on all primary outcomes. Methods: In this double-blind randomized controlled trial, English-speaking participants completed all cognitive training, PRIME activities, and assessments remotely. Participants completed a diagnostic interview and remote cognitive, clinical, and self-report measures at baseline, posttraining, and at a 6-month follow-up. Results: This study included participants from 27 states across the United States and 8 countries worldwide. The study population was 58% (58/100) female, with a mean age of 33.77 (SD 10.70) years. On average, participants completed more than half of the cognitive training regimen (mean 18.58, SD 12.47 hours of training), and logged into the PRIME app 4.71 (SD 1.58) times per week. The attrition rate of 22% (22/100) was lower than that reported in our previous studies on remote cognitive training. The total sample showed significant gains in global cognition (P=.03) and attention (P<.001). The TCT+PRIME participants showed significantly greater gains in emotion recognition (P<.001) and global cognition at the trend level (P=.09), although this was not statistically significant, relative to the CG+PRIME participants. The total sample also showed significant improvements on multiple indices of motivation (P=.02-0.05), in depression (P=.04), in positive symptoms (P=.04), and in negative symptoms at a trend level (P=.09), although this was not statistically significant. Satisfaction with the PRIME app was rated at 7.74 (SD 2.05) on a scale of 1 to 10, with higher values indicating more satisfaction. Conclusions: These results demonstrate the feasibility and acceptability of remote cognitive training combined with the PRIME app and that this intervention can improve cognition, motivation, and symptoms in individuals with psychosis. TCT+PRIME appeared more effective in improving emotion recognition and global cognition than CG+PRIME. Future analyses will test the relationship between hours of cognitive training completed; PRIME use; and changes in cognition, motivation, symptoms, and functioning. Trial Registration: ClinicalTrials.gov NCT02782442; https://clinicaltrials.gov/study/NCT02782442 %M 37955951 %R 10.2196/48634 %U https://www.jmir.org/2023/1/e48634 %U https://doi.org/10.2196/48634 %U http://www.ncbi.nlm.nih.gov/pubmed/37955951 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e48804 %T Supporting Clinical Competencies in Men’s Mental Health Using the Men in Mind Practitioner Training Program: User Experience Study %A Seidler,Zac E %A Benakovic,Ruben %A Wilson,Michael J %A Fletcher,Justine %A Oliffe,John L %A Owen,Jesse %A Rice,Simon M %+ Orygen, 35 Poplar Rd, Parkville, Melbourne, 3052, Australia, 61 0432 438 254, zac.seidler@orygen.org.au %K e-learning %K mental health services %K psychotherapy %K men’s mental health %K masculinity %D 2023 %7 7.11.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Engaging men in psychotherapy is essential in male suicide prevention efforts, yet to date, efforts to upskill mental health practitioners in delivering gender-sensitized therapy for men have been lacking. To address this, we developed Men in Mind, an e-learning training program designed to upskill mental health practitioners in engaging men in therapy. Objective: This study involves an in-depth analysis of the user experience of the Men in Mind intervention, assessed as part of a randomized controlled trial of the efficacy of the intervention. Methods: Following completion of the intervention, participants provided qualitative (n=392) and quantitative (n=395) user experience feedback, focused on successes and suggested improvements to the intervention and improvements to their confidence in delivering therapy with specific subpopulations of male clients. We also assessed practitioner learning goals (n=242) and explored the extent to which participants had achieved these goals at follow-up. Results: Participants valued the inclusion of video demonstrations of skills in action alongside the range of evidence-based content dedicated to improving their insight into the engagement of men in therapy. Suggested improvements most commonly reflected the desire for more or more diverse content, alongside the necessary adaptations to improve the learning and user experience. Participants also commonly reported improved confidence in assisting men with difficulty articulating their emotions in therapy and suicidal men. Conclusions: The evidence obtained from this study aids in plans to scale Men in Mind and informs the future development of practitioner training interventions in men’s mental health. International Registered Report Identifier (IRRID): RR2-10.1186/s40359-022-00875-9 %M 37934579 %R 10.2196/48804 %U https://mededu.jmir.org/2023/1/e48804 %U https://doi.org/10.2196/48804 %U http://www.ncbi.nlm.nih.gov/pubmed/37934579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42194 %T Effectiveness of Reducing Craving in Alcohol Use Disorder Using a Serious Game (SALIENCE): Randomized Controlled Trial %A Weber,Antonia %A Shevchenko,Yury %A Gerhardt,Sarah %A Hoffmann,Sabine %A Kiefer,Falk %A Vollstädt-Klein,Sabine %+ Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, Mannheim, 68159, Germany, 49 1792011684, sabine.vollstaedt-klein@zi-mannheim.de %K alcohol approach bias %K alcohol attentional bias %K alcohol use disorder %K alcohol %K attention %K cognitive bias modification therapy %K craving %K cue-exposure therapy %K decision-making training %K decision-making %K incentive salience %K serious games %K therapy %K training %D 2023 %7 7.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use disorder (AUD) has become a major global health problem. Therapy for this condition is still a great challenge. Recently, it has become increasingly evident that computer-based training is a valuable addition to the treatment of addictive disorders. Objective: This study aims to evaluate the web-based serious game SALIENCE (Stop Alcohol in Everyday Life-New Choices and Evaluations) as an add-on therapy for AUD. It combines the cue-exposure therapy approach with elements of decision-making training, enhanced by interactive panoramic images. The effects of SALIENCE training on levels of craving, attention, and cognitive bias are investigated. Methods: In a randomized controlled trial, 62 participants with AUD undergoing 3 weeks of an extended alcohol detoxification program were randomly allocated to an intervention and a control group. A total of 49 individuals (mean age 44.04 y; 17/49, 35% female) completed all sessions and were included in the analysis. Only pretreatment data were available from the other 13 patients. Participants answered questionnaires related to alcohol consumption and craving and completed neuropsychological tasks at the beginning of the study and 2 weeks later to evaluate levels of attention and cognitive biases. During the 2-week period, 27 of the participants additionally performed the SALIENCE training for 30 minutes 3 times a week, for a total of 6 sessions. Results: We observed a significant decrease in craving in both groups: the control group (mean 15.59, SD 8.02 on the first examination day vs mean 13.18, SD 8.38 on the second examination day) and the intervention group (mean 15.19, SD 6.71 on the first examination day vs mean 13.30, SD 8.47 on the second examination day; F1,47=4.31; P=.04), whereas the interaction effect was not statistically significant (F1,47=0.06; P=.80). Results of the multiple linear regression controlling for individual differences between participants indicated a significantly greater decrease in craving (β=4.12; t36=2.34; P=.03) with the SALIENCE intervention. Participants with lower drinking in negative situations reduced their craving (β=.38; t36=3.01; P=.005) more than people with higher drinking in negative situations. Conclusions: The general effectiveness of SALIENCE training as an add-on therapy in reducing alcohol craving was not confirmed. Nevertheless, taking into account individual differences (gender, duration of dependence, stress, anxiety, and drinking behavior in different situations), it was shown that SALIENCE training resulted in a larger reduction in craving than without. Notably, individuals who rarely consume alcohol due to negative affect profited the most from SALIENCE training. In addition to the beneficial effect of SALIENCE training, these findings highlight the relevance of individualized therapy for AUD, adapted to personal circumstances such as drinking motivation. Trial Registration: ClinicalTrials.gov NCT03765476; https://clinicaltrials.gov/show/NCT03765476 %M 37934561 %R 10.2196/42194 %U https://formative.jmir.org/2023/1/e42194 %U https://doi.org/10.2196/42194 %U http://www.ncbi.nlm.nih.gov/pubmed/37934561 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e45068 %T Effects of a Self-Guided Transdiagnostic Smartphone App on Patient Empowerment and Mental Health: Randomized Controlled Trial %A Kerber,André %A Beintner,Ina %A Burchert,Sebastian %A Knaevelsrud,Christine %+ Department of Clinical-Psychological Intervention, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 838 63093, andre.kerber@fu-berlin.de %K patient empowerment %K mental health–related self-management skills %K help-seeking attitude %K mental health literacy %K internet-based interventions %K unguided %K self-guided %K transdiagnostic mental health app %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental disorders impact both individuals and health systems. Symptoms and syndromes often remain undetected and untreated, resulting in chronification. Besides limited health care resources, within-person barriers such as the lack of trust in professionals, the fear of stigmatization, or the desire to cope with problems without professional help contribute to the treatment gap. Self-guided mental health apps may support treatment seeking by reducing within-person barriers and facilitating mental health literacy. Digital mental health interventions may also improve mental health related self-management skills and contribute to symptom reduction and the improvement of quality of life. Objective: This study aims to investigate the effects of a self-guided transdiagnostic app for mental health on help seeking, reduced stigma, mental health literacy, self-management skills, mental health symptoms, and quality of life using a randomized controlled design. Methods: Overall, 1045 participants (recruited via open, blinded, and web-based recruitment) with mild to moderate depression or anxiety-, sleep-, eating-, or somatization-related psychopathology were randomized to receive either access to a self-guided transdiagnostic mental health app (MindDoc) in addition to care as usual or care as usual only. The core features of the app were regular self-monitoring, automated feedback, and psychological courses and exercises. The coprimary outcomes were mental health literacy, mental health–related patient empowerment and self-management skills (MHPSS), attitudes toward help seeking, and actual mental health service use. The secondary outcomes were psychopathological symptom burden and quality of life. Data were collected at baseline and 8 weeks and 6 months after randomization. Treatment effects were investigated using analyses of covariance, including baseline variables as predictors and applying multiple imputation. Results: We found small but robust between-group effects for MHPSS (Cohen d=0.29), symptoms burden (Cohen d=0.28), and quality of life (Cohen d=0.19) 8 weeks after randomization. The effects on MHPSS were maintained at follow-up. Follow-up assessments also showed robust effects on mental health literacy and preliminary evidence for the improvement of help seeking. Predictors of attrition were lower age and higher personality dysfunction. Among the non-attritors, predictors for deterioration were less outpatient treatment and higher initial symptom severity. Conclusions: A self-guided transdiagnostic mental health app can contribute to lasting improvements in patient empowerment. Symptoms of common mental disorders and quality of life improved faster in the intervention group than in the control group. Therefore, such interventions may support individuals with symptoms of 1 or more internalizing disorders, develop health-centered coping skills, prevent chronification, and accelerate symptom improvement. Although the effects for individual users are small and predictors of attrition and deterioration need to be investigated further, the potential public health impact of a self-guided intervention can be large, given its high scalability. Trial Registration: German Clinical Trials Register DRKS00022531; https://drks.de/search/de/trial/DRKS00022531 %M 37930749 %R 10.2196/45068 %U https://mental.jmir.org/2023/1/e45068 %U https://doi.org/10.2196/45068 %U http://www.ncbi.nlm.nih.gov/pubmed/37930749 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e49715 %T Association Between User Interaction and Treatment Response of a Voice-Based Coach for Treating Depression and Anxiety: Secondary Analysis of a Pilot Randomized Controlled Trial %A Lv,Nan %A Kannampallil,Thomas %A Xiao,Lan %A Ronneberg,Corina R %A Kumar,Vikas %A Wittels,Nancy E %A Ajilore,Olusola A %A Smyth,Joshua M %A Ma,Jun %+ Department of Medicine, University of Illinois Chicago, Room 466 (MC 275), 1747 W. Roosevelt Rd, Chicago, IL, 60608, United States, 1 3124139830, maj2015@uic.edu %K user interaction %K treatment alliance %K treatment response %K voice assistant %K depression %K anxiety %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The quality of user interaction with therapeutic tools has been positively associated with treatment response; however, no studies have investigated these relationships for voice-based digital tools. Objective: This study evaluated the relationships between objective and subjective user interaction measures as well as treatment response on Lumen, a novel voice-based coach, delivering problem-solving treatment to patients with mild to moderate depression or anxiety or both. Methods: In a pilot trial, 42 adults with clinically significant depression (Patient Health Questionnaire-9 [PHQ-9]) or anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) symptoms or both received Lumen, a voice-based coach delivering 8 problem-solving treatment sessions. Objective (number of conversational breakdowns, ie, instances where a participant’s voice input could not be interpreted by Lumen) and subjective user interaction measures (task-related workload, user experience, and treatment alliance) were obtained for each session. Changes in PHQ-9 and GAD-7 scores at each ensuing session after session 1 measured the treatment response. Results: Participants were 38.9 (SD 12.9) years old, 28 (67%) were women, 8 (19%) were Black, 12 (29%) were Latino, 5 (12%) were Asian, and 28 (67%) had a high school or college education. Mean (SD) across sessions showed breakdowns (mean 6.5, SD 4.4 to mean 2.3, SD 1.8) decreasing over sessions, favorable task-related workload (mean 14.5, SD 5.6 to mean 17.6, SD 5.6) decreasing over sessions, neutral-to-positive user experience (mean 0.5, SD 1.4 to mean 1.1, SD 1.3), and high treatment alliance (mean 5.0, SD 1.4 to mean 5.3, SD 0.9). PHQ-9 (Ptrend=.001) and GAD-7 scores (Ptrend=.01) improved significantly over sessions. Treatment alliance correlated with improvements in PHQ-9 (Pearson r=–0.02 to –0.46) and GAD-7 (r=0.03 to –0.57) scores across sessions, whereas breakdowns and task-related workload did not. Mixed models showed that participants with higher individual mean treatment alliance had greater improvements in PHQ-9 (β=–1.13, 95% CI –2.16 to –0.10) and GAD-7 (β=–1.17, 95% CI –2.13 to –0.20) scores. Conclusions: The participants had fewer conversational breakdowns and largely favorable user interactions with Lumen across sessions. Conversational breakdowns were not associated with subjective user interaction measures or treatment responses, highlighting how participants adapted and effectively used Lumen. Individuals experiencing higher treatment alliance had greater improvements in depression and anxiety. Understanding treatment alliance can provide insights on improving treatment response for this new delivery modality, which provides accessibility, flexibility, comfort with disclosure, and cost-related advantages compared to conventional psychotherapy. Trial Registration: ClinicalTrials.gov NCT04524104; https://clinicaltrials.gov/study/NCT04524104 %M 37930781 %R 10.2196/49715 %U https://humanfactors.jmir.org/2023/1/e49715 %U https://doi.org/10.2196/49715 %U http://www.ncbi.nlm.nih.gov/pubmed/37930781 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48864 %T Digitally Enabled Peer Support Intervention to Address Loneliness and Mental Health: Prospective Cohort Analysis %A Bravata,Dena M %A Kim,Joseph %A Russell,Daniel W %A Goldman,Ron %A Pace,Elizabeth %+ Department of Human Development & Family Studies, Iowa State University, 86 Lebaron Hall, Ames, IA, 50011, United States, 1 515 294 6316, jkim7@iastate.edu %K peer-support %K social isolation %K loneliness %K companionship %K depression %K anxiety %K quality of life %K occupational health %D 2023 %7 6.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Social isolation and loneliness affect 61% of US adults and are associated with significant increases in excessive mental and physical morbidity and mortality. Annual health care spending is US $1643 higher for socially isolated individuals than for those not socially isolated. Objective: We prospectively evaluated the effects of participation with a digitally enabled peer support intervention on loneliness, depression, anxiety, and health-related quality of life among adults with loneliness. Methods: Adults aged 18 years and older living in Colorado were recruited to participate in a peer support program via social media campaigns. The intervention included peer support, group coaching, the ability to become a peer helper, and referral to other behavioral health resources. Participants were asked to complete surveys at baseline, 30, 60, and 90 days, which included questions from the validated University of California, Los Angeles Loneliness Scale, Patient Health Questionnaire 2-Item Scale, General Anxiety Disorder 7-Item Scale, and a 2-item measure assessing unhealthy days due to physical condition and mental condition. A growth curve modeling procedure using multilevel regression analyses was conducted to test for linear changes in the outcome variables from baseline to the end of the intervention. Results: In total, 815 ethnically and socially diverse participants completed registration (mean age 38, SD 12.7; range 18-70 years; female: n=310, 38%; White: n=438, 53.7%; Hispanic: n=133, 16.3%; Black: n=51, 6.3%; n=263, 56.1% had a high social vulnerability score). Participants most commonly joined the following peer communities: loneliness (n=220, 27%), building self-esteem (n=187, 23%), coping with depression (n=179, 22%), and anxiety (n=114, 14%). Program engagement was high, with 90% (n=733) engaged with the platform at 60 days and 86% (n=701) at 90 days. There was a statistically (P<.001 for all outcomes) and clinically significant improvement in all clinical outcomes of interest: a 14.6% (mean 6.47) decrease in loneliness at 90 days; a 50.1% (mean 1.89) decline in depression symptoms at 90 days; a 29% (mean 1.42) reduction in anxiety symptoms at 90 days; and a 13% (mean 21.35) improvement in health-related quality of life at 90 days. Based on changes in health-related quality of life, we estimated a reduction in annual medical costs of US $615 per participant. The program was successful in referring participants to behavioral health educational resources, with 27% (n=217) of participants accessing a resource about how to best support those experiencing psychological distress and 15% (n=45) of women accessing a program about the risks of excessive alcohol use. Conclusions: Our results suggest that a digitally enabled peer support program can be effective in addressing loneliness, depression, anxiety, and health-related quality of life among a diverse population of adults with loneliness. Moreover, it holds promise as a tool for identifying and referring members to relevant behavioral health resources. %M 37930770 %R 10.2196/48864 %U https://formative.jmir.org/2023/1/e48864 %U https://doi.org/10.2196/48864 %U http://www.ncbi.nlm.nih.gov/pubmed/37930770 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40710 %T Synchronous Web-Based Psychotherapy for Mental Disorders From a Health Quality Perspective: Scoping Review %A Dhaliwal,Raman %A Yap,Sidney %A Talarico,Fernanda %A Al-Shamali,Huda %A Mcweeny,Robert %A Reeson,Matthew %A Shalaby,Reham %A Chen,Teresa %A Spronk,Elena %A Snodgrass,Rayven %A Tu,Eileen %A Erick,Taylor %A Marshall,Tyler %A Kennedy,Megan %A Greenshaw,Andrew J %A Winkler,Olga %A Burback,Lisa %+ Department of Psychiatry, Faculty of Medicine & Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 780 492 2487, burback@ualberta.ca %K acceptability %K accessibility %K app %K application %K clinical %K cognitive %K computerized therapy %K culture %K database %K diagnosis %K Diagnostic and Statistical Manual of Mental Disorders %K DSM %K effectiveness %K health quality %K ICD %K International Statistical Classification of Diseases %K literature review %K mental disorder %K mental health %K mental %K Preferred Reporting Items for Systematic Reviews and Meta-Analysis %K PRISMA %K privacy %K psychoeducation %K psychotherapeutic %K psychotherapy %K psychotherapy %K remote delivery %K remote psychotherapy %K remote %K scoping review %K security %K synchronous %K therapist assisted %K therapist delivered %K therapist. %D 2023 %7 3.11.2023 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic necessitated rapid changes to health care delivery, including a shift from in-person to digitally delivered psychotherapy. While these changes helped ensure timely psychotherapy provision, many concerns exist, including clinical, cultural, practical, privacy, and security issues. Objective: This scoping review systematically mapped existing peer-reviewed research on synchronous, therapist-delivered web-based psychotherapy for individuals with a diagnosed mental illness. Data were analyzed through the lens of the Alberta Quality Matrix for Health (AQMH) to assess to what degree this literature addresses key indicators of health care quality. This analysis aided in the identification and organization of knowledge gaps with regard to web-based psychotherapies, highlighting potential disparities between previously prioritized dimensions of care and those requiring further attention. Methods: This review adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. We included peer-reviewed primary research studies in the English language investigating synchronous, therapist-delivered remote psychotherapy delivered to adults (aged 18 years and older) with a Diagnostic and Statistical Manual of Mental Disorders or International Statistical Classification of Diseases diagnosed mental illness. All other citations were excluded. Relevant studies were identified through MEDLINE, APA PsycINFO, Embase (OVID), Web of Science: Core Collection (Clarivate), Cochrane Library (Wiley), and Scopus (Elsevier) databases. Databases were searched on March 18, 2021. For every publication that was taken into consideration, the data were charted independently by 2 reviewers, and in the event of a discrepancy, the principal investigator validated the choice of either extractor. Results were thematically described according to the 6 AQMH dimensions: acceptability, accessibility, appropriateness, effectiveness, efficiency, and safety. Results: From 13,209 publications, 48 articles were included, largely from North American studies. Most studies measured treatment effectiveness (n=48, 100%) and acceptability (n=29, 60%) health quality dimensions. Over 80% (40/48) of studies investigated either a cognitive or exposure intervention for either posttraumatic stress disorder or a mood or anxiety disorder, generally indicating comparable results to in-person therapy. Safety (n=5, 10%) was measured in fewer studies, while treatment accessibility, appropriateness, and efficiency were not explicitly measured in any study, although these dimensions were mentioned as a future direction, hypothesis, or potential outcome. Conclusions: In relation to web-based therapist-delivered psychotherapies for those with a diagnosed mental illness, important aspects of health care quality (accessibility, appropriateness, efficiency, and safety) have received little scientific examination, underscoring a need to address these gaps. There are also significant issues related to the generalizability of this literature, including the underrepresentation of many geographic regions, cultures, populations, clinical contexts, and psychotherapy modalities. Qualitative research in underrepresented populations and settings may uncover important patient and contextual factors important for the future implementation of quality web-based psychotherapy. %M 37921863 %R 10.2196/40710 %U https://www.jmir.org/2023/1/e40710 %U https://doi.org/10.2196/40710 %U http://www.ncbi.nlm.nih.gov/pubmed/37921863 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51824 %T Video-Delivered Family Therapy for Perinatal Women With Depressive Symptoms and Family Conflict: Feasibility, Acceptability, Safety, and Tolerability Results From a Pilot Randomized Trial %A Cluxton-Keller,Fallon %A Hegel,Mark T %A Donnelly,Craig L %A Bruce,Martha L %+ Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 4726, Fallon.P.Cluxton-Keller@dartmouth.edu %K perinatal depression %K family conflict %K family therapy %K family %K conflict %K depression %K depressive %K perinatal %K pregnant %K pregnancy %K video %K videos %K feasibility %K safety %K acceptability %K tolerability %K tolerable %K families %K satisfaction %K resilience %K psychotherapy %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although individual-level treatments exist for pregnant and postpartum women with depression, family conflict is a significant factor that can contribute to the development and severity of perinatal depressive symptoms. Yet, there is a lack of research on family therapy for perinatal women with moderate to severe depressive symptoms and family conflict. Further, research is needed on the feasibility, acceptability, safety, and tolerability of family therapies for perinatal depression that are delivered using Health Insurance Portability and Accountability Act–compliant videoconferencing technology (VCT). Objective: This paper describes the feasibility, acceptability, safety, and tolerability of a VCT-based family therapeutic intervention, Resilience Enhancement Skills Training (REST), for perinatal women with moderate to severe depressive symptoms and moderate to high conflict with their family members. Methods: This paper includes data from an ongoing randomized trial that compares an experimental family therapeutic intervention (REST) to standard of care (VCT-based problem-solving individual therapy) for the treatment of moderate to severe depressive symptoms in perinatal women with moderate to high family conflict. Both interventions were delivered by masters-level therapists using VCT. A total of 83 perinatal women and their adult family members (N=166 individuals) were recruited for participation in the study. Feasibility, defined as therapist adherence to ≥80% of REST session content, was assessed in audio-recorded sessions by 2 expert raters. Acceptability was defined as ≥80% of families completing REST, including completion of ≥80% homework assignments and family report of satisfaction with REST. Completion of REST was assessed by review of therapist session notes, and satisfaction was assessed by participant completion of a web-based questionnaire. The Beck Depression Inventory-Second Edition was administered to perinatal women by research assistants (blind to study group assignment) to assess safety, defined as a reduction in depressive symptoms during the treatment phase. The Family Environment Scale-Family Conflict subscale was administered by therapists to participants during the treatment phase to assess tolerability, defined as a reduction in family conflict during the treatment phase. Results: On average, the therapists achieved 90% adherence to REST session content. Of the families who started REST, 84% (32/38) of them completed REST, and on average, they completed 89% (8/9) of the homework assignments. Families reported satisfaction with REST. The results showed that REST is safe for perinatal women with moderate to severe depressive symptoms, and none discontinued due to worsened depressive symptoms. The results showed that REST is well tolerated by families, and no families discontinued due to sustained family conflict. Conclusions: The results show that REST is feasible, acceptable, safe, and tolerable for families. These findings will guide our interpretation of REST’s preliminary effectiveness upon completion of outcome data collection. Trial Registration: ClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776 %M 37921846 %R 10.2196/51824 %U https://formative.jmir.org/2023/1/e51824 %U https://doi.org/10.2196/51824 %U http://www.ncbi.nlm.nih.gov/pubmed/37921846 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49846 %T Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study %A Cross,Shane %A Nicholas,Jennifer %A Mangelsdorf,Shaminka %A Valentine,Lee %A Baker,Simon %A McGorry,Patrick %A Gleeson,John %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Rd, Parkville, Melbourne, 3052, Australia, 61 3 9966 9383, shane.cross@orygen.org.au %K adolescence %K adolescent %K blended care %K blended %K co-design %K development %K digital health %K digital intervention %K digital mental health %K framework %K hybrid %K mental health %K model %K platform %K self-determination theory %K service %K services %K theory of change %K therapy %K youth mental health %K youth %D 2023 %7 3.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success. Objective: The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success. Methods: We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks. Results: The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs. Conclusions: The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact. %M 37921858 %R 10.2196/49846 %U https://formative.jmir.org/2023/1/e49846 %U https://doi.org/10.2196/49846 %U http://www.ncbi.nlm.nih.gov/pubmed/37921858 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44907 %T A Guided Web-Based Intervention Targeting Procrastination in College Students: Protocol for an Open Trial %A Ozmen,Sevin %A Amarnath,Arpana %A Struijs,Sascha %A de Wit,Leonore %A Cuijpers,Pim %+ Department of Clinical Psychology, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1081 HV, Netherlands, 31 205989898, s.ozmen@vu.nl %K eHealth %K feasibility %K guidance %K online intervention %K procrastination %K protocol %D 2023 %7 3.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Academic procrastination is a widespread problem among college students. It is linked to poor academic performance and increased college dropout intentions, as well as several mental health problems such as depression, anxiety, and stress. Guided web-based interventions can help reduce procrastination. However, guidance by professional clinicians draws upon valuable and limited societal resources, and a more efficient, scalable form of guidance is needed. Guidance by trained clinical psychology students has not yet been examined. Objective: The aim of this open trial is to examine the feasibility and acceptability of a web-based procrastination intervention for college students under the guidance of student digital coaches (e-coaches). Methods: We developed a single-arm trial of a guided web-based intervention targeting procrastination for the Dutch student population. Guidance is delivered by trained clinical psychology students asynchronously in the form of textual feedback on intervention progress, with the aim of supporting and motivating the participant. Participants are recruited at 7 Dutch universities. Primary outcomes are intervention satisfaction, usability, and adherence, which are assessed by the Client Satisfaction Scale (CSQ-8), System Usability Scale (SUS-10), and number of completed modules, respectively. The primary outcomes will be examined by calculating descriptive statistics. Secondary outcomes are e-coach satisfaction and changes to procrastination, depression, stress, and quality of life from pre- to posttest and follow-up. Results: The project was funded in 2019, and recruitment began in January 2021. As of May 2023, a total of 985 participants were enrolled, of which 372 had completed the posttest and 192 had completed the follow-up. The expected date of analysis and publication of the results is 2024. Conclusions: The results are expected to contribute to the body of literature regarding eHealth in 3 ways. First, we will examine whether students who procrastinate adhere to and are satisfied with an eHealth intervention targeting this problem. Second, we will explore whether an intervention targeting procrastination can also decrease depression and stress. Lastly, we will investigate whether trained psychology students can effectively guide their peers in web-based interventions. Given the shortage of licensed psychologists, exploring alternative sources of guidance is much needed in order to provide students with the mental health support they need. International Registered Report Identifier (IRRID): DERR1-10.2196/44907 %M 37921841 %R 10.2196/44907 %U https://www.researchprotocols.org/2023/1/e44907 %U https://doi.org/10.2196/44907 %U http://www.ncbi.nlm.nih.gov/pubmed/37921841 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e45197 %T Understanding Loneliness in Younger People: Review of the Opportunities and Challenges for Loneliness Interventions %A Shah,Hurmat Ali %A Househ,Mowafa %+ Hamad bin Khalifa University, Education City - Gate 8, Ar Rayyan, Doha, Qatar, 974 44547278, mhouseh@hbku.edu.qa %K health informatics %K loneliness informatics %K loneliness theory %K health effects %K loneliness interventions %K information and communication technology %K ICT-based interventions %K social-media–based interventions %K social media %K ICT %K lonely %K loneliness %K social isolation %K mental health %K psychological %D 2023 %7 2.11.2023 %9 Viewpoint %J Interact J Med Res %G English %X Loneliness affects the quality of life of people all around the world. Loneliness is also shown to be directly associated with mental health issues and is often the cause of mental health problems. It is also shown to increase the risk of heart diseases and other physical illnesses. Loneliness is studied both from the social and medical sciences perspectives. There are also interventions on the basis of health informatics, information and communication technologies (ICTs), social media, and other technological solutions. In the literature, loneliness is studied from various angles and perspectives ranging from biological to socioeconomical and through anthropological understandings of technology. From the ICT and technological sides, there are multiple reviews studying the effectiveness of intervention strategies and solutions. However, there is a lack of a comprehensive review on loneliness that engulfs the psychological, social, and technological studies of loneliness. From the perspective of loneliness informatics (ie, the application of health informatics practices and tools), it is important to understand the psychological and biological basis of loneliness. When it comes to technological interventions to fight off loneliness, the majority of interventions focus on older people. While loneliness is highest among older people, theoretical and demographical studies of loneliness give a U-shaped distribution age-wise to loneliness; that is, younger people and older people are the demographics most affected by loneliness. But the strategies and interventions designed for older people cannot be directly applied to younger people. We present the dynamics of loneliness in younger people and also provide an overview of the technological interventions for loneliness in younger people. This paper presents an approach wherein the studies carried out from the perspectives of digital health and informatics are discussed in detail. A comprehensive overview of the understanding of loneliness and the study of the overall field of tools and strategies of loneliness informatics was carried out. The need to study loneliness in younger people is addressed and particular digital solutions and interventions developed for younger people are presented. This paper can be used to overcome the challenges of technological gaps in the studies and strategies developed for loneliness. The findings of this study show that the majority of interventions and reviews are focused on older people, with ICT-based and social media–based interventions showing promise for countering the effects of loneliness. There are new technologies, such as conversational agents and robots, which are tailored to the particular needs of younger people. This literature review suggests that the digital solutions developed to overcome loneliness can benefit people, and younger people in particular, more if they are made interactive in order to retain users. %M 37917125 %R 10.2196/45197 %U https://www.i-jmr.org/2023/1/e45197 %U https://doi.org/10.2196/45197 %U http://www.ncbi.nlm.nih.gov/pubmed/37917125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49137 %T Gay App Use, Sexuality Traits, and High-Risk Sexual Behaviors Among Men Who Have Sex With Men in China: Mediation Analysis %A Luo,Rui %A Xie,Zhi %A Silenzio,Vincent M B %A Kuang,Yun %A Luo,Dan %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 172 Tongzipo Road, Changsha, 410078, China, 86 0731 84805454, luodan_csu_2011@126.com %K geosocial networking apps %K men who have sex with men %K respondent-driven sampling %K high-risk sexual behaviors %K sexuality traits %K mobile phone %D 2023 %7 1.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Gay geosocial networking apps, also known as “gay apps,” have gained increasing popularity in the men who have sex with men (MSM) community. Certain sexuality traits and gay app use are both associated with high-risk sexual behaviors among MSM. However, little is known about the underlying mechanism of such relationships. Objective: Based on the uses and gratifications theory, this study aimed to test the mediation effect of gay app use on the relationship between sexuality traits (sexual compulsivity and sexual sensation seeking) and high-risk sexual behaviors (multiple sexual partners and unprotected anal intercourse) among MSM. Methods: A cross-sectional, multicenter study was conducted in Wuhan and Changsha, China, from August to October 2020. A representative sample of 402 MSM was recruited through respondent-driven sampling. A self-administered web-based structured questionnaire was used to collect data on sociodemographic information, high-risk sexual behaviors, gay app use, sexual compulsivity, and sexual sensation seeking. Path analysis was conducted to assess the mediation effect. Results: Our study revealed that 67.42% (n=271) of MSM used gay apps for seeking potential sexual partners, with 37.06% (n=149) of them engaging in unprotected anal intercourse, and 45.42% (n=218) of them having multiple sexual partners. Of the participants, 17.16% (n=69) reported significant sexual compulsivity, while 29.10% (n=117) reported significant sexual sensation seeking. Notably, gay app usage partially mediated the relationship between sexual compulsivity and multiple sexual partners but fully mediated the relationship between sexual compulsivity and unprotected anal intercourse. Furthermore, gay app usage partially mediated the relationship between sexual sensation seeking and multiple sexual partners but fully mediated the relationship between sexual sensation seeking and unprotected anal intercourse. Conclusions: High-risk sexual behaviors are common among MSM. Most MSM rely on gay apps to find sexual partners, which, when combined with higher levels of sexual compulsivity and sexual sensation seeking, can increase the likelihood of engaging in high-risk sexual behaviors. Therefore, interventions aimed at reducing these behaviors among MSM should focus on addressing the use of gay apps, while also considering the influence of their sexuality traits on gay app use. %M 37910154 %R 10.2196/49137 %U https://www.jmir.org/2023/1/e49137 %U https://doi.org/10.2196/49137 %U http://www.ncbi.nlm.nih.gov/pubmed/37910154 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46826 %T Feasibility, Perceived Impact, and Acceptability of a Socially Assistive Robot to Support Emotion Regulation With Highly Anxious University Students: Mixed Methods Open Trial %A Williams,A Jess %A Freed,Maureen %A Theofanopoulou,Nikki %A Daudén Roquet,Claudia %A Klasnja,Predrag %A Gross,James %A Schleider,Jessica %A Slovak,Petr %+ Department of Informatics, King's College London, Strand Campus, London, WC2R 2LS, United Kingdom, 44 7969432592, amy_jess.williams@kcl.ac.uk %K emotion regulation %K students %K anxiety %K digital intervention %K mixed-methods %D 2023 %7 31.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health difficulties among university students have been rising rapidly over the last decade, and the demand for university mental health services commonly far exceeds available resources. Digital interventions are seen as one potential solution to these challenges. However, as in other mental health contexts, digital programs often face low engagement and uptake, and the field lacks usable, engaging, evidence-supported mental health interventions that may be used flexibly when students need them most. Objective: The aim of this study is to investigate the feasibility and acceptability of a new, in situ intervention tool (Purrble) among university students experiencing anxiety. As an intervention, Purrble was designed to provide in situ support for emotion regulation (ER)—a well-known transdiagnostic construct—directly in the moments when individuals are facing emotionally challenging situations. A secondary aim is to consider the perceived impact of Purrble on youth mental health, as reported by students over a 7-week deployment. Methods: A mixed methods open trial was conducted with 78 under- and postgraduate students at Oxford University. Participants were recruited based on moderate to high levels of anxiety measured by Generalized Anxiety Disorder-7 at baseline (mean 16.09, SD 3.03). All participants had access to Purrble for 7 weeks during the spring term with data on their perceived anxiety, emotion dysregulation, ER self-efficacy, and engagement with the intervention collected at baseline (pre), week 4 (mid), and week 8 (postintervention). Qualitative responses were also collected at the mid- and postintervention points. Results: The findings demonstrated a sustained engagement with Purrble over the 7-week period, with the acceptability further supported by the qualitative data indicating that students accepted Purrble and that Purrble was well-integrated into their daily routines. Exploratory quantitative data analysis indicated that Purrble was associated with reductions in student anxiety (dz=0.96, 95% CI 0.62-1.29) and emotion dysregulation (dz=0.69, 95% CI 0.38-0.99), and with an increase in ER self-efficacy (dz=–0.56, 95% CI –0.86 to –0.26). Conclusions: This is the first trial of a simple physical intervention that aims to provide ongoing ER support to university students. Both quantitative and qualitative data suggest that Purrble is an acceptable and feasible intervention among students, the engagement with which can be sustained at a stable level across a 7-week period while retaining a perceived benefit for those who use it (n=32, 61% of our sample). The consistency of use is particularly promising given that there was no clinician engagement or further support provided beyond Purrble being delivered to the students. These results show promise for an innovative intervention model, which could be complementary to the existing interventions. %M 37906230 %R 10.2196/46826 %U https://mental.jmir.org/2023/1/e46826 %U https://doi.org/10.2196/46826 %U http://www.ncbi.nlm.nih.gov/pubmed/37906230 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46603 %T Optimization of a Transdiagnostic Mobile Emotion Regulation Intervention for University Students: Protocol for a Microrandomized Trial %A Laure,Tajda %A Engels,Rutger C M E %A Remmerswaal,Danielle %A Spruijt-Metz,Donna %A Konigorski,Stefan %A Boffo,Marilisa %+ Department of Psychology, Education, and Child Studies, Erasmus School of Social and Behavioural Sciences, Erasmus University of Rotterdam, Burgemeester Oudlaan 50, Rotterdam, 3062 PA, Netherlands, 31 010 408 1111, laure@essb.eur.nl %K transdiagnostic %K mobile intervention %K microrandomized trial %K mental health %K emotion regulation %K university students %K mobile app %K mobile phone %D 2023 %7 27.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many university students experience mental health problems such as anxiety and depression. To support their mental health, a transdiagnostic mobile app intervention has been developed. The intervention provides short exercises rooted in various approaches (eg, positive psychology, mindfulness, self-compassion, and acceptance and commitment therapy) that aim to facilitate adaptive emotion regulation (ER) to help students cope with the various stressors they encounter during their time at university. Objective: The goals of this study are to investigate whether the intervention and its components function as intended and how participants engage with them. In addition, this study aims to monitor changes in distress symptoms and ER skills and identify relevant contextual factors that may moderate the intervention’s impact. Methods: A sequential explanatory mixed methods design combining a microrandomized trial and semistructured interviews will be used. During the microrandomized trial, students (N=200) will be prompted via the mobile app twice a day for 3 weeks to evaluate their emotional states and complete a randomly assigned intervention (ie, an exercise supporting ER) or a control intervention (ie, a health information snippet). A subsample of participants (21/200, 10.5%) will participate in interviews exploring their user experience with the app and the completed exercises. The primary outcomes will be changes in emotional states and engagement with the intervention (ie, objective and subjective engagement). Objective engagement will be evaluated through log data (eg, exercise completion time). Subjective engagement will be evaluated through exercise likability and helpfulness ratings as well as user experience interviews. The secondary outcomes will include the distal outcomes of the intervention (ie, ER skills and distress symptoms). Finally, the contextual moderators of intervention effectiveness will be explored (eg, the time of day and momentary emotional states). Results: The study commenced on February 9, 2023, and the data collection was concluded on June 13, 2023. Of the 172 eligible participants, 161 (93.6%) decided to participate. Of these 161 participants, 137 (85.1%) completed the first phase of the study. A subsample of participants (18/172, 10.5%) participated in the user experience interviews. Currently, the data processing and analyses are being conducted. Conclusions: This study will provide insight into the functioning of the intervention and identify areas for improvement. Furthermore, the findings will shed light on potential changes in the distal outcomes of the intervention (ie, ER skills and distress symptoms), which will be considered when designing a follow-up randomized controlled trial evaluating the full-scale effectiveness of this intervention. Finally, the results and data gathered will be used to design and train a recommendation algorithm that will be integrated into the app linking students to relevant content. Trial Registration: ClinicalTrials.gov NCT05576883; https://www.clinicaltrials.gov/study/NCT05576883 International Registered Report Identifier (IRRID): DERR1-10.2196/46603 %M 37889525 %R 10.2196/46603 %U https://www.researchprotocols.org/2023/1/e46603 %U https://doi.org/10.2196/46603 %U http://www.ncbi.nlm.nih.gov/pubmed/37889525 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48112 %T Participants’ Engagement With and Results From a Web-Based Integrative Population Mental Wellness Program (CHAMindWell) During the COVID-19 Pandemic: Program Evaluation Study %A Rosansky,Joseph A %A Okst,Kayley %A Tepper,Miriam C %A Baumgart Schreck,Ana %A Fulwiler,Carl %A Wang,Philip S %A Schuman-Olivier,Zev %+ Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, United States, 1 617 591 6132, zschuman@cha.harvard.edu %K COVID-19 pandemic %K digital psychiatry %K early identification %K integrative medicine %K mental wellness %K mindfulness %K population mental health %K prevention %K stratified care %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic involved a prolonged period of collective trauma and stress during which substantial increases in mental health concerns, like depression and anxiety, were observed across the population. In this context, CHAMindWell was developed as a web-based intervention to improve resilience and reduce symptom severity among a public health care system’s patient population. Objective: This program evaluation was conducted to explore participants’ engagement with and outcomes from CHAMindWell by retrospectively examining demographic information and mental health symptom severity scores throughout program participation. Methods: We examined participants’ symptom severity scores from repeated, web-based symptom screenings through Computerized Adaptive Testing for Mental Health (CAT-MH) surveys, and categorized participants into symptom severity-based tiers (tier 1=asymptomatic to mild; tier 2=moderate; and tier 3=severe). Participants were provided tier-based mindfulness resources, treatment recommendations, and referrals. Logistic regressions were conducted to evaluate associations between demographic variables and survey completion. The McNemar exact test and paired sample t tests were performed to evaluate changes in the numbers of participants in tier 1 versus tier 2 or 3 and changes in depression, anxiety, and posttraumatic stress disorder severity scores between baseline and follow-up. Results: The program enrolled 903 participants (664/903, 73.5% female; 556/903, 61.6% White; 113/903, 12.5% Black; 84/903, 9.3% Asian; 7/903, 0.8% Native; 36/903, 4% other; and 227/903, 25.1% Hispanic) between December 16, 2020, and March 17, 2022. Of those, 623 (69%) completed a baseline CAT-MH survey, and 196 completed at least one follow-up survey 3 to 6 months after baseline. White racial identity was associated with completing baseline CAT-MH (odds ratio [OR] 1.80, 95% CI 1.14-2.84; P=.01). Participants’ odds of having symptom severity below the clinical threshold (ie, tier 1) were significantly greater at follow-up (OR 2.60, 95% CI 1.40-5.08; P=.001), and significant reductions were observed across symptom domains over time. Conclusions: CHAMindWell is associated with reduced severity of mental health symptoms. Future work should aim to address program engagement inequities and attrition and compare the impacts of CHAMindWell to a control condition to better characterize its effects. %M 37883149 %R 10.2196/48112 %U https://mental.jmir.org/2023/1/e48112 %U https://doi.org/10.2196/48112 %U http://www.ncbi.nlm.nih.gov/pubmed/37883149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46494 %T Application of a Digital Mental Health Clinic in Secondary Schools: Functionality and Effectiveness Evaluation %A Xu,Yi %A Yang,Hongshen %A Jin,Zhou %A Xiang,Jian %A Xu,Haiyun %A Pokay,Yili Huang %A Mao,Haibo %A Cai,Xugong %A Wu,Yili %A Wang,Deborah Baofeng %+ Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Kangning Hospital, Wenzhou Medical University, 1 Shengjin Road, Huanglong Residential District, Wenzhou, 325000, China, 86 13757707429, debbiebwang@msn.com %K adolescents %K digital mental health clinic %K emotional distress %K mental health service %K secondary school %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents experience relatively more stress than other populations as they are facing rapid physical changes and adapting to complex social environments. However, access for this population to professional service providers is limited. Therefore, there is an increasing need for access to mental health services and new mental health care resources tailored to adolescents. Objective: The aim of this study was to evaluate the functionality and effectiveness of a school digital mental health clinic (DMHC) created by a Chinese psychiatric hospital and provided to secondary school students for a trial. Methods: The trial period of the DMHC was from January to July 2021 at three secondary schools in Taizhou City, China. Under a collaborative agreement between the local educational bureau and provider, use of the DMHC was free to all students, teachers, and staff of the schools. The functionality of the DMHC was compared with existing digital health interventions introduced in the literature and its effectiveness was quantitatively analyzed in terms of the volume of received counseling calls, number of calls per 100 students, length and time of calls, and reasons for the calls. The mini course video views were analyzed by topics and viewing time. Results: The design functions of the DMHC are well aligned with required factors defined in the literature. The first advantage of this DMHC is its high accessibility to students in the three schools. All functions of the DMHC are free to use by students, thereby eliminating the economic barriers to seeking and receiving care. Students can receive virtual counseling during or after regular working hours. Acceptability of the DHMC was further ensured by the full support from a national top-tier mental health facility. Any audio or video call from a student user would connect them to a live, qualified professional (ie, a psychiatrist or psychologist). Options are provided to view and listen to resources for stress relief or tips to help address mental health needs. The major reasons for the counseling calls included difficulties in learning, interpersonal relationships, and emotional distress. The three topics with the highest level of interest for the mini course videos were emotional assistance, personal growth, and family member relationships. The DMHC served as an effective tool for crisis prevention and intervention during nonworking hours as most of the live calls and mini video viewing occurred after school or over the weekend. Furthermore, the DMHC helped three students at high risk for suicide and self-injury through live-call intervention. Conclusions: The DMHC is an effective complementary solution to improve access to professional mental health care facilities, especially during nonworking hours, thereby helping adolescents meet their mental health needs. Extension of the DMHC into more schools and other settings is recommended. %M 37883144 %R 10.2196/46494 %U https://formative.jmir.org/2023/1/e46494 %U https://doi.org/10.2196/46494 %U http://www.ncbi.nlm.nih.gov/pubmed/37883144 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48912 %T Effect of Individual Virtual Reality Cognitive Training Programs on Cognitive Function and Depression in Middle-Aged Women: Randomized Controlled Trial %A Kim,Du-Ri %A Moon,EunSoo %A Shin,Myung-Jun %A Yang,Yeong-Ae %A Park,Jong-Hwan %+ Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, 179, Gudeok-ro, Seo-gu, Busan, 49241, Republic of Korea, 82 0512407071, parkj@pusan.ac.kr %K cognitive function %K depression %K middle aged %K virtual reality %K women %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given the increasing incidence of early-onset Alzheimer disease, strategies for early diagnosis and swift treatment interventions are crucial for mitigating cognitive problems in women and middle-aged individuals who face a high risk of cognitive impairment. Objective: This study aimed to assess the effectiveness of individual cognitive training programs based on virtual reality (VR), a nonpharmacological intervention, on cognitive function and depression in middle-aged women at risk of cognitive impairment. It used VR technology, which has recently been recognized as a promising tool. Methods: We administered a VR-based cognitive training program for 30 minutes daily, twice a week, for 12 weeks (24 sessions). This study included middle-aged women residing in older adults’ welfare facilities in G-gu, Busan, from May to August 2021. A total of 60 participants were randomly divided into the training (n=30) and control (n=30) groups. Cognitive and depressive functions were assessed using the Korean versions of the Montreal Cognitive Assessment (K-MoCA), Digit Span Test (DST), Korean-Color Word Stroop Test (K-CWST), and Short Form of the Geriatric Depression Scale (SGDS-K) before the intervention. The training group underwent a VR-based cognitive training program, whereas the control group was educated to maintain regular daily activities. The same assessments were performed 12 weeks after treatment. Results: A comparison of the mean scores before and after K-MoCA in the training group revealed a significant increase from 24.87 (SD 2.62) to 27.50 (SD 1.70; P<.01), indicating substantial cognitive improvement. Similarly, the mean DST forward scores increased significantly from 6.97 (SD 1.10) to 7.90 (SD 1.18; P<.01), suggesting enhanced short-term auditory memory and attention. The mean DST backward scores also showed a significant improvement from 4.10 (SD 0.71) to 4.77 (SD 1.2; P=.01). Notably, the mean SGDS-K scores decreased significantly from 3.97 (SD 2.51) to 2.13 (SD 1.87; P<.01), indicating a reduction in depression within the training group. Conclusions: The VR-based cognitive training programs significantly enhanced cognitive function and reduced depression in middle-aged women. Consequently, these programs are considered beneficial nonpharmacological cognitive training interventions for middle-aged women at high risk of cognitive impairment. Trial Registration: UMIN Clinical Trials Registry UMIN000049752; https://tinyurl.com/z5du989z %M 37878378 %R 10.2196/48912 %U https://mental.jmir.org/2023/1/e48912 %U https://doi.org/10.2196/48912 %U http://www.ncbi.nlm.nih.gov/pubmed/37878378 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46008 %T Web-Based Cognitive Bias Modification Program for Young People With Social Anxiety and Hazardous Alcohol Use: Feasibility, Acceptability, and Preliminary Efficacy Study %A Prior,Katrina %A Salemink,Elske %A Piggott,Monique %A Manning,Victoria %A Wiers,Reinout W %A Teachman,Bethany A %A Teesson,Maree %A Baillie,Andrew J %A Mahoney,Alison %A McLellan,Lauren %A Newton,Nicola C %A Stapinski,Lexine A %+ Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell building (G02), Sydney, 2006, Australia, 61 286279032, katrina.prior@sydney.edu.au %K alcohol %K anxiety %K cognitive bias modification %K interpretation bias %K approach bias %K young adult %K mobile phone %D 2023 %7 25.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Interpretation bias modification (IBM) and approach bias modification (ApBM) cognitive retraining interventions can be efficacious adjunctive treatments for improving social anxiety and alcohol use problems. However, previous trials have not examined the combination of these interventions in a young, comorbid sample. Objective: This study aims to describe the feasibility, acceptability, and preliminary efficacy of a web-based IBM+ApBM program for young adults with social anxiety and hazardous alcohol use (“Re-Train Your Brain”) when delivered in conjunction with treatment as usual (TAU). Methods: The study involved a 3-arm randomized controlled pilot trial in which treatment-seeking young adults (aged 18-30 y) with co-occurring social anxiety and hazardous alcohol use were randomized to receive (1) the “integrated” Re-Train Your Brain program, where each session included both IBM and ApBM (50:50 ratio), plus TAU (35/100, 35%); (2) the “alternating” Re-Train Your Brain program, where each session focused on IBM or ApBM in an alternating pattern, plus TAU (32/100, 32%); or (3) TAU only (33/100, 33%). Primary outcomes included feasibility and acceptability, and secondary efficacy outcomes included changes in cognitive biases, social anxiety symptoms, and alcohol use. Assessments were conducted at baseline, after the intervention period (6 weeks after baseline), and 12 weeks after baseline. Results: Both Re-Train Your Brain program formats were feasible and acceptable for young adults. When coupled with TAU, both integrated and alternating programs resulted in greater self-reported improvements than TAU only in anxiety interpretation biases (at the 6-week follow-up; Cohen d=0.80 and Cohen d=0.89) and comorbid interpretation biases (at the 12-week follow-up; Cohen d=1.53 and Cohen d=1.67). In addition, the alternating group reported larger improvements over the control group in generalized social anxiety symptoms (at the 12-week follow-up; Cohen d=0.83) and alcohol cravings (at the 6-week follow-up; Cohen d=0.81). There were null effects on all other variables and no differences between the intervention groups in efficacy outcomes. Conclusions: Should these findings be replicated in a larger randomized controlled trial, Re-Train Your Brain has the potential to be a scalable, low-cost, and non–labor-intensive adjunct intervention for targeting interpretation and comorbidity biases as well as generalized anxiety and alcohol-related outcomes in the real world. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620001273976; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364131 International Registered Report Identifier (IRRID): RR2-10.2196/28667 %M 37878363 %R 10.2196/46008 %U https://formative.jmir.org/2023/1/e46008 %U https://doi.org/10.2196/46008 %U http://www.ncbi.nlm.nih.gov/pubmed/37878363 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46651 %T Improving Mild to Moderate Depression With an App-Based Self-Guided Intervention: Protocol for a Randomized Controlled Trial %A Beintner,Ina %A Kerber,André %A Dominke,Clara %A Voderholzer,Ulrich %+ MindDoc Health GmbH, Leopoldstraße 159, Munich, 80804, Germany, 49 015128346250, ibeintner@minddoc.de %K depression %K mobile app %K intervention %K unguided %K transdiagnostic %K randomized controlled trial %K e-mental health %K digital app %K self-management %K mental health %K mHealth %K mobile health %K unguided digital intervention %K public health %K digital intervention %K mobile phone %D 2023 %7 25.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression is one of the most prevalent mental disorders and frequently co-occurs with other mental disorders. Despite the high direct and indirect costs to both individuals and society, more than 80% of those diagnosed with depression remain with their primary care physician and do not receive specialized treatment. Self-guided digital interventions have been shown to improve depression and, due to their scalability, have a large potential public health impact. Current digital interventions often focus on specific disorders, while recent research suggests that transdiagnostic approaches are more suitable. Objective: This paper presents the protocol for a study that aims to assess the efficacy of a self-guided transdiagnostic app-based self-management intervention in patients with mild or moderate depression with and without comorbid mental disorders. Specifically, we are investigating the impact of the intervention on symptoms of depression, quality of life, anxiety symptoms, and mental health–related patient empowerment and self-management skills. Methods: The intervention under investigation, MindDoc with Prescription, is a self-guided digital intervention aimed at supporting individuals with mild to moderate mental disorders from the internalizing spectrum, including depression. The app can be used as a low-threshold psychosocial intervention. Up to 570 adult patients will be randomized to either receive the intervention in addition to care as usual or only care as usual. We are including adults with a permanent residency in Germany and mild or moderate depression according to International Classification of Diseases, 10th Revision, criteria (F32.0, F32.1, F33.0, and F33.1). Clinical interviews will be conducted to confirm the diagnosis. Data will be collected at baseline as well as 8 weeks and 6 months after randomization. The primary outcome will be depression symptom severity after 8 weeks. Secondary outcomes will be quality of life, anxiety symptom severity, and patient empowerment and self-management behaviors. Data will be analyzed using multiple imputations, using the intention-to-treat principle, while sensitivity analyses will be based on additional imputation strategies and a per-protocol analysis. Results: Recruitment for the trial started on February 7, 2023, and the first participant was randomized on February 14, 2023. As of September 5, 2023, 275 participants have been included in the trial and 176 have provided the primary outcome. The rate of missing values in the primary outcome is approximately 20%. Conclusions: Data from this efficacy trial will be used to establish whether access to the intervention is associated with an improvement in depression symptoms in individuals diagnosed with mild or moderate depression. The study will contribute to expanding the evidence base on transdiagnostic digital interventions. Trial Registration: German Registry of Clinical Trials DRKS00030852; https://drks.de/search/de/trial/DRKS00030852 International Registered Report Identifier (IRRID): DERR1-10.2196/46651 %M 37878374 %R 10.2196/46651 %U https://www.researchprotocols.org/2023/1/e46651 %U https://doi.org/10.2196/46651 %U http://www.ncbi.nlm.nih.gov/pubmed/37878374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48245 %T Preliminary Clinical Outcomes of the Hello Sunday Morning Alcohol and Wellbeing Self-Assessment: Feasibility and Acceptability Study %A Fletcher,Kathryn %A Moran-Pryor,Alex %A Robert-Hendren,Dominique %+ Hello Sunday Morning, 103 Alexander Street Crows Nest NSW, Sydney, 2065, Australia, 61 1300 403 196, kat.fletcher@hellosundaymorning.org %K web-based %K screening %K alcohol use %K brief intervention %K well-being %K psychological distress %K digital health %D 2023 %7 24.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol-related injuries and diseases are a leading cause of morbidity and mortality worldwide. Early intervention is essential given the chronic, relapsing nature of alcohol use disorders. There is significant potential for widely accessible web-based screening tools to help individuals determine where they stand in terms of alcohol use and provide support recommendations. Screening and brief interventions (SBIs) provide individuals with a stigma-free opportunity to learn and think about the potential risks of drinking and prompt help-seeking behavior by incorporating behavior change techniques. Furthermore, as excessive alcohol use and mental health problems often occur concurrently, SBIs for both conditions simultaneously can potentially address a critical gap in alcohol and mental health treatment. Objective: We investigated the feasibility, acceptability, and clinical outcomes of participants completing the Alcohol and Wellbeing Self-assessment (A&WS), a web-based SBI. Methods: The A&WS is freely available on the Hello Sunday Morning website as part of an uncontrolled observational prospective study. Feasibility was assessed based on the number of respondents who commenced and subsequently completed the A&WS. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the A&WS to others. Clinical outcomes were measured in two ways: (1) self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) or psychological distress (Kessler Psychological Distress Scale score) over time and (2) help seeking—both self-reported and immediate web-based help seeking. Preliminary baseline data collected for the first 9 months (March 2022 to December 2022) of the study were reported, including the 3-month follow-up outcomes. Results: A total of 17,628 participants commenced the A&WS, and of these, 14,419 (81.8%) completed it. Of those 14,419 who completed the A&WS, 1323 (9.18%) agreed to participate in the follow-up research. Acceptability was high, with 78.46% (1038/1323) reporting high satisfaction levels overall; 95.62% (1265/1323) found the A&WS easy to use and would recommend the tool to others. The 1-, 2-, and 3-month follow-ups were completed by 28.57% (378/1323), 21.09% (279/1323), and 17.61% (233/1323) of the participants, respectively. Significant reductions in the Alcohol Use Disorders Identification Test Consumption subscale (P<.001) and Kessler Psychological Distress Scale scores (P<.001) were observed over the 3-month follow-up period. Conclusions: Our results suggest that the A&WS is a highly feasible and acceptable digital SBI that may support individuals in making changes to their alcohol consumption and improve their psychological well-being. In the absence of a control group, positive clinical outcomes cannot be attributed to the A&WS, which should now be subjected to a randomized controlled trial. This scalable, freely available tool has the potential to reach a large number of adults who might not otherwise access help while complementing the alcohol and mental health treatment ecosystem. %M 37874615 %R 10.2196/48245 %U https://formative.jmir.org/2023/1/e48245 %U https://doi.org/10.2196/48245 %U http://www.ncbi.nlm.nih.gov/pubmed/37874615 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48758 %T Digital Training Program for Line Managers (Managing Minds at Work): Protocol for a Feasibility Pilot Cluster Randomized Controlled Trial %A Thomson,Louise %A Hassard,Juliet %A Frost,Alexandra %A Bartle,Craig %A Yarker,Joanna %A Munir,Fehmidah %A Kneller,Richard %A Marwaha,Steven %A Daly,Guy %A Russell,Sean %A Meyer,Caroline %A Vaughan,Benjamin %A Newman,Kristina %A Blake,Holly %+ School of Medicine, University of Nottingham, Yang Fujia Building, Jubilee Campus, Wollaton Road, Nottingham, NG8 1BB, United Kingdom, 44 1157484314, louise.thomson@nottingham.ac.uk %K acceptability %K anxiety %K burnout %K cluster randomised control trial %K depression %K digital training %K feasibility %K intervention %K intervention %K managers %K mental health %K stress %K usability %K work %K workplace %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health problems affect 1 in 6 workers annually and are one of the leading causes of sickness absence, with stress, anxiety, and depression being responsible for half of all working days lost in the United Kingdom. Primary interventions with a preventative focus are widely acknowledged as the priority for workplace mental health interventions. Line managers hold a primary role in preventing poor mental health within the workplace and, therefore, need to be equipped with the skills and knowledge to effectively carry out this role. However, most previous intervention studies have directly focused on increasing line managers’ understanding and awareness of mental health rather than giving them the skills and competencies to take a proactive preventative approach in how they manage and design work. The Managing Minds at Work (MMW) digital training intervention was collaboratively designed to address this gap. The intervention aims to increase line managers’ knowledge and confidence in preventing work-related stress and promoting mental health at work. It consists of 5 modules providing evidence-based interactive content on looking after your mental health, designing and managing work to promote mental well-being, management competencies that prevent work-related stress, developing a psychologically safe workplace, and having conversations about mental health at work. Objective: The primary aim of this study is to pilot and feasibility test MMW, a digital training intervention for line managers. Methods: We use a cluster randomized controlled trial design consisting of 2 arms, the intervention arm and a 3-month waitlist control, in this multicenter feasibility pilot study. Line managers in the intervention arm will complete a baseline questionnaire at screening, immediately post intervention (approximately 6 weeks after baseline), and at 3- and 6-month follow-ups. Line managers in the control arm will complete an initial baseline questionnaire, repeated after 3 months on the waitlist. They will then be granted access to the MMW intervention, following which they will complete the questionnaire post intervention. The direct reports of the line managers in both arms of the trial will also be invited to take part by completing questionnaires at baseline and follow-up. As a feasibility pilot study, a formal sample size is not required. A minimum of 8 clusters (randomized into 2 groups of 4) will be sought to inform a future trial from work organizations of different types and sectors. Results: Recruitment for the study closed in January 2022. Overall, 24 organizations and 224 line managers have been recruited. Data analysis was finished in August 2023. Conclusions: The results from this feasibility study will provide insight into the usability and acceptability of the MMW intervention and its potential for improving line manager outcomes and those of their direct reports. These results will inform the development of subsequent trials. Trial Registration: ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019 International Registered Report Identifier (IRRID): DERR1-10.2196/48758 %M 37874612 %R 10.2196/48758 %U https://www.researchprotocols.org/2023/1/e48758 %U https://doi.org/10.2196/48758 %U http://www.ncbi.nlm.nih.gov/pubmed/37874612 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51712 %T The Potential of Chatbots for Emotional Support and Promoting Mental Well-Being in Different Cultures: Mixed Methods Study %A Chin,Hyojin %A Song,Hyeonho %A Baek,Gumhee %A Shin,Mingi %A Jung,Chani %A Cha,Meeyoung %A Choi,Junghoi %A Cha,Chiyoung %+ College of Nursing and Ewha Research Institute of Nursing Science, System Health & Engineering Major in Graduate School, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 03760, Republic of Korea, 82 02 3277 2883, chiyoung@ewha.ac.kr %K chatbot %K depressive mood %K sad %K depressive discourse %K sentiment analysis %K conversational agent %K mental health %K health information %K cultural differences %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Artificial intelligence chatbot research has focused on technical advances in natural language processing and validating the effectiveness of human-machine conversations in specific settings. However, real-world chat data remain proprietary and unexplored despite their growing popularity, and new analyses of chatbot uses and their effects on mitigating negative moods are urgently needed. Objective: In this study, we investigated whether and how artificial intelligence chatbots facilitate the expression of user emotions, specifically sadness and depression. We also examined cultural differences in the expression of depressive moods among users in Western and Eastern countries. Methods: This study used SimSimi, a global open-domain social chatbot, to analyze 152,783 conversation utterances containing the terms “depress” and “sad” in 3 Western countries (Canada, the United Kingdom, and the United States) and 5 Eastern countries (Indonesia, India, Malaysia, the Philippines, and Thailand). Study 1 reports new findings on the cultural differences in how people talk about depression and sadness to chatbots based on Linguistic Inquiry and Word Count and n-gram analyses. In study 2, we classified chat conversations into predefined topics using semisupervised classification techniques to better understand the types of depressive moods prevalent in chats. We then identified the distinguishing features of chat-based depressive discourse data and the disparity between Eastern and Western users. Results: Our data revealed intriguing cultural differences. Chatbot users in Eastern countries indicated stronger emotions about depression than users in Western countries (positive: P<.001; negative: P=.01); for example, Eastern users used more words associated with sadness (P=.01). However, Western users were more likely to share vulnerable topics such as mental health (P<.001), and this group also had a greater tendency to discuss sensitive topics such as swear words (P<.001) and death (P<.001). In addition, when talking to chatbots, people expressed their depressive moods differently than on other platforms. Users were more open to expressing emotional vulnerability related to depressive or sad moods to chatbots (74,045/148,590, 49.83%) than on social media (149/1978, 7.53%). Chatbot conversations tended not to broach topics that require social support from others, such as seeking advice on daily life difficulties, unlike on social media. However, chatbot users acted in anticipation of conversational agents that exhibit active listening skills and foster a safe space where they can openly share emotional states such as sadness or depression. Conclusions: The findings highlight the potential of chatbot-assisted mental health support, emphasizing the importance of continued technical and policy-wise efforts to improve chatbot interactions for those in need of emotional assistance. Our data indicate the possibility of chatbots providing helpful information about depressive moods, especially for users who have difficulty communicating emotions to other humans. %M 37862063 %R 10.2196/51712 %U https://www.jmir.org/2023/1/e51712 %U https://doi.org/10.2196/51712 %U http://www.ncbi.nlm.nih.gov/pubmed/37862063 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45678 %T Mobile Behavioral Health Coaching as a Preventive Intervention for Occupational Public Health: Retrospective Longitudinal Study %A Toh,Sean Han Yang %A Lee,Sze Chi %A Sündermann,Oliver %+ Intellect Private Limited Company, 171 Tras St, #02-179 Union Building, Singapore, 079025, Singapore, 65 93571995, oliver@intellect.co %K mobile health apps %K mHealth apps %K behavioral health coaching %K behavioral coaching %K app-based coaching %K self-help %K employees %K well-being %K mood %K stress %K public health %K preventive interventions %K positive psychology %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Researchers have recently proposed that behavioral health coaching (BHC) is effective in promoting proactive care among employees. However, to qualify as a preventive workplace intervention, more research is needed to evaluate whether BHC can further elevate well-being among moderately mentally healthy employees. Objective: Using real-world data, this study evaluates the preliminary effectiveness of app-based BHC against a nonrandomized control group with open access to self-help tools in improving well-being (ie, mood levels and perceived stress). The study also explores the active ingredients of BHC and dose-response associations between the number of BHC sessions and well-being improvements. Methods: Employees residing across Asia-Pacific countries (N=1025; mean age 30.85, SD 6.97 y) who reported moderately positive mood and medium levels of perceived stress in their first week of using the mental health app Intellect were included in this study. Users who were given access by their organizations to Intellect’s BHC services were assigned to the “Coaching” condition (512/1025, 49.95%; mean age 31.09, SD 6.87 y), whereas other employees remained as “Control” participants (513/1025, 50.05%; mean age 30.61, SD 7.06 y). To evaluate effectiveness, monthly scores from the validated mood and stress sliders were aggregated into a composite well-being score and further examined using repeated-measure conditional growth models. Postcoaching items on “Perceived Usefulness of the BHC session” and “Working Alliance with my Coach” were examined as active ingredients of BHC using 1-1-1 multilevel mediation models. Finally, 2-way repeated-measure mixed ANOVA models were conducted to examine dose-response effects on well-being improvements between groups (coaching and control) across time. Results: Growth curve analyses revealed significant time by group interaction effects for composite well-being, where “Coaching” users reported significantly greater improvements in well-being than “Control” participants across time (composite well-being: F1,391=6.12; ηp2=0.02; P=.01). Among “Coaching” participants, dependent-sample 2-tailed t tests revealed significant improvements in composite well-being from baseline to 11 months (t512=1.98; Cohen d=0.17; P=.049). Improvements in “Usefulness of the BHC session” (β=.078, 95% Cl .043-.118; P<.001) and “Working Alliance” (β=.070, 95% Cl .037-.107; P<.001) fully mediated within-level well-being enhancements over time. Comparing against baseline or first month scores, significant time by group interactions were observed between the second and sixth months, with the largest effect size observed at the fifth month mark (first month vs fifth month: F1,282=15.0; P<.001; ηp2=0.051). Conclusions: We found preliminary evidence that BHC is an effective preventive workplace intervention. Mobile-based coaching may be a convenient, cost-effective, and scalable means for organizations and governments to boost public mental health. %M 37862086 %R 10.2196/45678 %U https://formative.jmir.org/2023/1/e45678 %U https://doi.org/10.2196/45678 %U http://www.ncbi.nlm.nih.gov/pubmed/37862086 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48444 %T Patient Health Questionnaire-9 Item Pairing Predictiveness for Prescreening Depressive Symptomatology: Machine Learning Analysis %A Glavin,Darragh %A Grua,Eoin Martino %A Nakamura,Carina Akemi %A Scazufca,Marcia %A Ribeiro dos Santos,Edinilza %A Wong,Gloria H Y %A Hollingworth,William %A Peters,Tim J %A Araya,Ricardo %A Van de Ven,Pepijn %+ Department of Electronic and Computer Engineering, University of Limerick, Plassey Park Road, Limerick, V94 T9PX, Ireland, 353 87 260 7623, Darragh.Glavin@ul.ie %K Patient Health Questionnaire-2 %K PHQ-2 %K Patient Health Questionnaire-9 %K PHQ-9 items %K depressive symptomatology %K ultrabrief questionnaires %K prescreening %K machine learning %K cardinal symptoms %K low energy %K psychomotor dysfunction %K depressed mood %D 2023 %7 19.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anhedonia and depressed mood are considered the cardinal symptoms of major depressive disorder. These are the first 2 items of the Patient Health Questionnaire (PHQ)–9 and comprise the ultrabrief PHQ-2 used for prescreening depressive symptomatology. The prescreening performance of alternative PHQ-9 item pairings is rarely compared with that of the PHQ-2. Objective: This study aims to use machine learning (ML) with the PHQ-9 items to identify and validate the most predictive 2-item depressive symptomatology ultrabrief questionnaire and to test the generalizability of the best pairings found on the primary data set, with 6 external data sets from different populations to validate their use as prescreening instruments. Methods: All 36 possible PHQ-9 item pairings (each yielding scores of 0-6) were investigated using ML-based methods with logistic regression models. Their performances were evaluated based on the classification of depressive symptomatology, defined as PHQ-9 scores ≥10. This gave each pairing an equal opportunity and avoided any bias in item pairing selection. Results: The ML-based PHQ-9 items 2 and 4 (phq2&4), the depressed mood and low-energy item pairing, and PHQ-9 items 2 and 8 (phq2&8), the depressed mood and psychomotor retardation or agitation item pairing, were found to be the best on the primary data set training split. They generalized well on the primary data set test split with area under the curves (AUCs) of 0.954 and 0.946, respectively, compared with an AUC of 0.942 for the PHQ-2. The phq2&4 had a higher AUC than the PHQ-2 on all 6 external data sets, and the phq2&8 had a higher AUC than the PHQ-2 on 3 data sets. The phq2&4 had the highest Youden index (an unweighted average of sensitivity and specificity) on 2 external data sets, and the phq2&8 had the highest Youden index on another 2. The PHQ-2≥2 cutoff also had the highest Youden index on 2 external data sets, joint highest with the phq2&4 on 1, but its performance fluctuated the most. The PHQ-2≥3 cutoff had the highest Youden index on 1 external data set. The sensitivity and specificity achieved by the phq2&4 and phq2&8 were more evenly balanced than the PHQ-2≥2 and ≥3 cutoffs. Conclusions: The PHQ-2 did not prove to be a more effective prescreening instrument when compared with other PHQ-9 item pairings. Evaluating all item pairings showed that, compared with alternative partner items, the anhedonia item underperformed alongside the depressed mood item. This suggests that the inclusion of anhedonia as a core symptom of depression and its presence in ultrabrief questionnaires may be incompatible with the empirical evidence. The use of the PHQ-2 to prescreen for depressive symptomatology could result in a greater number of misclassifications than alternative item pairings. %M 37856186 %R 10.2196/48444 %U https://mental.jmir.org/2023/1/e48444 %U https://doi.org/10.2196/48444 %U http://www.ncbi.nlm.nih.gov/pubmed/37856186 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44658 %T The Effectiveness of Fully Automated Digital Interventions in Promoting Mental Well-Being in the General Population: Systematic Review and Meta-Analysis %A Groot,Julia %A MacLellan,Alexander %A Butler,Madelaine %A Todor,Elisa %A Zulfiqar,Mahnoor %A Thackrah,Timothy %A Clarke,Christopher %A Brosnan,Mark %A Ainsworth,Ben %+ Department of Psychology, University of Bath, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 01225 383800, jmdg20@bath.ac.uk %K mental well-being %K promotion %K intervention %K digital %K web-based %K apps %K mobile phone %D 2023 %7 19.10.2023 %9 Review %J JMIR Ment Health %G English %X Background: Recent years have highlighted an increasing need to promote mental well-being in the general population. This has led to a rapidly growing market for fully automated digital mental well-being tools. Although many individuals have started using these tools in their daily lives, evidence on the overall effectiveness of digital mental well-being tools is currently lacking. Objective: This study aims to review the evidence on the effectiveness of fully automated digital interventions in promoting mental well-being in the general population. Methods: Following the preregistration of the systematic review protocol on PROSPERO, searches were carried out in MEDLINE, Web of Science, Cochrane, PsycINFO, PsycEXTRA, Scopus, and ACM Digital (initial searches in February 2022; updated in October 2022). Studies were included if they contained a general population sample and a fully automated digital intervention that exclusively used psychological mental well-being promotion activities. Two reviewers, blinded to each other’s decisions, conducted data selection, extraction, and quality assessment of the included studies. Narrative synthesis and a random-effects model of per-protocol data were adopted. Results: We included 19 studies that involved 7243 participants. These studies included 24 fully automated digital mental well-being interventions, of which 15 (63%) were included in the meta-analysis. Compared with no intervention, there was a significant small effect of fully automated digital mental well-being interventions on mental well-being in the general population (standardized mean difference 0.19, 95% CI 0.04-0.33; P=.02). Specifically, mindfulness-, acceptance-, commitment-, and compassion-based interventions significantly promoted mental well-being in the general population (P=.006); insufficient evidence was available for positive psychology and cognitive behavioral therapy–based interventions; and contraindications were found for integrative approaches. Overall, there was substantial heterogeneity, which could be partially explained by the intervention duration, comparator, and study outcomes. The risk of bias was high, and confidence in the quality of the evidence was very low (Grading of Recommendations, Assessment, Development, and Evaluations), primarily because of the high rates of study dropout (average 37%; range 0%-85%) and suboptimal intervention adherence (average 40%). Conclusions: This study provides a novel contribution to knowledge regarding the effectiveness, strengths, and weaknesses of fully automated digital mental well-being interventions in the general population. Future research and practice should consider these findings when developing fully automated digital mental well-being tools. In addition, research should aim to investigate positive psychology and cognitive behavioral therapy–based tools as well as develop further strategies to improve adherence and reduce dropout in fully automated digital mental well-being interventions. Finally, it should aim to understand when and for whom these interventions are particularly beneficial. Trial Registration: PROSPERO CRD42022310702; https://tinyurl.com/yc7tcwy7 %M 37856172 %R 10.2196/44658 %U https://mental.jmir.org/2023/1/e44658 %U https://doi.org/10.2196/44658 %U http://www.ncbi.nlm.nih.gov/pubmed/37856172 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48365 %T Real-World User Demographics of Three Web-Based Digital Mental Health Interventions Provided by the US Department of Veterans Affairs: Observational Study Using Web Analytics Data %A Ryan,Arthur T %A Stearns-Yoder,Kelly A %A Brenner,Lisa A %+ Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Rocky Mountain Regional Veterans Affairs Medical Center, 1700 N Wheeling St, G-3-116M, Aurora, CO, 80045, United States, 1 720 723 7493, arthur.t.ryan@gmail.com %K digital intervention %K unguided %K web-based %K internet-delivered %K mental health %K veterans %K Google Analytics %K insomnia %K anger %K depression %K mobile phone %D 2023 %7 18.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Unguided digital mental health interventions (UDMHIs) have the potential to provide low-cost and effective mental health care at scale. Controlled trials have demonstrated the efficacy of UDMHIs to address mental health symptoms and conditions. However, few previous publications have described the demographics of real-world users of UDMHIs that are freely available to the public. The US Department of Veterans Affairs has created and hosts several UDMHIs on its Veteran Training Portal website. These web-based, free-to-use, and publicly available UDMHIs include Path to Better Sleep, Anger and Irritability Management Skills, and Moving Forward, which focus on insomnia, problematic anger, and depression symptoms, respectively. Objective: This study aimed to examine the user demographics of these 3 UDMHIs in the year 2021. In addition, it aimed to compare the age and gender distribution of the users of those 3 UDMHIs with one another and with the age and gender distribution of the total US veteran population. Methods: Google Analytics was used to collect user data for each of the 3 UDMHIs. The age and gender distribution of the users of each UDMHI was compared with that of the other UDMHIs as well as with that of the overall US veteran population using chi-square tests. Information on the total number of users, the country they were in, and the devices they used to access the UDMHIs was also collected and reported. Results: In 2021, the 3 UDMHIs together recorded 29,306 unique users. The estimated age range and gender were available for 24.12% (7068/29,306) of those users. Each UDMHI’s age and gender distribution significantly differed from that of the other UDMHIs and from that of the overall US veteran population (P<.001 on all chi-square tests). Women and younger age groups were overrepresented among UDMHI users compared with the overall US veteran population. The majority of devices used to access the UDMHIs were desktop or laptop devices, although a substantial proportion of devices used were mobile devices (10,199/29,752, 34.28%). Most users (27,789/29,748, 93.41%) were located in the United States, with users from Canada, the United Kingdom, and Australia accounting for another 2.61% (775/29,748) of total users. Conclusions: Our use of Google Analytics data provided useful information about the users of 3 free and publicly available UDMHIs provided by the US Department of Veterans Affairs. Although our findings should be considered in light of the limitations of autonomously collected web analytics data, they still offer useful information for health care policy makers, administrators, and UDMHI developers. %M 37851501 %R 10.2196/48365 %U https://formative.jmir.org/2023/1/e48365 %U https://doi.org/10.2196/48365 %U http://www.ncbi.nlm.nih.gov/pubmed/37851501 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47443 %T Patient Perceptions of In Vivo Versus Virtual Reality Exposures for the Treatment of Anxiety Disorders: Cross-Sectional Survey Study %A Levy,Amanda N %A Nittas,Vasileios %A Wray,Tyler B %+ Department of Computer Science, Brown University, 115 Waterman St, Providence, RI, 02906, United States, 1 401 863 7600, amanda_levy@brown.edu %K counseling treatment %K phobias %K PTSD %K patient perspective %K in vivo exposures %K virtual reality %K exposure therapy %K anxiety %K psychotherapy %K effectiveness %K digital therapy %K affective disorders %D 2023 %7 16.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychotherapy, and particularly exposure therapy, has been proven to be an effective treatment for many anxiety disorders, including social and specific phobias, as well as posttraumatic stress disorders. Currently, exposures are underused and mostly delivered in vivo. Virtual reality exposure therapy (VRET) offers a more flexible delivery mechanism that has the potential to address some of the implementation barriers of in vivo exposures while retaining effectiveness. Yet, there is little evidence on how patients perceive different exposure therapy methods. Objective: This study aims to explore the perceptions of individuals with anxiety disorders toward in vivo and VRET. Our findings can inform therapists about the degree of patient interest in both methods while exploring the demand for VRET as an alternative and novel treatment approach. Methods: Web-based survey assessing the (1) interest in, (2) willingness to use, (3) comfort with, (4) enthusiasm toward, and (5) perceived effectiveness of exposure therapy when delivered in vivo and through VR. Participants included individuals with specific phobia, social phobia, posttraumatic stress disorder, or acute stress disorder or reaction. Participants were presented with educational videos about in vivo and VRET and asked to provide their perceptions quantitatively and qualitatively through a rated scale and free-text responses. Results: In total, 184 surveys were completed and analyzed, in which 82% (n=151) of participants reported being willing to receive in vivo exposures and 90.2% (n=166) reported willingness to receive VRET. Participants reported higher interest in, comfort with, enthusiasm toward, and perceived effectiveness of VRET compared to in vivo. Most reported in vivo concerns were linked to (1) increased anxiety, (2) feelings of embarrassment or shame, and (3) exacerbation of current condition. Most reported VRET concerns were linked to (1) risk of side effects including increased anxiety, (2) efficacy uncertainty, and (3) health insurance coverage. The most frequently mentioned VRET benefits include (1) privacy, (2) safety, (3) the ability to control exposures, (4) comfort, (5) the absence of real-life consequences, (6) effectiveness, and (7) customizability to a wider variety of exposures. Conclusions: On average, our participants expressed positive perceptions toward exposure therapy, with slightly more positive perceptions of VRET over in vivo exposures. Despite valid personal concerns and some misconceptions, our findings emphasize that VRET provides an opportunity to get much-needed therapy to patients in ways that are more acceptable and less concerning. %M 37843884 %R 10.2196/47443 %U https://formative.jmir.org/2023/1/e47443 %U https://doi.org/10.2196/47443 %U http://www.ncbi.nlm.nih.gov/pubmed/37843884 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46652 %T Identification of Psycho-Socio-Judicial Trajectories and Factors Associated With Posttraumatic Stress Disorder in People Over 15 Years of Age Who Recently Reported Sexual Assault to a Forensic Medical Center: Protocol for a Multicentric Prospective Study Using Mixed Methods and Artificial Intelligence %A Fedele,Emma %A Trousset,Victor %A Schalk,Thibault %A Oliero,Juliette %A Fovet,Thomas %A Lefevre,Thomas %+ Institute for Interdisciplinary Research on Social Issues (UMR 8156), Campus Condorcet, 5 cours des Humanités, Batiment Recherche Sud, Aubervilliers Cedex, Aubervilliers, 93322, France, 33 1 88 12 11 75, emma.fedele@univ-paris13.fr %K sexual violence %K posttraumatic stress disorder %K functional outcomes %K risk factors %K artificial intelligence %K trajectory %K longitudinal %K mixed methods %K sexual assault %K mental health %K cohort study %K PTSD %K innovative %D 2023 %7 16.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual assault (SA) can lead to a range of adverse effects on physical, sexual, and mental health, as well as on one’s social life, financial stability, and overall quality of life. However, not all people who experience SA will develop negative functional outcomes. Various risk and protective factors can influence psycho-socio-judicial trajectories. However, how these factors influence trauma adaptation and the onset of early posttraumatic stress disorder (PTSD) is not always clear. Objective: Guided by an ecological framework, this project has 3 primary objectives: (1) to describe the 1-year psycho-socio-judicial trajectories of individuals recently exposed to SA who sought consultation with a forensic practitioner; (2) to identify predictive factors for the development of PTSD during the initial forensic examination using artificial intelligence; and (3) to explore the perceptions, needs, and experiences of individuals who have been sexually assaulted. Methods: This longitudinal multicentric cohort study uses a mixed methods approach. Quantitative cohort data are collected through an initial questionnaire completed by the physician during the first forensic examination and through follow-up telephone questionnaires at 6 weeks, 3 months, 6 months, and 1 year after the SA. The questionnaires measure factors associated with PTSD, mental, physical, social, and overall functional outcomes, as well as psycho-socio-judicial trajectories. Cohort participants are recruited through their forensic examination at 1 of the 5 participating centers based in France. Eligible participants are aged 15 or older, have experienced SA in the last 30 days, are fluent in French, and can be reached by phone. Qualitative data are gathered through semistructured interviews with cohort participants, individuals who have experienced SA but are not part of the cohort, and professionals involved in their psycho-socio-judicial care. Results: Bivariate and multivariate analyses will be conducted to examine the associations between each variable and mental, physical, social, and judicial outcomes. Predictive analyses will be performed using multiple prediction algorithms to forecast PTSD. Qualitative data will be integrated with quantitative data to identify psycho-socio-judicial trajectories and enhance the prediction of PTSD. Additionally, data on the perceptions and needs of individuals who have experienced SA will be analyzed independently to gain a deeper understanding of their experiences and requirements. Conclusions: This project will collect extensive qualitative and quantitative data that have never been gathered over such an extended period, leading to unprecedented insights into the psycho-socio-judicial trajectories of individuals who have recently experienced SA. It represents the initial phase of developing a functional artificial intelligence tool that forensic practitioners can use to better guide individuals who have recently experienced SA, with the aim of preventing the onset of PTSD. Furthermore, it will contribute to addressing the existing gap in the literature regarding the accessibility and effectiveness of support services for individuals who have experienced SA in Europe. This comprehensive approach, encompassing the entire psycho-socio-judicial continuum and taking into account the viewpoints of SA survivors, will enable the generation of innovative recommendations for enhancing their care across all stages, starting from the initial forensic examination. International Registered Report Identifier (IRRID): DERR1-10.2196/46652 %M 37843900 %R 10.2196/46652 %U https://www.researchprotocols.org/2023/1/e46652 %U https://doi.org/10.2196/46652 %U http://www.ncbi.nlm.nih.gov/pubmed/37843900 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47198 %T User Engagement Clusters of an 8-Week Digital Mental Health Intervention Guided by a Relational Agent (Woebot): Exploratory Study %A Hoffman,Valerie %A Flom,Megan %A Mariano,Timothy Y %A Chiauzzi,Emil %A Williams,Andre %A Kirvin-Quamme,Andrew %A Pajarito,Sarah %A Durden,Emily %A Perski,Olga %+ Woebot Health, Inc., 535 Mission St, San Francisco, CA, 94107, United States, 1 4152739742, valerie_hoffman@woebothealth.com %K anxiety %K clustering %K depression %K digital health %K digital mental health intervention %K mental health %K relational agents %K user engagement %D 2023 %7 13.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: With the proliferation of digital mental health interventions (DMHIs) guided by relational agents, little is known about the behavioral, cognitive, and affective engagement components associated with symptom improvement over time. Obtaining a better understanding could lend clues about recommended use for particular subgroups of the population, the potency of different intervention components, and the mechanisms underlying the intervention’s success. Objective: This exploratory study applied clustering techniques to a range of engagement indicators, which were mapped to the intervention’s active components and the connect, attend, participate, and enact (CAPE) model, to examine the prevalence and characterization of each identified cluster among users of a relational agent-guided DMHI. Methods: We invited adults aged 18 years or older who were interested in using digital support to help with mood management or stress reduction through social media to participate in an 8-week DMHI guided by a natural language processing–supported relational agent, Woebot. Users completed assessments of affective and cognitive engagement, working alliance as measured by goal and task working alliance subscale scores, and enactment (ie, application of therapeutic recommendations in real-world settings). The app passively collected data on behavioral engagement (ie, utilization). We applied agglomerative hierarchical clustering analysis to the engagement indicators to identify the number of clusters that provided the best fit to the data collected, characterized the clusters, and then examined associations with baseline demographic and clinical characteristics as well as mental health outcomes at week 8. Results: Exploratory analyses (n=202) supported 3 clusters: (1) “typical utilizers” (n=81, 40%), who had intermediate levels of behavioral engagement; (2) “early utilizers” (n=58, 29%), who had the nominally highest levels of behavioral engagement in week 1; and (3) “efficient engagers” (n=63, 31%), who had significantly higher levels of affective and cognitive engagement but the lowest level of behavioral engagement. With respect to mental health baseline and outcome measures, efficient engagers had significantly higher levels of baseline resilience (P<.001) and greater declines in depressive symptoms (P=.01) and stress (P=.01) from baseline to week 8 compared to typical utilizers. Significant differences across clusters were found by age, gender identity, race and ethnicity, sexual orientation, education, and insurance coverage. The main analytic findings remained robust in sensitivity analyses. Conclusions: There were 3 distinct engagement clusters found, each with distinct baseline demographic and clinical traits and mental health outcomes. Additional research is needed to inform fine-grained recommendations regarding optimal engagement and to determine the best sequence of particular intervention components with known potency. The findings represent an important first step in disentangling the complex interplay between different affective, cognitive, and behavioral engagement indicators and outcomes associated with use of a DMHI incorporating a natural language processing–supported relational agent. Trial Registration: ClinicalTrials.gov NCT05672745; https://classic.clinicaltrials.gov/ct2/show/NCT05672745 %M 37831490 %R 10.2196/47198 %U https://www.jmir.org/2023/1/e47198 %U https://doi.org/10.2196/47198 %U http://www.ncbi.nlm.nih.gov/pubmed/37831490 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e47371 %T App-Based Mindfulness for Attenuation of Subjective and Physiological Stress Reactivity in a Population With Elevated Stress: Randomized Controlled Trial %A Kirk,Ulrich %A Staiano,Walter %A Hu,Emily %A Ngnoumen,Christelle %A Kunkle,Sarah %A Shih,Emily %A Clausel,Alicia %A Purvis,Clare %A Lee,Lauren %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 65502695, ukirk@health.sdu.dk %K Mindfulness %K mental health %K stress %K smartphone %K technology %K Headspace %K mobile phone %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stress-related mental health disorders have steadily increased and contributed to a worldwide disease burden with up to 50% experiencing a stress-related mental health disorder worldwide. Data suggest that only approximately 20%-65% of individuals receive treatment. This gap in receiving treatment may be attributed to barriers such as limited treatment access, negative stigma surrounding mental health treatment, approachability (ie, not having a usual treatment plan or provider), affordability (ie, lack of insurance coverage and high treatment cost), and availability (ie, long waits for appointments) leaving those who need treatment without necessary care. To mitigate the limited access mental health treatment, there has been a rise in the application and study of digital mental health interventions. As such, there is an urgent need and opportunity for effective digital mental health interventions to alleviate stress symptoms, potentially reducing adverse outcomes of stress-related disorders. Objective: This study examined if app-based guided mindfulness could improve subjective levels of stress and influence physiological markers of stress reactivity in a population with elevated symptoms of stress. Methods: The study included 163 participants who had moderate to high perceived stress as assessed by the Perceived Stress Scale (PSS-10). Participants were randomly allocated to 1 of 5 groups: a digital guided program designed to alleviate stress (Managing Stress), a digital mindfulness fundamentals course (Basics), digitally delivered breathing exercises, an active control intervention (Audiobook), and a Waitlist Control group. The 3 formats of mindfulness interventions (Managing Stress, Basics, and Breathing) all had a total duration of 300 minutes spanning 20-30 days. Primary outcome measures were perceived stress using the PSS-10, self-reported sleep quality using the Pittsburgh Sleep Quality Index, and trait mindfulness using the Mindful Attention Awareness Scale. To probe the effects of physiological stress, an acute stress manipulation task was included, specifically the cold pressor task (CPT). Heart rate variability was collected before, during, and after exposure to the CPT and used as a measure of physiological stress. Results: The results showed that PSS-10 and Pittsburgh Sleep Quality Index scores for the Managing Stress (all P<.001) and Basics (all P≤.002) groups were significantly reduced between preintervention and postintervention periods, while no significant differences were reported for the other groups. No significant differences among groups were reported for Mindful Attention Awareness Scale (P=.13). The physiological results revealed that the Managing Stress (P<.001) and Basics (P=.01) groups displayed reduced physiological stress reactivity between the preintervention and postintervention periods on the CPT. There were no significant differences reported for the other groups. Conclusions: These results demonstrate efficacy of app-based mindfulness in a population with moderate to high stress on improving self-reported stress, sleep quality, and physiological measures of stress during an acute stress manipulation task. Trial Registration: ClinicalTrials.gov NCT05832632; https://www.clinicaltrials.gov/ct2/show/NCT05832632 %M 37831493 %R 10.2196/47371 %U https://mhealth.jmir.org/2023/1/e47371 %U https://doi.org/10.2196/47371 %U http://www.ncbi.nlm.nih.gov/pubmed/37831493 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47903 %T Enhancing Mental Health and Medication Adherence Among Men Who Have Sex With Men Recently Diagnosed With HIV With a Dialectical Behavior Therapy–Informed Intervention Incorporating mHealth, Online Skills Training, and Phone Coaching: Development Study Using Human-Centered Design Approach %A Wang,Liying %A Yuwen,Weichao %A Hua,Wenzhe %A Chen,Lingxiao %A Forsythe Cox,Vibh %A Zheng,Huang %A Ning,Zhen %A Zhao,Zhuojun %A Liu,Zhaoyu %A Jiang,Yunzhang %A Li,Xinran %A Guo,Yawen %A Simoni,Jane M %+ Department of Psychology, University of Washington, 3921 W Stevens Way NE, Seattle, WA, 98195, United States, 1 (206) 543 2640, liyingw@uw.edu %K intervention mapping %K participatory approach %K cultural adaptation %K dialectical behavior therapy %K DBT %K men who have sex with men %K MSM %K coping skill training %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health problems are common among men who have sex with men (MSM) living with HIV and may negatively affect medication adherence. Psychosocial interventions designed to address these urgent needs are scarce in China. Incorporating behavioral health theories into intervention development strengthens the effectiveness of these interventions. The absence of a robust theoretical basis for interventions may also present challenges to identify active intervention ingredients. Objective: This study aims to systematically describe the development of a mobile health–based intervention for MSM recently diagnosed with HIV in China, including the theoretical basis for the content and the considerations for its technological delivery. Methods: We used intervention mapping (IM) to guide overall intervention development, a behavioral intervention technology model for technological delivery design, and a human-centered design and cultural adaptation model for intervention tailoring throughout all steps of IM. Results: The dialectical behavior therapy (DBT)–informed intervention, Turning to Sunshine, comprised 3 components: app-based individual skills learning, group-based skills training, and on-demand phone coaching. The theoretical basis for the intervention content is based on the DBT model of emotions, which fits our conceptualization of the intervention user’s mental health needs. The intervention aims to help MSM recently diagnosed with HIV (1) survive moments of high emotional intensity and strong action urges, (2) change emotional expression to regulate emotions, and (3) reduce emotional vulnerability, as well as (4) augment community resources for mental health services. Technological delivery considerations included rationale of the medium, complexity, and esthetics of information delivery; data logs; data visualization; notifications; and passive data collection. Conclusions: This study laid out the steps for the development of a DBT-informed mobile health intervention that integrated app-based individual learning, group-based skills training, and phone coaching. This intervention, Turning to Sunshine, aims to improve mental health outcomes for MSM newly diagnosed with HIV in China. The IM framework informed by human-centered design principles and cultural adaptation considerations offered a systematic approach to develop the current intervention and tailor it to the target intervention users. The behavioral intervention technology model facilitated the translation of behavioral intervention strategies into technological delivery components. The systematic development and reporting of the current intervention can serve as a guide for similar intervention studies. The content of the current intervention could be adapted for a broader population with similar emotional struggles to improve their mental health outcomes. %M 37831497 %R 10.2196/47903 %U https://formative.jmir.org/2023/1/e47903 %U https://doi.org/10.2196/47903 %U http://www.ncbi.nlm.nih.gov/pubmed/37831497 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44887 %T Acceptability and Feasibility of Online Support Groups for Mental Health Promotion in Brazilian Graduate Students During the COVID-19 Pandemic: Longitudinal Observational Study %A Prado,Aneliana da Silva %A Kohls,Elisabeth %A Baldofski,Sabrina %A Rummel-Kluge,Christine %A Freitas,Joanneliese de Lucas %+ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Semmelweisstraße 10, Haus 13, Leipzig, 04103, Germany, 49 3419724464, Aneliana.daSilvaPrado@medizin.uni-leipzig.de %K support group %K online group %K COVID-19 pandemic %K higher education %K graduate students %K university students %K mental health %K online intervention %K internet intervention %K e–mental health %K mental health promotion %K feasibility %K students %K acceptability %D 2023 %7 13.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The outbreak of the COVID-19 pandemic in 2020 aggravated already existing difficulties and added new challenges for students. Owing to the gap between needed and available psychological services, group interventions may offer a helpful strategy for student mental health promotion. Objective: This study aimed to investigate the acceptability and feasibility of a 4-week online support group program designed for mental health promotion tailored to graduate students at a Brazilian public university in the context of the COVID-19 pandemic (May 2022 to June 2022). Methods: Participants in the program took part in online support groups based on a pilot group facilitated by a trained clinical psychologist. Self-administered, standardized web-based questionnaires were assessed at the baseline (T0; before the intervention), postintervention (T2), and follow-up (T3; after 4-6 weeks) time points. We measured sociodemographic variables, treatment credibility and expectancy (Credibility and Expectancy Questionnaire), satisfaction (Client Satisfaction Questionnaire), negative effects of the intervention (Negative Effects Questionnaire), depressive symptoms (Patient Health Questionnaire–9 [PHQ-9]), and participants’ quality of life (abbreviated World Health Organization Quality of Life assessment). A 9–answer option questionnaire and open-ended questions also assessed the group’s perceived positive and negative outcomes. Results: The total sample comprised 32 participants. Most (23/32, 72%) were doctoral students. Credibility and expectancy scores were high. Participants’ satisfaction (Client Satisfaction Questionnaire) with the program was high at the postintervention (T2) and follow-up (T3) evaluations (T2: mean 28.66, SD 3.02; T3: mean 27.91, SD 3.02). Most participants reported that they could learn from other participants’ experiences (T2: 29/32, 91%; T3: 27/32, 84%) and felt encouraged to take better care of themselves (T2: 22/32, 69%; T3: 24/32, 75%). None of the participants reported that they had no benefits from the program. The PHQ-9 scores showed mild to moderate depressive symptoms (mean 9.59, SD 6.34), whereas the answers of 9% (3/32) of the participants to the PHQ-9 item 9 indicated suicidality at baseline (T0). Finally, the 4 domains of quality of life (physical: P=.01; psychological: P=.004; social: P=.02; and environmental: P<.001) showed a slight and statistically significant improvement at the postintervention evaluation (T0: mean 57.03, SD 15.39 to 59.64, SD 17.21; T2: mean 64.32, SD 11.97 to 68.75, SD 8.87). Conclusions: Online support groups for the mental health promotion of graduate students are feasible and can be especially useful for universities with students allocated to different cities. They are also satisfactory and may positively influence participants’ quality of life. Therefore, they can be considered a helpful mental health promotion strategy in the educational context. Further studies could evaluate these (or similar) programs under nonpandemic circumstances. %M 37831483 %R 10.2196/44887 %U https://formative.jmir.org/2023/1/e44887 %U https://doi.org/10.2196/44887 %U http://www.ncbi.nlm.nih.gov/pubmed/37831483 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51320 %T A Digital Music-Based Mindfulness Intervention (“healing attempt”) for Race-Based Anxiety in Black Americans %A Jones,Grant %A Castro-Ramirez,Franchesca %A McGuire,Taylor %A Al-Suwaidi,Maha %A Herrmann,Felipe %+ Department of Psychology, Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, United States, gmj005@g.harvard.edu %K Black music %K mindfulness %K meditation %K music %K song %K songs %K psychotherapy %K self-compassion %K ethnic %K cultural %K culturally %K single-case experiment %K race %K racial %K anxiety %K digital health intervention %K Black %K digital health %K low income %K Black community %K racial disparity %K mental health %D 2023 %7 12.10.2023 %9 Research Letter %J J Med Internet Res %G English %X This study replicates and extends findings that “healing attempt”—a brief digital music-based mindfulness intervention—represents a feasible and potentially effective intervention for race-based anxiety in the Black community. %M 37824179 %R 10.2196/51320 %U https://www.jmir.org/2023/1/e51320 %U https://doi.org/10.2196/51320 %U http://www.ncbi.nlm.nih.gov/pubmed/37824179 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44556 %T Exploring Young Adults’ Views About Aroha, a Chatbot for Stress Associated With the COVID-19 Pandemic: Interview Study Among Students %A Kang,Annie %A Hetrick,Sarah %A Cargo,Tania %A Hopkins,Sarah %A Ludin,Nicola %A Bodmer,Sarah %A Stevenson,Kiani %A Holt-Quick,Chester %A Stasiak,Karolina %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, 22-30 Park Road Avenue, Grafton, Auckland, 1142, New Zealand, 64 99233890, k.stasiak@auckland.ac.nz %K chatbot %K mental health %K COVID-19 %K young adults %K acceptability %K qualitative methods %D 2023 %7 12.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In March 2020, New Zealand was plunged into its first nationwide lockdown to halt the spread of COVID-19. Our team rapidly adapted our existing chatbot platform to create Aroha, a well-being chatbot intended to address the stress experienced by young people aged 13 to 24 years in the early phase of the pandemic. Aroha was made available nationally within 2 weeks of the lockdown and continued to be available throughout 2020. Objective: In this study, we aimed to evaluate the acceptability and relevance of the chatbot format and Aroha’s content in young adults and to identify areas for improvement. Methods: We conducted qualitative in-depth and semistructured interviews with young adults as well as in situ demonstrations of Aroha to elicit immediate feedback. Interviews were recorded, transcribed, and analyzed using thematic analysis assisted by NVivo (version 12; QSR International). Results: A total of 15 young adults (age in years: median 20; mean 20.07, SD 3.17; female students: n=13, 87%; male students: n=2, 13%; all tertiary students) were interviewed in person. Participants spoke of the challenges of living during the lockdown, including social isolation, loss of motivation, and the demands of remote work or study, although some were able to find silver linings. Aroha was well liked for sounding like a “real person” and peer with its friendly local “Kiwi” communication style, rather than an authoritative adult or counselor. The chatbot was praised for including content that went beyond traditional mental health advice. Participants particularly enjoyed the modules on gratitude, being active, anger management, job seeking, and how to deal with alcohol and drugs. Aroha was described as being more accessible than traditional mental health counseling and resources. It was an appealing option for those who did not want to talk to someone in person for fear of the stigma associated with mental health. However, participants disliked the software bugs. They also wanted a more sophisticated conversational interface where they could express themselves and “vent” in free text. There were several suggestions for making Aroha more relevant to a diverse range of users, including developing content on navigating relationships and diverse chatbot avatars. Conclusions: Chatbots are an acceptable format for scaling up the delivery of public mental health and well-being–enhancing strategies. We make the following recommendations for others interested in designing and rolling out mental health chatbots to better support young people: make the chatbot relatable to its target audience by working with them to develop an authentic and relevant communication style; consider including holistic health and lifestyle content beyond traditional “mental health” support; and focus on developing features that make users feel heard, understood, and empowered. %M 37527545 %R 10.2196/44556 %U https://formative.jmir.org/2023/1/e44556 %U https://doi.org/10.2196/44556 %U http://www.ncbi.nlm.nih.gov/pubmed/37527545 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48843 %T Patient Experience of Digitalized Follow-up of Antidepressant Treatment in Psychiatric Outpatient Care: Qualitative Analysis %A Hamlin,Matilda %A Holmén,Joacim %A Wentz,Elisabet %A Aiff,Harald %A Ali,Lilas %A Steingrimsson,Steinn %+ Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Universitetsplatsen 1, Gothenburg, 405 30, Sweden, 46 31786 00 00, steinn.steingrimsson@vgregion.se %K major depressive disorder %K digital psychiatry %K mobile app %K adherence %K antidepressant %K antidepressants %K depressive %K depression %K mHealth %K mobile health %K app %K apps %K application %K applications %K experience %K interview %K interviews %K medication %K prescribe %K prescription %K dose %D 2023 %7 11.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Nonadherence to pharmaceutical antidepressant treatment is common among patients with depression. Digitalized follow-up (ie, self-monitoring systems through mobile apps) has been suggested as an effective adjunct to conventional antidepressant treatment to increase medical adherence, improve symptoms of depression, and reduce health care resource use. Objective: The aim of this study was to determine patients’ experience of digitalized follow-up using a mobile app as an adjunct to treatment concurrent with a new prescription, a change of antidepressant, or a dose increase. Methods: This was a qualitative, descriptive study. Patients at 2 psychiatric outpatient clinics were recruited at the time of changing antidepressant medication. After using a mobile app (either a commercial app or a public app) for 4-6 weeks with daily registrations of active data, such as medical intake and questions concerning general mental health status, individual semistructured interviews were conducted. Recorded data were transcribed and then analyzed using content analysis. Results: In total, 13 patients completed the study. The mean age was 35 (range 20-67) years, 8 (61.5%) were female, and all reported high digital literacy. Overall, the emerging themes indicated that the patients found the digital app to be a valuable adjunct to antidepressant treatment but with potential for improvement. Both user adherence and medical adherence were positively affected by a daily reminder and the app’s ease of use. User adherence was negatively affected by the severity of depression. The positive experience of visually presented data as graphs was a key finding, which was beneficial for self-awareness, the patient-physician relationship, and user adherence. Finally, the patients had mixed reactions to the app’s content and requested tailored content. Conclusions: The patients identified several factors addressing both medical adherence and user adherence to a digital app when using it for digitalized follow-up concurrent with the critical time related to changes in antidepressant medication. The findings highlight the need for rigorous evidence-based empirical studies to generate sustainable research results. %M 37819697 %R 10.2196/48843 %U https://mental.jmir.org/2023/1/e48843 %U https://doi.org/10.2196/48843 %U http://www.ncbi.nlm.nih.gov/pubmed/37819697 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48362 %T A Digital Mental Health Support Program for Depression and Anxiety in Populations With Attention-Deficit/Hyperactivity Disorder: Feasibility and Usability Study %A Tsirmpas,Charalampos %A Nikolakopoulou,Maria %A Kaplow,Sharon %A Andrikopoulos,Dimitrios %A Fatouros,Panagiotis %A Kontoangelos,Konstantinos %A Papageorgiou,Charalabos %+ Feel Therapeutics Inc., 479 Jessie Street, San Francisco, CA, CA94103, United States, 1 3124784041, dimitris@feeltherapeutics.com %K precision medicine %K internet-based intervention %K mobile apps %K major depressive disorder %K anxiety disorders %K attention-deficit/hyperactivity disorder %K personalized medicine %K comorbidity %K quality of life %K mobile phone %D 2023 %7 11.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A total of 1 in 2 adults with attention-deficit/hyperactivity disorder (ADHD) struggles with major depressive or anxiety disorders. The co-occurrence of these disorders adds to the complexity of finding utility in as well as adherence to a treatment option. Digital therapeutic solutions may present a promising alternative treatment option that could mitigate these challenges and alleviate symptoms. Objective: This study aims to investigate (1) the feasibility and acceptance of a digital mental health intervention, (2) participants’ engagement and retention levels, and (3) the potential efficacy with respect to anxiety and depression symptoms in a population with ADHD. Our main hypothesis was that a digital, data-driven, and personalized intervention for adults with coexisting ADHD and depressive or anxiety symptoms would show high engagement and adherence, which would be accompanied by a decrease in depressive and anxiety symptoms along with an increase in quality of life and life satisfaction levels. Methods: This real-world data, single-arm study included 30 adult participants with ADHD symptomatology and coexisting depressive or anxiety symptoms who joined a 16-week digital, data-driven mental health support program. This intervention is based on a combination of evidence-based approaches such as cognitive behavioral therapy, mindfulness, and positive psychology techniques. The targeted symptomatology was evaluated using the Patient Health Questionnaire–9, Generalized Anxiety Disorder–7, and Barkley Adult ADHD Rating Scale–IV. Quality of life aspects were evaluated using the Satisfaction With Life Scale and the Life Satisfaction Questionnaire, and user feedback surveys were used to assess user experience and acceptability. Results: The study retention rate was 97% (29/30), and high engagement levels were observed, as depicted by the 69 minutes spent on the app per week, 5 emotion logs per week, and 11.5 mental health actions per week. An average decrease of 46.2% (P<.001; r=0.89) in depressive symptoms and 46.4% (P<.001; r=0.86) in anxiety symptoms was observed, with clinically significant improvement for more than half (17/30, 57% and 18/30, 60%, respectively) of the participants. This was followed by an average increase of 23% (P<.001; r=0.78) and 20% (P=.003; r=0.8) in Satisfaction With Life Scale and Life Satisfaction Questionnaire scores, respectively. The overall participant satisfaction level was 4.3 out of 5. Conclusions: The findings support the feasibility, acceptability, and value of the examined digital program for adults with ADHD symptomatology to address the coexisting depressive or anxiety symptoms. However, controlled trials with larger sample sizes and more diverse participant profiles are required to provide further evidence of clinical efficacy. %M 37819688 %R 10.2196/48362 %U https://formative.jmir.org/2023/1/e48362 %U https://doi.org/10.2196/48362 %U http://www.ncbi.nlm.nih.gov/pubmed/37819688 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47433 %T The Safety of Digital Mental Health Interventions: Systematic Review and Recommendations %A Taher,Rayan %A Hsu,Che-Wei %A Hampshire,Chloe %A Fialho,Carolina %A Heaysman,Clare %A Stahl,Daniel %A Shergill,Sukhi %A Yiend,Jenny %+ Psychosis Studies Department, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 020 7848 0002, jenny.yiend@kcl.ac.uk %K digital %K digital therapeutics %K mental health %K psychological %K safety %K risk %K negative effects %K harm %K adverse event %K risk mitigation %K mobile phone %D 2023 %7 9.10.2023 %9 Review %J JMIR Ment Health %G English %X Background: Evidence suggests that digital mental health interventions (DMHIs) for common mental health conditions are effective. However, digital interventions, such as face-to-face therapies, pose risks to patients. A safe intervention is considered one in which the measured benefits outweigh the identified and mitigated risks. Objective: This study aims to review the literature to assess how DMHIs assess safety, what risks are reported, and how they are mitigated in both the research and postmarket phases and building on existing recommendations for assessing, reporting, and mitigating safety in the DMHI and standardizing practice. Methods: PsycINFO, Embase, and MEDLINE databases were searched for studies that addressed the safety of DMHIs. The inclusion criteria were any study that addressed the safety of a clinical DMHI, even if not as a main outcome, in an adult population, and in English. As the outcome data were mainly qualitative in nature, a meta-analysis was not possible, and qualitative analysis was used to collate the results. Quantitative results were synthesized in the form of tables and percentages. To illustrate the use of a single common safety metric across studies, we calculated odds ratios and CIs, wherever possible. Results: Overall, 23 studies were included in this review. Although many of the included studies assessed safety by actively collecting adverse event (AE) data, over one-third (8/23, 35%) did not assess or collect any safety data. The methods and frequency of safety data collection varied widely, and very few studies have performed formal statistical analyses. The main treatment-related reported AE was symptom deterioration. The main method used to mitigate risk was exclusion of high-risk groups. A secondary web-based search found that 6 DMHIs were available for users or patients to use (postmarket phase), all of which used indications and contraindications to mitigate risk, although there was no evidence of ongoing safety review. Conclusions: The findings of this review show the need for a standardized classification of AEs, a standardized method for assessing AEs to statically analyze AE data, and evidence-based practices for mitigating risk in DMHIs, both in the research and postmarket phases. This review produced 7 specific, measurable, and achievable recommendations with the potential to have an immediate impact on the field, which were implemented across ongoing and future research. Improving the quality of DMHI safety data will allow meaningful assessment of the safety of DMHIs and confidence in whether the benefits of a new DMHI outweigh its risks. Trial Registration: PROSPERO CRD42022333181; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=333181 %M 37812471 %R 10.2196/47433 %U https://mental.jmir.org/2023/1/e47433 %U https://doi.org/10.2196/47433 %U http://www.ncbi.nlm.nih.gov/pubmed/37812471 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48395 %T HD-DRUM, a Tablet-Based Drumming Training App Intervention for People With Huntington Disease: App Development Study %A Metzler-Baddeley,Claudia %A Busse,Monica %A Drew,Cheney %A Pallmann,Philip %A Cantera,Jaime %A Ioakeimidis,Vasileios %A Rosser,Anne %+ Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Maindy Road, Cathays, Cardiff, CF24 4HQ, United Kingdom, 44 29 208 ext 70705, Metzler-BaddeleyC@cardiff.ac.uk %K Huntington disease %K electronic health %K intervention %K training application %K rhythm %K timing %K drumming %K movement %K cognition %K integrated knowledge translation %K gamification %K Template for Intervention Description and Replication (TIDieR) %K TIDieR %K mobile phone %D 2023 %7 6.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Huntington disease (HD) is a neurodegenerative condition that leads to progressive loss of cognitive-executive and motor functions, largely due to basal ganglia (BG) atrophy. Currently, there are no therapeutic interventions tailored to address executive and motor dysfunction in people with HD. Music-based interventions may aid executive abilities by compensating for impaired BG-reliant timing and rhythm generation using external rhythmic beats. Here, we applied an integrated knowledge translation (IKT) framework to co-design a tablet-based rhythmic drumming training app (HD-DRUM) to stimulate executive and motor abilities in people with HD. Objective: The primary aim was to develop the HD-DRUM app for at-home use that addressed the accessibility needs of people with HD and allowed for the quantification of performance improvements and adherence for controlled clinical evaluation. Methods: The IKT framework was applied to iteratively refine the design of HD-DRUM. This process involved 3 phases of knowledge user engagement and co-design: a web-based survey of people with HD (n=29) to inform about their accessibility needs, usability testing of tablet-based touch screens as hardware solutions, and usability testing of the design and build of HD-DRUM to meet the identified accessibility needs of people affected by HD and their clinicians (n=12). Results: The survey identified accessibility problems due to cognitive and motor control impairments such as difficulties in finding and navigating through information and using PC keyboards and mouses to interact with apps. Tablet-based touch screens were identified as feasible and accessible solutions for app delivery. Key elements to ensure that the app design and build met the needs of people with HD were identified and implemented. These included the facilitation of intuitive navigation through the app using large and visually distinctive buttons; the use of audio and visual cues as training guides; and gamification, positive feedback, and drumming to background music as a means to increase motivation and engagement. The co-design development process resulted in the proof-of-concept HD-DRUM app that is described here according to the Template for Intervention Description and Replication checklist. HD-DRUM can be used at home, allowing the quantification of performance improvements and adherence for clinical evaluation, matching of training difficulty to users’ performance levels using gamification, and future scale-up to reach a wide range of interested users. Conclusions: Applying an IKT-based co-design framework involving knowledge user engagement allowed for the iterative refinement of the design and build of the tablet-based HD-DRUM app intervention, with the aim of stimulating BG-reliant cognitive and motor functions. Mapping the intervention against the Template for Intervention Description and Replication framework to describe complex interventions allowed for the detailed description of the HD-DRUM intervention and identification of areas that required refinement before finalizing the intervention protocol. %M 37801351 %R 10.2196/48395 %U https://formative.jmir.org/2023/1/e48395 %U https://doi.org/10.2196/48395 %U http://www.ncbi.nlm.nih.gov/pubmed/37801351 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48152 %T Mental Health Self-Tracking Preferences of Young Adults With Depression and Anxiety Not Engaged in Treatment: Qualitative Analysis %A Beltzer,Miranda L %A Meyerhoff,Jonah %A Popowski,Sarah A %A Mohr,David C %A Kornfield,Rachel %+ Center for Behavior Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 6585, miranda.beltzer@northwestern.edu %K self-tracking %K self-monitoring %K self-help %K depression %K anxiety %K young adults %K mHealth %K technology %K qualitative analysis %K focus group %K personal informatics %K mood %K thematic analysis %D 2023 %7 6.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the high prevalence of anxiety and depression among young adults, many do not seek formal treatment. Some may turn to digital mental health tools for support instead, including to self-track moods, behaviors, and other variables related to mental health. Researchers have sought to understand processes and motivations involved in self-tracking, but few have considered the specific needs and preferences of young adults who are not engaged in treatment and who seek to use self-tracking to support mental health. Objective: This study seeks to assess the types of experiences young adults not engaged in treatment have had with digital self-tracking for mood and other mental health data and to assess how young adults not seeking treatment want to engage in self-tracking to support their mental health. Methods: We conducted 2 online asynchronous discussion groups with 50 young adults aged 18 years to 25 years who were not engaged in treatment. Participants were recruited after indicating moderate to severe symptoms of depression or anxiety on screening surveys hosted on the website of Mental Health America. Participants who enrolled in the study responded anonymously to discussion prompts on a message board, as well as to each other’s responses, and 3 coders performed a thematic analysis of their responses. Results: Participants had mixed experiences with self-tracking in the past, including disliking when tracking highlighted unwanted behaviors and discontinuing tracking for a variety of reasons. They had more positive past experiences tracking behaviors and tasks they wanted to increase, using open-ended journaling, and with gamified elements to increase motivation. Participants highlighted several design considerations they wanted self-tracking tools to address, including building self-understanding; organization, reminders, and structure; and simplifying the self-tracking experience. Participants wanted self-tracking to help them identify their feelings and how their feelings related to other variables like sleep, exercise, and events in their lives. Participants also highlighted self-tracking as useful for motivating and supporting basic activities and tasks of daily living during periods of feeling overwhelmed or low mood and providing a sense of accomplishment and stability. Although self-tracking can be burdensome, participants were interested and provided suggestions for simplifying the process. Conclusions: These young adults not engaged in treatment reported interest in using self-tracking to build self-understanding as a goal in and of itself or as a first step in contemplating and preparing for behavior change or treatment-seeking. Alexithymia, amotivation, and feeling overwhelmed may serve both as barriers to self-tracking and opportunities for self-tracking to help. %M 37801349 %R 10.2196/48152 %U https://formative.jmir.org/2023/1/e48152 %U https://doi.org/10.2196/48152 %U http://www.ncbi.nlm.nih.gov/pubmed/37801349 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48750 %T The Degree of Anxiety and Depression in Patients With Cardiovascular Diseases as Assessed Using a Mobile App: Cross-Sectional Study %A Li,Yongguang %A Cen,Jue %A Wu,Junxia %A Tang,Min %A Guo,Jingyi %A Hang,Jingyu %A Zhao,Qing %A Zhao,Gang %A Huang,Xiaoli %A Han,Beibei %+ Department of Cardiology, Shanghai Sixth People’s Hospital, Shanghai Jiao Tong University School of Medicine, 600 Yishan Rd, Shanghai, 200233, China, 86 18930172337, hanbbxu@126.com %K mobile app %K anxiety %K depression %K cardiovascular diseases %K Haodf platform %D 2023 %7 4.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression and anxiety are common comorbidities in cardiovascular clinic outpatients. Timely identification and intervention of these mental and psychological disorders can contribute to correct diagnosis, better prognosis, less medical expenses, and improved quality of life. The convenience of online doctor-patient communication platforms has increasingly attracted patients to online consultations. However, online health care and offline health care are very different. Research on how to identify psychological disorders in patients who engage in an online cardiology consultation is lacking. Objective: This study aimed to explore the feasibility of using a self-rating scale to assess mental illness among patients who consult with a cardiologist online and to compare the differences in anxiety and depression between online and offline patients. Methods: From June 2022 to July 2022, we conducted follow-up visits with 10,173 patients on the Haodf platform. We conducted detailed consultations with 286 patients who visited the same cardiologist in the outpatient department. We used the self-rated Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) scales to assess anxiety and depression, respectively. We analyzed the influencing factors related to the degree of coordination of online patients. We also compared the prevalence of anxiety or depression between online and offline patients and analyzed the factors related to anxiety or depression. Results: Of the 10,173 online consultation patients, only 186 (1.8%) responded effectively. The response rate of the offline consultation patients was 96.5% (276/286). Frequent online communication and watching live video broadcasts were significantly related to effective responses from online patients (P<.001). The prevalence of anxiety (70/160, 43.7% vs 69/266, 25.8%; P<.001) or depression (78/160, 48.7% vs 74/266, 27.7%; P<.001) in online consultation patients was significantly higher than that in offline patients. In bivariate analyses, the factors related to anxiety included female sex, unemployment, no confirmed cardiovascular disease, and the online consultation mode, while smokers and those who underwent COVID-19 quarantine were less likely to present with anxiety. The factors related to depression included female sex, divorced or separated individuals, and the online consultation mode. COVID-19 quarantine was related with a lower likelihood of depression. BMI was negatively correlated with depression. In multiple ordered logistic regression analysis, women were more likely than men to present with anxiety (odds ratio [OR] 2.181, 95% CI 1.365-3.486; P=.001). Women (OR 1.664, 95% CI 1.082-2.559; P=.02) and online patients (OR 2.631, 95% CI 1.305-5.304; P=.007) were more likely to have depression. Conclusions: Online patients had more anxiety or depression than offline patients. Anxiety was more prevalent in women, the unemployed, and those without confirmed cardiovascular disease. Women and divorced or separated individuals were more prone to depression. Increasing the frequency of doctor-patient communication and participating in video interactions can help improve patient cooperation. %M 37792455 %R 10.2196/48750 %U https://www.jmir.org/2023/1/e48750 %U https://doi.org/10.2196/48750 %U http://www.ncbi.nlm.nih.gov/pubmed/37792455 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49998 %T The Appa Health App for Youth Mental Health: Development and Usability Study %A Giovanelli,Alison %A Sanchez Karver,Tahilin %A Roundfield,Katrina D %A Woodruff,Sean %A Wierzba,Catherine %A Wolny,J %A Kaufman,Michelle R %+ Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, San Francisco, CA, 94143, United States, 1 8054050772, alison.giovanelli@ucsf.edu %K digital mental health %K youth mentoring %K cognitive behavioral therapy %K teenager %K adolescent %K mobile phone %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Demand for adolescent mental health services has surged in the aftermath of the COVID-19 pandemic, and traditional models of care entailing in-person services with licensed mental health providers are inadequate to meet demand. However, research has shown that with proper training and supervision mentors can work with youth with mental health challenges like depression and anxiety and can even support the use of evidence-based strategies like cognitive behavioral therapy (CBT). In our increasingly connected world, youth mentors can meet with young people on a web-based platform at their convenience, reducing barriers to care. Moreover, the internet has made evidence-based CBT skills for addressing depression and anxiety more accessible than ever. As such, when trained and supervised by licensed clinicians, mentors are an untapped resource to support youth with mental health challenges. Objective: The objective of this study was to develop and assess the feasibility and acceptability of Appa Health (Appa), an evidence-based mental health mentoring program for youth experiencing symptoms of depression and anxiety. This paper describes the development, pilot testing process, and preliminary quantitative and qualitative outcomes of Appa’s 12-week smartphone app program which combines web-based near-peer mentorship with short-form TikTok-style videos teaching CBT skills created by licensed mental health professionals who are also social media influencers. Methods: The development and testing processes were executed through collaboration with key stakeholders, including young people and clinical and research advisory boards. In the pilot study, young people were assessed for symptoms of depression or anxiety using standard self-report clinical measures: the Patient Health Questionnaire-8 and the Generalized Anxiety Disorder-7 scales. Teenagers endorsing symptoms of depression or anxiety (n=14) were paired with a mentor (n=10) based on preferred characteristics such as gender, race or ethnicity, and lesbian, gay, bisexual, transgender, queer (LGBTQ) status. Quantitative survey data about the teenagers’ characteristics, mental health, and feasibility and acceptability were combined with qualitative data assessing youth perspectives on the program, their mentors, and the CBT content. Results: Participants reported finding Appa helpful, with 100% (n=14) of teenagers expressing that they felt better after the 12-week program. Over 85% (n=12) said they would strongly recommend the program to a friend. The teenagers were engaged, video chatting with mentors consistently over the 12 weeks. Metrics of anxiety and depressive symptoms reduced consistently from week 1 to week 12, supporting qualitative data suggesting that mentoring combined with CBT strategies has the potential to positively impact youth mental health and warrants further study. Conclusions: Appa Health is a novel smartphone app aiming to improve the well-being of youth and reduce anxiety and depressive symptoms through web-based mentoring and engaging CBT video content. This formative research sets the stage for a large-scale randomized controlled trial recently funded by the National Institutes of Health Small Business Innovation Research program. %M 37792468 %R 10.2196/49998 %U https://formative.jmir.org/2023/1/e49998 %U https://doi.org/10.2196/49998 %U http://www.ncbi.nlm.nih.gov/pubmed/37792468 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46757 %T Development and Implementation of DIALOG+S in the School Setting as a Tool for Promoting Adolescent Mental Well-Being and Resilience in a Post–Armed Conflict Area in Colombia: Exploratory Cluster Randomized Controlled Trial %A Gómez-Restrepo,Carlos %A Sarmiento-Suárez,María José %A Alba-Saavedra,Magda %A Calvo-Valderrama,Maria Gabriela %A Rincón-Rodríguez,Carlos Javier %A Bird,Victoria Jane %A Priebe,Stefan %A van Loggerenberg,Francois %+ Youth Resilience Unit, Centre for Psychiatry and Mental Health, Wolfson Institute of Population Health, Queen Mary University of London, Academic Centre, Newham Centre for Mental Health, Cherry Tree Way, London, E13 8SP, United Kingdom, 44 02075404210, f.vanloggerenberg@qmul.ac.uk %K mental health %K digital intervention %K psychosocial intervention %K armed conflict %K adolescents %K school %K DIALOG+ %K DIALOG+S %K mobile phone %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Educational settings are ideal for promoting mental well-being and resilience in children. The challenges of the COVID-19 pandemic made evident the important role that teachers and school counselors play in the mental health of their students. Therefore, it is imperative to develop and implement cost-effective interventions that allow them to identify and address mental health problems early, especially in post–armed conflict areas, to reduce the burden of mental disorders in this population. Objective: This study aimed to adapt an existing patient-focused digital intervention called DIALOG+ from an adult clinical setting to an adolescent educational setting and to assess the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for promoting quality of life, mental well-being, and resilience. Methods: We conducted an exploratory mixed methods study in 2 public schools in postconflict areas in Tolima, Colombia. This study was conducted in 3 phases. In the adaptation phase, focus groups were conducted with students and teachers to identify changes required in DIALOG+ for it to be used in the school setting. The exploration phase consisted of an exploratory cluster randomized controlled trial. A total of 14 clusters, each with 1 teacher and 5 students, were randomly allocated to either the experimental (DIALOG+S) group or to an active control group (counseling as usual). Teachers in both groups delivered the intervention once a month for 6 months. Through screening scales, information was collected on mental health symptoms, quality of life, self-esteem, resilience, and family functionality before and after the intervention. Finally, the consolidation phase explored the experiences of teachers and students with DIALOG+S using focus group discussions. Results: The changes suggested by participants in the adaptation phase highlighted the central importance of the school setting in the mental health of adolescents. In the exploratory phase, 70 participants with a mean age of 14.69 (SD 2.13) years were included. Changes observed in the screening scale scores of the intervention group suggest that the DIALOG+S intervention has the potential to improve aspects of mental health, especially quality of life, resilience, and emotional symptoms. The consolidation phase showed that stakeholders felt that using this intervention in the school setting was feasible, acceptable, and an enriching experience that generated changes in the perceived mental health and behavior of participants. Conclusions: Our results are encouraging and show that the DIALOG+S intervention is feasible and acceptable as a promising opportunity to promote well-being and prevent and identify mental health problems in the school context in a postconflict area in Colombia. Larger, fully powered studies are warranted to properly assess the efficacy and potential impact of the intervention and to refine implementation plans. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374 International Registered Report Identifier (IRRID): RR2-10.2196/40286 %M 37792465 %R 10.2196/46757 %U https://formative.jmir.org/2023/1/e46757 %U https://doi.org/10.2196/46757 %U http://www.ncbi.nlm.nih.gov/pubmed/37792465 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e42851 %T The Effectiveness of a Neurofeedback-Assisted Mindfulness Training Program Using a Mobile App on Stress Reduction in Employees: Randomized Controlled Trial %A Min,Beomjun %A Park,Heyeon %A Kim,Johanna Inhyang %A Lee,Sungmin %A Back,Soyoung %A Lee,Eunhwa %A Oh,Sohee %A Yun,Je-Yeon %A Kim,Bung-Nyun %A Kim,Yonghoon %A Hwang,JungHyun %A Lee,Sanghyop %A Kim,Jeong-Hyun %+ Department of Public Health Medical Services, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 31 787 2025, retrial3@hanmail.net %K mindfulness %K neurofeedback %K stress %K resilience %K mobile app %K employee %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness-based training programs have consistently shown efficacy in stress reduction. However, questions regarding the optimal duration and most effective delivery methods remain. Objective: This research explores a 4-week neurofeedback-assisted mindfulness training for employees via a mobile app. The study’s core query is whether incorporating neurofeedback can amplify the benefits on stress reduction and related metrics compared with conventional mindfulness training. Methods: A total of 92 full-time employees were randomized into 3 groups: group 1 received mobile mindfulness training with neurofeedback assistance (n=29, mean age 39.72 years); group 2 received mobile mindfulness training without neurofeedback (n=32, mean age 37.66 years); and group 3 were given self-learning paper materials on stress management during their first visit (n=31, mean age 38.65 years). The primary outcomes were perceived stress and resilience scales. The secondary outcomes were mindfulness awareness, emotional labor, occupational stress, insomnia, and depression. Heart rate variability and electroencephalography were measured for physiological outcomes. These measurements were collected at 3 different times, namely, at baseline, immediately after training, and at a 4-week follow-up. The generalized estimating equation model was used for data analysis. Results: The 4-week program showed significant stress reduction (Wald χ22=107.167, P<.001) and improvements in psychological indices including resilience, emotional labor, insomnia, and depression. A significant interaction was observed in resilience (time × group, Wald χ42=10.846, P=.02). The post hoc analysis showed a statistically significant difference between groups 1 (least squares mean [LSM] 21.62, SE 0.55) and 3 (LSM 19.90, SE 0.61) at the posttraining assessment (P=.008). Group 1 showed a significant improvement (P<.001) at the posttraining assessment, with continued improvements through the 1-month follow-up assessment period (LSM 21.55, SE 0.61). Physiological indices were analyzed only for data of 67 participants (22 in group 1, 22 in group 2, and 23 in group 3) due to the data quality. The relaxation index (ratio of alpha to high beta power) from the right electroencephalography channel showed a significant interaction (time × group, Wald χ22=6.947, P=.03), with group 1 revealing the highest improvement (LSM 0.43, SE 0.15) compared with groups 2 (LSM –0.11, SE 0.10) and 3 (LSM 0.12, SE 0.10) at the 1-month follow-up assessment. Conclusions: The study demonstrated that the neurofeedback-assisted group achieved superior outcomes in resilience and relaxation during the 4-week mobile mindfulness program. Further research with larger samples and long-term follow-up is warranted. Trial Registration: ClinicalTrials.gov NCT03787407; https://clinicaltrials.gov/ct2/show/NCT03787407 %M 37788060 %R 10.2196/42851 %U https://mhealth.jmir.org/2023/1/e42851 %U https://doi.org/10.2196/42851 %U http://www.ncbi.nlm.nih.gov/pubmed/37788060 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36596 %T The Effect of a Digital Mental Health Program on Anxiety and Depression Symptoms: Retrospective Analysis of Clinical Severity %A Dzubur,Eldin %A Yu,Jessica %A Hoffman,Julia %A Painter,Stefanie %A James,Roberta %A Shah,Bimal %+ Teladoc Health, 2 Manhattanville Rd, Purchase, NY, 10577, United States, 1 3123307236, spainter@teladoc.com %K digital health %K mental health %K anxiety %K depression %K digital mental health %K program usage %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Evidence-based digital health programs have shown efficacy in being primary tools to improve emotional and mental health, as well as offering supplementary support to individuals undergoing psychotherapy for anxiety, depression, and other mental health disorders. However, information is lacking about the dose response to digital mental health interventions. Objective: The objective of the study was to examine the effect of time in program and program usage on symptom change among individuals enrolled in a real-world comprehensive digital mental health program (myStrength) who are experiencing severe anxiety or depression. Methods: Eligible participants (N=18,626) were adults aged 18 years and older who were enrolled in myStrength for at least four weeks as part of their employee wellness benefit program, who completed baseline, the 2-week, 2-month, and 6-month surveys querying symptoms of anxiety (Generalized Anxiety Disorder–7 [GAD-7]) and depression (Patient Health Questionnaire–9 [PHQ-9]). Linear growth curve models were used to analyze the effect of average weekly program usage on subsequent GAD-7 and PHQ-9 scores for participants with scores indicating severe anxiety (GAD-7≥15) or depression (PHQ-9≥15). All models were adjusted for baseline score and demographics. Results: Participants in the study (N=1519) were 77.4% female (1176/1519), had a mean age of 45 years (SD 14 years), and had an average enrollment time of 3 months. At baseline, participants reported an average of 9.39 (SD 6.04) on the GAD-7 and 11.0 (SD 6.6) on the PHQ-9. Those who reported 6-month results had an average of 8.18 (SD 6.15) on the GAD-7 and 9.18 (SD 6.79) on the PHQ-9. Participants with severe scores (n=506) experienced a significant improvement of 2.97 (SE 0.35) and 3.97 (SE 0.46) at each time point for anxiety and depression, respectively (t=–8.53 and t=–8.69, respectively; Ps<.001). Those with severe baseline scores also saw a reduction of 0.27 (SE 0.08) and 0.25 (SE 0.09) points in anxiety and depression, respectively, for each additional program activity per week (t=–3.47 and t=–2.66, respectively; Ps<.05). Conclusions: For participants with severe baseline scores, the study found a clinically significant reduction of approximately 9 points for anxiety and 12 points for depression after 6 months of enrollment, suggesting that interventions targeting mental health must maintain active, ongoing engagement when symptoms are present and be available as a continuous resource to maximize clinical impact, specifically in those experiencing severe anxiety or depression. Moreover, a dosing effect was shown, indicating improvement in outcomes among participants who engaged with the program every other day for both anxiety and depression. This suggests that digital mental health programs that provide both interesting and evidence-based activities could be more successful in further improving mental health outcomes. %M 37788069 %R 10.2196/36596 %U https://formative.jmir.org/2023/1/e36596 %U https://doi.org/10.2196/36596 %U http://www.ncbi.nlm.nih.gov/pubmed/37788069 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47617 %T Individualized Virtual Reality for Increasing Self-Compassion: Evaluation Study %A Halim,Ilona %A Stemmet,Lehan %A Hach,Sylvia %A Porter,Richard %A Liang,Hai-Ning %A Vaezipour,Atiyeh %A Henry,Julie D %A Baghaei,Nilufar %+ School of Electrical Engineering and Computer Science, The University of Queensland, Staff House Road, St Lucia, 4072, Australia, 61 450150234, n.baghaei@uq.edu.au %K individualized virtual reality %K mental health %K self-compassion %K depression %K depressive symptoms %K mobile phone %D 2023 %7 2.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression and anxiety are common and debilitating mental disorders with severe negative repercussions at both individual and societal levels. Although virtual reality (VR) has emerged as a safe and effective tool for the treatment of anxiety disorders, studies of the therapeutic application of VR to treat depression are more limited. Objective: The purpose of this study was to test whether a novel type of individualized VR (iVR) can be used to improve self-compassion and decrease depressive symptoms and to evaluate the usability and acceptability of this approach, as rated by participants. The iVR system was designed and developed based on the feedback obtained from a previous study, with improved appearance and feel of the avatar and enhanced graphical quality. Methods: A total of 36 young adult participants were recruited from a university community social media site. Participants were aware that the study was investigating a treatment for depression but were not recruited based on depression diagnosis. Participants were asked to complete 2 iVR sessions, spaced 2 weeks apart. At baseline and upon completion of each iVR session, participants were asked to complete validated measures of self-compassion and depression. Upon completion of both iVR sessions, additional measures were administered to assess participants’ perceptions about the perceived usability and system acceptability of the iVR approach. Results: Self-compassion was assessed at the beginning of session 1 (preintervention baseline) and at the end of session 1 (postintervention assessment). Owing to COVID-19 constraints, 36% (13/36) of the participants were unable to complete the follow-up iVR session. Self-compassion was assessed again for the remaining 64% (23/36) of the participants at the end of session 2 (postintervention assessment). Within-group analyses revealed that self-compassion was significantly increased at the end of both session 1 (P=.01) and session 2 (P=.03) relative to baseline. There was also a nonsignificant trend for depressive symptoms to be low at the end of session 2 relative to baseline. Both quantitative and qualitative participant data supported the iVR approach as being acceptable and usable. Conclusions: Although these data must be treated as preliminary owing to the small sample size and potential selection bias, the data provide encouraging initial evidence that iVR might be a useful tool to enhance self-compassion and reduce depressive symptoms, highlighting the need for randomized controlled trials in the future. %M 37782537 %R 10.2196/47617 %U https://mental.jmir.org/2023/1/e47617 %U https://doi.org/10.2196/47617 %U http://www.ncbi.nlm.nih.gov/pubmed/37782537 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e48425 %T Validation of a Brief Internet-Based Self-Report Measure of Maladaptive Personality and Interpersonal Schema: Confirmatory Factor Analysis %A Kim,Hyeonseong %A Jeong,Seohyun %A Hwang,Inae %A Sung,Kiyoung %A Moon,Woori %A Shin,Min-Sup %+ Psychiatry Department, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, 6th Floor, Seoul, 03080, Republic of Korea, 82 0220720725, shinms@snu.ac.kr %K maladaptive schema %K measure of schema %K self-report measure %K internet-based measure %K digital mental health care %K interpersonal schema %D 2023 %7 29.9.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Existing digital mental health interventions mainly focus on the symptoms of specific mental disorders, but do not focus on Maladaptive Personalities and Interpersonal Schemas (MPISs). As an initial step toward considering personalities and schemas in intervention programs, there is a need for the development of tools for measuring core personality traits and interpersonal schemas known to cause psychological discomfort among potential users of digital mental health interventions. Thus, the MPIS was developed. Objective: The objectives of this study are to validate the MPIS by comparing 2 models of the MPIS factor structure and to understand the characteristics of the MPIS by assessing its correlations with other measures. Methods: Data were collected from 234 participants who were using web-based community sites in South Korea, including university students, graduate students, working professionals, and homemakers. All the data were gathered through web-based surveys. Confirmatory factor analysis was used to compare a single-factor model with a 5-factor model. Reliability and correlation analyses with other scales were performed. Results: The results of confirmatory factor analysis indicated that the 5-factor model (χ2550=1278.1; Tucker-Lewis index=0.80; comparative fit index=0.81; and Root Mean Square Error of Approximation=0.07) was more suitable than the single-factor model (χ2560=2341.5; Tucker-Lewis index=0.52; comparative fit index=0.54; and Root Mean Square Error of Approximation=0.11) for measuring maladaptive personality traits and interpersonal relationship patterns. The internal consistency of each factor of the MPIS was good (Cronbach α=.71-.88), and the correlations with existing measures were statistically significant. The MPIS is a validated 35-item tool for measuring 5 essential personality traits and interpersonal schemas in adults aged 18-39 years. Conclusions: This study introduced the MPIS, a concise and effective questionnaire capable of measuring maladaptive personality traits and interpersonal relationship schemas. Through analysis, the MPIS was shown to reliably assess these psychological constructs and validate them. Its web-based accessibility and reduced item count make it a valuable tool for mental health assessment. Future applications include its integration into digital mental health care services, allowing easy web-based administration and aiding in the classification of psychological therapy programs based on the obtained results. Trial Registration: ClinicalTrials.gov NCT05952063; https://www.clinicaltrials.gov/study/NCT05952063 %M 37773606 %R 10.2196/48425 %U https://www.i-jmr.org/2023/1/e48425 %U https://doi.org/10.2196/48425 %U http://www.ncbi.nlm.nih.gov/pubmed/37773606 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 3 %N %P e48189 %T Corpus-Based Discourse Analysis of a Reddit Community of Users of Crystal Methamphetamine: Mixed Methods Study %A Lustig,Andrew %A Brookes,Gavin %+ Department of Linguistics and English Language, Lancaster University, County South, Bailrigg, Lancaster, LA1 4YL, United Kingdom, 44 1524 593045, g.brookes@lancaster.ac.uk %K methamphetamine %K social media %K substance-related disorders %K discourse analysis %K mental health %K mixed methods %K corpus analysis %K web-based health %D 2023 %7 29.9.2023 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Methamphetamine is a highly addictive stimulant that affects the central nervous system. Crystal methamphetamine is a form of the drug resembling glass fragments or shiny bluish-white rocks that can be taken through smoking, swallowing, snorting, or injecting the powder once it has been dissolved in water or alcohol. Objective: The objective of this study is to examine how identities are socially (discursively) constructed by people who use methamphetamine within a subreddit for people who regularly use crystal meth. Methods: Using a mixed methods approach, we analyzed 1000 threads (318,422 words) from a subreddit for regular crystal meth users. The qualitative component of the analysis used concordancing and corpus-based discourse analysis to identify discursive themes informed by assemblage theory. The quantitative portion of the analysis used corpus linguistic techniques including keyword analysis to identify words occurring with statistically marked frequency in the corpus and collocation analysis to analyze their discursive context. Results: Our findings reveal that the subreddit contributors use a rich and varied lexicon to describe crystal meth and other substances, ranging from a neuroscientific register (eg, methamphetamine and dopamine) to informal vernacular (eg, meth, dope, and fent) and commercial appellations (eg, Adderall and Seroquel). They also use linguistic resources to construct symbolic boundaries between different types of methamphetamine users, differentiating between the esteemed category of “functional addicts” and relegating others to the stigmatized category of “tweakers.” In addition, contributors contest the dominant view that methamphetamine use inevitably leads to psychosis, arguing instead for a more nuanced understanding that considers the interplay of factors such as sleep deprivation, poor nutrition, and neglected hygiene. Conclusions: The subreddit contributors’ discourse offers a “set and setting” perspective, which provides a fresh viewpoint on drug-induced psychosis and can guide future harm reduction strategies and research. In contrast to this view, many previous studies overlook the real-world complexities of methamphetamine use, perhaps due to the use of controlled experimental settings. Actual drug use, intoxication, and addiction are complex, multifaceted, and elusive phenomena that defy straightforward characterization. %M 37773617 %R 10.2196/48189 %U https://infodemiology.jmir.org/2023/1/e48189 %U https://doi.org/10.2196/48189 %U http://www.ncbi.nlm.nih.gov/pubmed/37773617 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48177 %T A Suicide Prevention Intervention for Emerging Adult Sexual and Gender Minority Groups: Protocol for a Pilot Hybrid Effectiveness Randomized Controlled Trial %A Brown,Lily A %A Webster,Jessica L %A Tran,Jennifer T %A Wolfe,James R %A Golinkoff,Jesse %A Patel,Esha %A Arcomano,Amanda C %A Ben Nathan,Jennifer %A Azat O'Connor,Alexander %A Zhu,Yiqin %A Oquendo,Maria %A Brown,Gregory K %A Mandell,David %A Mowery,Danielle %A Bauermeister,José A %+ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street Suite 600 N, Philadelphia, PA, 19147, United States, 1 215 746 3346, lilybr@upenn.edu %K lesbian, gay, bisexual, transgender, queer, plus %K LGBTQ+ health %K suicide %K peer navigator %K emerging adults %K life skills %K mobile phone %D 2023 %7 29.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide attempts and suicide death disproportionately affect sexual and gender minority emerging adults (age 18-24 years). However, suicide prevention strategies tailored for emerging adult sexual and gender minority (EA-SGM) groups are not widely available. The Safety Planning Intervention (SPI) has strong evidence for reducing the risk for suicide in the general population, but it is unclear how best to support EA-SGM groups in their use of a safety plan. Our intervention (Supporting Transitions to Adulthood and Reducing Suicide [STARS]) builds on content from an existing life skills mobile app for adolescent men who have sex with men (iREACH) and seeks to target core risk factors for suicide among EA-SGM groups, namely, positive affect, discrimination, and social disconnection. The mobile app is delivered to participants randomized to STARS alongside 6 peer mentoring sessions to support the use of the safety plan and other life skills from the app to ultimately reduce suicide risk. Objective: We will pilot-test the combination of peer mentoring alongside an app-based intervention (STARS) designed to reduce suicidal ideation and behaviors. STARS will include suicide prevention content and will target positive affect, discrimination, and social support. After an in-person SPI with a clinician, STARS users can access content and activities to increase their intention to use SPI and overcome obstacles to its use. EA-SGM groups will be randomized to receive either SPI alone or STARS and will be assessed for 6 months. Methods: Guided by the RE-AIM (reach, efficacy, adoption, implementation, and maintenance) framework, we will recruit and enroll a racially and ethnically diverse sample of 60 EA-SGM individuals reporting past-month suicidal ideation. Using a type-1 effectiveness-implementation hybrid design, participants will be randomized to receive SPI (control arm) or to receive SPI alongside STARS (intervention arm). We will follow the participants for 6 months, with evaluations at 2, 4, and 6 months. Preliminary effectiveness outcomes (suicidal ideation and behavior) and hypothesized mechanisms of change (positive affect, coping with discrimination, and social support) will serve as our primary outcomes. Secondary outcomes include key implementation indicators, including participants’ willingness and adoption of SPI and STARS and staff’s experiences with delivering the program. Results: Study activities began in September 2021 and are ongoing. The study was approved by the institutional review board of the University of Pennsylvania (protocol number 849500). Study recruitment began on October 14, 2022. Conclusions: This project will be among the first tailored, mobile-based interventions for EA-SGM groups at risk for suicide. This project is responsive to the documented gaps for this population: approaches that address chosen family, focus on a life-course perspective, web approaches, and focus on health equity and provision of additional services relevant to sexual and gender minority youth. Trial Registration: ClinicalTrials.gov NCT05018143; https://classic.clinicaltrials.gov/ct2/show/NCT05018143 International Registered Report Identifier (IRRID): DERR1-10.2196/48177 %M 37773618 %R 10.2196/48177 %U https://www.researchprotocols.org/2023/1/e48177 %U https://doi.org/10.2196/48177 %U http://www.ncbi.nlm.nih.gov/pubmed/37773618 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44220 %T Experiences of Using Digital Mindfulness-Based Interventions: Rapid Scoping Review and Thematic Synthesis %A Osborne,Emma Louise %A Ainsworth,Ben %A Hooper,Nic %A Atkinson,Melissa Jayne %+ Department of Psychology, University of Bath, 10 West, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 383843 ext 01225, elo25@bath.ac.uk %K mindfulness %K digital intervention %K dropout %K eHealth %K engagement %K mobile health %K mHealth %K psychosocial intervention %K qualitative research %K scoping review %K thematic synthesis %K mobile phone %D 2023 %7 28.9.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital mindfulness-based interventions (MBIs) are a promising approach to deliver accessible and scalable mindfulness training and have been shown to improve a range of health outcomes. However, the success of digital MBIs is reliant on adequate engagement, which remains a crucial challenge. Understanding people’s experiences of using digital MBIs and identifying the core factors that facilitate or act as barriers to engagement is essential to inform intervention development and maximize engagement and outcomes. Objective: This study aims to systematically map the literature on people’s experiences of using digital MBIs that target psychosocial variables (eg, anxiety, depression, distress, and well-being) and identify key barriers to and facilitators of engagement. Methods: We conducted a scoping review to synthesize empirical qualitative research on people’s experiences of using digital MBIs. We adopted a streamlined approach to ensure that the evidence could be incorporated into the early stages of intervention development. The search strategy identified articles with at least one keyword related to mindfulness, digital, user experience, and psychosocial variables in their title or abstract. Inclusion criteria specified that articles must have a qualitative component, report on participants’ experiences of using a digital MBI designed to improve psychosocial variables, and have a sample age range that at least partially overlapped with 16 to 35 years. Qualitative data on user experience were charted and analyzed using inductive thematic synthesis to generate understandings that go beyond the content of the original studies. We used the Quality of Reporting Tool to critically appraise the included sources of evidence. Results: The search identified 530 studies, 22 (4.2%) of which met the inclusion criteria. Overall, the samples were approximately 78% female and 79% White; participants were aged between 16 and 69 years; and the most used measures in intervention studies were mindfulness, psychological flexibility, and variables related to mental health (including depression, anxiety, stress, and well-being). All studies were judged to be adequately reported. We identified 3 themes characterizing barriers to and facilitators of engagement: responses to own practice (ie, negative reactions to one’s own practice are common and can deplete motivation), making mindfulness a habit (ie, creating a consistent training routine is essential yet challenging), and leaning on others (ie, those engaging depend on someone else for support). Conclusions: The themes identified in this review provide crucial insights as to why people frequently stop engaging with digital MBIs. Researchers and developers should consider using person-based coparticipatory methods to improve acceptability of and engagement with digital MBIs, increase their effectiveness, and support their translation to real-world use. Such strategies must be grounded in relevant literature and meet the priorities and needs of the individuals who will use the interventions. %M 37768709 %R 10.2196/44220 %U https://www.jmir.org/2023/1/e44220 %U https://doi.org/10.2196/44220 %U http://www.ncbi.nlm.nih.gov/pubmed/37768709 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45216 %T Evaluating a Peer-Support Mobile App for Mental Health and Substance Use Among Adolescents Over 12 Months During the COVID-19 Pandemic: Randomized Controlled Trial %A Birrell,Louise %A Debenham,Jennifer %A Furneaux-Bate,Ainsley %A Prior,Katrina %A Spallek,Sophia %A Thornton,Louise %A Chapman,Catherine %A Newton,Nicola %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building G02, Sydney, 2006, Australia, 61 2 8627 9003, louise.birrell@sydney.edu.au %K mental health %K substance use %K prevention %K school-based %K peer support %K anxiety %K social support %K psychosocial support systems %K depression %K adolescent %K mobile apps %K eHealth %K mHealth %K mobile phone %K COVID-19 %D 2023 %7 27.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Although it is well known that adolescents frequently turn to their friends for support around mental health and substance use problems, there are currently no evidence-based digital programs to support them to do this. Objective: The aim of this study was to evaluate the efficacy of the Mind your Mate program, a digital peer-support program, in improving mental health symptoms, reducing the uptake of substance use, and increasing help seeking. The Mind your Mate program consists of a 40-minute web-based classroom lesson and a companion smartphone mobile app. The active control group received school-based health education as usual. Methods: A cluster randomized controlled trial was conducted with 12 secondary schools and 166 students (mean age 15.3, SD 0.41 years; 72/166, 43.4% female; and 133/166, 80.1% born in Australia). Participants completed self-reported questionnaires assessing symptoms of mental health (depression, anxiety, and psychological distress), substance use (alcohol and other drug use), and help-seeking measures at baseline and at 6-month and 12-month follow-ups. Results: Students who received the Mind your Mate program had greater reductions in depressive symptoms over a 12-month period than controls (b=−1.86, 95% CI −3.73 to 0.02; Cohen d=−0.31). Anxiety symptoms decreased among students in the intervention group; however, these reductions did not meet statistical significance thresholds. No differences were observed in relation to psychological distress or help-seeking. Conclusions: Small to moderate reductions in depression symptoms were observed among students allocated to receive the Mind your Mate intervention. Although the current results are encouraging, there is a need to continue to refine, develop, and evaluate innovative applied approaches for the prevention of mental disorders in real-world settings. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000753954; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000753954 International Registered Report Identifier (IRRID): RR2-10.2196/26796 %M 37756116 %R 10.2196/45216 %U https://www.jmir.org/2023/1/e45216 %U https://doi.org/10.2196/45216 %U http://www.ncbi.nlm.nih.gov/pubmed/37756116 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46877 %T Efficacy, Safety, and Evaluation Criteria of mHealth Interventions for Depression: Systematic Review %A Duarte-Díaz,Andrea %A Perestelo-Pérez,Lilisbeth %A Gelabert,Estel %A Robles,Noemí %A Pérez-Navarro,Antoni %A Vidal-Alaball,Josep %A Solà-Morales,Oriol %A Sales Masnou,Ariadna %A Carrion,Carme %+ Canary Islands Health Research Institute Foundation (FIISC), Camino Candelaria, 44, El Rosario, 38109, Spain, 34 922478320, andrea.duartediaz@sescs.es %K mobile health %K mHealth %K apps %K depression %K systematic review %K meta-analysis %D 2023 %7 27.9.2023 %9 Review %J JMIR Ment Health %G English %X Background: Depression is a significant public health issue that can lead to considerable disability and reduced quality of life. With the rise of technology, mobile health (mHealth) interventions, particularly smartphone apps, are emerging as a promising approach for addressing depression. However, the lack of standardized evaluation tools and evidence-based principles for these interventions remains a concern. Objective: In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of mHealth interventions for depression and identify the criteria and evaluation tools used for their assessment. Methods: A systematic review and meta-analysis of the literature was carried out following the recommendations of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Studies that recruited adult patients exhibiting elevated depressive symptoms or those diagnosed with depressive disorders and aimed to assess the effectiveness or safety of mHealth interventions were eligible for consideration. The primary outcome of interest was the reduction of depressive symptoms, and only randomized controlled trials (RCTs) were included in the analysis. The risk of bias in the original RCTs was assessed using version 2 of the Cochrane risk-of-bias tool for randomized trials. Results: A total of 29 RCTs were included in the analysis after a comprehensive search of electronic databases and manual searches. The efficacy of mHealth interventions in reducing depressive symptoms was assessed using a random effects meta-analysis. In total, 20 RCTs had an unclear risk of bias and 9 were assessed as having a high risk of bias. The most common element in mHealth interventions was psychoeducation, followed by goal setting and gamification strategies. The meta-analysis revealed a significant effect for mHealth interventions in reducing depressive symptoms compared with nonactive control (Hedges g=−0.62, 95% CI −0.87 to −0.37, I2=87%). Hybrid interventions that combined mHealth with face-to-face sessions were found to be the most effective. Three studies compared mHealth interventions with active controls and reported overall positive results. Safety analyses showed that most studies did not report any study-related adverse events. Conclusions: This review suggests that mHealth interventions can be effective in reducing depressive symptoms, with hybrid interventions achieving the best results. However, the high level of heterogeneity in the characteristics and components of mHealth interventions indicates the need for personalized approaches that consider individual differences, preferences, and needs. It is also important to prioritize evidence-based principles and standardized evaluation tools for mHealth interventions to ensure their efficacy and safety in the treatment of depression. Overall, the findings of this study support the use of mHealth interventions as a viable method for delivering mental health care. Trial Registration: PROSPERO CRD42022304684; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=304684 %M 37756042 %R 10.2196/46877 %U https://mental.jmir.org/2023/1/e46877 %U https://doi.org/10.2196/46877 %U http://www.ncbi.nlm.nih.gov/pubmed/37756042 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51088 %T Internet-Delivered Cognitive Behavioral Therapy Tailored to Spouses and Significant Others of Public Safety Personnel: Formative Evaluation Study %A Hadjistavropoulos,Heather D %A Reiser,Sarah J %A Beahm,Janine D %A McCall,Hugh C %A Dena,Isabelle %A Phillips,Abby R %A Scheltgen,Melissa %A Sekhar,Shimona %A Cox,Marilyn %A Cramm,Heidi %A Reid,Nathalie %+ Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK, S4S 0A2, Canada, 1 306 585 5133, Heather.Hadjistavropoulos@uregina.ca %K internet-delivered cognitive behavioral therapy %K ICBT %K internet interventions %K transdiagnostic %K spouses and significant others %K public safety personnel %K formative evaluation %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Spouses and significant others (SSOs) of public safety personnel (PSP) are affected by the risks and requirements of these occupations. Internet-delivered cognitive behavioral therapy (ICBT) provides a convenient and accessible treatment format that can be tailored to the needs of SSOs of PSP. Objective: This study aimed to assess the initial use and client perceptions (eg, likes, helpfulness, and areas for improvement) of a self-guided, transdiagnostic ICBT course designed for Canadian SSOs of PSP and identify opportunities to further tailor ICBT for this group. Methods: SSOs were invited to complete a 5-lesson, self-guided, transdiagnostic ICBT course. Descriptive statistics were used to analyze the demographic and clinical characteristics of participants. Content analysis was used to analyze the data from open-ended survey responses and interviews to understand their experiences with ICBT. Results: Clients (N=118) endorsed various mental health concerns (eg, depression, anxiety, posttraumatic stress symptoms, and relationship concerns) with a range of severity levels. Most clients identified as White (110/116, 94.8%) and women (108/116, 91.5%), with a mean age of 42.03 (SD 9.36) years. Of the 26 clients who were interviewed, 89% (23/26) reported believing that ICBT is helpful and 92% (24/26) reported finding at least 1 skill helpful. Clients provided suggestions for course improvements. On the basis of this feedback and quantitative data, changes were made to areas such as the delivery of materials, content, case stories, and timelines. Overall, the results indicated that many SSOs of PSP had positive perceptions of ICBT tailored to their needs and found several aspects of the course helpful, supporting the continued delivery of tailored ICBT to this population. However, there remains a need for continued promotion of the course and outreach to diverse groups of SSOs of PSP. Conclusions: Findings from this formative evaluation provide insight into the unique experiences and needs of SSOs of PSP and provide preliminary evidence for the use of tailored ICBT to support the mental health of this group in Canada. %M 37756033 %R 10.2196/51088 %U https://formative.jmir.org/2023/1/e51088 %U https://doi.org/10.2196/51088 %U http://www.ncbi.nlm.nih.gov/pubmed/37756033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50239 %T A Spiritual Self-Care Mobile App (Skylight) for Mental Health, Sleep, and Spiritual Well-Being Among Generation Z and Young Millennials: Cross-Sectional Survey %A Park,Susanna Y %A Huberty,Jennifer %A Yourell,Jacqlyn %A McAlister,Kelsey L %A Beatty,Clare C %+ Skylight, Radiant Foundation, 55 N 300 W Suite 800, Salt Lake City, UT, 84180, United States, 1 7202515121, syjpark@gmail.com %K Gen Z %K millennial %K spirituality %K spiritual self-care %K mental health %K sleep %K mobile health %K mHealth %K digital health %K spiritual %K self-care %K app %K apps %K mental wellness %K mental well-being %K young adult %K young adults %K engagement %K perception %K perceptions %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Generation Z (Gen Z) and young millennials (GenZennials) (ages 18-35 years) are unique in that they either have no memory of or were born shortly after the internet “explosion.” They are constantly on the internet, face significant challenges with their mental health and sleep, and are frequent users of digital wellness apps. GenZennials also uniquely identify with and practice spirituality, which has been linked to better mental health and sleep in adult populations. Research has not examined digital approaches to spiritual self-care and its relationship to mental health and sleep in GenZennials. Objective: The purpose of this study was to describe a sample of adult GenZennials who use a spiritual self-care app (ie, Skylight), describe how users engage with and perceive the app, and assess the relationship between frequency of using the app with mental health, sleep, and spiritual well-being. Methods: Participants were 475 adult Gen Z (ages 18-28 years) and young millennial (ages 29-35 years) Skylight app users who responded to an anonymous survey on the web. The survey asked about demographics, spiritual self-care and practice, and user engagement and perceptions of the app. Outcome measures included 4 validated surveys for mental health (ie, depression, anxiety, and stress) and sleep disturbance, and one validated survey on spiritual well-being. Mean scores were calculated for all measures, and linear regressions were conducted to examine the relationship between the frequency of app use and mental health, sleep, and spiritual well-being outcomes. Results: Participants were predominantly White (324/475, 68.2%) and female (255/475, 53.7%), and approximately half Gen Z (260/475, 54.5%) and half young millennials (215/475, 45.3%). Most users engaged in spiritual self-care (399/475, 84%) and said it was important or very important to them (437/475, 92%). Users downloaded the app for spiritual well-being (130/475, 30%) and overall health (125/475, 26.3%). Users had normal, average depressive symptoms (6.9/21), borderline abnormal anxiety levels (7.7/21), slightly elevated stress (6.7/16), and nonclinically significant sleep disturbance (5.3/28). Frequency of app use was significantly associated with lower anxiety (Moderate use: β=–2.01; P=.02; high use: β=–2.58; P<.001). There were no significant relationships between the frequency of app use and mental health, sleep, and spiritual well-being outcomes except for the personal domain of spiritual well-being. Conclusions: This is the first study to describe a sample of adult GenZennials who use a spiritual self-care app and examine how the frequency of app use is related to their mental health, sleep, and spiritual well-being. Spiritual self-care apps like Skylight may be useful in addressing anxiety among GenZennials and be a resource to spiritually connect to their personal spiritual well-being. Future research is needed to determine how a spiritual self-care app may benefit mental health, sleep, and spiritual well-being in adult GenZennials. %M 37597179 %R 10.2196/50239 %U https://formative.jmir.org/2023/1/e50239 %U https://doi.org/10.2196/50239 %U http://www.ncbi.nlm.nih.gov/pubmed/37597179 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46473 %T Engagement, Satisfaction, and Mental Health Outcomes Across Different Residential Subgroup Users of a Digital Mental Health Relational Agent: Exploratory Single-Arm Study %A Forman-Hoffman,Valerie L %A Pirner,Maddison C %A Flom,Megan %A Kirvin-Quamme,Andrew %A Durden,Emily %A Kissinger,Jennifer A %A Robinson,Athena %+ Woebot Health, 535 Mission Street, 14th Floor, San Francisco, CA, 94105, United States, 1 415 273 9742, valerie_hoffman@woebothealth.com %K adoption %K anxiety %K chatbot %K cognitive behavioral therapy %K conversational agent %K CBT %K depression %K digital health %K medically underserved area %K mental health %K mhealth %K mobile app %K mobile health %K mobile phone %K mood %K psychotherapy %K relational agent %K rural %K satisfaction %K smartphone app %K smartphone %K underserved %K usage %K vulnerable %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental illness is a pervasive worldwide public health issue. Residentially vulnerable populations, such as those living in rural medically underserved areas (MUAs) or mental health provider shortage areas (MHPSAs), face unique access barriers to mental health care. Despite the growth of digital mental health interventions using relational agent technology, little is known about their use patterns, efficacy, and favorability among residentially vulnerable populations. Objective: This study aimed to explore differences in app use, therapeutic alliance, mental health outcomes, and satisfaction across residential subgroups (metropolitan, nonmetropolitan, or rural), MUAs (yes or no), and MHPSAs (yes or no) among users of a smartphone-based, digital mental health intervention, Woebot LIFE (WB-LIFE). WB-LIFE was designed to help users better understand and manage their moods and features a relational agent, Woebot, that converses through text-based messages. Methods: We used an exploratory study that examined data from 255 adults enrolled in an 8-week, single-arm trial of WB-LIFE. Analyses compared levels of app use and therapeutic alliance total scores as well as subscales (goal, task, and bond), mental health outcomes (depressive and anxiety symptoms, stress, resilience, and burnout), and program satisfaction across residential subgroups. Results: Few study participants resided in nonmetropolitan (25/255, 10%) or rural (3/255, 1%) areas, precluding estimates across this variable. Despite a largely metropolitan sample, nearly 39% (99/255) resided in an MUA and 55% (141/255) in an MHPSA. There were no significant differences in app use or satisfaction by MUA or MHPSA status. There also were no differences in depressive symptoms, anxiety, stress, resilience, or burnout, with the exception of MUA participants having higher baseline depressive symptoms among those starting in the moderate range or higher (Patient Health Questionnaire-8 item scale≥10) than non-MUA participants (mean 16.50 vs 14.41, respectively; P=.01). Although working alliance scores did not differ by MHPSA status, those who resided in an MUA had higher goal (2-tailed t203.47=2.21; P=.03), and bond (t203.47=1.94; P=.05) scores at day 3 (t192.98=2.15; P=.03), and higher goal scores at week 8 (t186.19=2.28; P=.02) as compared with those not living in an MUA. Conclusions: Despite the study not recruiting many participants from rural or nonmetropolitan populations, sizable proportions resided in an MUA or an MHPSA. Analyses revealed few differences in app use, therapeutic alliance, mental health outcomes (including baseline levels), or satisfaction across MUA or MHPSA status over the 8-week study. Findings suggest that vulnerable residential populations may benefit from using digital agent–guided cognitive behavioral therapy. Trial Registration: ClinicalTrials.gov NCT05672745; https://clinicaltrials.gov/study/NCT05672745 %M 37756047 %R 10.2196/46473 %U https://formative.jmir.org/2023/1/e46473 %U https://doi.org/10.2196/46473 %U http://www.ncbi.nlm.nih.gov/pubmed/37756047 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49698 %T Feasibility Study of Virtual Reality–Based Cognitive Behavioral Therapy for Patients With Depression: Protocol for an Open Trial and Therapeutic Intervention %A Ito,Ai %A Hiyoshi,Fumikazu %A Kanie,Ayako %A Maruyama,Azumi %A Oba,Mari S %A Kito,Shinsuke %+ Department of Clinical Psychology, National Center Hospital, National Center of Neurology and Psychiatry, 4 Chome-1-1 Ogawahigashicho, Kodaira-shi, 187-8551, Japan, 81 42 341 2711, kito@ncnp.go.jp %K depression %K cognitive behavioral therapy %K virtual reality %K CBT %K feasibility study %K open trial %K VR %D 2023 %7 26.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The clinical usefulness of cognitive behavioral therapy (CBT) for patients with depression who do not remit with pharmacotherapy has been recognized. However, the longer time burden on health care providers associated with conducting CBT and the lack of a system for providing CBT lead to inadequate CBT provision to patients who wish to receive it. Objective: We aim to evaluate the feasibility of introducing virtual reality (VR) into CBT for patients with depression. Methods: This is a single-center, interventional, exploratory, single-arm, nonrandomized, open, pre-post–comparative feasibility study of an unapproved medical device program to evaluate the acceptability, preliminary efficacy, and safety of the study device. Eligible patients meet the diagnostic criteria of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) for major depressive disorder, have a 17-item Hamilton Depression Rating Scale (HAMD-17) score of ≥12, and are aged 18-65 years. The sample will comprise 12 patients. VR-based CBT (CBT-VR) sessions will be conducted once a week in an outpatient setting. CBT-VR has been developed in accordance with 6 stages and 16 sessions in the current CBT therapist manual. VR contents and other components correspond to the themes of these 16 sessions. The flow of CBT-VR treatment is similar to that of normal CBT; however, this product replaces the in-person portion of CBT. The primary end point will be the change in the HAMD-17 score from baseline up to 16 sessions. Secondary end points will be treatment retention; psychiatrist consultation time; satisfaction with the equipment or program; ease of use; homework compliance; change in the HAMD-17 score from baseline up to 8 sessions; change in Montgomery-Åsberg Depression Rating Scale (MADRS), Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), EQ-5D-5L, and Clinical Global Impressions (CGI) scores from baseline up to 8 and 16 sessions; and change in remission and response rates and HAMD-17, MADRS, QIDS-SR, and EQ-5D-5L scores from baseline to 3 and 6 months post intervention (or discontinuation). CBT-VR’s feasibility will be assessed at baseline, after 8 sessions, after 16 sessions, or treatment discontinuation, by measuring the time required for testing and medical care during each session and with a patient questionnaire. After intervention discontinuation, a follow-up evaluation will be conducted unless the patient withdraws consent or otherwise discontinues participation in the study after 3 and 6 months. Results: Participant recruitment started on November 30, 2022, and data collection is ongoing as of September 2023. Conclusions: This study is the first step in testing the acceptability, feasibility, and preliminary efficacy and safety of CBT-VR for patients with depression without controls in an open-label trial. If its feasibility for depression treatment is confirmed, we intend to proceed to a large-scale validation study. Trial Registration: Japan Registry of Clinical Trials jRCTs032220481; https://jrct.niph.go.jp/en-latest-detail/jRCTs032220481 International Registered Report Identifier (IRRID): DERR1-10.2196/49698 %M 37751242 %R 10.2196/49698 %U https://www.researchprotocols.org/2023/1/e49698 %U https://doi.org/10.2196/49698 %U http://www.ncbi.nlm.nih.gov/pubmed/37751242 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47350 %T Specifying the Efficacy of Digital Therapeutic Tools for Depression and Anxiety: Retrospective, 2-Cohort, Real-World Analysis %A Fundoiano-Hershcovitz,Yifat %A Breuer Asher,Inbar %A Ritholz,Marilyn D %A Feniger,Eitan %A Manejwala,Omar %A Goldstein,Pavel %+ Dario Health, Ofek 8, 5 Tarshish St, Caesarea, 3079821, Israel, 972 525296979, yifat@dariohealth.com %K mental health %K depression %K anxiety %K digital health %K coaching %K behavioral health %K breathing exercises %K behavioral change %K digital health intervention %K cognitive behavior therapy %K health outcome %K health app %K intervention %K cohort %K retrospective %D 2023 %7 22.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression and anxiety are the main sources of work and social disabilities as well as health-related problems around the world. Digital therapeutic solutions using cognitive behavioral therapy have demonstrated efficacy in depression and anxiety. A common goal of digital health apps is to increase user digital engagement to improve outcomes. However, there is a limited understanding of the association between digital platform components and clinical outcomes. Objective: The aim of the study is to investigate the contribution of specific digital engagement tools to mental health conditions. We hypothesized that participation in coaching sessions and breathing exercises would be associated with a reduction in depression and anxiety. Methods: Depression and general anxiety symptoms were evaluated in real-world data cohorts using the digital health platform for digital intervention and monitoring change. This retrospective real-world analysis of users on a mobile platform–based treatment followed two cohorts of people: (1) users who started with moderate levels of depression and completed at least 2 depression assessments (n=519) and (2) users who started with moderate levels of anxiety and completed at least 2 anxiety assessments (n=474). Levels of depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) were tracked throughout the first 16 weeks. A piecewise mixed-effects model was applied to model the trajectories of the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 mean scores in 2 segments (1-6 weeks and 7-16 weeks). Finally, simple slope analysis was used for the interpretation of the interactions probing the moderators: coaching sessions and breathing exercises in both depression and anxiety cohorts. Results: Analysis revealed a significant decrease in depression symptoms (β=–.37, 95% CI –0.46 to 0.28; P≤.001) during the period of weeks 1-6 of app use, which was maintained during the period of 7-16 weeks. Coach interaction significantly moderated the reduction in depression symptoms during the period of weeks 1-6 (β=–.03, 95% CI –0.05 to –0.001; P=.02). A significant decrease in anxiety symptoms (β=–.41, 95% CI –0.50 to –0.33; P≤.001) was revealed during the period of 1-6 weeks, which was maintained during the period of 7-16 weeks. Breathing exercises significantly moderated the reduction in anxiety symptoms during the period of 1-6 weeks (β=–.07, 95% CI –0.14 to –0.01; P=.04). Conclusions: This study demonstrated general improvement followed by a period of stability of depression and anxiety symptoms associated with cognitive behavioral therapy–based digital intervention. Interestingly, engagement with a coaching session but not a breathing exercise was associated with a reduction in depression symptoms. Moreover, breathing exercise but not engagement with a coaching session was associated with a reduction of anxiety symptoms. These findings emphasize the importance of using a personalized approach to behavioral health during digital health interventions. %M 37738076 %R 10.2196/47350 %U https://www.jmir.org/2023/1/e47350 %U https://doi.org/10.2196/47350 %U http://www.ncbi.nlm.nih.gov/pubmed/37738076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42786 %T The Effect of Internet-Based Cognitive Behavioral Therapy on Major Depressive Disorder: Randomized Controlled Trial %A Lin,Ziyi %A Cheng,Lu %A Han,Xue %A Wang,Hongqiong %A Liao,Yuhua %A Guo,Lan %A Shi,Jingman %A Fan,Beifang %A Teopiz,Kayla M %A Jawad,Muhammad Youshay %A Zhang,Huimin %A Chen,Yan %A Lu,Ciyong %A McIntyre,Roger S %+ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, No. 74 Zhongshan Rd 2, Guangzhou, 510080, China, 86 020 87332477, luciyong@mail.sysu.edu.cn %K depressive symptoms %K major depressive disorder %K internet-based cognitive behavioral therapy %K self-efficacy %K stigma %K social function %K health-related quality of life %K mental health services %D 2023 %7 22.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Many people living with major depressive disorder (MDD) in China do not receive treatment owing to a lack of mental health services, along with significant stigma toward mental illness. Internet-based cognitive behavioral therapy (ICBT) has been proposed to increase access to mental health care for people with MDD. Objective: The aims of this study were to (1) evaluate the efficacy of ICBT for depressive symptoms in patients with MDD; (2) evaluate the effect of ICBT on anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social function, and health-related quality of life (HRQoL); and (3) explore the acceptability of and satisfaction with the ICBT program among participants. Methods: Patients with MDD were enrolled and randomized to the ICBT group or the waiting-list control (WLC) group. The ICBT group received ICBT delivered through a WeChat mini-program with general support by nonspecialists. Participants in the 2 groups were self-evaluated online at baseline and posttreatment for changes in the primary outcome (ie, depressive symptoms) and secondary outcomes (ie, anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social functional impairment, and HRQoL). Changes in outcomes were measured by changes in overall scores on respective scales, and response and remission rates were calculated based on depressive symptoms. The acceptability of and satisfaction with the ICBT program were measured by treatment adherence and participants’ feelings (ie, modules seriously completed, perceived benefit, and satisfaction). Results: We included 40 patients who were randomly assigned to the ICBT group and 44 who were assigned to the WLC group. Compared with the WLC group, the ICBT group had fewer depressive symptoms, fewer anxiety symptoms, less nonspecific psychological distress, and greater general self-efficacy. Moreover, the ICBT group had higher response (18/31, 58%) and remission rates (17/31, 55%). The adherence rate in the ICBT group was 78% (31/40), and the majority of participants who completed all ICBT modules were satisfied with the ICBT program. Conclusions: ICBT demonstrated greater improvements in depressive symptoms, anxiety symptoms, nonspecific psychological distress, and general self-efficacy among selected patients with MDD in comparison with the findings in waiting-list controls. The ICBT program in this study had good acceptability and satisfaction among participants. Trial Registration: Chinese Clinical Trial Registry (ChiCTR2100046425); https://tinyurl.com/bdcrj4zv %M 37738092 %R 10.2196/42786 %U https://www.jmir.org/2023/1/e42786 %U https://doi.org/10.2196/42786 %U http://www.ncbi.nlm.nih.gov/pubmed/37738092 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46458 %T Efficacy of a Text-Based Mental Health Coaching App in Improving the Symptoms of Stress, Anxiety, and Depression: Randomized Controlled Trial %A Lim,Yee Siew %A Quek,Jia Hui %A Ching,Xiu Wei %A Lim,Dominic Tao Ran %A Lim,Kean Ghee %A Thuraisingham,Chandramani %A George,Parikial Philip %+ International Medical University (IMU), Jalan Rasah, Bukit Rasah, Seremban, 70300, Malaysia, 60 67677798, lim.yeesiew@outlook.com %K digital mental health %K mobile health %K randomized control trial %K mobile phone %K mental health %K Depression, Anxiety, and Stress Scale–21 items %K DASS-21 %K Asia %K Malaysia %D 2023 %7 22.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress, anxiety, and depression are major mental health concerns worldwide. A wide variety of digital mental health interventions have demonstrated efficacy in improving one’s mental health status, and digital interventions that involve some form of human involvement have been shown to demonstrate greater efficacy than self-guided digital interventions. Studies demonstrating the efficacy of digital mental health interventions within the Asian region are scarce. Objective: This study aimed to investigate the potential efficacy of the digital mental health intervention, ThoughtFullChat, which consists of one-on-one, asynchronous, text-based coaching with certified mental health professionals and self-guided tools, in improving self-reported symptoms of depression, anxiety, and stress. The study also aims to examine the potential differences in efficacy among occupational subgroups and between sexes. Methods: A randomized controlled study was conducted among housemen (trainee physicians), students, faculty members, and corporate staff at International Medical University, Malaysia. A total of 392 participants were enrolled and randomized to the intervention (n=197, 50.3%) and control (n=195, 49.7%) groups. Depression, anxiety, and stress symptoms were measured using the Depression, Anxiety, and Stress Scale–21 items at baseline and after the 3-month intervention period. The Satisfaction with Life Scale and Brief Resilience Scale were also included, along with a questionnaire about demographics. Results: Significant decrease was observed in depression (P=.02) and anxiety (P=.002) scores in the intervention group. A subgroup (corporate staff) also demonstrated significant decrease in stress (P=.005) alongside depression (P=.006) and anxiety (P=.002). Females showed significant improvements in depression (P=.02) and anxiety (P<.001) when compared with males. Conclusions: This study provides evidence that the ThoughtFullChat app is effective in improving the symptoms of depression, anxiety, and stress in individuals, particularly among corporate staff from the educational field. It also supports the notion that mobile mental health apps that connect users to mental health professionals in a discreet and cost-efficient manner can make important contributions to the improvement of mental health outcomes. The differential improvements among occupational subgroups and between sexes in this study indicate the need for future digital mental health app designs to consider an element of personalization focused on systemic components relating to occupation. Trial Registration: Clinicaltrials.gov NCT04944277; https://classic.clinicaltrials.gov/ct2/show/NCT04944277 %M 37738081 %R 10.2196/46458 %U https://formative.jmir.org/2023/1/e46458 %U https://doi.org/10.2196/46458 %U http://www.ncbi.nlm.nih.gov/pubmed/37738081 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45535 %T Technology-Enabled Intervention to Enhance Mindfulness, Safety, and Health Promotion Among Corrections Professionals: Protocol for a Prospective Quasi-Experimental Trial %A Elliot,Diane %A Kuehl,Kerry %A DeFrancesco,Carol %A McGinnis,Wendy %A Ek,Susanna %A Van Horne,Allee %A Kempany,Katherine Ginsberg %+ Health Promotion & Sports Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR110, Portland, OR, 97239, United States, 1 5037995598, elliotd@ohsu.edu %K corrections professionals %K mindfulness %K total worker health %K occupational safety %K digital %K health promotion %K safety %K depression %K suicide %K obesity %K cardiovascular disease %K well-being %K stress %K survey %K healthy eating %K physical activity %K mood %K vascular health %K injury %K cop %K police %K security %K undercover %K remand %K detention %K prison %K state correctional %K state corrections %K correction %K penitentiary %D 2023 %7 22.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Correction professionals are a highly stressed workforce with heightened risks for depression, suicide, obesity, cardiovascular disease, and injury. These professionals, largely hidden from view, have received little study concerning means to improve their safety, health, and well-being. In other settings, mindfulness has resulted in lowered stress, along with other benefits. We hypothesized that a program that promoted mindfulness combined with more typical health and safety components could uniquely benefit corrections professionals. Objective: This project will assess a novel scalable, self-administered program to enhance the mindfulness, safety, and health of a vulnerable worker group. Methods: In partnership with the Oregon Department of Corrections, we are conducting a prospective quasi-experimental trial of a safety, health, and mindfulness program among 100 corrections professionals from 2 institutions. Survey and physiologic data will be collected at enrollment, upon weekly program completion (3 months), and at 9 months after enrollment. Primary outcome behaviors promoted by the program are being mindful, healthier eating, more physical activity, and greater restorative sleep. Secondary downstream benefits are anticipated in stress level, mood, positive feelings about the organization, vascular health, and cellular aging, along with job performance, injuries, and economic costs. Participants will meet in-person or in a Zoom-type meeting as 3- to 5-member coworker groups during their usual work hours for 30-minute sessions once a week for 12 weeks. The program uses self-guided web-based learning modules that include brief mindfulness practice, and it is accessible by smartphone, tablet, or laptop. Daily mindfulness practice is encouraged between sessions, which is facilitated by the study website and group format. The modules’ structure emphasizes prerequisite knowledge, peer support, skill practice, self-monitoring, and enhancing self-efficacy for change. The program continues through self-directed use of the Headspace app following the 12 weekly sessions. Results: Participants are being enrolled, and the intervention is ready to launch. Conclusions: Although mindfulness training has gained traction for worker well-being, its usual format requires a skilled trainer, an initial retreat, and weekly 2-hour meetings for several weeks. The content is limited to mindfulness without safety or health promotion aspects. The need for skilled trainers and time commitment limits the scalability of the usual mindfulness interventions. The planned program is an innovative combination of technology, e-learning, and a group format to add mindfulness to a safety and health curriculum. If acceptable and effective, the format would facilitate its widespread use. Trial Registration: ClinicalTrials.gov NCT05608889; https://classic.clinicaltrials.gov/ct2/show/NCT05608889 International Registered Report Identifier (IRRID): PRR1-10.2196/45535 %M 36602914 %R 10.2196/45535 %U https://www.researchprotocols.org/2023/1/e45535 %U https://doi.org/10.2196/45535 %U http://www.ncbi.nlm.nih.gov/pubmed/36602914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49043 %T Blending Video Therapy and Digital Self-Help for Individuals With Suicidal Ideation: Intervention Design and a Qualitative Study Within the Development Process %A Büscher,Rebekka %A Sander,Lasse B %A Nuding,Mattis %A Baumeister,Harald %A Teismann,Tobias %+ Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstr. 29, Freiburg, 79085, Germany, 49 76120395204, rebekka.buescher@mps.uni-freiburg.de %K blended care %K digital interventions %K video therapy %K suicidal ideation %K personalized treatment %K cognitive behavioral therapy %K CBT %K suicide %K suicidal %K digital intervention %K digital health %K video %K web-based module %K blended %K self-help %D 2023 %7 21.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital formats have the potential to enhance accessibility to care for individuals with suicidal ideation. However, digital self-help interventions have faced limitations, including small effect sizes in reducing suicidal ideation, low adherence, and safety concerns. Objective: Therefore, we aimed to develop a remote blended cognitive behavioral therapy intervention that specifically targets suicidal ideation by blending video therapy with web-based self-help modules. The objective of this paper is to describe the collaborative development process and the resulting intervention and treatment rationale. Methods: First, we compiled intervention components from established treatment manuals designed for people with suicidal ideation or behavior, resulting in the development of 11 drafts of web-based modules. Second, we conducted a qualitative study, involving 5 licensed psychotherapists and 3 lay counselors specialized in individuals with suicidal ideation who reviewed these module drafts. Data were collected using the think-aloud method and semistructured interviews, and a qualitative content analysis was performed. The 4 a priori main categories of interest were blended care for individuals with suicidal ideation, contents of web-based modules, usability of modules, and layout. Subcategories emerged inductively from the interview transcripts. Finally, informed by previous treatment manuals and qualitative findings, we developed the remote blended treatment program. Results: The participants suggested that therapists should thoroughly prepare the web-based therapy with patients to tailor the therapy to each individual’s needs. Participants emphasized that the web-based modules should explain concepts in a simple manner, convey empathy and validation, and include reminders for the safety plan. In addition, participants highlighted the need for a simple navigation and layout. Taking these recommendations into account, we developed a fully remote blended cognitive behavioral therapy intervention comprising 12 video therapy sessions and up to 31 web-based modules. The treatment involves collaboratively developing a personalized treatment plan to address individual suicidal drivers. Conclusions: This remote treatment takes advantage of the high accessibility of digital formats while incorporating full sessions with a therapist. In a subsequent pilot trial, we will seek input from individuals with lived experience and therapists to test the feasibility of the treatment. %M 37733414 %R 10.2196/49043 %U https://formative.jmir.org/2023/1/e49043 %U https://doi.org/10.2196/49043 %U http://www.ncbi.nlm.nih.gov/pubmed/37733414 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e51232 %T Suicide Risk Assessments Through the Eyes of ChatGPT-3.5 Versus ChatGPT-4: Vignette Study %A Levkovich,Inbar %A Elyoseph,Zohar %+ Department of Psychology and Educational Counseling, The Center for Psychobiological Research, Max Stern Yezreel Valley College, Hatena 14b Kiryat Tivon, Emek Yezreel, 3650414, Israel, 972 54 783 6088, Zohare@yvc.ac.il %K artificial intelligence %K ChatGPT %K diagnosis %K psychological assessment %K psychological %K suicide risk %K risk assessment %K text vignette %K NLP %K natural language processing %K suicide %K suicidal %K risk %K assessment %K vignette %K vignettes %K assessments %K mental %K self-harm %D 2023 %7 20.9.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: ChatGPT, a linguistic artificial intelligence (AI) model engineered by OpenAI, offers prospective contributions to mental health professionals. Although having significant theoretical implications, ChatGPT’s practical capabilities, particularly regarding suicide prevention, have not yet been substantiated. Objective: The study’s aim was to evaluate ChatGPT’s ability to assess suicide risk, taking into consideration 2 discernable factors—perceived burdensomeness and thwarted belongingness—over a 2-month period. In addition, we evaluated whether ChatGPT-4 more accurately evaluated suicide risk than did ChatGPT-3.5. Methods: ChatGPT was tasked with assessing a vignette that depicted a hypothetical patient exhibiting differing degrees of perceived burdensomeness and thwarted belongingness. The assessments generated by ChatGPT were subsequently contrasted with standard evaluations rendered by mental health professionals. Using both ChatGPT-3.5 and ChatGPT-4 (May 24, 2023), we executed 3 evaluative procedures in June and July 2023. Our intent was to scrutinize ChatGPT-4’s proficiency in assessing various facets of suicide risk in relation to the evaluative abilities of both mental health professionals and an earlier version of ChatGPT-3.5 (March 14 version). Results: During the period of June and July 2023, we found that the likelihood of suicide attempts as evaluated by ChatGPT-4 was similar to the norms of mental health professionals (n=379) under all conditions (average Z score of 0.01). Nonetheless, a pronounced discrepancy was observed regarding the assessments performed by ChatGPT-3.5 (May version), which markedly underestimated the potential for suicide attempts, in comparison to the assessments carried out by the mental health professionals (average Z score of –0.83). The empirical evidence suggests that ChatGPT-4’s evaluation of the incidence of suicidal ideation and psychache was higher than that of the mental health professionals (average Z score of 0.47 and 1.00, respectively). Conversely, the level of resilience as assessed by both ChatGPT-4 and ChatGPT-3.5 (both versions) was observed to be lower in comparison to the assessments offered by mental health professionals (average Z score of –0.89 and –0.90, respectively). Conclusions: The findings suggest that ChatGPT-4 estimates the likelihood of suicide attempts in a manner akin to evaluations provided by professionals. In terms of recognizing suicidal ideation, ChatGPT-4 appears to be more precise. However, regarding psychache, there was an observed overestimation by ChatGPT-4, indicating a need for further research. These results have implications regarding ChatGPT-4’s potential to support gatekeepers, patients, and even mental health professionals’ decision-making. Despite the clinical potential, intensive follow-up studies are necessary to establish the use of ChatGPT-4’s capabilities in clinical practice. The finding that ChatGPT-3.5 frequently underestimates suicide risk, especially in severe cases, is particularly troubling. It indicates that ChatGPT may downplay one’s actual suicide risk level. %M 37728984 %R 10.2196/51232 %U https://mental.jmir.org/2023/1/e51232 %U https://doi.org/10.2196/51232 %U http://www.ncbi.nlm.nih.gov/pubmed/37728984 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e42117 %T Using Augmented Reality Toward Improving Social Skills: Scoping Review %A Mittmann,Gloria %A Zehetner,Vanessa %A Hoehl,Stefanie %A Schrank,Beate %A Barnard,Adam %A Woodcock,Kate %+ School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2SA, United Kingdom, 44 121 414 6036, papers@katewoodcock.com %K virtual reality %K serious games %K autism spectrum disorder %K social learning %K communication %K cooperation %K mobile phone %D 2023 %7 20.9.2023 %9 Review %J JMIR Serious Games %G English %X Background: Augmented reality (AR) has emerged as a promising technology in educational settings owing to its engaging nature. However, apart from applications aimed at the autism spectrum disorder population, the potential of AR in social-emotional learning has received less attention. Objective: This scoping review aims to map the range of AR applications that improve social skills and map the characteristics of such applications. Methods: In total, 2 independent researchers screened 2748 records derived from 3 databases in December 2021—PubMed, IEEE Xplore, and ACM Guide to Computing Literature. In addition, the reference lists of all the included records and existing reviews were screened. Records that had developed a prototype with the main outcome of improving social skills were included in the scoping review. Included records were narratively described for their content regarding AR and social skills, their target populations, and their outcomes. Evaluation studies were assessed for methodological quality. Results: A total of 17 records met the inclusion criteria for this study. Overall, 10 records describe applications for children with autism, primarily teaching about reading emotions in facial expressions; 7 records describe applications for a general population, targeting both children and adults, with a diverse range of outcome goals. The methodological quality of evaluation studies was found to be weak. Conclusions: Most applications are designed to be used alone, although AR is well suited to facilitating real-world interactions during a digital experience, including interactions with other people. Therefore, future AR applications could endorse social skills in a general population in more complex group settings. %M 37728971 %R 10.2196/42117 %U https://games.jmir.org/2023/1/e42117 %U https://doi.org/10.2196/42117 %U http://www.ncbi.nlm.nih.gov/pubmed/37728971 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47178 %T Developing Suicide Prevention Tools in the Context of Digital Peer Support: Qualitative Analysis of a Workshop With Multidisciplinary Stakeholders %A Cliffe,Bethany %A Gore-Rodney,Jessica %A Linton,Myles-Jay %A Biddle,Lucy %+ Population Health Sciences, Bristol Medical School, University of Bristol, Beacon House, Queens Road, Bristol, BS8 1QU, United Kingdom, 44 01179289000, bethany.cliffe@bristol.ac.uk %K digital interventions %K smartphone app %K suicide prevention %K mental health %K mobile phone %D 2023 %7 20.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is the fourth leading cause of death among young people aged 15-29 years worldwide and suicide rates are increasing. Suicide prevention strategies can be effective but young people face barriers to accessing them. Providing support digitally can facilitate access, but this can also pose risks if there is inappropriate or harmful content. Collaborative approaches are key for developing digital suicide prevention tools to ensure support is appropriate and helpful for young people. Tellmi (previously MeeToo) is a premoderated UK-based peer-support app where people aged 11-25 years can anonymously discuss issues ranging from worries to life challenges. It has procedures to support high-risk users, nevertheless, Tellmi is interested in improving the support they provide to users with more acute mental health needs, such as young people struggling with suicide and self-harm ideation. Further research into the best ways of providing such support for this population is necessary. Objective: The aim of this study is to explore the key considerations for developing and delivering digital suicide prevention tools for young people aged 18-25 years from a multidisciplinary perspective, including the views of young people, practitioners, and academics. Methods: A full-day, in-person workshop was conducted with mental health academics (n=3) and mental health practitioners (n=2) with expertise in suicide prevention, young people with lived experience of suicidal ideation (n=4), and a computer scientist (n=1) and technical staff from the Tellmi app (n=6). Tellmi technical staff presented 14 possible evidence-based adaptations for the app as a basis for the discussions. A range of methods were used to evaluate them, including questionnaires to rate the ideas, annotating printouts of the ideas with post-it notes, and group discussions. A reflexive thematic analysis was performed on the qualitative data to explore key considerations for designing digital suicide prevention tools in the context of peer support. Results: Participants discussed the needs of both those receiving and providing support, noting several key considerations for developing and delivering digital support for high-risk young people. In total, four themes were developed: (1) the aims of the app must be clear and consistent, (2) there are unique considerations for supporting high-risk users: (subtheme) customization helps tailor support to high-risk users, (3) “progress” is a broad and multifaceted concept, and (4) considering the roles of those providing support: (subtheme) expertise required to support app users and (subtheme) mitigating the impact of the role on supporters. Conclusions: This study outlined suggestions that may be beneficial for developing digital suicide prevention tools for young people. Suggestions included apps being customizable, transparent, accessible, visually appealing, and working with users to develop content and language. Future research should further explore this with a diverse group of young people and clinicians. %M 37728967 %R 10.2196/47178 %U https://formative.jmir.org/2023/1/e47178 %U https://doi.org/10.2196/47178 %U http://www.ncbi.nlm.nih.gov/pubmed/37728967 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48899 %T Comparing the Efficacy of an Electronically Delivered Cognitive Behavioral Therapy Program to a Mental Health Check-In Program for Generalized Anxiety Disorder: Protocol for a Randomized Trial %A Stephenson,Callum %A Kumar,Anchan %A Malakouti,Niloufar %A Nikjoo,Niloofar %A Jagayat,Jasleen %A Gizzarelli,Tessa %A Patel,Charmy %A Gutierrez,Gilmar %A Shirazi,Amirhossein %A Yang,Megan %A Omrani,Mohsen %A Alavi,Nazanin %+ Department of Psychiatry, Faculty of Health Sciences, Queen's University, Hotel Dieu Hospital, 166 Brock Street, Kingston, ON, K7L 5G2, Canada, 1 6135443310, nazanin.alavitabari@kingstonhsc.ca %K anxiety %K cognitive behavioral therapy %K eHealth %K electronic care %K generalized anxiety disorder %K internet %K mental health %K psychotherapy %K treatment %K web-based %D 2023 %7 20.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Generalized anxiety disorder (GAD) is a prevalent anxiety disorder, with cognitive behavioral therapy (CBT) being the gold standard treatment. However, it is inaccessible and costly to many, as the mental health industry is overwhelmed by the demand for treatment. This means effective, accessible, and time-saving strategies must be developed to combat these problems. Web-based interventions for mental health disorders are an innovative and promising way to address these barriers. While electronically delivered CBT (e-CBT) has already proved productive and scalable for treating anxiety, other less resource-intensive interventions can be innovated. Checking up on mental health face-to-face has been shown to provide similar benefits to patients with anxiety disorders previously, but more research is needed to evaluate the efficacy of web-based delivery of this intervention. Objective: This study will compare the efficacy of e-CBT and a web-based mental health check-in program to treat GAD. These programs will both be delivered through a secure, web-based care delivery platform. Methods: We will randomly allocate participants (N=100) who are 18 years or older with a confirmed diagnosis of GAD to either an e-CBT program or a mental health check-in program over 12 weeks to address their anxiety symptoms. Participants in the e-CBT arm will complete predesigned modules and homework assignments while receiving personalized feedback and asynchronous interaction with a therapist through the platform. Participants in the mental health check-in arm will be contacted weekly through the web-based platform’s written chat feature (messaging system). Therapists will ask the participants a series of predesigned questions that revolve around a different theme each week to prompt conversation. Using clinically validated questionnaires, the efficacy of the e-CBT arm will be compared to the mental health check-in arm. These questionnaires will be completed at baseline, week 6, and week 12. Results: The study received ethics approval in April 2021, and participant recruitment began in May 2021. Participant recruitment has been conducted through targeted advertisements and physician referrals. Complete data collection and analysis are expected to conclude by August 2023. Linear and binomial regression (continuous and categorical outcomes, respectively) will be conducted. Conclusions: To the research team’s knowledge, this will be the first study to date comparing the efficacy of e-CBT with a web-based mental health check-in program to treat GAD. The findings from this study can help progress the development of more scalable, accessible, and efficacious mental health treatments. Trial Registration: ClinicalTrials.gov NCT04754438; https://classic.clinicaltrials.gov/ct2/show/NCT04754438 International Registered Report Identifier (IRRID): DERR1-10.2196/48899 %M 37587552 %R 10.2196/48899 %U https://www.researchprotocols.org/2023/1/e48899 %U https://doi.org/10.2196/48899 %U http://www.ncbi.nlm.nih.gov/pubmed/37587552 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45540 %T The Use of Mobile Assessments for Monitoring Mental Health in Youth: Umbrella Review %A Marciano,Laura %A Vocaj,Emanuela %A Bekalu,Mesfin A %A La Tona,Antonino %A Rocchi,Giulia %A Viswanath,Kasisomayajula %+ Lee Kum Sheung Center for Health and Happiness, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States, 1 6175828025, lmarciano@hsph.harvard.edu %K mobile assessment %K ecological momentary assessments %K EMAs %K digital phenotyping %K umbrella review %K youth %K mental health %K mobile phone %D 2023 %7 19.9.2023 %9 Review %J J Med Internet Res %G English %X Background: Improving mental health in youth is a major concern. Future approaches to monitor and intervene in youth mental health problems should rely on mobile tools that allow for the daily monitoring of mental health both actively (eg, using ecological momentary assessments [EMAs]) and passively (eg, digital phenotyping) by capturing individuals’ data. Objective: This umbrella review aims to (1) report the main characteristics of existing reviews on mental health and young people, including mobile approaches to mental health; (2) describe EMAs and trace data and the mental health conditions investigated; (3) report the main results; and (4) outline promises, limitations, and directions for future research. Methods: A systematic literature search was carried out in 9 scientific databases (Communication & Mass Media Complete, Psychology and Behavioral Sciences Collection, PsycINFO, CINAHL, ERIC, MEDLINE, the ProQuest Sociology Database, Web of Science, and PubMed) on January 30, 2022, coupled with a hand search and updated in July 2022. We included (systematic) reviews of EMAs and trace data in the context of mental health, with a specific focus on young populations, including children, adolescents, and young adults. The quality of the included reviews was evaluated using the AMSTAR (Assessment of Multiple Systematic Reviews) checklist. Results: After the screening process, 30 reviews (published between 2016 and 2022) were included in this umbrella review, of which 21 (70%) were systematic reviews and 9 (30%) were narrative reviews. The included systematic reviews focused on symptoms of depression (5/21, 24%); bipolar disorders, schizophrenia, or psychosis (6/21, 29%); general ill-being (5/21, 24%); cognitive abilities (2/21, 9.5%); well-being (1/21, 5%); personality (1/21, 5%); and suicidal thoughts (1/21, 5%). Of the 21 systematic reviews, 15 (71%) summarized studies that used mobile apps for tracing, 2 (10%) summarized studies that used them for intervention, and 4 (19%) summarized studies that used them for both intervention and tracing. Mobile tools used in the systematic reviews were smartphones only (8/21, 38%), smartphones and wearable devices (6/21, 29%), and smartphones with other tools (7/21, 33%). In total, 29% (6/21) of the systematic reviews focused on EMAs, including ecological momentary interventions; 33% (7/21) focused on trace data; and 38% (8/21) focused on both. Narrative reviews mainly focused on the discussion of issues related to digital phenotyping, existing theoretical frameworks used, new opportunities, and practical examples. Conclusions: EMAs and trace data in the context of mental health assessments and interventions are promising tools. Opportunities (eg, using mobile approaches in low- and middle-income countries, integration of multimodal data, and improving self-efficacy and self-awareness on mental health) and limitations (eg, absence of theoretical frameworks, difficulty in assessing the reliability and effectiveness of such approaches, and need to appropriately assess the quality of the studies) were further discussed. Trial Registration: PROSPERO CRD42022347717; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=347717 %M 37725422 %R 10.2196/45540 %U https://www.jmir.org/2023/1/e45540 %U https://doi.org/10.2196/45540 %U http://www.ncbi.nlm.nih.gov/pubmed/37725422 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e47691 %T Web-Based Cognitive Behavioral Therapy for Depression Among Homebound Older Adults: Development and Usability Study %A Xiang,Xiaoling %A Kayser,Jay %A Ash,Samson %A Zheng,Chuxuan %A Sun,Yihang %A Weaver,Addie %A Dunkle,Ruth %A Blackburn,James A %A Halavanau,Alex %A Xue,Jia %A Himle,Joseph A %+ School of Social Work, University of Michigan-Ann Arbor, 1080 S University Avenue, Ann Arbor, MI, 48109, United States, 1 7347636581, xiangxi@umich.edu %K internet-based cognitive behavioral therapy %K usability %K geriatric depression %K community-engaged research %K web-based %K geriatrics %K geriatric %K depression %K psychotherapy %K mental health %K older adults %K older adult %K cognitive behavioral therapy %K CBT %K design %K development %K community %K user centered design %K digital health %K aging %K old age %K digital mental health %K web-based health %K internet %D 2023 %7 19.9.2023 %9 Original Paper %J JMIR Aging %G English %X Background: Homebound older adults are a high-risk group for depression. However, many of them face barriers to accessing evidence-supported mental health treatments. Digital mental health interventions can potentially improve treatment access, but few web-based interventions are explicitly tailored for depression in older adults. Objective: This paper describes the development process of Empower@Home, a web-delivered intervention for depression in homebound older adults that is based on cognitive behavioral therapy, and reports on the outcomes of usability studies. Methods: Empower@Home was developed in collaboration with community agencies, stakeholders, and older adults, guided by user-centered design principles. User needs were assessed through secondary data analysis, demographic and health profiles from administrative data, and interviews and surveys of community partners. A comparative usability evaluation was conducted with 10 older adults to assess the usability of Empower@Home compared to 2 similar programs. Field testing was conducted with 4 end users to detect additional usability issues. Results: Feedback and recommendations from community partners heavily influenced the content and design of Empower@Home. The intervention consists of 9 sessions, including psychoeducation and an introduction to cognitive behavioral therapy skills and tools through short video clips, in-session exercises, an animated storyline, and weekly out-of-session home practice. A printed workbook accompanies the web-based lessons. In comparative usability testing (N=10), Empower@Home received a System Usability Scale score of 78 (SD 7.4), which was significantly higher than the 2 comparator programs (t9=3.28; P=.005 and t9=2.78; P=.011). Most participants, 80% (n=8), preferred Empower@Home over the comparators. In the longitudinal field test (n=4), all participants reported liking the program procedures and feeling confident in performing program-related tasks. The single-subject line graph showed an overall downward trend in their depression scores over time, offering an encouraging indication of the intervention’s potential effects. Conclusions: Collaboration with community stakeholders and careful consideration of potential implementation issues during the design process can result in more usable, engaging, and effective digital mental health interventions. %M 37725423 %R 10.2196/47691 %U https://aging.jmir.org/2023/1/e47691 %U https://doi.org/10.2196/47691 %U http://www.ncbi.nlm.nih.gov/pubmed/37725423 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47059 %T e–Mental Health Program to Prevent Psychological Distress Among French-Speaking International Students in a Linguistic-Cultural Minority Context (Ottawa, Alberta, and Quebec): Protocol for the Implementation and Evaluation of Psy-Web %A Beogo,Idrissa %A Ramdé,Jean %A Anne,Abdoulaye %A Gagnon,Marie-Pierre %A Sia,Drissa %A Nguemeleu Tchouaket,Eric %+ Faculty of Health Sciences, School of Nursing, University of Ottawa, Room 420F, 200, Lees Avenue, Ottawa, ON, K1N 6N5, Canada, 1 613 562 5800, ibeogo@uottawa.ca %K international students %K psychological distress %K Covid-19 pandemic %K web-based %K internet-based %K peer support %K distress %K loneliness %K isolation %K isolated %K psychological %K student %K students %K immigrant %K immigrants %K foreign %K social interaction %K French %K design %K develop %K development %D 2023 %7 19.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Based on experiences with the COVID-19 pandemic, postsecondary institutions were most affected by the restrictions. Students, especially international students, have borne the brunt associated with in-person learning restrictions imposed by public health recommendations. Canada is among the top 3 countries hosting international students (ISs), including Francophone students in provinces such as Quebec and other anglophone regions. Academic restrictions were accompanied by other measures such as quarantine, self-isolation, social distancing, and travel ban, to cite some. This has had a wide-ranging impact on these ISs. The resulting psychological distress and burden may have a much greater impact on Francophone ISs in anglophone settings, many of whom had ordinarily limited access to active offers of care in French in addition to cultural barriers and low literacy of the health care system. In order to take advantage of the effectiveness of eHealth as a pertinent and promising avenue, our project intends to build a web-based application that is cost-effective, user-friendly, anonymous, and capable to prompt interactive interventions as a first-line resource for psychological distress. In fact, internet applications have been increasingly used for the management of psychological distresses, and internet-based cognitive behavioral therapy is one of the preferred methods to prevent or control them. Objective: The aims of this study are to (1) design, implement, and maintain Psy-Web for the psychological support of ISs and (2) analyze the results of the implementation of the Psy-Web platform, the additional resources solicited, and the results obtained. Methods: This interventional project will use a sequential mixed design in the exploratory phase (phase 1) including the construction of the Psy-Web platform. A quantitative prospective component (phase 2) will include the intervention content of the Psy-Web platform. In total, 105 ISs participants (study group) and 52 ISs (control group), based on a ratio of 1:2, will be considered. The control group participants include those who did not use the web platform. Results: The project is at the data collection stage (phase 1). Psy-Web will be built in accordance with the DMAIC (Define, Measure, Analyze, Improve and Control) model with the perspective of boosting its robustness. As a first-line resource to prevent psychological distress and ultimately improve their academic performance, Psy-Web is an innovative opportunity for high education managers. The project involves a multisectoral and a multidisciplinary partnership. Conclusions: The project will develop a promising web-based solution to prevent psychological distress. Ultimately, Psy-Web will be operable in multiple languages including French. International Registered Report Identifier (IRRID): PRR1-10.2196/47059 %M 37725428 %R 10.2196/47059 %U https://www.researchprotocols.org/2023/1/e47059 %U https://doi.org/10.2196/47059 %U http://www.ncbi.nlm.nih.gov/pubmed/37725428 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48437 %T Internet-Based Cognitive Behavioral Therapy and Virtual Reality Exposure Therapy for Social Anxiety Disorder: Protocol for a Randomized Controlled Trial in Hong Kong %A Pan,Jia-Yan %+ Department of Social Work, Hong Kong Baptist University, 10/F, Academic and Administration Building, 15 Baptist University Road, Baptist University Road Campus, Hong Kong, China (Hong Kong), 852 34116415, jiayan@hkbu.edu.hk %K internet-based cognitive behavioral therapy %K virtual reality exposure therapy %K social anxiety disorder %K Chinese %K CBT %K iCBT %K internet %K virtual reality %K anxiety %K social phobia %K mental disorder %K mental health %K quality of life %K treatment %K cognitive behavioral therapy %K psychological intervention %D 2023 %7 14.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social anxiety disorder (SAD), also known as social phobia, is one of the most common mental disorders worldwide. In Hong Kong, the prevalence of SAD is high, but its treatment rate is low. SAD has immense impact on academic or work performance, social life, career development, and quality of life. One of the most effective treatments for SAD is cognitive behavioral therapy (CBT), with internet-based CBT (iCBT) and virtual reality exposure therapy (VRET) showing promise in treating SAD. However, internet interventions are underdeveloped in Chinese communities including Hong Kong. Objective: This study aims to develop an iCBT program that includes VRET, called “Ease Anxiety in Social Event Online” (Ease Online), for Hong Kong adults with SAD in a randomized controlled trial. Methods: The 14-week Ease Online program is a guided self-help iCBT program with a blended mode of service delivery. The program comprises 9 web-based modules and 5 individual counseling sessions (including 2 VRET sessions) conducted remotely or face-to-face with a therapist to provide therapist support, as guided iCBT shows superior effects than unguided iCBT. Other program components include therapist feedback on assignments, internal messages, forums, client portfolios, web-based questionnaires, reminders, and web-based bookings. The program can be accessed either through a mobile app or program website through a PC with an internet connection. The participants are openly recruited and screened using a questionnaire and through an intake interview. Eligible participants are randomized by placing them into a web-based iCBT group, app-based iCBT group, or a waitlist control (WLC) group. Participants in the WLC group are assigned to the app-based program upon completion of the service of the 2 experimental groups. Measurements of social anxiety, depression and anxiety symptoms, psychological distress, automatic thoughts, and quality of life are administered at pretest, posttest, and 3- and 6-month follow-ups. Multivariate ANOVA with repeated measures will be performed to determine the intervention effectiveness on the continuous variables over time. Results: Participant recruitment commenced in January 2021. As of February 2023, a total of 1811 individuals applied for the Ease Online program. In total, 401 intake interviews have been completed, and 329 eligible participants have joined the program, among whom 166 have completed the service. Data collection is still ongoing, which is expected to be completed in March 2024. Conclusions: This study is the first of its kind in combining iCBT and VRET for the treatment of SAD in Hong Kong. At a theoretical level, this study contributes to the development and evaluation of internet-based psychological interventions in Hong Kong. At a practical level, the Ease Online program may serve as an alternative service option for SAD clients in Hong Kong if proven effective. Trial Registration: ClinicalTrials.gov NCT04995913; https://clinicaltrials.gov/study/NCT04995913 International Registered Report Identifier (IRRID): DERR1-10.2196/48437 %M 37707944 %R 10.2196/48437 %U https://www.researchprotocols.org/2023/1/e48437 %U https://doi.org/10.2196/48437 %U http://www.ncbi.nlm.nih.gov/pubmed/37707944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44016 %T Web-Based Self-Compassion Training to Improve the Well-Being of Youth With Chronic Medical Conditions: Randomized Controlled Trial %A Finlay-Jones,Amy Louise %A Parkinson,Asha %A Sirois,Fuschia %A Perry,Yael %A Boyes,Mark %A Rees,Clare S %+ Youth Mental Health Team, Telethon Kids Institute, 15 Hospital Avenue, Nedlands, 6009, Australia, 61 08 63191808, Amy.Finlay-Jones@telethonkids.org.au %K self-compassion %K chronic illness %K adolescent psychology %K mental health %K digital interventions %K internet %K well-being %K mobile phone %D 2023 %7 13.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Up to one-third of young people live with chronic physical conditions (eg, diabetes, asthma, and autoimmune disease) that frequently involve recurrent pain, fatigue, activity limitations, stigma, and isolation. These issues may be exacerbated as young people transition through adolescence. Accordingly, young people with chronic illness are at a high risk of psychological distress. Accessible, evidence-based interventions for young people with chronic illnesses are urgently needed to improve well-being, support adaptation, and enhance daily functioning. Self-compassion, which is an adaptive means of relating to oneself during times of difficulty, is a promising intervention target for this population. Objective: This study aims to test the efficacy of a 4-week, self-guided, web-based self-compassion training program for improving well-being among young Australians (aged 16-25 years) living with a chronic medical condition. The primary outcomes were self-compassion, emotion regulation difficulties, and coping; the secondary outcomes were well-being, distress, and quality of life. We also sought to test whether changes in primary outcomes mediated changes in secondary outcomes and gather feedback about the strengths and limitations of the program. Methods: We conducted a single-blind, parallel-group, randomized controlled trial comparing a 4-week, fully automated, web-based self-compassion training program with a waitlist control. Participants were recruited via the internet, and outcomes were self-assessed at 4 (T1) and 12 weeks (T2) after the baseline time point via a web-based survey. A mixed methods approach was used to evaluate the program feedback. Results: Overall, 151 patients (age: mean 21.15, SD 2.77 years; female patients: n=132, 87.4%) were randomized to the intervention (n=76, 50.3%) and control (n=75, 49.7%) groups. The loss–to–follow-up rate was 47.4%, and program use statistics indicated that only 29% (22/76) of young people in the experimental group completed 100% of the program. The main reported barrier to completion was a lack of time. As anticipated, treatment effects were observed for self-compassion (P=.01; partial η2=0.05; small effect); well-being (P≤.001; partial η2=0.07; medium effect); and distress (P=.003; partial η2=0.054; small-medium effect) at the posttest time point and maintained at follow-up. Contrary to our hypotheses, no intervention effects were observed for emotion regulation difficulties or maladaptive coping strategies. Improvements in adaptive coping were observed at the posttest time point but were not maintained at follow-up. Self-compassion, but not emotion regulation difficulties or coping, mediated the improvements in well-being. Conclusions: Minimal-contact, web-based self-compassion training can confer mental health benefits on young people with chronic conditions. This group experiences substantial challenges to participation in mental health supports, and program engagement and retention in this trial were suboptimal. Future work should focus on refining the program content, engagement, and delivery to optimize engagement and treatment outcomes for the target group. Trial Registration: Australian New Zealand Clinical Trials Registry 12619000572167; https://tinyurl.com/5n6hevt International Registered Report Identifier (IRRID): RR2-10.1186/s12889-020-8226-7 %M 37703081 %R 10.2196/44016 %U https://www.jmir.org/2023/1/e44016 %U https://doi.org/10.2196/44016 %U http://www.ncbi.nlm.nih.gov/pubmed/37703081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46675 %T Cardiff Online Cognitive Assessment in a National Sample: Cross-Sectional Web-Based Study %A Lynham,Amy Joanne %A Jones,Ian R %A Walters,James T R %+ Division of Psychological Medicine, School of Medicine, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, United Kingdom, 44 2920688434, waltersjt@cardiff.ac.uk %K cognition %K digital assessment %K mental health %K mobile phone %K normative data %K web-based %K cognitive assessment %K CONCA %D 2023 %7 13.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychiatric disorders are associated with cognitive impairment. We have developed a web-based, 9-task cognitive battery to measure the core domains affected in people with psychiatric disorders. To date, this assessment has been used to collect data on a clinical sample of participants with psychiatric disorders. Objective: The aims of this study were (1) to establish a briefer version of the battery (called the Cardiff Online Cognitive Assessment [CONCA]) that can give a valid measure of cognitive ability (“g”) and (2) to collect normative data and demonstrate CONCA’s application in a health population sample. Methods: Based on 6 criteria and data from our previous study, we selected 5 out of the original 9 tasks to include in CONCA. These included 3 core tasks that were sufficient to derive a measure of “g” and 2 optional tasks. Participants from a web-based national cohort study (HealthWise Wales) were invited to complete CONCA. Completion rates, sample characteristics, performance distributions, and associations between cognitive performance and demographic characteristics and mental health measures were examined. Results: A total of 3679 participants completed at least one CONCA task, of which 3135 completed all 3 core CONCA tasks. Performance on CONCA was associated with age (B=–0.05, SE 0.002; P<.001), device (tablet computer: B=–0.26, SE 0.05; P<.001; smartphone: B=–0.46, SE 0.05; P<.001), education (degree: B=1.68, SE 0.14; P<.001), depression symptoms (B=–0.04, SE 0.01; P<.001), and anxiety symptoms (B=–0.04, SE 0.01; P<.001). Conclusions: CONCA provides a valid measure of “g,” which can be derived using as few as 3 tasks that take no more than 15 minutes. Performance on CONCA showed associations with demographic characteristics in the expected direction and was associated with current depression and anxiety symptoms. The effect of device on cognitive performance is an important consideration for research using web-based assessments. %M 37703073 %R 10.2196/46675 %U https://www.jmir.org/2023/1/e46675 %U https://doi.org/10.2196/46675 %U http://www.ncbi.nlm.nih.gov/pubmed/37703073 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49999 %T A Family-Based Mental Health Navigator Intervention for Youth in the Child Welfare System: Protocol for a Randomized Controlled Trial %A Tolou-Shams,Marina %A Ramaiya,Megan %A Lara Salas,Jannet %A Ezimora,Ifunanya %A Shumway,Martha %A Duerr Berrick,Jill %A Aguilera,Adrian %A Borsari,Brian %A Dauria,Emily %A Friedling,Naomi %A Holmes,Crystal %A Grandi,Adam %+ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 1001 Potrero Ave, San Francisco, CA, 94110, United States, 1 415 361 1081, megan.ramaiya@ucsf.edu %K randomized clinical trial %K foster care %K child welfare–involved youth %K navigator interventions %K digital health technology %K implementation science %K community engagement %D 2023 %7 12.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Youth in the child welfare system (child welfare–involved [CWI] youth) have high documented rates of mental health symptoms and experience significant disparities in mental health care services access and engagement. Adolescence is a developmental stage that confers increased likelihood of experiencing mental health symptoms and the emergence of disorders that can persist into adulthood. Despite a high documented need for evidence-based mental health services for CWI youth, coordination between child welfare and mental health service systems to increase access to care remains inadequate, and engagement in mental health services is low. Navigator models developed in the health care field to address challenges of service access, fragmentation, and continuity that affect the quality of care provide a promising approach to increase linkage to, and engagement in, mental health services for CWI youth. However, at present, there is no empirically supported mental health navigator model to address the unique and complex mental health needs of CWI youth and their families. Objective: Using a randomized controlled trial, this study aims to develop and test a foster care family navigator (FCFN) model to improve mental health service outcomes for CWI adolescents (aged 12-17 years). Methods: The navigator model leverages an in-person navigator and use of adjunctive digital health technology to engage with, and improve, care coordination, tracking, and monitoring of mental health service needs for CWI youth and families. In total, 80 caregiver-youth dyads will be randomized to receive either the FCFN intervention or standard of care (clinical case management services): 40 (50%) to FCFN and 40 (50%) to control. Qualitative exit interviews will inform the feasibility and acceptability of the services received during the 6-month period. The primary trial outcomes are mental health treatment initiation and engagement. Other pre- and postservice outcomes, such as proportion screened and time to screening, will also be evaluated. We hypothesize that youth receiving the FCFN intervention will have higher rates of mental health treatment initiation and engagement than youth receiving standard of care. Results: We propose enrollment of 80 dyads by March 2024, final data collection by September 2024, and the publication of main findings in March 2025. After final data analysis and writing of the results, the resulting manuscripts will be submitted to journals for dissemination. Conclusions: This study will be the first to produce empirically driven conclusions and recommendations for implementing a family mental health navigation model for CWI youth with long-standing and unaddressed disparities in behavioral health services access. The study findings have potential to have large-scale trial applicability and be feasible and acceptable for eventual system implementation and adoption. Trial Registration: ClinicalTrials.gov NCT04506437; https://www.clinicaltrials.gov/study/NCT04506437 International Registered Report Identifier (IRRID): DERR1-10.2196/49999 %M 37698896 %R 10.2196/49999 %U https://www.researchprotocols.org/2023/1/e49999 %U https://doi.org/10.2196/49999 %U http://www.ncbi.nlm.nih.gov/pubmed/37698896 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45170 %T A Digital System (YouXin) to Facilitate Self-Management by People With Psychosis in China: Protocol for a Nonrandomized Validity and Feasibility Study With a Mixed Methods Design %A Zhang,Xiaolong %A Lewis,Shôn %A Carter,Lesley-Anne %A Bucci,Sandra %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom, 44 161 306 0422, Sandra.Bucci@manchester.ac.uk %K psychosis %K self-management %K digital %K smartphone app %K eHealth %K mHealth %K China %D 2023 %7 12.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychosis is one of the most disabling mental health conditions and causes significant personal, social, and economic burden. Accurate and timely symptom monitoring is critical to offering prompt and time-sensitive clinical services. Digital health is a promising solution for the barriers encountered by conventional symptom monitoring approaches, including accessibility, the ecological validity of assessments, and recall bias. However, to date, there has been no digital health technology developed to support self-management for people with psychosis in China. Objective: We report the study protocol to evaluate the validity, feasibility, acceptability, usability, and safety of a symptom self-monitoring smartphone app (YouXin; Chinese name 佑心) for people with psychosis in China. Methods: This is a nonrandomized validity and feasibility study with a mixed methods design. The study was approved by the University of Manchester and Beijing Anding Hospital Research Ethics Committee. YouXin is a smartphone app designed to facilitate symptom self-monitoring for people with psychosis. YouXin has 2 core functions: active monitoring of symptoms (ie, smartphone survey) and passive monitoring of behavioral activity (ie, passive data collection via embedded smartphone sensors). The development process of YouXin utilized a systematic coproduction approach. A series of coproduction consultation meetings was conducted by the principal researcher with service users and clinicians to maximize the usability and acceptability of the app for end users. Participants with psychosis aged 16 years to 65 years were recruited from Beijing Anding Hospital, Beijing, China. All participants were invited to use the YouXin app to self-monitor symptoms for 4 weeks. At the end of the 4-week follow-up, we invited participants to take part in a qualitative interview to explore the acceptability of the app and trial procedures postintervention. Results: Recruitment to the study was initiated in August 2022. Of the 47 participants who were approached for the study from August 2022 to October 2022, 41 participants agreed to take part in the study. We excluded 1 of the 41 participants for not meeting the inclusion criteria, leaving a total of 40 participants who began the study. As of December 2022, 40 participants had completed the study, and the recruitment was complete. Conclusions: This study is the first to develop and test a symptom self-monitoring app specifically designed for people with psychosis in China. If the study shows the feasibility of YouXin, a potential future direction is to integrate the app into clinical workflows to facilitate digital mental health care for people with psychosis in China. This study will inform improvements to the app, trial procedures, and implementation strategies with this population. Moreover, the findings of this trial could lead to optimization of digital health technologies designed for people with psychosis in China. International Registered Report Identifier (IRRID): DERR1-10.2196/45170 %M 37698905 %R 10.2196/45170 %U https://www.researchprotocols.org/2023/1/e45170 %U https://doi.org/10.2196/45170 %U http://www.ncbi.nlm.nih.gov/pubmed/37698905 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49240 %T Clinical Accuracy of Large Language Models and Google Search Responses to Postpartum Depression Questions: Cross-Sectional Study %A Sezgin,Emre %A Chekeni,Faraaz %A Lee,Jennifer %A Keim,Sarah %+ Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, 43205, United States, 1 614 722 3179, emre.sezgin@nationwidechildrens.org %K mental health %K postpartum depression %K health information seeking %K large language model %K GPT %K LaMDA %K Google %K ChatGPT %K artificial intelligence %K natural language processing %K generative AI %K depression %K cross-sectional study %K clinical accuracy %D 2023 %7 11.9.2023 %9 Research Letter %J J Med Internet Res %G English %X %M 37695668 %R 10.2196/49240 %U https://www.jmir.org/2023/1/e49240 %U https://doi.org/10.2196/49240 %U http://www.ncbi.nlm.nih.gov/pubmed/37695668 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45161 %T Digital Application of Clinical Staging to Support Stratification in Youth Mental Health Services: Validity and Reliability Study %A Chong,Min K %A Hickie,Ian B %A Cross,Shane P %A McKenna,Sarah %A Varidel,Mathew %A Capon,William %A Davenport,Tracey A %A LaMonica,Haley M %A Sawrikar,Vilas %A Guastella,Adam %A Naismith,Sharon L %A Scott,Elizabeth M %A Iorfino,Frank %+ Brain and Mind Centre, University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 291142199, min.chong@sydney.edu.au %K clinical staging %K digital health solution %K online diagnosis %K service transformation %K staged care %K stratified care %K youth mental health %D 2023 %7 8.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As the demand for youth mental health care continues to rise, managing wait times and reducing treatment delays are key challenges to delivering timely and quality care. Clinical staging is a heuristic model for youth mental health that can stratify care allocation according to individuals’ risk of illness progression. The application of staging has been traditionally limited to trained clinicians yet leveraging digital technologies to apply clinical staging could increase the scalability and usability of this model in services. Objective: The aim of this study was to validate a digital algorithm to accurately differentiate young people at lower and higher risk of developing mental disorders. Methods: We conducted a study with a cohort comprising 131 young people, aged between 16 and 25 years, who presented to youth mental health services in Australia between November 2018 and March 2021. Expert psychiatrists independently assigned clinical stages (either stage 1a or stage 1b+), which were then compared to the digital algorithm’s allocation based on a multidimensional self-report questionnaire. Results: Of the 131 participants, the mean age was 20.3 (SD 2.4) years, and 72% (94/131) of them were female. Ninety-one percent of clinical stage ratings were concordant between the digital algorithm and the experts’ ratings, with a substantial interrater agreement (κ=0.67; P<.001). The algorithm demonstrated an accuracy of 91% (95% CI 86%-95%; P=.03), a sensitivity of 80%, a specificity of 93%, and an F1-score of 73%. Of the concordant ratings, 16 young people were allocated to stage 1a, while 103 were assigned to stage 1b+. Among the 12 discordant cases, the digital algorithm allocated a lower stage (stage 1a) to 8 participants compared to the experts. These individuals had significantly milder symptoms of depression (P<.001) and anxiety (P<.001) compared to those with concordant stage 1b+ ratings. Conclusions: This novel digital algorithm is sufficiently robust to be used as an adjunctive decision support tool to stratify care and assist with demand management in youth mental health services. This work could transform care pathways and expedite care allocation for those in the early stages of common anxiety and depressive disorders. Between 11% and 27% of young people seeking care may benefit from low-intensity, self-directed, or brief interventions. Findings from this study suggest the possibility of redirecting clinical capacity to focus on individuals in stage 1b+ for further assessment and intervention. %M 37682588 %R 10.2196/45161 %U https://formative.jmir.org/2023/1/e45161 %U https://doi.org/10.2196/45161 %U http://www.ncbi.nlm.nih.gov/pubmed/37682588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47917 %T Predicting Youth and Young Adult Treatment Engagement in a Transdiagnostic Remote Intensive Outpatient Program: Latent Profile Analysis %A Gliske,Kate %A Berry,Katie R %A Ballard,Jaime %A Schmidt,Clare %A Kroll,Elizabeth %A Kohlmeier,Jonathan %A Killian,Michael %A Fenkel,Caroline %+ Charlie Health Inc, 233 E Main St, Ste 233, Bozeman, MT, 59715-5045, United States, 1 9523341411, kgliske@umn.edu %K youth %K young adult %K virtual %K mental health %K intensive outpatient treatment %K latent profile analysis %K personalized treatment %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The youth mental health crisis in the United States continues to worsen, and research has shown poor mental health treatment engagement. Despite the need for personalized engagement strategies, there is a lack of research involving youth. Due to complex youth developmental milestones, there is a need to better understand clinical presentation and factors associated with treatment engagement to effectively identify and tailor beneficial treatments. Objective: This quality improvement investigation sought to identify subgroups of clients attending a remote intensive outpatient program (IOP) based on clinical acuity data at intake, to determine the factors associated with engagement outcomes for clients who present in complex developmental periods and with cooccurring conditions. The identification of these subgroups was used to inform programmatic decisions within this remote IOP system. Methods: Data were collected as part of ongoing quality improvement initiatives at a remote IOP for youth and young adults. Participants included clients (N=2924) discharged between July 2021 and February 2023. A latent profile analysis was conducted using 5 indicators of clinical acuity at treatment entry, and the resulting profiles were assessed for associations with demographic factors and treatment engagement outcomes. Results: Among the 2924 participants, 4 profiles of clinical acuity were identified: a low-acuity profile (n=943, 32.25%), characterized by minimal anxiety, depression, and self-harm, and 3 high-acuity profiles defined by moderately severe depression and anxiety but differentiated by rates of self-harm (high acuity+low self-harm: n=1452, 49.66%; high acuity+moderate self-harm: n=203, 6.94%; high acuity+high self-harm: n=326, 11.15%). Age, gender, transgender identity, and sexual orientation were significantly associated with profile membership. Clients identified as sexually and gender-marginalized populations were more likely to be classified into high-acuity profiles than into the low-acuity profile (eg, for clients who identified as transgender, high acuity+low self-harm: odds ratio [OR] 2.07, 95% CI 1.35-3.18; P<.001; high acuity+moderate self-harm: OR 2.85, 95% CI 1.66-4.90; P<.001; high acuity+high self-harm: OR 3.67, 95% CI 2.45-5.51; P<.001). Race was unrelated to the profile membership. Profile membership was significantly associated with treatment engagement: youth and young adults in the low-acuity and high-acuity+low–self-harm profiles attended an average of 4 fewer treatment sessions compared with youth in the high-acuity+moderate–self-harm and high-acuity+high–self-harm profiles (ꭓ23=27.6, P<.001). Individuals in the high-acuity+low–self-harm profile completed treatment at a significantly lower rate relative to the other 2 high-acuity profiles (ꭓ23=13.4, P=.004). Finally, those in the high-acuity+high–self-harm profile were significantly less likely to disengage early relative to youth in all other profiles (ꭓ23=71.12, P<.001). Conclusions: This investigation represents a novel application for identifying subgroups of adolescents and young adults based on clinical acuity data at intake to identify patterns in treatment engagement outcomes. Identifying subgroups that differentially engage in treatment is a critical first step toward targeting engagement strategies for complex populations. %M 37676700 %R 10.2196/47917 %U https://formative.jmir.org/2023/1/e47917 %U https://doi.org/10.2196/47917 %U http://www.ncbi.nlm.nih.gov/pubmed/37676700 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49384 %T Satisfaction, Perceived Usefulness, and Therapeutic Alliance as Correlates of Participant Engagement in a Pediatric Digital Mental Health Intervention: Cross-Sectional Questionnaire Study %A Huffman,Landry %A Lawrence-Sidebottom,Darian %A Huberty,Jennifer %A Beatty,Clare %A Roots,Monika %A Roots,Kurt %A Parikh,Amit %A Guerra,Rachael %+ Bend Health Inc, 155 Windsor Ct, Athens, GA, 30606, United States, 1 7708619131, landry.huffman@bendhealth.com %K service satisfaction %K satisfaction %K patient-provider %K adolescent %K child %K children %K youth %K mental health %K perceived usefulness %K internet-based coaching %K coach %K coaching %K internet-based therapy %K collaborative care %K digital mental health intervention %K mental health %K engagement %D 2023 %7 6.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although evidence suggests that digital mental health interventions (DMHIs) are effective alternatives to traditional mental health care, participant engagement continues to be an issue, especially for pediatric DMHIs. Extant studies of DMHIs among adults suggest that participants’ satisfaction, perceived usefulness, and therapeutic alliance are closely tied to engagement. However, these associations have not been investigated among children and adolescents involved in DMHIs. Objective: To address these gaps in extant DMHI research, the purpose of this study was to (1) develop and implement a measure to assess satisfaction, perceived usefulness, and therapeutic alliance among children and adolescents participating in a DMHI and (2) investigate satisfaction, perceived usefulness, and therapeutic alliance as correlates of children’s and adolescents’ engagement in the DMHI. Methods: Members (children and adolescents) of a pediatric DMHI who had completed at least one session with a care provider (eg, coach or therapist) were eligible for inclusion in the study. Adolescent members and caregivers of children completed a survey assessing satisfaction with service, perceived usefulness of care, and therapeutic alliance with care team members. Results: This study provides evidence for the reliability and validity of an adolescent- and caregiver-reported user experience assessment in a pediatric DMHI. Moreover, our findings suggest that adolescents' and caregivers’ satisfaction and perceived usefulness are salient correlates of youths’ engagement with a DMHI. Conclusions: This study provides valuable preliminary evidence that caregivers’ satisfaction and perceived usefulness are salient correlates of youths’ engagement with a DMHI. Although further research is required, these findings offer preliminary evidence that caregivers play a critical role in effectively increasing engagement among children and adolescents involved in DMHIs. %M 37672321 %R 10.2196/49384 %U https://formative.jmir.org/2023/1/e49384 %U https://doi.org/10.2196/49384 %U http://www.ncbi.nlm.nih.gov/pubmed/37672321 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e42173 %T The Development of Game-Based Digital Mental Health Interventions: Bridging the Paradigms of Health Care and Entertainment %A Lukka,Lauri %A Palva,J Matias %+ Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2, Espoo, 02150, Finland, 358 440375666, lauri.lukka@aalto.fi %K digital mental health interventions %K development frameworks %K gamification %K game-based interventions %K intervention development %K mental health %K paradigms %K serious games %D 2023 %7 4.9.2023 %9 Viewpoint %J JMIR Serious Games %G English %X Game elements are increasingly used to improve user engagement in digital mental health interventions, and specific game mechanics may yield therapeutic effects per se and thereby contribute to digital mental health intervention efficacy. However, only a few commercial game–based interventions are available. We suggest that the key challenge in their development reflects the tension between the 2 underlying paradigms, health care and entertainment, which have disparate goals and processes in digital development. We describe 3 approaches currently used to negotiate the 2 paradigms: the gamification of health care software, designing serious games, and purpose shifting existing entertainment games. We advanced an integrative framework to focus attention on 4 key themes in intervention development: target audience, engagement, mechanisms of action, and health-related effectiveness. On each theme, we show how the 2 paradigms contrast and can complement each other. Finally, we consider the 4 interdependent themes through the new product development phases from concept to production. Our viewpoint provides an integrative synthesis that facilitates the research, design, and development of game-based digital mental health interventions. %M 37665624 %R 10.2196/42173 %U https://games.jmir.org/2023/1/e42173 %U https://doi.org/10.2196/42173 %U http://www.ncbi.nlm.nih.gov/pubmed/37665624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43719 %T One-Week Suicide Risk Prediction Using Real-Time Smartphone Monitoring: Prospective Cohort Study %A Barrigon,Maria Luisa %A Romero-Medrano,Lorena %A Moreno-Muñoz,Pablo %A Porras-Segovia,Alejandro %A Lopez-Castroman,Jorge %A Courtet,Philippe %A Artés-Rodríguez,Antonio %A Baca-Garcia,Enrique %+ Department of Psychiatry, Jimenez Diaz Foundation University Hospital, Av Reyes Católicos, 2, Madrid, 28040, Spain, 34 91 541 72 67, ebacgar2@yahoo.es %K e-health %K m-health %K Ecological Mometary Asssessment %K risk prediction %K sensor monitoring %K suicidal %K suicide attempt %K suicide %D 2023 %7 1.9.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a major global public health issue that is becoming increasingly common despite preventive efforts. Though current methods for predicting suicide risk are not sufficiently accurate, technological advances provide invaluable tools with which we may evolve toward a personalized, predictive approach. Objective: We aim to predict the short-term (1-week) risk of suicide by identifying changes in behavioral patterns characterized through real-time smartphone monitoring in a cohort of patients with suicidal ideation. Methods: We recruited 225 patients between February 2018 and March 2020 with a history of suicidal thoughts and behavior as part of the multicenter SmartCrisis study. Throughout 6 months of follow-up, we collected information on the risk of suicide or mental health crises. All participants underwent voluntary passive monitoring using data generated by their own smartphones, including distance walked and steps taken, time spent at home, and app usage. The algorithm constructs daily activity profiles for each patient according to these data and detects changes in the distribution of these profiles over time. Such changes are considered critical periods, and their relationship with suicide-risk events was tested. Results: During follow-up, 18 (8%) participants attempted suicide, and 14 (6.2%) presented to the emergency department for psychiatric care. The behavioral changes identified by the algorithm predicted suicide risk in a time frame of 1 week with an area under the curve of 0.78, indicating good accuracy. Conclusions: We describe an innovative method to identify mental health crises based on passively collected information from patients’ smartphones. This technology could be applied to homogeneous groups of patients to identify different types of crises. %M 37656498 %R 10.2196/43719 %U https://www.jmir.org/2023/1/e43719 %U https://doi.org/10.2196/43719 %U http://www.ncbi.nlm.nih.gov/pubmed/37656498 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46343 %T Seeking and Providing Social Support on Twitter for Trauma and Distress During the COVID-19 Pandemic: Content and Sentiment Analysis %A Esener,Yildiz %A McCall,Terika %A Lakdawala,Adnan %A Kim,Heejun %+ Department of Information Science, University of North Texas, 3940 North Elm, Suite E295G, Denton, TX, 76203, United States, 1 940 369 8285, heejun.kim@unt.edu %K COVID-19 %K social support %K trauma %K distress %K posttraumatic stress disorder %K PTSD %K Twitter %K social media %K mental health %D 2023 %7 31.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic can be recognized as a traumatic event that led to stressors, resulting in trauma or distress among the general population. Social support is vital in the management of these stressors, especially during a traumatic event, such as the COVID-19 pandemic. Because of the limited face-to-face interactions enforced by physical distancing regulations during the pandemic, people sought solace on social media platforms to connect with, and receive support from, one another. Hence, it is crucial to investigate the ways in which people seek and offer support on social media for mental health management. Objective: The research aimed to examine the types of social support (eg, emotional, informational, instrumental, and appraisal) sought and provided for trauma or distress on Twitter during the COVID-19 pandemic. In addition, this study aimed to gain insight into the difficulties and concerns of people during the pandemic by identifying the associations between terms representing the topics of interest related to trauma or distress and their corresponding sentiments. Methods: The study methods included content analysis to investigate the type of social support people sought for trauma or distress during the pandemic. Sentiment analysis was also performed to track the negative and positive sentiment tweets posted between January 1, 2020, and March 15, 2021. Association rule mining was used to uncover associations between terms and sentiments in tweets. In addition, the research used Kruskal-Wallis and Mann-Whitney U tests to determine whether the retweet count and like count varied based on the social support type. Results: Most Twitter users who indicated trauma or distress sought emotional support. Regarding sentiment, Twitter users mostly posted negative sentiment tweets, particularly in January 2021. An intriguing observation was that wearing masks could trigger and exacerbate trauma or distress. The results revealed that people mostly sought and provided emotional support on Twitter regarding difficulties with wearing masks, mental health status, financial hardships, and treatment methods for trauma or distress. In addition, tweets regarding emotional support received the most endorsements from other users, highlighting the critical role of social support in fostering a sense of community and reducing the feelings of isolation during the pandemic. Conclusions: This study demonstrates the potential of social media as a platform to exchange social support during challenging times and to identify the specific concerns (eg, wearing masks and exacerbated symptoms) of individuals with self-reported trauma or distress. The findings provide insights into the types of support that were most beneficial for those struggling with trauma or distress during the pandemic and may inform policy makers and health organizations regarding better practices for pandemic response and special considerations for groups with a history of trauma or distress. %M 37651178 %R 10.2196/46343 %U https://www.jmir.org/2023/1/e46343 %U https://doi.org/10.2196/46343 %U http://www.ncbi.nlm.nih.gov/pubmed/37651178 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47126 %T Culturally Adapting an Internet-Delivered Mindfulness Intervention for Indonesian University Students Experiencing Psychological Distress: Mixed Methods Study %A Listiyandini,Ratih Arruum %A Andriani,Annisa %A Kusristanti,Chandradewi %A Moulds,Michelle %A Mahoney,Alison %A Newby,Jill M %+ School of Psychology, Faculty of Science, University of New South Wales, Mathews Building, Entry Via Gate 11 Botany Street, Sydney, 2052, Australia, 61 2 9385 3041, r.listiyandini@unsw.edu.au %K psychological distress %K mindfulness %K cultural adaptation %K internet-delivered %K students %K Indonesia %K mobile phone %D 2023 %7 31.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychological distress is prevalent among university students. However, the availability of evidence-based mental health treatment remains limited in many low- and middle-income countries, including Indonesia. Internet-delivered, mindfulness-based interventions that reduce distress have potential for treating university student distress at scale. Unfortunately, evidence-based, internet-delivered mindfulness treatments are not yet available in Indonesia. Cultural adaptation of established evidence-based, internet-delivered mindfulness interventions is needed. Objective: In this paper, we describe the process of culturally adapting an Australian internet-delivered mindfulness program (Introduction to Mindfulness) to be relevant and appropriate for treating Indonesian university students’ psychological distress. Methods: To assist the cultural adaptation process, we used a systematic cultural adaptation framework and a mixed methods approach combining quantitative and qualitative methods. In study 1 (information gathering), we administered an internet-delivered questionnaire to Indonesian university students (n=248) to examine their preferences regarding an internet-delivered mindfulness intervention. In study 2 (preliminary design), a draft program was developed and independently reviewed by Indonesian stakeholders. Stakeholders (n=25) included local Indonesian mindfulness and mental health professionals (n=6) and university students (n=19), who were selected to maximize sample representativeness regarding personal and professional characteristics. To evaluate the initial design and cultural congruence of the internet-delivered mindfulness program in the Indonesian context, we conducted interviews and focus groups with stakeholders. Stakeholders also completed the Cultural Relevance Questionnaire. Results: In study 1, most Indonesian university students (240/248, 96.8%) reported openness to an internet-delivered mindfulness program. Most of interested students (127/240, 52.9%) preferred the length of the program to be 3 to 4 sessions, with 45.8% (110/240) preferring brief lessons taking only 15 to 30 minutes to complete. They (194/240, 80.8%) recommended that the program be accessible both through websites and mobile phones. In study 2, Indonesian stakeholders generally found the internet-delivered program to be highly culturally appropriate in terms of language, concepts, context, treatment goals, and depictions of students’ emotional and behavioral experiences. However, stakeholders also recommended some specific adaptations regarding the program’s delivery model (eg, combining visual and audio modalities when delivering psychoeducation), cultural components (eg, including more social and spiritual activities), program practicality (eg, including rewards to promote engagement), and design elements (eg, including additional culturally relevant illustrations). Following stakeholder feedback, a new culturally adapted Indonesian internet-delivered mindfulness program called Program Intervensi Mindfulness Daring Mahasiswa Indonesia was created. Conclusions: This study highlights the process and importance of cultural adaptation of an evidence-based mindfulness treatment and demonstrates how this may be achieved for internet-delivered psychotherapy programs. We found that a culturally adapted internet-delivered mindfulness program was relevant for Indonesian students with some adjustments to the programs’ content and delivery. Future research is now needed to evaluate the clinical benefit of this program. %M 37651168 %R 10.2196/47126 %U https://formative.jmir.org/2023/1/e47126 %U https://doi.org/10.2196/47126 %U http://www.ncbi.nlm.nih.gov/pubmed/37651168 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44514 %T Multidimensional Internet Use, Social Participation, and Depression Among Middle-Aged and Elderly Chinese Individuals: Nationwide Cross-Sectional Study %A Du,Xiwang %A Liao,Jiazhi %A Ye,Qing %A Wu,Hong %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Qiaokou District, Wuhan, , China, 86 13277942186, hongwu@hust.edu.cn %K internet use %K depression %K social participation %K middle-aged and elderly Chinese %K RIDL %D 2023 %7 30.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: There is growing evidence that the internet has beneficial effects on the mental health of middle-aged and older people (≥45 years), but the evidence is inconclusive, and the underlying mechanisms are less known. Objective: This study aims to explore the relationship between multidimensional (devices, frequency, and purpose) internet use and depression in middle-aged and elderly Chinese, as well as the mediating effect of social participation. Moreover, this study will explore the moderating effect of the regional informatization development level (RIDL) on the relationships between individual internet use, social participation, and depression. Methods: Data on 17,676 participants aged 45 years or older were obtained from the China Health and Retirement Longitudinal Study (CHARLS) 2018 data set. The 10-item Center for Epidemiologic Studies Depression Scale (CES-D-10) was used to identify the presence of depression. Logistic regression was used to explore the relationship between each dimension of internet use and depression. Multiple linear regression was used to explore the mediating effect of social participation and the moderating effect of the RIDL. Results: The results showed that 28.33% (5008/17,676) of the total population had depression. In terms of regional subgroups, respondents living in the western region exhibited the highest proportion of depression (2041/5884, 34.69%). Internet use was negatively associated with depression (odds ratio 0.613, 95% CI 0.542-0.692; P<.001). Various dimensions of internet use positively contributed to individual social participation and reduced individual depression (devices: β=–.170, 95% CI –0.209 to –0.127; frequency: β=–.065, 95% CI –0.081 to –0.047; and purpose: β=–.043, 95% CI –0.053 to –0.031). In addition, the RIDL weakened the relationship between individual-level internet use and social participation (internet use: F74.12,9.82=7.55, P<.001; devices: F51.65/9.88=5.23, P=.005; frequency: F66.74/10.08=6.62, P=.001; and purpose: F66.52/9.78=6.80, P=.001), and negatively moderated the relationship between the frequency of internet use and depression (frequency: F662.67/188.79=3.51, P=.03). Conclusions: This study found that different dimensions of internet use are associated with lower levels of depression. Social participation partially mediates the association between multidimensional internet use and depression in the eastern, central, and western regions, respectively. Additionally, the RIDL helps individuals further their internet use and social participation, reducing the impact of depression. However, this effect weakens sequentially from the western region to the central region and then to the eastern region. %M 37647119 %R 10.2196/44514 %U https://www.jmir.org/2023/1/e44514 %U https://doi.org/10.2196/44514 %U http://www.ncbi.nlm.nih.gov/pubmed/37647119 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e49364 %T Evaluating the Effectiveness of a Codeveloped e-Mental Health Intervention for University Students: Protocol for a Randomized Controlled Trial %A Wang,Angel Y %A Vereschagin,Melissa %A Richardson,Chris G %A Xie,Hui %A Hudec,Kristen L %A Munthali,Richard J %A Munro,Lonna %A Leung,Calista %A Kessler,Ronald C %A Vigo,Daniel V %+ Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T2A1, Canada, 1 6048228048, daniel.vigo@ubc.ca %K mental health %K substance use %K college students %K digital interventions %K randomized controlled trial %K mobile phone %D 2023 %7 30.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: University life typically occurs during a period of life transition, where the incidence of mental health and substance use problems and disorders peaks. However, relatively few students obtain effective treatment and support. e-Interventions have proven effective in improving the psychological outcomes of university students and have the potential to provide scalable services that can easily integrate into existing models of care. Minder is a mobile app codeveloped with university students that offers users a collection of evidence-based interventions tailored to help university students maintain their mental health and well-being and manage their substance use. Objective: This paper describes the protocol for a randomized controlled trial (RCT) that aims to assess the effectiveness of the Minder app in improving the mental health and substance use outcomes of university students. Methods: This study is a 2-arm, parallel assignment, single-blinded, 30-day RCT with 1 intervention group and 1 waitlist control group. Overall, 1496 (748 per trial arm) university students from the University of British Columbia Vancouver Campus (N=54,000) who are aged ≥17 years, have a smartphone with Wi-Fi or cellular data, and speak English will be recruited via a variety of web-based and offline strategies. Participants will be randomized into the intervention or control group after completing a baseline survey. Those randomized into the intervention group will gain immediate access to the Minder app and will be assessed at 2 weeks and 30 days. Those randomized into the control group will be given access to the app content after their follow-up assessment at 30 days. The primary outcomes are measured from baseline to follow-up at 30 days and include changes in general anxiety symptomology, depressive symptomology, and alcohol consumption risk measured by the General Anxiety Disorder 7-Item scale, Patient Health Questionnaire 9-Item scale, and US Alcohol Use Disorders Identification Test-Consumption Scale, respectively. Secondary outcomes include measures related to changes in the frequency of substance use, mental well-being, self-efficacy in managing mental health and substance use, readiness to change, and self-reported use of mental health services and supports (including referral) from baseline to follow-up at 30 days. Results: Trial recruitment and data collection began in September 2022, and the completion of data collection for the trial is anticipated by June 2023. As of May 10, 2023, a total of 1425 participants have been enrolled. Conclusions: The RCT described in this protocol paper will assess whether the Minder app is effective in improving the mental health and substance use outcomes of a general population of Canadian university students. Additional secondary outcome research aims to explore additional outcomes of interest for further research and better understand how to support students’ general mental well-being. Trial Registration: ClinicalTrials.gov NCT05606601; https://clinicaltrials.gov/ct2/show/NCT05606601 International Registered Report Identifier (IRRID): DERR1-10.2196/49364 %M 37647105 %R 10.2196/49364 %U https://www.researchprotocols.org/2023/1/e49364 %U https://doi.org/10.2196/49364 %U http://www.ncbi.nlm.nih.gov/pubmed/37647105 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44000 %T Effects of Web-Based Mindfulness-Based Interventions on Anxiety, Depression, and Stress Among Frontline Health Care Workers During the COVID-19 Pandemic: Systematic Review and Meta-Analysis %A Yang,Jia-ming %A Ye,Hua %A Long,Yi %A Zhu,Qiang %A Huang,Hui %A Zhong,Yan-biao %A Luo,Yun %A Yang,Lei %A Wang,Mao-yuan %+ Department of Rehabilitation Medicine, First Affiliated Hospital of Gannan Medical University, 128 Jinling Road, Zhanggong District, Ganzhou City, Jiangxi Province, Ganzhou, 341000, China, 86 13767766152, wmy.gmu.kf@gmail.com %K web-based %K mindfulness-based intervention %K COVID-19 %K health care worker %K mental disorder %D 2023 %7 29.8.2023 %9 Review %J J Med Internet Res %G English %X Background: Since 2019, the COVID-19 outbreak has spread around the world, and health care workers, as frontline workers, have faced tremendous psychological stress. Objective: The purpose of this study is to explore whether web-based mindfulness-based interventions continue to have a positive impact on anxiety, depression, and stress among health care workers during the COVID-19 pandemic. Methods: The inclusion criteria were as follows: (1) participants were frontline health care workers during the COVID-19 pandemic; (2) the experimental group was a web-based mindfulness-based intervention; (3) the control group used either general psychological intervention or no intervention; (4) outcome indicators included scales to assess anxiety, depression, and stress; and (5) the study type was a randomized controlled study. Studies that did not meet the above requirements were excluded. We searched 9 databases, including Web of Science, Embase, PubMed, Cochrane Library, Scopus, ScienceDirect, SinoMed, China National Knowledge Infrastructure (CNKI), and Wanfang Database, for randomized controlled studies on the effects of web-based mindfulness-based interventions on common mental disorder symptoms among health care workers from January 1, 2020, to October 20, 2022. The methodological quality of the included studies was assessed using the Physiotherapy Evidence Database scale. The Cochrane risk of bias tool was used to assess the risk of bias. Subgroup analysis was used to look for sources of heterogeneity and to explore whether the results were the same for subgroups under different conditions. Sensitivity analysis was used to verify the stability of the pooled results. Results: A total of 10 randomized controlled studies with 1311 participants were included. The results showed that web-based mindfulness-based interventions were effective in reducing the symptoms of anxiety (standard mean difference [SMD]=–0.63, 95% CI –0.96 to –0.31, P<.001, I2=87%), depression (SMD=–0.52, 95% CI –0.77 to –0.26, P<.001, I2=75%), and stress (SMD=–0.20, 95% CI –0.35 to –0.05, P=.01, I2=58%) among health care workers during the COVID-19 pandemic, but with wide CIs and high heterogeneity. Conclusions: Web-based mindfulness-based interventions may be effective in reducing the symptoms of anxiety, depression, and stress among frontline health care workers during the COVID-19 pandemic. However, this effect is relatively mild and needs to be further explored by better studies in the future. Trial Registration: PROSPERO CRD42022343727; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=343727 %M 37527546 %R 10.2196/44000 %U https://www.jmir.org/2023/1/e44000 %U https://doi.org/10.2196/44000 %U http://www.ncbi.nlm.nih.gov/pubmed/37527546 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42541 %T Evaluating the Effectiveness of Apps Designed to Reduce Mobile Phone Use and Prevent Maladaptive Mobile Phone Use: Multimethod Study %A Rahmillah,Fety Ilma %A Tariq,Amina %A King,Mark %A Oviedo-Trespalacios,Oscar %+ Faculty of Technology, Policy and Management, Delft University of Technology, Jaffalaan 5, Delft, 2628 BX, Netherlands, 31 15 2783887, O.OviedoTrespalacios@tudelft.nl %K mobile phone %K maladaptive mobile phone use %K apps %K features %K problematic phone use %D 2023 %7 29.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps are a popular strategy for reducing mobile phone use and preventing maladaptive mobile phone use (MMPU). Previous research efforts have been made to understand the features of apps that have the potential to reduce mobile phone use and MMPU. However, there has been a lack of a comprehensive examination of the effectiveness of such apps and their features. Objective: This paper investigated existing apps designed to reduce mobile phone use and prevent MMPU and examined the evidence of their effectiveness. The research aimed to provide a comprehensive analysis of app features that can reduce mobile phone use and MMPU, while also assessing their effectiveness. In addition, we explored users’ perceptions of these apps and the various features the apps offer to understand potential adoption issues and identify opportunities. Methods: This study used 3 methods: a review of scientific evidence, content analysis, and sentiment analysis. Results: Our study comprehensively examine the common features of 13 apps designed to reduce mobile phone use. We extracted and classified the features into 7 types: self-tracking, social tracking, goal setting, blocking, gamification, simplification, and assessment. The effectiveness of these apps in reducing mobile phone use and MMPU varied from weak to strong. On the basis of content analysis, self-tracking and goal setting were the most frequently used features, whereas gamification and assessment were used the least frequently. The intervention strategies that effectively reduce mobile phone use and MMPU included using grayscale mode, app limit features, and mixed interventions. Overall, users tended to accept these apps, as indicated by sentiment scores ranging from 61 to 86 out of 100. Conclusions: This study demonstrates that app-based management has the potential to reduce mobile phone use and MMPU. However, further research is required to evaluate the effectiveness of app-based interventions. Collaborations among researchers, app developers, mobile phone manufacturers, and policy makers could enhance the process of delivering, evaluating, and optimizing apps aimed at reducing mobile phone use and MMPU. %M 37643002 %R 10.2196/42541 %U https://www.jmir.org/2023/1/e42541 %U https://doi.org/10.2196/42541 %U http://www.ncbi.nlm.nih.gov/pubmed/37643002 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e42415 %T Stress Management Apps: Systematic Search and Multidimensional Assessment of Quality and Characteristics %A Paganini,Sarah %A Meier,Evelyn %A Terhorst,Yannik %A Wurst,Ramona %A Hohberg,Vivien %A Schultchen,Dana %A Strahler,Jana %A Wursthorn,Max %A Baumeister,Harald %A Messner,Eva-Maria %+ Department of Sport Psychology, Institute of Sports and Sport Science, University of Freiburg, Sandfangweg 4, Freiburg, 79102, Germany, 49 76120345, sarah.paganini@sport.uni-freiburg.de %K stress management %K mobile app %K mHealth %K mobile health %K quality assessment %K review %K evidence base %K availability %D 2023 %7 29.8.2023 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Chronic stress poses risks for physical and mental well-being. Stress management interventions have been shown to be effective, and stress management apps (SMAs) might help to transfer strategies into everyday life. Objective: This review aims to provide a comprehensive overview of the quality and characteristics of SMAs to give potential users or health professionals a guideline when searching for SMAs in common app stores. Methods: SMAs were identified with a systematic search in the European Google Play Store and Apple App Store. SMAs were screened and checked according to the inclusion criteria. General characteristics and quality were assessed by 2 independent raters using the German Mobile Application Rating Scale (MARS-G). The MARS-G assesses quality (range 1 to 5) on the following four dimensions: (1) engagement, (2) functionality, (3) esthetics, and (4) information. In addition, the theory-based stress management strategies, evidence base, long-term availability, and common characteristics of the 5 top-rated SMAs were assessed and derived. Results: Of 2044 identified apps, 121 SMAs were included. Frequently implemented strategies (also in the 5 top-rated SMAs) were psychoeducation, breathing, and mindfulness, as well as the use of monitoring and reminder functions. Of the 121 SMAs, 111 (91.7%) provided a privacy policy, but only 44 (36.4%) required an active confirmation of informed consent. Data sharing with third parties was disclosed in only 14.0% (17/121) of the SMAs. The average quality of the included apps was above the cutoff score of 3.5 (mean 3.59, SD 0.50). The MARS-G dimensions yielded values above this cutoff score (functionality: mean 4.14, SD 0.47; esthetics: mean 3.76, SD 0.73) and below this score (information: mean 3.42, SD 0.46; engagement: mean 3.05, SD 0.78). Most theory-based stress management strategies were regenerative stress management strategies. The evidence base for 9.1% (11/121) of the SMAs could be identified, indicating significant group differences in several variables (eg, stress or depressive symptoms) in favor of SMAs. Moreover, 38.0% (46/121) of the SMAs were no longer available after a 2-year period. Conclusions: The moderate information quality, scarce evidence base, constraints in data privacy and security features, and high volatility of SMAs pose challenges for users, health professionals, and researchers. However, owing to the scalability of SMAs and the few but promising results regarding their effectiveness, they have a high potential to reach and help a broad audience. For a holistic stress management approach, SMAs could benefit from a broader repertoire of strategies, such as more instrumental and mental stress management strategies. The common characteristics of SMAs with top-rated quality can be used as guidance for potential users and health professionals, but owing to the high volatility of SMAs, enhanced evaluation frameworks are needed. %M 37642999 %R 10.2196/42415 %U https://mhealth.jmir.org/2023/1/e42415 %U https://doi.org/10.2196/42415 %U http://www.ncbi.nlm.nih.gov/pubmed/37642999 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e47183 %T Acceptability and Utility of a Smartphone App to Support Adolescent Mental Health (BeMe): Program Evaluation Study %A Prochaska,Judith J %A Wang,Yixin %A Bowdring,Molly A %A Chieng,Amy %A Chaudhary,Neha P %A Ramo,Danielle E %+ Stanford Prevention Research Center, Department of Medicine, Stanford University, 3180 Porter Drive Room A105, Palo Alto, CA, 94304-1212, United States, 1 650 724 3608, jpro@stanford.edu %K adolescents %K mobile app %K depression %K anxiety %K resilience %K digital intervention %K digital mental health %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescents face unprecedented mental health challenges, and technology has the opportunity to facilitate access and support digitally connected generations. The combination of digital tools and live human connection may hold particular promise for resonating with and flexibly supporting young people’s mental health. Objective: This study aimed to describe the BeMe app-based platform to support adolescents’ mental health and well-being and to examine app engagement, usability, and satisfaction. Methods: Adolescents in the United States, aged 13 to 20 years, were recruited via the web and enrolled between September 1 and October 31, 2022. App engagement, feature use, clinical functioning, and satisfaction with BeMe were examined for 30 days. BeMe provides content based on cognitive behavioral therapy, dialectical behavior therapy, motivational interviewing, and positive psychology; interactive activities; live text-based coaching; links to clinical services; and crisis support tools (digital and live). Results: The average age of the sample (N=13,421) was 15.04 (SD 1.7) years, and 56.72% (7612/13,421) identified with she/her pronouns. For the subsample that completed the in-app assessments, the mean scores indicated concern for depression (8-item Patient Health Questionnaire mean 15.68/20, SD 5.9; n=239), anxiety (7-item Generalized Anxiety Disorder Questionnaire mean 13.37/17, SD 5.0; n=791), and poor well-being (World Health Organization–Five Well-being Index mean 30.15/100, SD 16.1; n=1923). Overall, the adolescents engaged with BeMe for an average of 2.38 (SD 2.7) days in 7.94 (SD 24.1) sessions and completed 11.26 (SD 19.8) activities. Most adolescents engaged with BeMe’s content (12,270/13,421, 91.42%), mood ratings (13,094/13,421, 97.56%), and interactive skills (10,098/13,421, 75.24%), and almost one-fifth of the adolescents engaged with coaching (2539/13,421, 18.92%), clinical resources (2411/13,421, 17.96%), and crisis support resources (2499/13,421, 18.62%). Overall app engagement (total activities) was highest among female and gender-neutral adolescents compared with male adolescents (all P<.001) and was highest among younger adolescents (aged 13-14 years) compared with all other ages (all P<.001). Satisfaction ratings were generally high for content (eg, 158/176, 89.8% rated as helpful and 1044/1139, 91.66% improved coping self-efficacy), activities (5362/8468, 63.32% helpful and 4408/6072, 72.6% useful in coping with big feelings), and coaching (747/894, 83.6% helpful and 747/894, 83.6% improved coping self-efficacy). Engagement (total activities completed) predicted the likelihood of app satisfaction (P<.001). Conclusions: Many adolescents downloaded the BeMe app and completed multiple sessions and activities. Engagement with BeMe was higher among female and younger adolescents. Ratings of BeMe’s content, activities, and coaching were very positive for cognitive precursors aimed at reducing depression and anxiety and improving well-being. The findings will inform future app development to promote more sustained engagement, and future evaluations will assess the effects of BeMe on changes in mental health outcomes. %M 37639293 %R 10.2196/47183 %U https://mhealth.jmir.org/2023/1/e47183 %U https://doi.org/10.2196/47183 %U http://www.ncbi.nlm.nih.gov/pubmed/37639293 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46508 %T Evaluating a Smartphone App (MeT4VeT) to Support the Mental Health of UK Armed Forces Veterans: Feasibility Randomized Controlled Trial %A Parkes,Steven %A Croak,Bethany %A Brooks,Samantha K %A Stevelink,Sharon A M %A Leightley,Daniel %A Fear,Nicola T %A Rafferty,Laura %A Greenberg,Neil %+ King’s Centre for Military Health Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, 10 Cutcombe Road, London, SE5 9RJ, United Kingdom, 44 0207848 ext 5335, steven.j.parkes@kcl.ac.uk %K military %K veteran %K mental health %K military to civilian transition %K digital health %K mobile apps %K smartphone %K mobile phone %K mobile health %K mHealth %K digital intervention %K support %K app %K feasibility %K acceptability %K engagement %K usability %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Previous research demonstrates that less than 50% of military veterans experiencing mental health difficulties seek formal support. Veterans often struggle to identify problems as mental health difficulties. In addition, they may fail to recognize the need for support before reaching a crisis point and face difficulties navigating care pathways to access support. Objective: A feasibility trial was conducted to assess a novel digital smartphone app (Mental Health Toolkit for Veterans Project [MeT4VeT]) for UK Armed Forces (UKAF) veterans experiencing mental health difficulties. The trial aimed to explore the feasibility and acceptability of trial procedures for a later randomized controlled trial (RCT) and to assess the acceptability of the MeT4VeT app. Methods: Participants were recruited at UK military medical centers, by advertising on social media, and through veteran third-sector organizations between February and November 2021, and assessed for eligibility (male, owned a smartphone, served at least 2 years in the UKAF, left the UKAF within the last 2 years, not undertaking formal mental health treatment). Eligible participants were assigned, on a 1:1 ratio, to either the intervention group (full app) or a control group (noninteractive app with signposting information). Three key objectives were determined a priori to assess the practicality of running an RCT including an assessment of recruitment and retention, evaluation of the technical app delivery and measurement processes, and acceptability and usability of the intervention. Results: In total, 791 individuals completed the participant information sheet, of which 261 (33%) were ineligible, 377 (48%) declined or were unable to be contacted for consent, and 103 (13%) did not download the app or complete the baseline measures. Of this, 50 participants completed baseline measures and were randomly assigned to the intervention group (n=24) or the control group (n=26). The trial was effective at enabling both the technical delivery of the intervention and collection of outcome measures, with improvements in mental health demonstrated for the intervention group from baseline to the 3-month follow-up. Recruitment and retention challenges were highlighted with only 50 out of the 530 eligible participants enrolled in the trial. The acceptability and usability of the MeT4VeT app were generally supported, and it was reported to be a useful, accessible way for veterans to monitor and manage their mental health. Conclusions: The results highlighted that further work is needed to refine recruitment processes and maintain engagement with the app. Following this, an RCT can be considered to robustly assess the ability of the app to positively affect mental health outcomes indicated within this trial. Trial Registration: ClinicalTrials.gov NCT05993676; https://clinicaltrials.gov/ct2/show/NCT05993676 %M 37639295 %R 10.2196/46508 %U https://mental.jmir.org/2023/1/e46508 %U https://doi.org/10.2196/46508 %U http://www.ncbi.nlm.nih.gov/pubmed/37639295 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 9 %N %P e38515 %T Smartphone-Based Psychotherapeutic Interventions in Blended Care of Cancer Survivors: Nested Randomized Clinical Trial %A Meinlschmidt,Gunther %A Grossert,Astrid %A Meffert,Cornelia %A Roemmel,Noa %A Hess,Viviane %A Rochlitz,Christoph %A Pless,Miklos %A Hunziker,Sabina %A Wössmer,Brigitta %A Geuter,Ulfried %A Schaefert,Rainer %+ Department of Psychosomatic Medicine, University Hospital Basel, Hebelstrasse 2, Basel, 4031, Switzerland, 41 61 328 63 10, gunther.meinlschmidt@unibas.ch %K digital therapeutics %K ecological momentary assessment (EMA) %K ecological momentary intervention (EMI) %K internet- and mobile-based intervention %K microintervention %K neoplasm %K smartphone-based intervention %K postcancer treatment %K body psychotherapy %K mobile phone %D 2023 %7 28.8.2023 %9 Original Paper %J JMIR Cancer %G English %X Background: Cancer is related to not only physical but also mental suffering. Notably, body image disturbances are highly relevant to cancer-related changes often persisting beyond recovery from cancer. Scalable and low-barrier interventions that can be blended with face-to-face psychotherapy for cancer survivors are highly warranted. Objective: The aim of the study is to investigate whether smartphone-based bodily interventions are more effective to improve the mood of patients with cancer than smartphone-based fairy tale interventions (control intervention). Methods: We recruited patients with cancer in 2 Swiss hospitals and conducted daily, fully automated smartphone-based interventions 6 times a week for 5 consecutive weeks, blended with weekly face-to-face group body psychotherapy. We applied 2 types of smartphone-based interventions using a within-subject design, randomly assigning patients daily to either bodily interventions or fairy tales. Each intervention type was presented 3 times a week. For this secondary analysis, 3-level mixed models were estimated with mood assessed by the 3 Multidimensional Mood Questionnaire subscales for good-bad mood, wakefulness, and calmness as key indicators. In addition, the effects on experience of presence, vitality, and burden assessed with visual analog scales were investigated. Results: Based on the data from s=732 interventions performed by 36 participants, good-bad mood improved (β=.27; 95% CI 0.062-0.483), and participants became calmer (β=.98; 95% CI 0.740-1.211) following smartphone-based interventions. Wakefulness did not significantly change from pre- to postsmartphone–based intervention (β=.17; 95% CI –0.081 to 0.412). This was true for both intervention types. There was no interaction effect of intervention type with change in good-bad mood (β=–.01; 95% CI –0.439 to 0.417), calmness (β=.22; 95% CI –0.228 to 0.728), or wakefulness (β=.14; 95% CI –0.354 to 0.644). Experience of presence (β=.34; 95% CI 0.271-0.417) and vitality (β=.35; 95% CI 0.268-0.426) increased from pre- to postsmartphone–based intervention, while experience of burden decreased (β=–0.40; 95% CI –0.481 to 0.311). Again, these effects were present for both intervention types. There were no significant interaction effects of intervention type with pre- to postintervention changes in experience of presence (β=.14; 95% CI –0.104 to 0.384), experience of vitality (β=.06; 95% CI –0.152 to 0.265), and experience of burden (β=–.16; 95% CI –0.358 to 0.017). Conclusions: Our results suggest that both smartphone-based audio-guided bodily interventions and fairy tales have the potential to improve the mood of cancer survivors. Trial Registration: ClinicalTrials.gov NCT03707548; https://clinicaltrials.gov/study/NCT03707548 International Registered Report Identifier (IRRID): RR2-10.1186/s40359-019-0357-1 %M 37639296 %R 10.2196/38515 %U https://cancer.jmir.org/2023/1/e38515 %U https://doi.org/10.2196/38515 %U http://www.ncbi.nlm.nih.gov/pubmed/37639296 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e51799 %T Digital Health Tools Can Support Patient Access to Culturally and Linguistically Competent Behavioral Health Treatment %A Berger,Mitchell %+ US Department of Health and Human Services, 5600 Fishers Lane, Rockville, MD, 200857, United States, 1 5712177722, mazruia@hotmail.com %K African American %K women %K depression %K telemedicine %K mobile health %K mHealth %K mobile apps %K digital health %K mental health %K gender minority %K mobile technology %K mobile phone %D 2023 %7 25.8.2023 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 37624636 %R 10.2196/51799 %U https://www.jmir.org/2023/1/e51799 %U https://doi.org/10.2196/51799 %U http://www.ncbi.nlm.nih.gov/pubmed/37624636 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40227 %T The Impact of Cybervictimization on the Self-Management of Chronic Conditions: Lived Experiences %A Alhaboby,Zhraa A %A Evans,Hala %A Barnes,James %A Short,Emma %+ The Open University, School of Life, Health & Chemical Sciences, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908 65 ext 4987, zhraa.alhaboby@open.ac.uk %K chronic diseases %K biographical disruption %K long-term conditions %K self-management %K cybervictimization %K cyber abuse %K cyberbullying %K cyber harassment %K disability discrimination %K discrimination %K awareness %D 2023 %7 25.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Cybervictimization of people with long-term conditions is a disturbing phenomenon with a documented impact on health and well-being. These experiences are primarily examined using quantitative methods, focusing on children and young people. However, research centered on the cybervictimization of adults with chronic conditions is scarce, with limited qualitative input from the victims as experts in their own experiences. Objective: This study aims to understand the impact of cybervictimization on the self-management of long-term conditions among adults with chronic conditions and disabilities in the United Kingdom. Methods: This paper reports the findings from the qualitative phase of a phenomenologically informed mixed methods study. The biographical disruption concept was used to conceptualize the study. In-depth semistructured interviews were conducted with 13 participants with chronic conditions who experienced cybervictimization. A codebook was developed, and a zigzag approach to thematic analysis was used to define and refine themes. Ethical considerations and risk assessment were ongoing during the research process because of the sensitivity of the topic and cases of harassment. Results: Cybervictimization has direct and indirect impacts on the self-management of chronic conditions. This impact was verified across 6 overarching themes that emerged from this study. First, biomedical events included overall health deterioration because of existing conditions, new diagnoses, and subjective physical complaints. Second, the impact on mental health was perceived through psychological consequences and psychiatric disorders that developed after or during this traumatic experience. Third, the multilevel impact theme focused on disrupting the strategies for coping with health conditions and involved unplanned changes to victims’ health management priorities. Fourth, the impact of complexity reflected the perceived uniqueness in each case, intersectionality, struggle to obtain formal support, and subsequent health complications. Fifth, social network involvement comprised the effects of social isolation, victim blaming, and deception. Finally, the disability discrimination theme focused on prejudice, issues on inclusion, and hostility in society, with subsequent effects on well-being. Conclusions: People with long-term conditions experienced different forms of cybervictimization, all disruptive with various effects on health. Disability discrimination was a prominent finding to be further investigated. This paper reports the impact as themes to guide further research and practice, with the recognition that long-term conditions and impairments are not a homogeneous group. Despite the devastating consequences, there are positive points that strengthen potential interventions. Awareness-raising campaigns, training of support channels, and multidisciplinary research are recommended to tackle this issue and initiate change. %M 37624637 %R 10.2196/40227 %U https://www.jmir.org/2023/1/e40227 %U https://doi.org/10.2196/40227 %U http://www.ncbi.nlm.nih.gov/pubmed/37624637 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44742 %T Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study %A Atik,Ece %A Stricker,Johannes %A Schückes,Magnus %A Pittig,Andre %+ Clinical Psychology Research Group, Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Universitätsstr. 1, Düsseldorf, 40225, Germany, 49 211 81 10850, johannes.stricker@hhu.de %K blended cognitive behavioral therapy %K bCBT %K digital mental health %K e–mental health %K depression %K anxiety disorder %K video psychotherapy %K mobile phone %D 2023 %7 25.8.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Blended cognitive behavioral therapy (bCBT)—the combination of cognitive behavioral therapy and digital mental health applications—has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental health care services, for example, as an early intervention before the chronification of symptoms. However, further research on the efficacy and feasibility of integrated bCBT interventions is needed. Objective: This study aimed to evaluate the efficacy of a novel bCBT program comprising short (25 min), weekly face-to-face therapy sessions combined with a smartphone-based digital health app for treating mild to moderate symptoms of depression or anxiety. Methods: This prospective uncontrolled trial comprised 2 measurement points (before and after treatment) and 2 intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. On the basis of the primary symptoms, participants were assigned to either a depression intervention group (n=67 completers) or an anxiety intervention group (n=33 completers). Participants in each group received 6 weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health app. Results: The depression group displayed medium to large improvements in the symptoms of depression (Cohen d=−0.70 to −0.90; P<.001). The anxiety group experienced significant improvements in the symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder-7 scale with a large effect size (Cohen d=−0.80; P<.001) but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (Cohen d=−0.35; P=.06). In addition, both groups experienced significant improvements in their perceived self-efficacy (Cohen d=0.50; P<.001 in the depression group and Cohen d=0.71; P<.001 in the anxiety group) and quality of life related to psychological health (Cohen d=0.87; P<.001 in the depression group and Cohen d=0.40; P=.03 in the anxiety group). Work and social adjustment of patients improved significantly in the depression group (Cohen d=−0.49; P<.001) but not in the anxiety group (Cohen d=−0.06; P=.72). Patients’ mental health literacy improved in the anxiety group (Cohen d=0.45; P=.02) but not in the depression group (Cohen d=0.21; P=.10). Patient satisfaction with the bCBT program and ratings of the usability of the digital app were high in both treatment groups. Conclusions: This study provides preliminary evidence for the feasibility and efficacy of a novel brief bCBT intervention. The intervention effects were generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults. %M 37624631 %R 10.2196/44742 %U https://mental.jmir.org/2023/1/e44742 %U https://doi.org/10.2196/44742 %U http://www.ncbi.nlm.nih.gov/pubmed/37624631 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45963 %T Selective Prevention of Depression in Workers Using a Smartphone App: Randomized Controlled Trial %A Deady,Mark %A Collins,Daniel A J %A Lavender,Isobel %A Mackinnon,Andrew %A Glozier,Nicholas %A Bryant,Richard %A Christensen,Helen %A Harvey,Samuel B %+ Black Dog Institute, Faculty of Medicine and Health, University of New South Wales, Hospital Rd, Randwick, 2031, Australia, 61 02 9065 9144, m.deady@unsw.edu.au %K depression %K smartphone app %K workplace mental health %K randomized controlled trial %K prevention %K stress %K mobile phone %D 2023 %7 24.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: There is increasing evidence that depression can be prevented; however, universal approaches have had limited success. Appropriate targeting of interventions to at-risk populations has been shown to have potential, but how to selectively determine at-risk individuals remains unclear. Workplace stress is a risk factor for depression and a target for intervention, but few interventions exist to prevent depression among workers at risk due to heightened stress. Objective: This trial aimed to evaluate the efficacy of a smartphone-based intervention in reducing the onset of depression and improving related outcomes in workers experiencing at least moderate levels of stress. Methods: A randomized controlled trial was conducted with participants who were currently employed and reported no clinically significant depression and at least moderate stress. The intervention group (n=1053) were assigned Anchored, a 30-day self-directed smartphone app-based cognitive behavioral- and mindfulness-based intervention. The attention-control group (n=1031) were assigned a psychoeducation website. Assessment was performed via web-based self-report questionnaires at baseline and at 1-, 3-, and 6-month postbaseline time points. The primary outcome was new depression caseness aggregated over the follow-up period. The secondary outcomes included depressive and anxiety symptoms, stress, well-being, resilience, work performance, work-related burnout, and quality of life. Analyses were conducted within an intention-to-treat framework using mixed modeling. Results: There was no significant between-group difference in new depression caseness (z score=0.69; P=.49); however, those in the Anchored arm had significantly greater depressive symptom reduction at 1 month (Cohen d=0.02; P=.049) and 6 months (Cohen d=0.08; P=.03). Anchored participants also showed significantly greater reduction in anxiety symptoms at 1 month (Cohen d=0.07; P=.04) and increased work performance at 1 month (Cohen d=0.07; P=.008) and 6 months (Cohen d=0.13; P=.01), compared with controls. Notably, for Anchored participants completing at least two-thirds of the intervention, there was a significantly lower rate of depression onset (1.1%, 95% CI 0.0%-3.7%) compared with controls (9.0%, 95% CI 6.8%-12.3%) at 1 month (z score=4.50; P<.001). Significant small to medium effect sizes for most secondary outcomes were seen in the highly engaged Anchored users compared with controls, with effects maintained at the 6-month follow-up for depressive symptoms, well-being, stress, and quality of life. Conclusions: Anchored was associated with a small comparative reduction in depressive symptoms compared with controls, although selective prevention of case-level depression was not observed in the intention-to-treat analysis. When users adequately engaged with the app, significant findings pertaining to depression prevention, overall symptom reduction, and functional improvement were found, compared with controls. There is a need for a greater focus on engagement techniques in future research. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12620000178943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378592 %M 37616040 %R 10.2196/45963 %U https://www.jmir.org/2023/1/e45963 %U https://doi.org/10.2196/45963 %U http://www.ncbi.nlm.nih.gov/pubmed/37616040 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46949 %T Mobile Technologies for Supporting Mental Health in Youths: Scoping Review of Effectiveness, Limitations, and Inclusivity %A Litke,Shannon Grace %A Resnikoff,Annie %A Anil,Ashley %A Montgomery,Meredith %A Matta,Rishabh %A Huh-Yoo,Jina %A Daly,Brian P %+ Department of Psychological and Brain Sciences, Drexel University, Stratton Hall Suite 118/119, 3201 Chestnut Street, Philadelphia, PA, 19104, United States, 1 7329938165, sgl46@drexel.edu %K mHealth %K mobile app %K children %K adolescents %K mental health %K effectiveness %K efficacy %K scoping review %K mobile phone %D 2023 %7 23.8.2023 %9 Review %J JMIR Ment Health %G English %X Background: Over the past decade, there has been growing support for the use of mobile health (mHealth) technologies to improve the availability of mental health interventions. While mHealth is a promising tool for improving access to interventions, research on the effectiveness and efficacy of mHealth apps for youths is limited, particularly for underrepresented populations, including youths of color and economically marginalized youths. Objective: This scoping review study sought to evaluate the following research questions: (1) What is the extent of the current literature on mHealth apps that provide intervention for mental health problems in children and adolescents? (2) What is known from the existing literature about the effectiveness or efficacy of delivering mental health services via mHealth apps? (3) What are the gaps in the knowledge base in the fields of technology and mental health? (4) Do the reviewed mHealth apps address issues of cultural sensitivity or have they been tested with underrepresented groups (ie, youths of color or economically marginalized groups)? Methods: An electronic database search was conducted using relevant search terms. Seven independent reviewers screened identified studies, including title and abstract review to determine if studies met the following inclusion criteria: (1) targeted samples with mental health symptomology or disorders, (2) studied youth participants aged 6-17 years, and (3) examined the use of a mobile app–based platform for intervention. Relevant studies were subjected to full-text review to extract and chart relevant data based on a priori research questions. Results: The initial database search yielded 304 papers published from 2010 to 2021. After screening and selection, the final review included 10 papers on the effectiveness and efficacy of mental health intervention apps for youths aged 8 to 17 years. Identified apps targeted a broad range of mental health challenges in youths (ie, depression, self-harm, autism spectrum disorder, anxiety, and obsessive-compulsive disorder). Results identified only a small number of studies suggesting that current effectiveness and efficacy research in this area are limited. While some studies provided general support for the effectiveness of mHealth apps in improving mental health outcomes in youths, several notable limitations were present across the literature, reducing the generalizability of findings. Additionally, considerations around racial, ethnic, and socioeconomic diversity were scarce across studies. Conclusions: Although some studies cited in this scoping review provide support for the effectiveness and efficacy of mHealth apps targeting mental health concerns in youths, the overall body of literature remains quite limited. Moreover, mHealth apps expressly developed to be culturally responsive are almost nonexistent. Further efforts are needed to recruit youths who are typically underrepresented in research and invite stakeholder participation and collaborative input in the early stages of the mHealth app development process. %M 37610818 %R 10.2196/46949 %U https://mental.jmir.org/2023/1/e46949 %U https://doi.org/10.2196/46949 %U http://www.ncbi.nlm.nih.gov/pubmed/37610818 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46925 %T Long-Term Efficacy of Internet-Based Cognitive Behavioral Therapy Self-Help Programs for Adults With Depression: Systematic Review and Meta-Analysis of Randomized Controlled Trials %A Mamukashvili-Delau,Megi %A Koburger,Nicole %A Dietrich,Sandra %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Klinik und Poliklinik für Psychiatrie und Psychotherapie Semmelweisstraße 10, Haus 13, Leipzig, 04103, Germany, 49 0341 97 24464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K depression %K internet-based cognitive behavioral therapy %K iCBT %K self-help %K minimal guidance %K long-term %K follow-up %K mental health %K psychotherapy %K cognitive behavioral therapy %K CBT %K systematic review %K meta-analysis %K meta-analyses %K review method %D 2023 %7 22.8.2023 %9 Review %J JMIR Ment Health %G English %X Background: Depression is a worldwide mental disorder and a leading cause of disability. Many people with depression do not want to take medication or have the motivation to seek psychotherapy treatment for many reasons. Guided internet-based self-help programs may be a promising solution for addressing these issues. This kind of intervention has proven to be effective in reducing depression symptoms on a short-term scale. However, as treatment often is a long-term rehabilitation process, it is important to examine not only the short-term effects of internet-based cognitive behavioral therapy (iCBT) self-help treatment but also the follow-up or long-term efficacy of this kind of intervention. Objective: This systematic review and meta-analysis aimed to identify studies that examined follow-up data ≥8 weeks after posttreatment measurements and thereby examined the long-term efficacy of iCBT self-help programs with minimal weekly guidance for people with depression. It aimed to analyze the long-term efficacy of iCBT treatments compared to control conditions as well as long-term efficacy within the iCBT treatment conditions. Additionally, it aimed to conduct subgroup analyses according to the follow-up time points for each outcome. Finally, it examined long-term improvements in quality of life. Methods: The Cochrane Collaboration Depression, Anxiety, and Neurosis Controlled Trials Register (CCDANCTR), grey literature, reference lists, and correspondence were used to search for published and unpublished randomized controlled trials (RCTs) that reported the long-term or follow-up efficacy of computer-based or iCBT self-help treatments for depression with minimal guidance of up to 10 min/wk. The search took place between 2015 and 2022 (October). Results: The search resulted in a total of 2809 study abstracts, of which 15 studies (with 17 samples) met all inclusion criteria and were included in the long-term analysis. The results showed that the depression outcomes of all follow-up time points together in the treatment conditions were favored over the control conditions with a medium effect size of 0.43 (n=1689 participants; 9 RCTs; standardized mean difference [SMD] –0.43, 95% CI –0.67 to –0.20; P<.001). The analysis of long-term efficacy within the iCBT treatment conditions showed that the follow-up outcomes of the treatment groups were favored over the posttreatment outcomes with a small effect size of 0.20 (n=2196 participants; 17 RCTs; SMD 0.20, 95% CI 0.07-0.49; P=.003). Findings for improving quality of life also showed that the iCBT conditions were favored over the control conditions with a small effect size of 0.19 (n=1345 participants; 3 RCTs; SMD 0.19, 95% CI 0.08-0.30; P<.001). Conclusions: This systematic review and meta-analysis found that iCBT self-help interventions had a superior long-term efficacy for individuals with depressive symptoms compared to control groups. The within-group analysis of iCBT treatment conditions also showed statistically significant improvements in reducing depressive symptoms at follow-up compared to posttreatment measurements. %M 37606990 %R 10.2196/46925 %U https://mental.jmir.org/2023/1/e46925 %U https://doi.org/10.2196/46925 %U http://www.ncbi.nlm.nih.gov/pubmed/37606990 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50316 %T Efficacy of Cognitive Behavioral Therapy With Local Wisdom and Web-Based Counseling on Generalized Anxiety Disorders and Functional Gastrointestinal Disorders in Adolescent College Girls: Protocol for a Randomized Controlled Trial %A Ardi,Zadrian %A Eseadi,Chiedu %A Yuniarti,Elsa %A Yendi,Frischa Meivilona %A Murni,Arina Widya %+ Department of Educational Psychology, Faculty of Education, University of Johannesburg, Auckland Park, Johannesburg, 2006, South Africa, 27 0749381079, chiedu.eseadi@unn.edu.ng %K adolescent college girls %K cognitive behavioral therapy %K CBT %K functional gastrointestinal disorders %K FGIDs %K generalized anxiety disorders %K GADs %K local wisdom %K web-based counseling %D 2023 %7 22.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The high academic demands experienced by students will often have an impact on the quality of their mental and physical health. The most common health problems reported are gastrointestinal disorders. This condition tends to manifest in the emergence of generalized anxiety disorders (GADs) and reduces the quality of life and productivity. The population that experiences this disorder the most is female adolescents, and this condition occurs in both South African and Indonesian populations. The use of drugs, especially benzodiazepines, often causes psychological conditions as side effects. For this reason, it is necessary to have a solution in the form of a targeted and efficient approach to reduce psychological symptoms that arise from functional gastrointestinal disorders (FGIDs) in the form of anxiety. Objective: The purpose of this study is to produce and implement a counseling intervention model to assist female students with GADs caused by FGID factors using an approach combining cognitive behavioral therapy (CBT), web-based counseling, and local wisdom in Indonesian and South African populations. Methods: The research subjects will comprise 118 female adolescent students from Indonesia and 118 female adolescent students from South Africa, making a total sample of 236 participants, and the study will use a prospective, parallel randomized controlled trial design. The recruitment process will begin in July 2023, and the trial will begin in August 2023. The posttest assessment data gathering will take place by November 2023. Questionnaires that will be used in this study include the Functional Gastrointestinal Disorder Checklist (FGI-Checklist) to collect data related to FGIDs and the Generalized Anxiety Disorder 7-item (GAD-7) to measure the anxiety conditions experienced by respondents. Results: By adopting the intention-to-treat principle, there will be significant mean changes in GAD scores and FGID scores after exposure to this combined approach in the Indonesian and South African populations. Implementing this comprehensive intervention will improve the students’ psychological symptoms related to FGIDs and ultimately enhance their overall well-being. Conclusions: This study will develop and implement a model of counseling intervention for female students with GADs obtained from FGIDs using a combination approach to CBT, web-based counseling, and local wisdom in both the Indonesian and South African populations. The trial findings will contribute to our understanding of the effects of CBT combined with local wisdom and web-based counseling approaches that mental health counselors can use to treat GAD-affected adolescent girls who have FGIDs. Trial Registration: UMIN Clinical Trial Registry UMIN000051386; https://tinyurl.com/yjwz8kht International Registered Report Identifier (IRRID): PRR1-10.2196/50316 %M 37606989 %R 10.2196/50316 %U https://www.researchprotocols.org/2023/1/e50316 %U https://doi.org/10.2196/50316 %U http://www.ncbi.nlm.nih.gov/pubmed/37606989 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42647 %T Key Factors in Helpfulness and Use of the SAFE Intervention for Women Experiencing Intimate Partner Violence and Abuse: Qualitative Outcomes From a Randomized Controlled Trial and Process Evaluation %A van Gelder,Nicole E %A Ligthart,Suzanne A %A van Rosmalen-Nooijens,Karin A W L %A Prins,Judith B %A Oertelt-Prigione,Sabine %+ Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Geert Grooteplein Noord 21, Nijmegen, 6525 EZ, Netherlands, 31 243618181, nicole.vangelder@radboudumc.nl %K intimate partner violence and abuse %K domestic violence and abuse %K eHealth %K web based %K web-based intervention %K help seeking %K interview %K qualitative %K randomized controlled trial %K process evaluation %D 2023 %7 21.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Many women experience at least one type of intimate partner violence and abuse (IPVA), and although various support options are available, we still know relatively little about web-based interventions for IPVA survivors. We conducted a qualitative evaluation of the SAFE eHealth intervention for women experiencing IPVA in the Netherlands, complementing the quantitative evaluation of self-efficacy, depression, anxiety, and multiple feasibility aspects. Objective: This study assessed users’ experiences and what, according to them, were useful and helpful aspects of the intervention. Methods: The intervention consisted of modules with information on relationships and IPVA, help options, physical and mental health, and social support. It also contained interactive elements such as exercises, stories from survivors, a chat, and a forum. A randomized controlled trial was conducted with an intervention arm receiving the complete version of the intervention and a control arm receiving only a static version with the modules on relationships and IPVA and help options. We gathered data through open questions from surveys (for both study arms; n=65) and semistructured interviews (for the intervention study arm; n=10), all conducted on the web, during the randomized controlled trial and process evaluation. Interview data were coded following the principles of open thematic coding, and all qualitative data were analyzed using qualitative content analysis. Results: Overall, most users positively rated the intervention regarding safety, content, and suiting their needs, especially participants from the intervention study arm. The intervention was helpful in the domains of acknowledgment, awareness, and support. However, participants also identified points for improvement: the availability of a simplified version for acute situations; more attention for survivors in the aftermath of ending an abusive relationship; and more information on certain topics, such as technological IPVA, support for children, and legal affairs. Furthermore, although participants expressed a prominent need for interactive contact options such as a chat or forum, the intervention study arm (the only group that had these features at their disposal) mainly used them in a passive way—reading instead of actively joining the conversation. The participants provided various reasons for this passive use. Conclusions: The positive outcomes of this study are similar to those of other web-based interventions for IPVA survivors, and specific points for improvement were identified. The availability of interactive elements seems to be of added value even when they are used passively. This study provides in-depth insight into the experiences of female IPVA survivors with the SAFE eHealth intervention and makes suggestions for improvements to SAFE and comparable web-based interventions for IPVA as well as inspiring future research. Furthermore, this study shows the importance of a varied assessment of an intervention’s effectiveness to understand the real-world impact on its users. Trial Registration: Netherlands Trial Register NTR7313; https://tinyurl.com/3t7vwswz %M 37603391 %R 10.2196/42647 %U https://www.jmir.org/2023/1/e42647 %U https://doi.org/10.2196/42647 %U http://www.ncbi.nlm.nih.gov/pubmed/37603391 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44679 %T Health Economic Evaluation of Cognitive Control Training for Depression: Key Considerations %A Nève de Mévergnies,Constance %A Verhaeghe,Nick %A Koster,Ernst H W %A Baeken,Chris %A Vander Zwalmen,Yannick %A Hoorelbeke,Kristof %+ Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium, 32 9 264 64 74, kristof.hoorelbeke@Ugent.be %K health economic evaluation %K cost utility %K cognitive control training %K CCT %K depression recurrence %K health policies %D 2023 %7 18.8.2023 %9 Viewpoint %J JMIR Ment Health %G English %X Depression is a serious and burdensome psychiatric illness that contributes heavily to health expenditures. These costs are partly related to the observation that depression is often not limited to a single episode but can recur or follow a chronic pathway. In terms of risk factors, it is acknowledged that cognitive impairments play a crucial role in vulnerability to depression. Within this context, cognitive control training (CCT) has shown its effectiveness in reducing the risk for recurrence of depression. CCT is low cost intensive and can be provided as a web-based intervention, which makes it easy to disseminate. Despite increasing interest in the field, studies examining the cost-effectiveness of CCT in the context of depression are largely missing. Health economic evaluation (HEE) allows to inform decision makers with evidence-based insights about how to spend limited available (financial) resources in the most efficient way. HEE studies constitute a crucial step in the implementation of a new intervention in clinical practice. Approaching preventive measures for depression such as CCT from an HEE perspective is informative to health policy, fostering optimal use of health expenditures. The aim of this paper was to inform and guide researchers during the phase of designing HEE studies in the context of CCT for depression. A clear view of CCT’s cost-effectiveness is paramount for its clinical implementation. %M 37594847 %R 10.2196/44679 %U https://mental.jmir.org/2023/1/e44679 %U https://doi.org/10.2196/44679 %U http://www.ncbi.nlm.nih.gov/pubmed/37594847 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45362 %T The Overall Anxiety Severity and Impairment Scale as an Outcome Measure in Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders: Observational Study %A Karpov,Boris %A Lipsanen,Jari Olavi %A Ritola,Ville %A Rosenström,Tom %A Saarni,Suoma %A Pihlaja,Satu %A Stenberg,Jan-Henry %A Laizane,Paula %A Joffe,Grigori %+ Department of Psychiatry, Helsinki University Hospital, Välskärinkatu 12, Helsinki, 00260, Finland, 358 401854948, boris.karpov@hus.fi %K Overall Anxiety Severity and Impairment Scale %K OASIS %K internet-delivered cognitive behavioral therapy %K iCBT %K anxiety %K social anxiety disorder %K panic disorder %K obsessive-compulsive disorder %K OCD %D 2023 %7 17.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-delivered cognitive behavioral therapy (iCBT) is effective in the treatment of anxiety disorders. iCBT clinical trials use relatively long and time-consuming disorder-specific rather than transdiagnostic anxiety measurements. Overall Anxiety Severity and Impairment Scale (OASIS) is a brief self-report scale that could offer a universal, easy-to-use anxiety measurement option in disorder-specific and transdiagnostic iCBT programs. Objective: We aimed to investigate relationships between OASIS and disorder-specific instruments in iCBT. We expected these relationships to be positive. Methods: We investigated patients in original nationwide iCBT programs for generalized anxiety disorder (GAD), obsessive-compulsive disorder, panic disorder, and social anxiety disorder, which were administered by Helsinki University Hospital, Finland. In each program, anxiety symptoms were measured using both disorder-specific scales (the 7-item Generalized Anxiety Disorder scale, Penn State Worry Questionnaire, revised Obsessive-Compulsive Inventory, Panic Disorder Severity Scale, and Social Phobia Inventory) and by OASIS. A general linear model for repeated measures (mixed models) and interaction analysis were used for investigating the changes and relationships in the mean scores of OASIS and disorder-specific scales from the first session to the last one. Results: The main effect of linear mixed models indicated a distinct positive association between OASIS and disorder-specific scale scores. Interaction analysis demonstrated relatively stable associations between OASIS and the revised Obsessive-Compulsive Inventory (F822.9=0.09; 95% CI 0.090-0.277; P=.32), and OASIS and the Panic Disorder Severity Scale (F596.6=–0.02; 95% CI –0.108 to –0.065; P=.63) from first the session to the last one, while the 7-item Generalized Anxiety Disorder scale (F4345.8=–0.06; 95% CI –0.109 to –0.017; P=.007), Penn State Worry Questionnaire (F4270.8=–0.52; 95% CI –0.620 to –0.437; P<.001), and Social Phobia Inventory (F862.1=–0.39; 95% CI –0.596 to –0.187; P<.001) interrelated with OASIS more strongly at the last session than at the first one. Conclusions: OASIS demonstrates clear and relatively stable associations with disorder-specific symptom measures. Thus, OASIS might serve as an outcome measurement instrument for disorder-specific and plausibly transdiagnostic iCBT programs for anxiety disorders in regular clinical practice. %M 37590055 %R 10.2196/45362 %U https://www.jmir.org/2023/1/e45362 %U https://doi.org/10.2196/45362 %U http://www.ncbi.nlm.nih.gov/pubmed/37590055 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46326 %T Effectiveness of an Internet-Based Self-Guided Program to Treat Depression in a Sample of Brazilian Users: Randomized Controlled Trial %A Lopes,Rodrigo T %A da Rocha,Gustavo Chapetta %A Svacina,Maria Adriana %A Meyer,Björn %A Šipka,Dajana %A Berger,Thomas %+ University of Bern, Fabrikstrasse, 8, Clinical Psychology and Psychotherapy Department, Bern, 3012, Switzerland, 41 0787574701, rodrigo.lopes@psy.unibe.ch %K depression %K internet-based interventions %K self-guided interventions %K cognitive behavioral therapy %D 2023 %7 17.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression is undertreated in Brazil. Deprexis is a self-guided internet-based program used to treat depressive symptoms based on empirically supported integrative and cognitive behavioral therapy. Evidence from a meta-analysis supports Deprexis’ efficacy in German-speaking countries and the United States, but no study has been conducted using this program in countries with low literacy rates and large social disparities. Furthermore, few studies have investigated whether internet-based interventions ameliorate the psychological processes that might underlie depressive symptomatology, such as low perceived self-efficacy. Objective: The main objective of this study was to replicate in Brazil previously reported effects of Deprexis on depressive symptom reduction. Therefore, the main research question was whether Deprexis is effective in reducing depressive symptoms and the general psychological state in Brazilian users with moderate and severe depression in comparison with a control group that does not receive access to Deprexis. A secondary research question was whether the use of Deprexis affects perceptions of self-efficacy. Methods: We interviewed 312 participants recruited over the internet and randomized 189 participants with moderate to severe depression (according to the Patient Health Questionnaire–9 and a semistructured interview) to an intervention condition (treatment as usual plus immediate access to Deprexis for 90 days, n=94) or to a control condition (treatment as usual and delayed access to Deprexis, after 8 weeks, n=95). Results: Participants from the immediate access group logged in at Deprexis an average of 14.81 (SD 12.16) times. The intention-to-treat analysis using a linear mixed model showed that participants who received Deprexis improved significantly more than participants assigned to the delayed access control group on the primary depression self-assessment measure (Patient Health Questionnaire–9; Cohen d=0.80; P<.001) and secondary outcomes, such as general psychological state measure (Clinical Outcome in Routine Evaluation–Outcome Measurement; Cohen d=0.82; P<.001) and the perceived self-efficacy measure (Cohen d=0.63; P<.001). The intention-to-treat analyses showed that 21% (20/94) of the participants achieved remission compared with 7% (7/95) in the control group (P<.001). The deterioration rates were lower in the immediate access control group. The dropout rate was high, but no differences in demographic and clinical variables were found. Participants reported a medium to high level of satisfaction with Deprexis. Conclusions: These results replicate previous findings by showing that Deprexis can facilitate symptomatic improvement over 3 months in depressed samples of Brazilian users. From a public health perspective, this is important information to expand the reach of internet-based interventions for those who really need them, especially in countries with less access to mental health care. This extends previous research by showing significant effects on perceived self-efficacy. Trial Registration: Registro Brasileiro de Ensaios Clíncos (ReBec) RBR-6kk3bx UTN U1111-1212-8998; https://ensaiosclinicos.gov.br/rg/RBR-6kk3bx/ International Registered Report Identifier (IRRID): RR2-10.1590/1516-4446-2019-0582 %M 37590052 %R 10.2196/46326 %U https://formative.jmir.org/2023/1/e46326 %U https://doi.org/10.2196/46326 %U http://www.ncbi.nlm.nih.gov/pubmed/37590052 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49284 %T A Digital Music-Based Mindfulness Intervention for Black Americans With Elevated Race-Based Anxiety: A Multiple-Baseline Pilot Study %A Jones,Grant %A Herrmann,Felipe %A Nock,Matthew K %+ Harvard University, 33 Kirkland Street, Cambridge, MA, 02138, United States, gmj005@g.harvard.edu %K Black music %K mindfulness %K meditation %K single-case experiment %K race %K anxiety %K mindfulness %K digital health intervention %K low income %K Black community %K racial disparity %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Race-based anxiety is a substantial health issue for the Black community. Although mindfulness interventions have demonstrated efficacy for alleviating anxiety, three central barriers prevent Black Americans from accessing existing mindfulness treatments: high costs, excessive time commitments, and limited cultural relevance. There is a need for novel mindfulness interventions for the Black community that can overcome these barriers. Objective: The goal of this web-based study was to examine the preliminary efficacy, feasibility, and acceptability of a novel digital music-based mindfulness intervention for middle-to-low-income Black Americans with elevated race-based anxiety. Methods: This study used a nonconcurrent multiple-baseline design (n=5). The intervention featured contributions from Lama Rod Owens (a world-renowned meditation teacher and LA Times best-selling author) and Terry Edmonds (the former chief speechwriter for President Bill Clinton). We examined the effect of the intervention on state anxiety and assessed its feasibility and acceptability using quantitative and qualitative measures. Results: Results revealed that administration of the intervention led to significant decreases in state anxiety (Tau-U range –0.75 to –0.38; P values<.001). Virtually all feasibility and acceptability metrics were high (ie, the average likelihood of recommending the intervention was 98 out of 100). Conclusions: This study offers preliminary evidence that a digital music-based mindfulness intervention can decrease race-based anxiety in Black Americans. Future research is needed to replicate these results, test whether the intervention can elicit lasting changes in anxiety, assess mechanisms of change, and explore the efficacy of the intervention in real-world contexts. %M 37585252 %R 10.2196/49284 %U https://formative.jmir.org/2023/1/e49284 %U https://doi.org/10.2196/49284 %U http://www.ncbi.nlm.nih.gov/pubmed/37585252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43526 %T Effects of Community-Based Caring Contact in Reducing Thwarted Belongingness Among Postdischarge Young Adults With Self-Harm: Randomized Controlled Trial %A Law,Yik Wa %A Lok,Rita Hui Ting %A Chiang,Byron %A Lai,Carmen Chui Shan %A Tsui,Sik Hon Matthew %A Chung,Pui Yin Joseph %A Leung,Siu Chung %+ Department of Social Work and Social Administration, University of Hong Kong, RM534, The Jockey Club Tower,, The Centennial Campus, HKU, Pokfulam, Hong Kong, Hong Kong, 852 93029863, flawhk@hku.hk %K self-harm %K suicidal ideation %K volunteers %K mobile app %K thwarted belongingness %K suicide %K youth %K community %K support %K treatment %K effectiveness %K risk %K patient %K intervention %K model %K care %K hospital %D 2023 %7 16.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: For patients with self-harm behaviors, the urge to hurt themselves persists after hospital discharge, leading to costly readmissions and even death. Hence, postdischarge intervention programs that reduce self-harm behavior among patients should be part of a cogent community mental health care policy. Objective: We aimed to determine whether a combination of a self-help mobile app and volunteer support could complement treatment as usual (TAU) to reduce the risk of suicide among these patients. Methods: We conducted a pragmatic randomized controlled trial on discharged patients aged between 18 and 45 years with self-harm episodes/suicide attempts, all of whom were recruited from 4 hospital emergency departments in Hong Kong. Participants were randomly assigned to one of three groups: (1) mobile app + TAU (“apps”), (2) mobile app + volunteer support + TAU (“volunteers”), or (3) TAU only as the control group (“TAU”). They were asked to submit a mobile app–based questionnaire during 4 measurement time points at monthly intervals. Results: A total of 40 participants were recruited. Blending volunteer care with a preprogrammed mobile app was found to be effective in improving service compliance. Drawing upon the interpersonal-psychological theory of suicide, our findings suggested that a reduction in perceived burdensomeness and thwarted belongingness through community-based caring contact are linked to improvement in hopelessness, albeit a transient one, and suicide risk. Conclusions: A combination of volunteer care with a self-help mobile app as a strategy for strengthening the continuity of care can be cautiously implemented for discharged patients at risk of self-harm during the transition from the hospital to a community setting. Trial Registration: ClinicalTrials.gov NCT03081078; https://clinicaltrials.gov/study/NCT03081078 %M 37585260 %R 10.2196/43526 %U https://formative.jmir.org/2023/1/e43526 %U https://doi.org/10.2196/43526 %U http://www.ncbi.nlm.nih.gov/pubmed/37585260 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46061 %T Relationship Factors in Internet-Delivered Psychological Interventions for Veterans Experiencing Postpartum Depression: Qualitative Analysis %A Solness,Cara L %A Holdefer,Paul J %A Hsu,Ti %A Thomas,Emily B K %A O'Hara,Michael W %+ Department of Psychiatry, School of Medicine, University of Colorado, 1890 N Revere Court, Anschutz Medical Campus, Aurora, CO, 80045, United States, 1 319 331 3566, cara.solness@cuanschutz.edu %K internet-delivered treatment %K postpartum depression %K therapeutic alliance %K qualitative methodology %K veteran %D 2023 %7 15.8.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-delivered psychological interventions (IPIs) have been shown to be effective for a variety of psychological concerns, including postpartum depression. Human-supported programs produce better adherence and larger effect sizes than unsupported programs; however, what it is about support that affects outcomes is not well understood. Therapeutic alliance is one possibility that has been found to contribute to outcomes; however, the specific mechanism is not well understood. Participant perspectives and qualitative methodology are nearly absent from the IPI alliance research and may help provide new directions. Objective: In this study, we aimed to provide participant perspectives on engagement with an IPI for postpartum depression to help inform alliance research, development of new IPIs, and inform resource allocation. Methods: A qualitative methodology was used to explore participant perspectives of veteran women’s engagement with the MomMoodBooster program, a human-supported internet-delivered intervention for postpartum depression. Participants were asked 4 open-ended questions with the 3-month postintervention survey, “In what ways did you find the MomMoodBooster most helpful?” “How do you think the MomMoodBooster could have been improved?” “In what ways did you find the personal coach calls to be helpful?” and “How do you think the personal coach calls could have been improved?” Results: Data were collected from 184 participants who responded to at least 1 of the open-ended questions. These were analyzed using thematic analysis and a process of reaching a consensus among coders. The results suggest that not only the engagement with the support person is perceived as a significant contributor to participant experiences while using the MomMoodBooster content but also the relationship factors are particularly meaningful. The results provide insights into the specific qualities of the support person that were perceived as most impactful, such as warmth, empathy and genuineness, and feeling normalized and supported. In addition, the results provide insight into the specific change processes that can be targeted through support interactions, such as encouraging self-reflection and self-care and challenging negative thinking. Conclusions: These data emphasize the importance of relationship factors between support persons and an IPI program for postpartum depression. The findings suggest that focusing on specific aspects of the alliance and the therapeutic relationship could yield fruitful directions for the training of support personnel and for future alliance-based research of internet-delivered treatments. %M 37581917 %R 10.2196/46061 %U https://mental.jmir.org/2023/1/e46061 %U https://doi.org/10.2196/46061 %U http://www.ncbi.nlm.nih.gov/pubmed/37581917 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43000 %T Frontline Health Care Workers’ Mental Health and Well-Being During the First Year of the COVID-19 Pandemic: Analysis of Interviews and Social Media Data %A Vera San Juan,Norha %A Martin,Sam %A Badley,Anna %A Maio,Laura %A Gronholm,Petra C %A Buck,Caroline %A Flores,Elaine C %A Vanderslott,Samantha %A Syversen,Aron %A Symmons,Sophie Mulcahy %A Uddin,Inayah %A Karia,Amelia %A Iqbal,Syka %A Vindrola-Padros,Cecilia %+ Rapid Research Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, n.verasanjuan@ucl.ac.uk %K mental health %K frontline %K health care workers %K COVID-19 %K health services research %K Collaborative and Digital Analysis of Big Qualitative Data in Time Sensitive Contexts %K LISTEN method %D 2023 %7 14.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has shed light on fractures in health care systems worldwide and continues to have a significant impact, particularly in relation to the health care workforce. Frontline staff have been exposed to unprecedented strain, and delivering care during the pandemic has affected their safety, mental health, and well-being. Objective: This study aimed to explore the experiences of health care workers (HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to understand their well-being needs, experiences, and strategies used to maintain well-being (at individual and organizational levels). Methods: We analyzed 94 telephone interviews with HCWs and 2000 tweets about HCWs’ mental health during the first year of the COVID-19 pandemic. Results: The results were grouped under 6 themes: redeployment, clinical work, and sense of duty; well-being support and HCW’s coping strategies; negative mental health effects; organizational support; social network and support; and public and government support. Conclusions: These findings demonstrate the need for open conversations, where staff’s well-being needs and the strategies they adopted can be shared and encouraged, rather than implementing top-down psychological interventions alone. At the macro level, the findings also highlighted the impact on HCW’s well-being of public and government support as well as the need to ensure protection through personal protective equipment, testing, and vaccines for frontline workers. %M 37402283 %R 10.2196/43000 %U https://www.jmir.org/2023/1/e43000 %U https://doi.org/10.2196/43000 %U http://www.ncbi.nlm.nih.gov/pubmed/37402283 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45233 %T Challenges in Using mHealth Data From Smartphones and Wearable Devices to Predict Depression Symptom Severity: Retrospective Analysis %A Sun,Shaoxiong %A Folarin,Amos A %A Zhang,Yuezhou %A Cummins,Nicholas %A Garcia-Dias,Rafael %A Stewart,Callum %A Ranjan,Yatharth %A Rashid,Zulqarnain %A Conde,Pauline %A Laiou,Petroula %A Sankesara,Heet %A Matcham,Faith %A Leightley,Daniel %A White,Katie M %A Oetzmann,Carolin %A Ivan,Alina %A Lamers,Femke %A Siddi,Sara %A Simblett,Sara %A Nica,Raluca %A Rintala,Aki %A Mohr,David C %A Myin-Germeys,Inez %A Wykes,Til %A Haro,Josep Maria %A Penninx,Brenda W J H %A Vairavan,Srinivasan %A Narayan,Vaibhav A %A Annas,Peter %A Hotopf,Matthew %A Dobson,Richard J B %A , %+ Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Social Genetic and Developmental Psychiatry Centre, Memory Lane, London, SE5 8AF, United Kingdom, 44 02078480951, shaoxiong.sun@kcl.ac.uk %K mobile health %K depression %K digital phenotypes %K behavioral patterns %K missing data %K smartphones %K wearable devices %K mobile phone %D 2023 %7 14.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Major depressive disorder (MDD) affects millions of people worldwide, but timely treatment is not often received owing in part to inaccurate subjective recall and variability in the symptom course. Objective and frequent MDD monitoring can improve subjective recall and help to guide treatment selection. Attempts have been made, with varying degrees of success, to explore the relationship between the measures of depression and passive digital phenotypes (features) extracted from smartphones and wearables devices to remotely and continuously monitor changes in symptomatology. However, a number of challenges exist for the analysis of these data. These include maintaining participant engagement over extended time periods and therefore understanding what constitutes an acceptable threshold of missing data; distinguishing between the cross-sectional and longitudinal relationships for different features to determine their utility in tracking within-individual longitudinal variation or screening individuals at high risk; and understanding the heterogeneity with which depression manifests itself in behavioral patterns quantified by the passive features. Objective: We aimed to address these 3 challenges to inform future work in stratified analyses. Methods: Using smartphone and wearable data collected from 479 participants with MDD, we extracted 21 features capturing mobility, sleep, and smartphone use. We investigated the impact of the number of days of available data on feature quality using the intraclass correlation coefficient and Bland-Altman analysis. We then examined the nature of the correlation between the 8-item Patient Health Questionnaire (PHQ-8) depression scale (measured every 14 days) and the features using the individual-mean correlation, repeated measures correlation, and linear mixed effects model. Furthermore, we stratified the participants based on their behavioral difference, quantified by the features, between periods of high (depression) and low (no depression) PHQ-8 scores using the Gaussian mixture model. Results: We demonstrated that at least 8 (range 2-12) days were needed for reliable calculation of most of the features in the 14-day time window. We observed that features such as sleep onset time correlated better with PHQ-8 scores cross-sectionally than longitudinally, whereas features such as wakefulness after sleep onset correlated well with PHQ-8 longitudinally but worse cross-sectionally. Finally, we found that participants could be separated into 3 distinct clusters according to their behavioral difference between periods of depression and periods of no depression. Conclusions: This work contributes to our understanding of how these mobile health–derived features are associated with depression symptom severity to inform future work in stratified analyses. %M 37578823 %R 10.2196/45233 %U https://www.jmir.org/2023/1/e45233 %U https://doi.org/10.2196/45233 %U http://www.ncbi.nlm.nih.gov/pubmed/37578823 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45749 %T Investigating Relationships Among Self-Efficacy, Mood, and Anxiety Using Digital Technologies: Randomized Controlled Trial %A Rohde,Judith %A Marciniak,Marta Anna %A Henninger,Mirka %A Homan,Stephanie %A Paersch,Christina %A Egger,Stephan T %A Seifritz,Erich %A Brown,Adam D %A Kleim,Birgit %+ Department of Psychiatry, Psychotherapy and Psychosomatic, Psychiatric University Hospital Zurich, Lenggstrasse 31, Zurich, 8008, Switzerland, 41 058 384 2111, judith.rohde@uzh.ch %K self-efficacy %K digital intervention %K digital assessment %K EMA %K EMI %K mood %K anxiety %K emotional flexibility %D 2023 %7 14.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital tools assessing momentary parameters and offering interventions in people’s daily lives play an increasingly important role in mental health research and treatment. Ecological momentary assessment (EMA) makes it possible to assess transient mental health states and their parameters. Ecological momentary interventions (EMIs) offer mental health interventions that fit well into individuals’ daily lives and routines. Self-efficacy is a transdiagnostic construct that is commonly associated with positive mental health outcomes. Objective: The aim of our study assessing mood, specific self-efficacy, and other parameters using EMA was 2-fold. First, we wanted to determine the effects of daily assessed moods and dissatisfaction with social contacts as well as the effects of baseline variables, such as depression, on specific self-efficacy in the training group (TG). Second, we aimed to explore which variables influenced both groups’ positive and negative moods during the 7-day study period. Methods: In this randomized controlled trial, we applied digital self-efficacy training (EMI) to 93 university students with elevated self-reported stress levels and daily collected different parameters, such as mood, dissatisfaction with social contacts, and specific self-efficacy, using EMA. Participants were randomized to either the TG, where they completed the self-efficacy training combined with EMA, or the control group, where they completed EMA only. Results: In total, 93 university students participated in the trial. Positive momentary mood was associated with higher specific self-efficacy in the evening of the same day (b=0.15, SE 0.05, P=.005). Higher self-efficacy at baseline was associated with reduced negative mood during study participation (b=–0.61, SE 0.30, P=.04), while we could not determine an effect on positive mood. Baseline depression severity was significantly associated with lower specific self-efficacy over the week of the training (b=–0.92, SE 0.35, P=.004). Associations between higher baseline anxiety with higher mean negative mood (state anxiety: b=0.78, SE 0.38, P=.04; trait anxiety: b=0.73, SE 0.33, P=.03) and lower mean positive mood (b=–0.64, SE 0.28, P=.02) during study participation were found. Emotional flexibility was significantly enhanced in the TG. Additionally, dissatisfaction with social contacts was associated with both a decreased positive mood (b=–0.56, SE 0.15, P<.001) and an increased negative mood (b=0.45, SE 0.12, P<.001). Conclusions: This study showed several significant associations between mood and self-efficacy as well as those between mood and anxiety in students with elevated stress levels, for example, suggesting that improving mood in people with low mood could enhance the effects of digital self-efficacy training. In addition, engaging in 1-week self-efficacy training was associated with increased emotional flexibility. Future work is needed to replicate and investigate the training’s effects in other groups and settings. Trial Registration: ClinicalTrials.gov NCT05617248; https://clinicaltrials.gov/study/NCT05617248 %M 37578827 %R 10.2196/45749 %U https://formative.jmir.org/2023/1/e45749 %U https://doi.org/10.2196/45749 %U http://www.ncbi.nlm.nih.gov/pubmed/37578827 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43727 %T Assessing Patient Adherence to and Engagement With Digital Interventions for Depression in Clinical Trials: Systematic Literature Review %A Forbes,Ainslie %A Keleher,Madeline Rose %A Venditto,Michael %A DiBiasi,Faith %+ Otsuka Pharmaceutical Development & Commercialization, Inc, 508 Carnegie Center Dr, Princeton, NJ, 08540, United States, 1 301 956 2702, ainslie.forbes@otsuka-us.com %K digital therapeutics %K digital interventions %K digital health %K mobile health %K mobile phone %K depression %K major depressive disorder %K engagement %K adherence %K systematic literature review %D 2023 %7 11.8.2023 %9 Review %J J Med Internet Res %G English %X Background: New approaches to the treatment of depression are necessary for patients who do not respond to current treatments or lack access to them because of barriers such as cost, stigma, and provider shortage. Digital interventions for depression are promising; however, low patient engagement could limit their effectiveness. Objective: This systematic literature review (SLR) assessed how participant adherence to and engagement with digital interventions for depression have been measured in the published literature, what levels of adherence and engagement have been reported, and whether higher adherence and increased engagement are linked to increased efficacy. Methods: We focused on a participant population of adults (aged ≥18 years) with depression or major depressive disorder as the primary diagnosis and included clinical trials, feasibility studies, and pilot studies of digital interventions for treating depression, such as digital therapeutics. We screened 756 unique records from Ovid MEDLINE, Embase, and Cochrane published between January 1, 2000, and April 15, 2022; extracted data from and appraised the 94 studies meeting the inclusion criteria; and performed a primarily descriptive analysis. Otsuka Pharmaceutical Development & Commercialization, Inc (Princeton, New Jersey, United States) funded this study. Results: This SLR encompassed results from 20,111 participants in studies using 47 unique web-based interventions (an additional 10 web-based interventions were not described by name), 15 mobile app interventions, 5 app-based interventions that are also accessible via the web, and 1 CD-ROM. Adherence was most often measured as the percentage of participants who completed all available modules. Less than half (44.2%) of the participants completed all the modules; however, the average dose received was 60.7% of the available modules. Although engagement with digital interventions was measured differently in different studies, it was most commonly measured as the number of modules completed, the mean of which was 6.4 (means ranged from 1.0 to 19.7) modules. The mean amount of time participants engaged with the interventions was 3.9 (means ranged from 0.7 to 8.4) hours. Most studies of web-based (34/45, 76%) and app-based (8/9, 89%) interventions found that the intervention group had substantially greater improvement for at least 1 outcome than the control group (eg, care as usual, waitlist, or active control). Of the 14 studies that investigated the relationship between engagement and efficacy, 9 (64%) found that increased engagement with digital interventions was significantly associated with improved participant outcomes. The limitations of this SLR include publication bias, which may overstate engagement and efficacy, and low participant diversity, which reduces the generalizability. Conclusions: Patient adherence to and engagement with digital interventions for depression have been reported in the literature using various metrics. Arriving at more standardized ways of reporting adherence and engagement would enable more effective comparisons across different digital interventions, studies, and populations. %M 37566447 %R 10.2196/43727 %U https://www.jmir.org/2023/1/e43727 %U https://doi.org/10.2196/43727 %U http://www.ncbi.nlm.nih.gov/pubmed/37566447 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45438 %T A Clinical Model for the Differentiation of Suicidality: Protocol for a Usability Study of the Proposed Model %A de Winter,Remco F P %A Meijer,Connie M %A Enterman,John H %A Kool-Goudzwaard,Nienke %A Gemen,Manuela %A van den Bos,Anne T %A Steentjes,Danielle %A van Son,Gabrielle E %A Hazewinkel,Mirjam C %A de Beurs,Derek P %A de Groot,Marieke H %+ Mental Health Institute Rivierduinen, Sandifortdreef 19, 2333 ZZ Leiden Postbox 405, Leiden, 2333 ZZ, Netherlands, 31 71 890 8888, bgd@rivierduinen.nl %K differentiation %K suicidality %K suicidal behavior %K subtype %K subcategory %K category %K categories %K categorize %K subcategories %K validation study %K mental health %K suicide %K suicidal %K differentiation %K classification %K psychiatry %K classify %K psychiatric %K suicide prevention %K suicidal ideation %K mental illness %K suicidal thought %K dying %K perceptual disintegration %K PD %K primary depressive cognition %K PDC %K psychosocial turmoil %K inadequate communication %K intraclass correlation coefficients %K ICC %D 2023 %7 11.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Even though various types of suicidality are observed in clinical practice, suicidality is still considered a uniform concept. To distinguish different types of suicidality and consequently improve detection and management of suicidality, we developed a clinical differentiation model for suicidality. We believe that the model allows for a more targeted assessment of suicidal conditions and improves the use of evidence-based treatment strategies. The differentiation model is based on the experience with suicidality that we have encountered in clinical practice. This model distinguishes 4 subtypes of entrapment leading to suicidality. The earliest description of this model and a proposal for usability research has been previously presented in a book chapter. Objective: In this study, we present the most recent version of the 4-type differentiation model of suicidality and a protocol for a study into the usability of the proposed model. Methods: The 4-type differentiation model of suicidality distinguishes the following subtypes: (1) perceptual disintegration, (2) primary depressive cognition, (3) psychosocial turmoil, and (4) inadequate coping or communication. We plan to test the usability of the 4 subtypes in a pilot study of 25 cases, and subsequently, we will include 75 cases in a follow-up study. We looked at the case notes of 100 anonymized patients with suicidality who presented to mental health care emergency service in The Hague International Center. The summary and conclusions of the letters sent to the patients’ general practitioners after suicide risk assessment will be independently rated by 3 psychiatrists and 3 nurse-scientists for absolute and dimensional scores. The Suicidality Differentiation version 2 (SUICIDI-II) instrument, developed for this study, is used for rating all the cases. Intraclass correlation coefficients for absolute and dimensional scores will be calculated to examine type agreement between raters to examine the usability of the model and the feasibility of the SUICIDI-II instrument. Results: We consider the model tentatively valid if the intraclass correlation coefficients are ≥0.70. Subsequently, if the model turns out to be valid, we plan to rate 75 other cases in a follow-up study, according to a similar or adjusted procedure. Study results are expected to be published by the end of 2023. Conclusions: The theoretical roots of the differentiation model stem from classic and contemporary theoretical models of suicidality and from our clinical practice experiences with suicidal behaviors. We believe that this model can be used to adjust the diagnosis, management, treatment, and research of suicidality, in addition to distinguishing different dynamics between practitioners and patients with suicidality and their families. International Registered Report Identifier (IRRID): DERR1-10.2196/45438 %M 37566444 %R 10.2196/45438 %U https://www.researchprotocols.org/2023/1/e45438 %U https://doi.org/10.2196/45438 %U http://www.ncbi.nlm.nih.gov/pubmed/37566444 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44922 %T The Impact of Social Media Use Interventions on Mental Well-Being: Systematic Review %A Plackett,Ruth %A Blyth,Alexandra %A Schartau,Patricia %+ Research Department of Primary Care & Population Health, University College London, Royal Free Hospital, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 20 3108 3096, ruth.plackett.15@ucl.ac.uk %K review %K social media %K mental well-being %K mental health %K addiction %K intervention %K mobile phone %D 2023 %7 11.8.2023 %9 Review %J J Med Internet Res %G English %X Background: There is some evidence that more social media use is related to poorer mental well-being and that social media use can become problematic when it starts to interfere with a person’s daily life and mental well-being. To address this issue and improve users’ mental well-being, social media use interventions (eg, abstinence from social media) have been developed and evaluated. However, there is limited understanding of the effectiveness of these interventions in improving mental well-being. Objective: This systematic review aimed to synthesize the literature on the effectiveness of social media use interventions in improving mental well-being in adults. Methods: A systematic search (January 1, 2004, to July 31, 2022) was completed across 3 databases in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Experimental studies evaluating the impact of social media use interventions on mental well-being in adults were included. Outcomes related to mental well-being, such as depression, anxiety, stress, and loneliness, were included. A narrative synthesis without meta-analysis was completed to summarize the study characteristics and effectiveness by outcome and intervention type. The Effective Public Health Practice Project Quality Assessment Tool was used to measure the quality of the studies. Results: Of the 2785 studies identified through the systematic search, 23 (0.83%) were included in the analysis. Many of the included studies (9/23, 39%) found improvements in mental well-being, some (7/23, 30%) found mixed effects, and others (7/23, 30%) found no effect on mental well-being. Therapy-based interventions that used techniques such as cognitive behavioral therapy were more effective than limiting use of social media or full abstinence from social media, with 83% (5/6) of these studies showing improvements in mental well-being compared with 20% (1/5) and 25% (3/12), respectively. Depression was the most frequently investigated and improved outcome with 70% (7/10) of the studies showing a significant improvement in depression after the intervention, whereas other outcomes showed more varied results. Quality was poor, with 96% (22/23) of the studies receiving a weak global score, mostly for issues related to selection bias because most of the studies (16/23, 70%) used a convenience sampling of university students. Conclusions: This review provides some evidence that social media use interventions are effective in improving mental well-being, especially for depression and when using therapy-based interventions. Further experimental and longitudinal research is needed with representative samples to investigate who may benefit most from social media use interventions. This will help to develop guidance and recommendations for policy makers and clinicians on how best to manage problematic social media use. %M 37565693 %R 10.2196/44922 %U https://www.jmir.org/2023/1/e44922 %U https://doi.org/10.2196/44922 %U http://www.ncbi.nlm.nih.gov/pubmed/37565693 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48709 %T Evaluating the Psychometric Properties and Clinical Utility of a Digital Psychosocial Self-Screening Tool (HEARTSMAP-U) for Postsecondary Students: Prospective Cohort Study %A Virk,Punit %A Arora,Ravia %A Burt,Heather %A Finnamore,Caitlin %A Gadermann,Anne %A Barbic,Skye %A Doan,Quynh %+ School of Population and Public Health, The University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 822 2772, punit.virk@ucalgary.ca %K mental health %K screening %K validity %K postsecondary students %K clinical utility %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Existing screening tools for mental health issues among postsecondary students have several challenges, including a lack of standardization and codevelopment by students. HEARTSMAP-U was adapted to address these issues. Objective: This study aimed to evaluate the suitability of HEARTSMAP-U as a self-screening tool for psychosocial issues among postsecondary students by evaluating its validity evidence and clinical utility. Methods: A prospective cohort study was conducted with University of British Columbia Vancouver students to evaluate HEARTSMAP-U’s predictive validity and convergent validity. Participating students completed baseline and 3-month follow-up assessments via HEARTSMAP-U and a clinician-administered interview. Results: In a diverse student sample (n=100), HEARTSMAP-U demonstrated high sensitivity (95%-100%) in identifying any psychiatric concerns that were flagged by a research clinician, with lower specificity (21%-25%). Strong convergent validity (r=0.54-0.68) was demonstrated when relevant domains and sections of HEARTSMAP-U were compared with those of other conceptually similar instruments. Conclusions: This preliminary evaluation suggests that HEARTSMAP-U may be suitable for screening in the postsecondary educational setting. However, a larger-scale evaluation is necessary to confirm and expand on these findings. %M 37556180 %R 10.2196/48709 %U https://mental.jmir.org/2023/1/e48709 %U https://doi.org/10.2196/48709 %U http://www.ncbi.nlm.nih.gov/pubmed/37556180 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44888 %T Changes in Learning From Social Feedback After Web-Based Interpretation Bias Modification: Secondary Analysis of a Digital Mental Health Intervention Among Individuals With High Social Anxiety Symptoms %A Beltzer,Miranda L %A Daniel,Katharine E %A Daros,Alexander R %A Teachman,Bethany A %+ Center for Behavioral Intervention Technologies, Northwestern University Feinberg School of Medicine, 750 N. Lake Shore Dr., 10th Floor, Chicago, IL, 60611, United States, 1 9144622962, miranda.beltzer@northwestern.edu %K social anxiety %K reinforcement learning %K cognitive bias modification %K interpretation bias %K reward learning %K probabilistic learning %K Q-learning %K digital intervention %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Biases in social reinforcement learning, or the process of learning to predict and optimize behavior based on rewards and punishments in the social environment, may underlie and maintain some negative cognitive biases that are characteristic of social anxiety. However, little is known about how cognitive and behavioral interventions may change social reinforcement learning in individuals who are anxious. Objective: This study assessed whether a scalable, web-based cognitive bias modification for interpretations (CBM-I) intervention changed social reinforcement learning biases in participants with high social anxiety symptoms. This study focused on 2 types of social reinforcement learning relevant to social anxiety: learning about other people and learning about one’s own social performance. Methods: Participants (N=106) completed 2 laboratory sessions, separated by 5 weeks of ecological momentary assessment tracking emotion regulation strategy use and affect. Approximately half (n=51, 48.1%) of the participants completed up to 6 brief daily sessions of CBM-I in week 3. Participants completed a task that assessed social reinforcement learning about other people in both laboratory sessions and a task that assessed social reinforcement learning about one’s own social performance in the second session. Behavioral data from these tasks were computationally modeled using Q-learning and analyzed using mixed effects models. Results: After the CBM-I intervention, participants updated their beliefs about others more slowly (P=.04; Cohen d=−0.29) but used what they learned to make more accurate decisions (P=.005; Cohen d=0.20), choosing rewarding faces more frequently. These effects were not observed among participants who did not complete the CBM-I intervention. Participants who completed the CBM-I intervention also showed less-biased updating about their social performance than participants who did not complete the CBM-I intervention, learning similarly from positive and negative feedback and from feedback on items related to poor versus good social performance. Regardless of the intervention condition, participants at session 2 versus session 1 updated their expectancies about others more from rewarding (P=.003; Cohen d=0.43) and less from punishing outcomes (P=.001; Cohen d=−0.47), and they became more accurate at learning to avoid punishing faces (P=.001; Cohen d=0.20). Conclusions: Taken together, our results provide initial evidence that there may be some beneficial effects of both the CBM-I intervention and self-tracking of emotion regulation on social reinforcement learning in individuals who are socially anxious, although replication will be important. %M 37556186 %R 10.2196/44888 %U https://formative.jmir.org/2023/1/e44888 %U https://doi.org/10.2196/44888 %U http://www.ncbi.nlm.nih.gov/pubmed/37556186 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45666 %T Referring Adolescent Primary Care Patients to Single-Session Interventions for Anxiety and Depression: Protocol for a Feasibility Study %A Eyllon,Mara %A Dalal,Michelle %A Jans,Laura %A Sotomayor,Ian %A Peloquin,Gabrielle %A Yon,James %A Fritz,Rochelle %A Schleider,Jessica %+ Practice Research Network, Reliant Medical Group, 5 Neponset Street, Worcester, MA, 01606, United States, 1 6178754554, mara.eyllon@reliantmedicalgroup.org %K adolescents %K behavioral health care %K mental health %K primary care %K single-session interventions %D 2023 %7 9.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the growing prevalence of depression and anxiety among adolescents, fewer than half access appropriate mental health care. Single-session interventions (SSIs) for depression and anxiety offered in primary care are a promising approach to bridging the treatment gap. Objective: We aimed to implement a clinical workflow for primary care and behavioral health providers to refer patients aged 13 to 17 years with mild to moderate depression and anxiety symptoms to Project YES (Youth Empowerment and Support), an open-access SSI platform, in a large group medical practice with an integrated behavioral health department. Methods: Pediatric primary care and integrated behavioral health providers will be educated on the benefits of Project YES for adolescent anxiety and depression and trained in a workflow integrated within the electronic health record system, Epic, to refer patients during well-child visits and pediatric behavioral health visits. Patients with mild to moderate internalizing symptoms based on the 17-item Pediatric Symptom Checklist or youth Pediatric Symptom Checklist will be invited to try an SSI through Project YES. We will examine provider uptake and perceptions of acceptability, feasibility, and appropriateness over time. Results: The rollout will take place between November 2022 and May 2023, when outcomes will be evaluated. Data analysis and manuscript writing are anticipated to be completed during the summer of 2023. Conclusions: SSIs such as those available through Project YES have the potential to provide low-cost, evidence-based mental health treatment to adolescents with mild to moderate depression and anxiety. If deemed feasible and acceptable, providing SSIs in primary care settings could significantly improve access to mental health care without taxing pediatric primary care and behavioral health providers. International Registered Report Identifier (IRRID): DERR1-10.2196/45666 %M 37556202 %R 10.2196/45666 %U https://www.researchprotocols.org/2023/1/e45666 %U https://doi.org/10.2196/45666 %U http://www.ncbi.nlm.nih.gov/pubmed/37556202 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44388 %T Assessing Mood With the Identifying Depression Early in Adolescence Chatbot (IDEABot): Development and Implementation Study %A Viduani,Anna %A Cosenza,Victor %A Fisher,Helen L %A Buchweitz,Claudia %A Piccin,Jader %A Pereira,Rivka %A Kohrt,Brandon A %A Mondelli,Valeria %A van Heerden,Alastair %A Araújo,Ricardo Matsumura %A Kieling,Christian %+ Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2400, Porto Alegre, 90035003, Brazil, 55 5133085624, ckieling@ufrgs.com %K depression %K adolescent %K ambulatory assessment %K chatbot %K smartphone %K digital mental health %K mobile phone %D 2023 %7 7.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mental health status assessment is mostly limited to clinical or research settings, but recent technological advances provide new opportunities for measurement using more ecological approaches. Leveraging apps already in use by individuals on their smartphones, such as chatbots, could be a useful approach to capture subjective reports of mood in the moment. Objective: This study aimed to describe the development and implementation of the Identifying Depression Early in Adolescence Chatbot (IDEABot), a WhatsApp-based tool designed for collecting intensive longitudinal data on adolescents’ mood. Methods: The IDEABot was developed to collect data from Brazilian adolescents via WhatsApp as part of the Identifying Depression Early in Adolescence Risk Stratified Cohort (IDEA-RiSCo) study. It supports the administration and collection of self-reported structured items or questionnaires and audio responses. The development explored WhatsApp’s default features, such as emojis and recorded audio messages, and focused on scripting relevant and acceptable conversations. The IDEABot supports 5 types of interactions: textual and audio questions, administration of a version of the Short Mood and Feelings Questionnaire, unprompted interactions, and a snooze function. Six adolescents (n=4, 67% male participants and n=2, 33% female participants) aged 16 to 18 years tested the initial version of the IDEABot and were engaged to codevelop the final version of the app. The IDEABot was subsequently used for data collection in the second- and third-year follow-ups of the IDEA-RiSCo study. Results: The adolescents assessed the initial version of the IDEABot as enjoyable and made suggestions for improvements that were subsequently implemented. The IDEABot’s final version follows a structured script with the choice of answer based on exact text matches throughout 15 days. The implementation of the IDEABot in 2 waves of the IDEA-RiSCo sample (140 and 132 eligible adolescents in the second- and third-year follow-ups, respectively) evidenced adequate engagement indicators, with good acceptance for using the tool (113/140, 80.7% and 122/132, 92.4% for second- and third-year follow-up use, respectively), low attrition (only 1/113, 0.9% and 1/122, 0.8%, respectively, failed to engage in the protocol after initial interaction), and high compliance in terms of the proportion of responses in relation to the total number of elicited prompts (12.8, SD 3.5; 91% out of 14 possible interactions and 10.57, SD 3.4; 76% out of 14 possible interactions, respectively). Conclusions: The IDEABot is a frugal app that leverages an existing app already in daily use by our target population. It follows a simple rule-based approach that can be easily tested and implemented in diverse settings and possibly diminishes the burden of intensive data collection for participants by repurposing WhatsApp. In this context, the IDEABot appears as an acceptable and potentially scalable tool for gathering momentary information that can enhance our understanding of mood fluctuations and development. %M 37548996 %R 10.2196/44388 %U https://humanfactors.jmir.org/2023/1/e44388 %U https://doi.org/10.2196/44388 %U http://www.ncbi.nlm.nih.gov/pubmed/37548996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43271 %T Opportunities for the Implementation of a Digital Mental Health Assessment Tool in the United Kingdom: Exploratory Survey Study %A Spadaro,Benedetta %A Martin-Key,Nayra A %A Funnell,Erin %A Benáček,Jiří %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K assessment %K digital mental health %K development %K implementation %K mental health %K provision %K support %K mobile phone %D 2023 %7 7.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Every year, one-fourth of the people in the United Kingdom experience diagnosable mental health concerns, yet only a proportion receive a timely diagnosis and treatment. With novel developments in digital technologies, the potential to increase access to mental health assessments and triage is promising. Objective: This study aimed to investigate the current state of mental health provision in the United Kingdom and understand the utility of, and interest in, digital mental health technologies. Methods: A web-based survey was generated using Qualtrics XM. Participants were recruited via social media. Data were explored using descriptive statistics. Results: The majority of the respondents (555/618, 89.8%) had discussed their mental health with a general practitioner. More than three-fourths (503/618, 81.4%) of the respondents had been diagnosed with a mental health disorder, with the most common diagnoses being depression and generalized anxiety disorder. Diagnostic waiting times from first contact with a health care professional varied by diagnosis. Neurodevelopmental disorders (30/56, 54%), bipolar disorder (25/52, 48%), and personality disorders (48/101, 47.5%) had the longest waiting times, with almost half (103/209, 49.3%) of these diagnoses taking >6 months. Participants stated that waiting times resulted in symptoms worsening (262/353, 74.2%), lower quality of life (166/353, 47%), and the necessity to seek emergency care (109/353, 30.9%). Of the 618 participants, 386 (62.5%) stated that they felt that their mental health symptoms were not always taken seriously by their health care provider and 297 (48.1%) were not given any psychoeducational information. The majority of the respondents (416/595, 77.5%) did not have the chance to discuss mental health support and treatment options. Critically, 16.1% (96/595) did not find any treatment or support provided at all helpful, with 63% (48/76) having discontinued treatment with no effective alternatives. Furthermore, 88.3% (545/617) of the respondents) had sought help on the web regarding mental health symptoms, and 44.4% (272/612) had used a web application or smartphone app for their mental health. Psychoeducation (364/596, 61.1%), referral to a health care professional (332/596, 55.7%), and symptom monitoring (314/596, 52.7%) were the most desired app features. Only 6.8% (40/590) of the participants said that they would not be interested in using a mental health assessment app. Respondents were the most interested to receive an overall severity score of their mental health symptoms (441/546, 80.8%) and an indication of whether they should seek mental health support (454/546, 83.2%). Conclusions: Key gaps in current UK mental health care provision are highlighted. Assessment and treatment waiting times together with a lack of information regarding symptoms and treatment options translated into poor care experiences. The participants’ responses provide proof-of-concept support for the development of a digital mental health assessment app and valuable recommendations regarding desirable app features. %M 37549003 %R 10.2196/43271 %U https://formative.jmir.org/2023/1/e43271 %U https://doi.org/10.2196/43271 %U http://www.ncbi.nlm.nih.gov/pubmed/37549003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44323 %T The Influence of Greenspace Exposure on Affect in People With and Those Without Schizophrenia: Exploratory Study %A Kangarloo,Tairmae %A Mote,Jasmine %A Abplanalp,Samuel %A Gold,Alisa %A James,Peter %A Gard,David %A Fulford,Daniel %+ Sargent College of Health and Rehabilitation Sciences, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, United States, 1 6035681431, tairmaek@bu.edu %K greenspace %K mental health %K mobile technology %K affect %K smartphone %K sensing %K schizophrenia %K natural vegetation %K mental health %K exposure %K assessment %K mechanism %D 2023 %7 3.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Exposure to natural vegetation (ie, “greenspace”) is related to beneficial outcomes, including higher positive and lower negative affect, in individuals with and those without mental health concerns. Researchers have yet to examine dynamic associations between greenspace exposure and affect within individuals over time. Smartphone-based ecological momentary assessment (EMA) and passive sensors (eg, GPS, microphone) allow for frequent sampling of data that may reveal potential moment-to-moment mechanisms through which greenspace exposure impacts mental health. Objective: In this study, we examined associations between greenspace exposure and affect (both self-reported and inferred through speech) in people with and those without schizophrenia spectrum disorder (SSD) at the daily level using smartphones. Methods: Twenty people with SSD and 14 healthy controls reported on their current affect 3 times per day over 7 days using smartphone-based EMA. Affect expressed through speech was labeled from ambient audio data collected via the phone’s microphone using Linguistic Inquiry and Word Count (LIWC). Greenspace exposure, defined as the normalized difference vegetation index (NDVI), was quantified based on continuous geo-location data collected from the phone’s GPS. Results: Overall, people with SSD used significantly more positive affect words (P=.04) and fewer anger words (P=.04) than controls. Groups did not significantly differ in mean EMA-reported positive or negative affect, LIWC total word count, or NDVI exposure. Greater greenspace exposure showed small to moderate associations with lower EMA-reported negative affect across groups. In controls, greenspace exposure on a given day was associated with significantly lower EMA-reported anxiety on that day (b=–0.40, P=.03, 95% CI –0.76 to –0.04) but significantly higher use of negative affect words (b=0.66, P<.001, 95% CI 0.29-1.04). There were no significant associations between greenspace exposure and affect at the daily level among participants with SSD. Conclusions: Our findings speak to the utility of passive and active smartphone assessments for identifying potential mechanisms through which greenspace exposure influences mental health. We identified preliminary evidence that greenspace exposure could be associated with improved mental health by reducing experiences of negative affect. Future directions will focus on furthering our understanding of the relationship between greenspace exposure and affect on individuals with and those without SSD. %M 37535418 %R 10.2196/44323 %U https://formative.jmir.org/2023/1/e44323 %U https://doi.org/10.2196/44323 %U http://www.ncbi.nlm.nih.gov/pubmed/37535418 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40277 %T Expressive Interviewing Agents to Support Health-Related Behavior Change: Randomized Controlled Study of COVID-19 Behaviors %A Stewart,Ian %A Welch,Charles %A An,Lawrence %A Resnicow,Ken %A Pennebaker,James %A Mihalcea,Rada %+ School of Computer Science and Engineering, University of Michigan, 2260 Hayward Street, Ann Arbor, MI, 48109, United States, 1 7347648504, ianbstew@umich.edu %K expressive writing %K motivational interviewing %K dialogue systems %K counseling %K behavior change %K text analysis %K COVID-19 %K mental health %K automated writing %K writing system %K stress %K psychological health %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Expressive writing and motivational interviewing are well-known approaches to help patients cope with stressful life events. Although these methods are often applied by human counselors, it is less well understood if an automated artificial intelligence approach can benefit patients. Providing an automated method would help expose a wider range of people to the possible benefits of motivational interviewing, with lower cost and more adaptability to sudden events like the COVID-19 pandemic. Objective: This study presents an automated writing system and evaluates possible outcomes among participants with respect to behavior related to the COVID-19 pandemic. Methods: We developed a rule-based dialogue system for “Expressive Interviewing” to elicit writing from participants on the subject of how COVID-19 has impacted their lives. The system prompts participants to describe their life experiences and emotions and provides topic-specific prompts in response to participants’ use of topical keywords. In May 2021 and June 2021, we recruited participants (N=151) via Prolific to complete either the Expressive Interviewing task or a control task. We surveyed participants immediately before the intervention, immediately after the intervention, and again 2 weeks after the intervention. We measured participants’ self-reported stress, general mental health, COVID-19–related health behavior, and social behavior. Results: Participants generally wrote long responses during the task (53.3 words per response). In aggregate, task participants experienced a significant decrease in stress in the short term (~23% decrease, P<.001) and a slight difference in social activity compared with the control group (P=.03). No significant differences in short-term or long-term outcomes were detected between participant subgroups (eg, male versus female participants) except for some within-condition differences by ethnicity (eg, higher social activity among African American people participating in Expressive Interviewing vs participants of other ethnicities). For short-term effects, participants showed different outcomes based on their writing. Using more anxiety-related words was correlated with a greater short-term decrease in stress (r=–0.264, P<.001), and using more positive emotion words was correlated with a more meaningful experience (r=0.243, P=.001). As for long-term effects, writing with more lexical diversity was correlated with an increase in social activity (r=0.266, P<.001). Conclusions: Expressive Interviewing participants exhibited short-term, but not long-term, positive changes in mental health, and some linguistic metrics of writing style were correlated with positive change in behavior. Although there were no significant long-term effects observed, the positive short-term effects suggest that the Expressive Interviewing intervention could be used in cases in which a patient lacks access to traditional therapy and needs a short-term solution. Trial Registration: Clincaltrials.gov NCT05949840; https://www.clinicaltrials.gov/study/NCT05949840 %M 37074948 %R 10.2196/40277 %U https://formative.jmir.org/2023/1/e40277 %U https://doi.org/10.2196/40277 %U http://www.ncbi.nlm.nih.gov/pubmed/37074948 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44079 %T The Effectiveness and Cost-Effectiveness of a Universal Digital Parenting Intervention Designed and Implemented During the COVID-19 Pandemic: Evidence From a Rapid-Implementation Randomized Controlled Trial Within a Cohort %A Palmer,Melanie %A Beckley-Hoelscher,Nicholas %A Shearer,James %A Kostyrka-Allchorne,Katarzyna %A Robertson,Olly %A Koch,Marta %A Pearson,Oliver %A Slovak,Petr %A Day,Crispin %A Byford,Sarah %A Goldsmith,Kimberley %A Waite,Polly %A Creswell,Cathy %A Sonuga-Barke,Edmund J S %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 0207 848 0269, edmund.sonuga-barke@kcl.ac.uk %K parenting %K intervention %K digital application %K randomized controlled trial %K COVID-19 pandemic %K mobile phone %D 2023 %7 27.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Children’s conduct and emotional problems increased during the COVID-19 pandemic. Objective: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapted from standard face-to-face parent training programs to tackle 8 specific challenges identified by parents and parenting experts as particularly relevant for parents during the pandemic. The Parenting Exchange (zone 2) was a parent-to-parent and parent-to-expert communication forum. Parenting Resources (zone 3) provided access to existing high-quality web-based resources on a range of additional topics of value to parents (eg, neurodevelopmental problems, diet, and sleep). Methods: Supporting Parents And Kids Through Lockdown Experiences (SPARKLE), a randomized controlled trial, was embedded in the UK-wide COVID-19: Supporting Parents, Adolescents and Children during Epidemics (Co-SPACE) longitudinal study on families’ mental health during the pandemic. Parents of children aged 4 to 10 years were randomized 1:1 to Parent Positive or follow-up as usual (FAU) between May 19, 2021, and July 26, 2021. Parent Positive provided advice on common parenting challenges and evidence-based web-based resources and facilitated parent-to-parent and expert-to-parent support. Child conduct and emotional problems and family well-being were measured before randomization (T1) and at 1 (T2) and 2 (T3) months after randomization. Service use, costs, and adverse events were measured, along with app use and satisfaction. The primary outcome was T2 parent-reported child conduct problems, which were analyzed using linear mixed regression models. Results: A total of 320 participants were randomized to Parent Positive, and 326 were randomized to FAU. The primary outcome analysis included 79.3% (512/646) of the participants (dropout: 84/320, 26% on Parent Positive and 50/326, 15% on FAU). There were no statistically significant intervention effects on conduct problems at either T2 (standardized effect=−0.01) or T3 (secondary outcome; standardized effect=−0.09) and no moderation by baseline conduct problems. Significant intervention-related reductions in emotional problems were observed at T2 and T3 (secondary outcomes; standardized effect=−0.13 in both cases). Parent Positive, relative to FAU, was associated with more parental worries at T3 (standardized effect=0.14). Few intervention-attributable adverse events were reported. Parent Positive was cost-effective once 4 outliers with extremely high health care costs were excluded. Conclusions: Parent Positive reduced child emotional problems and was cost-effective compared with FAU once outliers were removed. Although small when considered against targeted therapeutic interventions, the size of these effects was in line with trials of nontargeted universal mental health interventions. This highlights the public health potential of Parent Positive if implemented at the community level. Nevertheless, caution is required before making such an interpretation, and the findings need to be replicated in large-scale, whole-community studies. Trial Registration: ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080 %M 37498669 %R 10.2196/44079 %U https://www.jmir.org/2023/1/e44079 %U https://doi.org/10.2196/44079 %U http://www.ncbi.nlm.nih.gov/pubmed/37498669 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45027 %T Boosting Empathy and Compassion Through Mindfulness-Based and Socioemotional Dyadic Practice: Randomized Controlled Trial With App-Delivered Trainings %A Silveira,Sarita %A Godara,Malvika %A Singer,Tania %+ Social Neuroscience Lab, Max Planck Society, Bertha-Benz-Str 3, Berlin, 10557, Germany, 49 030 23608 1512, sarita.silveira@social.mpg.de %K mental training %K compassion %K empathy %K mindfulness %K dyadic practice %K acceptance %K digital mental health %K self-compassion %K app-delivered training %K Affect Dyad %K mobile phone %D 2023 %7 26.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Contemplative trainings have been found to effectively improve social skills such as empathy and compassion. However, there is a lack of research on the efficacy of app-delivered mindfulness-based and dyadic practices in boosting socioaffective capacity. Objective: The first aim of this study was to compare a novel app-delivered, partner-based socioemotional intervention (Affect Dyad) with mindfulness-based training to foster empathy and compassion for the self or others. The second aim of this study was to investigate the underlying mechanisms of these effects. Methods: This randomized controlled trial included socioemotional and mindfulness-based interventions and a waitlist control group, which received socioemotional training after the postintervention assessment. We used linear mixed-effects models to test intervention effects on self-report measures and an ecologically valid computer task of empathy, compassion for the self and others, and theory of mind. Moderated mediation models were used to investigate whether changes in acceptance, empathic distress, empathic listening, interoceptive awareness, and mindfulness served as underlying psychological processes of intervention effects. Results: In 218 participants (mean age 44.12, SD 11.71 years; 160/218, 73.4% female), we found all interventions to have positive effects on composite scores for compassion toward the self (βsocioemotional=.44, P<.001; βwaitlist socioemotional=.30, P=.002; βmindfulness-based=.35, P<.001) and others (βsocioemotional=.24, P=.003; βwaitlist socioemotional=.35, P<.001; βmindfulness-based=.29, P<.001). Compassion measured with the computer task did not change significantly but showed a trend toward increase only in socioemotional dyadic practice (βsocioemotional=.08, P=.08; βwaitlist socioemotional=.11, P=.06). Similarly, on the empathic concern subscale of the Interpersonal Reactivity Index, a nonsignificant trend toward increase was found in the socioemotional intervention group (βsocioemotional=.17; P=.08). Empathy significantly increased in both socioemotional groups (βsocioemotional=.16, P=.03; βwaitlist socioemotional=.35, P<.001) and the mindfulness-based group (βmindfulness-based=.15; P=.04). The measures of theory of mind did not change over time. In the mindfulness-based group, the increase in self-compassion was mediated by a decrease in empathic distress (indirect effect abmindfulness-based=0.07, 95% CI 0.02-0.14). In the socioemotional group, an increase in self-compassion could be predicted by an increase in acceptance (βsocioemotional=6.63, 95% CI 0.52-12.38). Conclusions: Using a multimethod approach, this study shows that app-delivered socioemotional and mindfulness-based trainings are effective in fostering compassion for the self and others in self-report. Both low-dose trainings could boost behavioral empathy markers; however, the effects on behavioral and dispositional markers of compassion only trended after dyadic practice, yet these effects did not reach statistical significance. Training-related increases in self-compassion rely on differential psychological processes, that is, on improved empathic distress regulation through mindfulness-based training and the activation of a human care– and acceptance-based system through socioemotional dyadic training. Trial Registration: ClinicalTrials.gov NCT04889508; https://clinicaltrials.gov/ct2/show/NCT04889508 %M 37494106 %R 10.2196/45027 %U https://www.jmir.org/2023/1/e45027 %U https://doi.org/10.2196/45027 %U http://www.ncbi.nlm.nih.gov/pubmed/37494106 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41440 %T Evaluation of a Web-Based Self-Help Intervention for Patients With Generalized Anxiety Disorder: Protocol for a Randomized Controlled Trial %A Rubel,Julian %A Quest,Jannis %A Pruessner,Luise %A Timm,Christina %A Hartmann,Steffen %A Barnow,Sven %A Rittmeyer,Lisa %A Rosenbaum,David %A Lalk,Christopher %+ Faculty of Psychology and Sport Science, Justus-Liebig-University Giessen, Otto-Behaghel-Straße 10, Haus F1, Gießen, 35394, Germany, 49 1758438839, Christopher.lalk@uni-osnabrueck.de %K generalized anxiety disorder %K GAD %K online self-help %K randomized controlled trial %K RCT %K self-help %K guided %K anxiety %K online intervention %K mental health %K mental illness %K mental disorder %K psychotherapy %K internet-based %K internet intervention %K web-based %D 2023 %7 26.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Generalized anxiety disorder (GAD) is a highly prevalent and severely distressing condition that can lead to functional impairments and is considered one of the most difficult anxiety disorders to treat. Following new technological developments, a highly structured cognitive behavioral therapy (CBT) approach that has already shown success in face-to-face psychotherapy can be implemented: internet-delivered CBT (iCBT). There is now evidence for the efficacy of both guided and unguided iCBT interventions for GAD regarding symptom reduction. Objective: To establish the usefulness of such interventions, we plan to evaluate the efficacy of a web-based self-help program (Selfapy) for GAD in a relatively large sample. We aim to assess effects beyond symptom reduction, including effects on well-being, functioning, and mental health literacy, as well as the effect on health care burden, while testing the intervention in conditions comparable to routine care. Methods: Patients (n=156) who have been diagnosed with GAD, are aged between 18 and 65 years, have internet access, and have sufficient German language skills will be recruited for this study. The intervention group (n=78) will receive access to the 12-week self-help web-based program Selfapy. The waitlist control group (n=78) will receive no intervention in the context of the study. However, both groups will be allowed to access further health care services (eg, psychotherapy, medication), reflecting current routine care in Germany. Outcome measures will be assessed at baseline (T1) and 6 weeks (T2) and 12 weeks (T3) after the start of the intervention. The primary outcome will be generalized anxiety symptoms and quality of life at T3. Additional outcomes include depression, work capacity, therapy-related expenses and burdens, health literacy, and negative effects. Results: By May 2023, all participants had finished the trial and the report was being prepared for publication. Conclusions: Web-based interventions may be an important addition to the German health care system to reduce barriers to treatment access. Further, they may prove cost-effective for the treatment of GAD. Trial Registration: Deutsches Register Klinischer Studien DRKS00023799; https://tinyurl.com/22bds38x International Registered Report Identifier (IRRID): DERR1-10.2196/41440 %M 37494105 %R 10.2196/41440 %U https://www.researchprotocols.org/2023/1/e41440 %U https://doi.org/10.2196/41440 %U http://www.ncbi.nlm.nih.gov/pubmed/37494105 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42993 %T The Polarization of Clinician and Service Staff Perspectives After the Use of Health Information Technology in Youth Mental Health Services: Implementation and Evaluation Study %A McKenna,Sarah %A Piper,Sarah %A Capon,William %A Crowley,Alison %A Lira,Lucas %A LaMonica,Haley M %A Chong,Min Kyung %A Scott,Elizabeth %A Hickie,Ian %A Iorfino,Frank %+ Faculty of Medicine and Health, Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 0419517723, sarah.mckenna@sydney.edu.au %K mental health %K youth %K adolescent %K service delivery %K implementation science %K digital technologies %K measurement-based care %K health information technology %K information system %K perspective %K provider %K health care staff %K health care worker %K health care professional %D 2023 %7 25.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Highly personalized care is substantially improved by technology platforms that assess and track patient outcomes. However, evidence regarding how to successfully implement technology in real-world mental health settings is limited. Objective: This study aimed to naturalistically monitor how a health information technology (HIT) platform was used within 2 real-world mental health service settings to gain practical insights into how HIT can be implemented and sustained to improve mental health service delivery. Methods: An HIT (The Innowell Platform) was naturally implemented in 2 youth mental health services in Sydney, Australia. Web-based surveys (n=19) and implementation logs were used to investigate staff attitudes toward technology before and after implementation. Descriptive statistics were used to track staff attitudes over time, whereas qualitative thematic analysis was used to explore implementation log data to gain practical insights into useful implementation strategies in real-world settings. Results: After the implementation, the staff were nearly 3 times more likely to agree that the HIT would improve care for their clients (3/12, 25% agreed before the implementation compared with 7/10, 70% after the implementation). Despite this, there was also an increase in the number of staff who disagreed that the HIT would improve care (from 1/12, 8% to 2/10, 20%). There was also decreased uncertainty (from 6/12, 50% to 3/10, 30%) about the willingness of the service to implement the technology for its intended purpose, with similar increases in the number of staff who agreed and disagreed with this statement. Staff were more likely to be uncertain about whether colleagues in my service are receptive to changes in clinical processes (not sure rose from 5/12, 42% to 7/10, 70%). They were also more likely to report that their service already provides the best mental health care (agreement rose from 7/12, 58% to 8/10, 80%). After the implementation, a greater proportion of participants reported that the HIT enabled shared or collaborative decision-making with young people (2/10, 20%, compared with 1/12, 8%), enabled clients to proactively work on their mental health care through digital technologies (3/10, 30%, compared with 2/12, 16%), and improved their response to suicidal risk (4/10, 40% compared with 3/12, 25%). Conclusions: This study raises important questions about why clinicians, who have the same training and support in using technology, develop more polarized opinions on its usefulness after implementation. It seems that the uptake of HIT is heavily influenced by a clinician’s underlying beliefs and attitudes toward clinical practice in general as well as the role of technology, rather than their knowledge or the ease of use of the HIT in question. %M 37490321 %R 10.2196/42993 %U https://humanfactors.jmir.org/2023/1/e42993 %U https://doi.org/10.2196/42993 %U http://www.ncbi.nlm.nih.gov/pubmed/37490321 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46200 %T A Novel and Integrated Digitally Supported System of Care for Depression and Anxiety: Findings From an Open Trial %A Wolitzky-Taylor,Kate %A LeBeau,Richard %A Arnaudova,Inna %A Barnes-Horowitz,Nora %A Gong-Guy,Elizabeth %A Fears,Scott %A Congdon,Eliza %A Freimer,Nelson %A Craske,Michelle %+ Department of Psychiatry and Biobehavioral Sciences, University of California - Los Angeles, 760 Westwood Blvd., Los Angeles, CA, 90025, United States, 1 3102675339, kbtaylor@mednet.ucla.edu %K depression %K anxiety %K cognitive behavioral therapy %K digital mental health %K stratified models of care %K model of care %K care model %K depressive %K mental health %K CBT %K psychotherapy %K university %K postsecondary %K student %K college %K service delivery %K care system %K system of care %K mHealth %K eHealth %K online support %K student mental health %D 2023 %7 24.7.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The global burden of anxiety and depression has created an urgent need for scalable approaches to increase access to evidence-based mental health care. The Screening and Treatment for Anxiety and Depression (STAND) system of care was developed to meet this need through the use of internet-connected devices for assessment and provision of treatment. STAND triages to level of care (monitoring only, digital therapy with coaches, digital therapy assisted by clinicians in training, and clinical care) and then continuously monitors symptoms to adapt level of care. Triaging and adaptation are based on symptom severity and suicide risk scores obtained from computerized adaptive testing administered remotely. Objective: This article discusses how the STAND system of care improves upon current clinical paradigms, and presents preliminary data on feasibility, acceptability, and effectiveness of STAND in a sample of US-based university students. Methods: US-based university students were recruited and enrolled in an open trial of the STAND system of care. Participants were triaged based on initial symptom severity derived from a computerized adaptive test and monitored over 40 weeks on anxiety, depression, and suicide risk to inform treatment adaptation and evaluate preliminary effectiveness. Results: Nearly 5000 students were screened and 516 received care. Depression and anxiety severity scores improved across all tiers (P<.001 in all cases). Suicide risk severity improved in the highest tier (ie, clinical care; P<.001). Acceptability and feasibility were demonstrated. Conclusions: STAND is a feasible and acceptable model of care that can reach large numbers of individuals. STAND showed preliminary effectiveness on all primary outcome measures. Current directions to improve STAND are described. %M 37486735 %R 10.2196/46200 %U https://mental.jmir.org/2023/1/e46200 %U https://doi.org/10.2196/46200 %U http://www.ncbi.nlm.nih.gov/pubmed/37486735 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47285 %T The Impact of a Gamified Mobile Mental Health App (eQuoo) on Resilience and Mental Health in a Student Population: Large-Scale Randomized Controlled Trial %A Litvin,Silja %A Saunders,Rob %A Jefferies,Philip %A Seely,Hayley %A Pössel,Patrick %A Lüttke,Stefan %+ Department Psychologie, Ludwig-Maximilians-Universität, Geschwister-Scholl-Platz 1, München, 80539, Germany, 49 89 21800, silja@psycapps.com %K mobile health %K mHealth %K gamification %K resilience %K randomized controlled trial %K RCT %K mental health %K apps %K mobile health %K mobile game %K mobile games %K serious game %K depression %K anxiety %K university %K college %K student %K students %K controlled trial %K controlled trials %K young adult %K mobile phone %D 2023 %7 21.7.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: With many digital mental health interventions failing to engage clients for enough time to demonstrate substantive changes to their well-being and with only 2% of all digital solutions on app stores having undergone randomized controlled trials, the rising demand for mental health prevention and early intervention care is not being met. Young adults in particular struggle to find digital well-being apps that suit their needs. Objective: This study explored the effects of eQuoo, an evidence-based mental health game that teaches psychological skills through gamification, on resilience, depression, anxiety, and attrition in a student population. Methods: In total, 1165 students from 180 universities in the United Kingdom participated in a 5-week, 3-armed randomized controlled trial. Participants were randomly allocated into 1 of 3 groups: eQuoo users, users of a treatment-as-usual evidence-based cognitive behavioral health app called Sanvello, and a no-intervention waitlist. The Rugged Resilience Scale, Generalized Anxiety Disorder–7, and Patient Health Questionnaire–8 were administered to all participants at baseline and every 7 days until completion. Results: A repeated measures–ANOVA revealed statistically significant increases in resilience scores in the test group (P<.001) compared with both control groups (Sanvello: P=.10 and waitlist: P=.82) over 5 weeks. The app also significantly decreased anxiety and depression scores (both P<.001). With 64.5% (251/389) adherence, the eQuoo group retained 42% more participants than the control groups. Conclusions: Digital health interventions such as eQuoo are effective, scalable, and low-cost solutions for supporting young adults and are available on all leading mobile platforms. Further investigation could clarify the extent to which specific elements of the eQuoo app (including gamification) led to better outcomes. Trial Registration: German Clinical Trials Register (DRKS) DRKS00027638; https://drks.de/search/en/trial/DRKS00027638 %M 37477955 %R 10.2196/47285 %U https://mental.jmir.org/2023/1/e47285 %U https://doi.org/10.2196/47285 %U http://www.ncbi.nlm.nih.gov/pubmed/37477955 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46165 %T Privacy-Preserving Federated Model Predicting Bipolar Transition in Patients With Depression: Prediction Model Development Study %A Lee,Dong Yun %A Choi,Byungjin %A Kim,Chungsoo %A Fridgeirsson,Egill %A Reps,Jenna %A Kim,Myoungsuk %A Kim,Jihyeong %A Jang,Jae-Won %A Rhee,Sang Youl %A Seo,Won-Woo %A Lee,Seunghoon %A Son,Sang Joon %A Park,Rae Woong %+ Department of Biomedical Informatics, Ajou University School of Medicine, 164, World cup-ro, Yeongtong-gu, Suwon-si, 16499, Republic of Korea, 82 2194471, rwpark99@gmail.com %K federated learning %K depression %K bipolar disorder %K data standardization %K differential privacy %D 2023 %7 20.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mood disorder has emerged as a serious concern for public health; in particular, bipolar disorder has a less favorable prognosis than depression. Although prompt recognition of depression conversion to bipolar disorder is needed, early prediction is challenging due to overlapping symptoms. Recently, there have been attempts to develop a prediction model by using federated learning. Federated learning in medical fields is a method for training multi-institutional machine learning models without patient-level data sharing. Objective: This study aims to develop and validate a federated, differentially private multi-institutional bipolar transition prediction model. Methods: This retrospective study enrolled patients diagnosed with the first depressive episode at 5 tertiary hospitals in South Korea. We developed models for predicting bipolar transition by using data from 17,631 patients in 4 institutions. Further, we used data from 4541 patients for external validation from 1 institution. We created standardized pipelines to extract large-scale clinical features from the 4 institutions without any code modification. Moreover, we performed feature selection in a federated environment for computational efficiency and applied differential privacy to gradient updates. Finally, we compared the federated and the 4 local models developed with each hospital's data on internal and external validation data sets. Results: In the internal data set, 279 out of 17,631 patients showed bipolar disorder transition. In the external data set, 39 out of 4541 patients showed bipolar disorder transition. The average performance of the federated model in the internal test (area under the curve [AUC] 0.726) and external validation (AUC 0.719) data sets was higher than that of the other locally developed models (AUC 0.642-0.707 and AUC 0.642-0.699, respectively). In the federated model, classifications were driven by several predictors such as the Charlson index (low scores were associated with bipolar transition, which may be due to younger age), severe depression, anxiolytics, young age, and visiting months (the bipolar transition was associated with seasonality, especially during the spring and summer months). Conclusions: We developed and validated a differentially private federated model by using distributed multi-institutional psychiatric data with standardized pipelines in a real-world environment. The federated model performed better than models using local data only. %M 37471130 %R 10.2196/46165 %U https://www.jmir.org/2023/1/e46165 %U https://doi.org/10.2196/46165 %U http://www.ncbi.nlm.nih.gov/pubmed/37471130 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45766 %T Attitudes Toward Seeking Mental Health Services and Mobile Technology to Support the Management of Depression Among Black American Women: Cross-Sectional Survey Study %A McCall,Terika %A Foster,Meagan %A Schwartz,Todd A %+ Division of Health Informatics, Department of Biostatistics, Yale School of Public Health, 60 College Street, New Haven, CT, 06510, United States, 1 203 737 7902, terika.mccall@yale.edu %K African American %K women %K depression %K telemedicine %K mobile health %K mHealth %K mobile apps %K digital health %K mental health %K gender minority %K mobile technology %K mobile phone %D 2023 %7 19.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is a common mental health condition among Black American women. Many factors may contribute to the development of depressive symptoms, such as gender and racial discrimination, financial strain, chronic health conditions, and caregiving responsibilities. Barriers such as the stigmatization of mental illness, less access to treatment, the lack of or inadequate health insurance, mistrust of providers, and limited health literacy prevent marginalized populations from seeking care. Previous literature has shown that mobile health interventions are effective and can increase access to mental health services and resources. Objective: We aimed to understand the attitudes and perceptions of Black women toward using mental health services and determine the acceptability and concerns of using mobile technology (ie, voice call, video call, SMS text messaging, and mobile app) to support the management of depression. Methods: We launched a self-administered web-based questionnaire in October 2019 and closed it in January 2020. Women (aged ≥18 years) who identify as Black or African American or multiracial (defined as Black or African American and another race) were eligible to participate. The survey consisted of approximately 70 questions and included topics such as attitudes toward seeking professional psychological help, the acceptability of using a mobile phone to receive mental health care, and screening for depression. Results: The findings (n=395) showed that younger Black women were more likely to have greater severity of depression than their older counterparts. The results also revealed that Black women have favorable views toward seeking mental health services. Respondents were the most comfortable with the use of voice calls or video calls to communicate with a professional to receive support for managing depression in comparison with SMS text messaging or mobile apps. The results revealed that higher help-seeking propensity increased the odds of indicating agreement with the use of voice calls and video calls to communicate with a professional to receive support for managing depression by 27% and 38%, respectively. However, no statistically significant odds ratios (all P>.05) were found between help-seeking propensity and respondents’ agreement to use mobile apps or SMS text messaging. Moderate to severe depression severity increased the odds of using mobile apps to communicate with a professional to receive support for managing depression by 43%; however, no statistically significant odds ratios existed for the other modalities. Privacy and confidentiality, communication issues (eg, misinterpreting text), and the impersonal feeling of communicating by mobile phone (eg, SMS text messaging) were the primary concerns. Conclusions: Black American women, in general, have favorable views toward seeking mental health services and are comfortable with the use of mobile technology to receive support for managing depression. Future work should address the issues of access and consider the preferences and cultural appropriateness of the resources provided. %M 37467027 %R 10.2196/45766 %U https://www.jmir.org/2023/1/e45766 %U https://doi.org/10.2196/45766 %U http://www.ncbi.nlm.nih.gov/pubmed/37467027 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44365 %T Effects of Induced Mindfulness at Night on Repetitive Negative Thinking: Ecological Momentary Assessment Study %A Sommerhoff,Amanda %A Ehring,Thomas %A Takano,Keisuke %+ Human Informatics and Interaction Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), 1-1-1 Higashi, Tsukuba, Ibaraki, 305-8566, Japan, 81 29 849 1456, keisuke.takano@aist.go.jp %K mindfulness %K repetitive negative thinking %K stress %K daily life %K ecological momentary assessment %K mobile phone %D 2023 %7 19.7.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Repetitive negative thinking (RNT) is a cognitive risk factor for various disorders. Although brief mindfulness-based interventions (MBIs; lasting 20-30 minutes or shorter) are effective tools to reduce RNT, the effect of a minimal (5-minute) MBI remains largely unknown. Objective: We investigated the acute changes in RNT induced by a 10-day minimal MBI (body scan before sleeping) using an ecological momentary assessment (EMA) administered during the MBI training phase. In addition, we examined longer-term effects on the postintervention and 2-month follow-up assessments for questionnaire-based RNT and psychological distress. Methods: A total of 68 participants (community sample, aged 18-55 years; n=58, 85% women) were randomly allocated to either the intervention group (n=35, 51%) or the no-training control group (n=33, 49%). Both groups completed a 10-day EMA phase of RNT, during which only the intervention group performed a daily 5-minute body scan before sleeping. Results: The intervention group showed a significantly larger reduction in questionnaire-based RNT than the control group at the follow-up assessment (for growth-curve modeling analysis [GMA], dGMA=−0.91; P<.001), but this effect was not observed during the EMA phase or at the postintervention assessment. Furthermore, the intervention group showed significantly larger decreases in stress both at the postintervention (dGMA=−0.78; P<.001) and follow-up (dGMA=−0.60; P<.001) assessments than the control group. We found no intervention effects on depressive and anxiety symptoms. Conclusions: A 5-minute body scan before sleeping reduces RNT and stress when continued for at least 10 days; however, the results suggest that this effect only appears with some time lag because no acute changes during and immediately after the intervention emerged for RNT. %M 37467038 %R 10.2196/44365 %U https://mental.jmir.org/2023/1/e44365 %U https://doi.org/10.2196/44365 %U http://www.ncbi.nlm.nih.gov/pubmed/37467038 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44747 %T Understanding the Role of Patient Portals in Fostering Interprofessional Collaboration Within Mental Health Care Settings: Mixed Methods Study %A Durocher,Keri %A Shin,Hwayeon Danielle %A Lo,Brian %A Chen,Sheng %A Ma,Clement %A Strudwick,Gillian %+ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, ON, M6J 1H4, Canada, 1 (416) 599 1448, kduroch3@uwo.ca %K mental health %K patient portal %K mixed methods %K interprofessional collaboration %K communication %K self-empowerment %K nursing informatics %K digital health %D 2023 %7 19.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patient portals are web-based systems through which patients can access their personal health information and communicate with their clinicians. The integration of patient portals into mental health care settings has been evolving over the past decade, as cumulated research to date has highlighted the potential role of portals in facilitating positive health outcomes. However, it is currently unknown whether portal use can foster interprofessional collaboration between clinicians and patients or whether the portal is a tool to support an already established collaborative relationship. Objective: This mixed methods study aimed to understand how the use of a patient portal within mental health settings can impact the level of interprofessional collaboration between clinicians and patients. Methods: This study was conducted in a large mental health care organization in Ontario, Canada. A convergent mixed methods design was used, where the primary data collection methods included questionnaires and semistructured interviews with patients who had experience using a portal for their mental health care. For the quantitative strand, participants completed the Health Care Communication Questionnaire and the Self-Empowerment subscale of the Mental Health Recovery Measure at 3 time points (baseline, 3 months of use, and 6 months of use) to measure changes in scores over time. For the qualitative strand, semistructured interviews were conducted at the 3-month time point to assess the elements of interprofessional collaboration associated with the portal. Results: For the quantitative strand, 113 participants completed the questionnaire. For the Health Care Communication Questionnaire scores, the raw means of the total scores at the 3 time points were as follows: baseline, 43.01 (SD 7.28); three months, 43.19 (SD 6.65); and 6 months, 42.74 (SD 6.84). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.70). For the Mental Health Recovery Measure scores, the raw mean total scores at the 3 time points were as follows: baseline, 10.77 (SD 3.63); three months, 11.09 (SD 3.81); and 6 months, 11.10 (SD 3.33). In the univariate model with time as the only independent variable, the scores did not differ significantly across the 3 time points (P=.34). For the qualitative strand, 10 participants were interviewed and identified various elements of how interprofessional collaboration can be supplemented through the use of a patient portal, including improved team functioning, communication, and conflict resolution. Conclusions: Although the quantitative data produced nonsignificant findings in interprofessional collaboration scores over time, the patients’ narrative accounts described how the portal can support various interprofessional collaboration concepts, such as communication, leadership, and conflict resolution. This provides useful information for clinicians to support the interprofessional relationship when using a portal within a mental health setting. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-025508 %M 37467024 %R 10.2196/44747 %U https://humanfactors.jmir.org/2023/1/e44747 %U https://doi.org/10.2196/44747 %U http://www.ncbi.nlm.nih.gov/pubmed/37467024 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45984 %T Scope, Characteristics, Behavior Change Techniques, and Quality of Conversational Agents for Mental Health and Well-Being: Systematic Assessment of Apps %A Lin,Xiaowen %A Martinengo,Laura %A Jabir,Ahmad Ishqi %A Ho,Andy Hau Yan %A Car,Josip %A Atun,Rifat %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Rd, Singapore, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K conversational agent %K chatbot %K mental health %K mobile health %K mHealth %K behavior change %K apps %K Mobile Application Rating Scale %K MARS %K mobile phone %D 2023 %7 18.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental disorders cause substantial health-related burden worldwide. Mobile health interventions are increasingly being used to promote mental health and well-being, as they could improve access to treatment and reduce associated costs. Behavior change is an important feature of interventions aimed at improving mental health and well-being. There is a need to discern the active components that can promote behavior change in such interventions and ultimately improve users’ mental health. Objective: This study systematically identified mental health conversational agents (CAs) currently available in app stores and assessed the behavior change techniques (BCTs) used. We further described their main features, technical aspects, and quality in terms of engagement, functionality, esthetics, and information using the Mobile Application Rating Scale. Methods: The search, selection, and assessment of apps were adapted from a systematic review methodology and included a search, 2 rounds of selection, and an evaluation following predefined criteria. We conducted a systematic app search of Apple’s App Store and Google Play using 42matters. Apps with CAs in English that uploaded or updated from January 2020 and provided interventions aimed at improving mental health and well-being and the assessment or management of mental disorders were tested by at least 2 reviewers. The BCT taxonomy v1, a comprehensive list of 93 BCTs, was used to identify the specific behavior change components in CAs. Results: We found 18 app-based mental health CAs. Most CAs had <1000 user ratings on both app stores (12/18, 67%) and targeted several conditions such as stress, anxiety, and depression (13/18, 72%). All CAs addressed >1 mental disorder. Most CAs (14/18, 78%) used cognitive behavioral therapy (CBT). Half (9/18, 50%) of the CAs identified were rule based (ie, only offered predetermined answers) and the other half (9/18, 50%) were artificial intelligence enhanced (ie, included open-ended questions). CAs used 48 different BCTs and included on average 15 (SD 8.77; range 4-30) BCTs. The most common BCTs were 3.3 “Social support (emotional),” 4.1 “Instructions for how to perform a behavior,” 11.2 “Reduce negative emotions,” and 6.1 “Demonstration of the behavior.” One-third (5/14, 36%) of the CAs claiming to be CBT based did not include core CBT concepts. Conclusions: Mental health CAs mostly targeted various mental health issues such as stress, anxiety, and depression, reflecting a broad intervention focus. The most common BCTs identified serve to promote the self-management of mental disorders with few therapeutic elements. CA developers should consider the quality of information, user confidentiality, access, and emergency management when designing mental health CAs. Future research should assess the role of artificial intelligence in promoting behavior change within CAs and determine the choice of BCTs in evidence-based psychotherapies to enable systematic, consistent, and transparent development and evaluation of effective digital mental health interventions. %M 37463036 %R 10.2196/45984 %U https://www.jmir.org/2023/1/e45984 %U https://doi.org/10.2196/45984 %U http://www.ncbi.nlm.nih.gov/pubmed/37463036 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42093 %T Comparing Adherence to the Experience Sampling Method Among Patients With Schizophrenia Spectrum Disorder and Unaffected Individuals: Observational Study From the Multicentric DiAPAson Project %A Zarbo,Cristina %A Zamparini,Manuel %A Nielssen,Olav %A Casiraghi,Letizia %A Rocchetti,Matteo %A Starace,Fabrizio %A de Girolamo,Giovanni %A , %+ Unit of Epidemiological and Evaluation Psychiatry, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Via Pilastroni 4, Brescia, 25125, Italy, 39 3896875449, cristinazarbo@gmail.com %K ecological momentary assessment %K multicenter study %K mobile application %K mobile app %K compliance %K psychosis %D 2023 %7 18.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The Experience Sampling Method (ESM) is a valid method of remotely recording activities and mood, but the predictors of adherence to ESM in patients with Schizophrenia Spectrum Disorder (SSD) are not known. Studies on adherence are significant as they highlight the strengths and weaknesses of ESM-based study designs and allow the development of recommendations and practical guidelines for implementing future studies or treatment plans. Objective: The aim of this study was to compare the adherence to ESM in patients with SSD and unaffected control individuals, investigate their patterns, and report the predictors of adherence. Methods: In total, 131 patients with SSD (74 in residential facilities and 57 outpatients) and 115 unaffected control individuals were recruited at 10 different centers in Italy as part of the DiAPAson project. Demographic information, symptom severity, disability level, and level of function were recorded for the clinical sample. Participants were evaluated for daily time use and mood through a smartphone-based ESM 8 times a day for 7 consecutive days. Adherence was measured by the response rate to ESM notifications. Results were analyzed using the chi-square test, ANOVA, Kruskal-Wallis test, and Friedman test, and a logistic regression model. Results: The overall adherence rate in this study was 50% for residents, 59% for outpatients, and 78% for unaffected control individuals. Indeed, patients with SSD had a lower rate of adherence to ESM than the unaffected control group (P≤.001), independent of time slot, day of monitoring, or day of the week. No differences in adherence rates between weekdays and weekends were found among the 3 groups. The adherence rate was the lowest in the late evening time slot (8 PM to 12 AM) and days 6-7 of the study for both patients with SSD and unaffected control individuals. The adherence rate among patients with SSD was not predicted by sociodemographic characteristics, cognitive function, or other clinical features. A higher adherence rate (ie, ≥70%) among patients with SSD was predicted by higher collaboration skills (odds ratio [OR] 2.952; P=.046) and self-esteem (OR 3.394; P=.03), and lower positive symptom severity (OR 0.835; P=.04). Conclusions: Adherence to ESM prompts for both patients with SSD and unaffected control individuals decreased during late evening and after 6 days of monitoring. Higher self-esteem and collaboration skills predicted higher adherence to ESM among patients with SSD, while higher positive symptom scores predicted lower adherence rates. This study provides important information to guide protocols for future studies using ESM. Future clinical or research studies should set ESM monitoring to waking hours, limit the number of days of monitoring, select patients with more collaborative skills and avoid those with marked positive symptoms, provide intensive training sessions, and improve participants’ self-confidence with technologies. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-020-02588-y %M 37463030 %R 10.2196/42093 %U https://www.jmir.org/2023/1/e42093 %U https://doi.org/10.2196/42093 %U http://www.ncbi.nlm.nih.gov/pubmed/37463030 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42377 %T Examining Predictors of Depression and Anxiety Symptom Change in Cognitive Behavioral Immersion: Observational Study %A Ezawa,Iony D %A Hollon,Steven D %A Robinson,Noah %+ Department of Psychology, University of Southern California, 3620 McClintock Ave, Los Angeles, CA, 90089, United States, 1 213 740 2203, ezawa@usc.edu %K Cognitive Behavioral Immersion %K virtual reality %K metaverse %K alliance %K social support %K cognitive behavioral %K depression %K anxiety %K mood %K mental health %K mobile phone %D 2023 %7 14.7.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depressive and anxiety disorders are the most common mental disorders, and there is a critical need for effective, affordable, and accessible interventions. Cognitive Behavioral Immersion (CBI) is a novel group-based cognitive behavioral skills training program delivered by lay coaches in the metaverse that can be accessed through various modalities including virtual reality (VR) head-mounted displays or flat-screen devices. Combining its ability to offer empirically supported therapy skills in a digital setting that can still facilitate interpersonal variables (eg, working alliance and sense of social support) with the aid of lay coaches, CBI has the potential to help fill this critical need. Objective: This study had 2 primary aims. First, we aimed to examine changes in depression and anxiety symptoms in a sample of individuals who participated in CBI. Second, we aimed to examine 2 interpersonal process variables (working alliance and web-based social support) as predictors of symptom changes. We predicted CBI participants would experience depression and anxiety symptom improvements and that such improvements would be associated with an increase in both interpersonal process variables. Methods: The study sample consists of 127 participants who endorsed clinical levels of depression or anxiety symptoms during their first CBI session and attended at least 2 sessions. Participants were asked to complete self-report measures of depression symptoms, anxiety symptoms, alliance, and web-based social support throughout their participation in CBI. Results: Repeated measures ANOVAs determined that depression and anxiety symptom scores differed significantly across sessions (Ps<.01). We also found participants’ web-based social support predicted improvement in depression symptoms (P=.01), but neither the alliance nor web-based social support predicted change in anxiety symptoms (Ps>.05). We also observed a significant difference in anxiety symptoms between participants who used a VR head-mounted display to access CBI and those who did not, such that participants who used VR head-mounted displays endorsed lower anxiety symptoms than those who did not at nearly every session (P=.04). Conclusions: Participation in CBI is associated with both depression and anxiety symptom improvement. Web-based social support may play an important role in fostering changes in depression symptoms. Future studies are encouraged to continue examining the process of change in CBI with special attention paid to methods that can elucidate causal mechanisms of change. %M 37450322 %R 10.2196/42377 %U https://mental.jmir.org/2023/1/e42377 %U https://doi.org/10.2196/42377 %U http://www.ncbi.nlm.nih.gov/pubmed/37450322 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46867 %T Investigating COVID-19’s Impact on Mental Health: Trend and Thematic Analysis of Reddit Users’ Discourse %A Zhu,Jianfeng %A Yalamanchi,Neha %A Jin,Ruoming %A Kenne,Deric R %A Phan,NhatHai %+ Department of Computer Science, Kent State University, 800 E Summit St, Kent, OH, 44240, United States, 1 2348639445, jzhu10@kent.edu %K COVID-19 %K Reddit %K r/Depression %K r/Anxiety %K pandemic %K mental health %K trend analysis %K thematic analysis %K natural language processing (NLP) %K Word2Vec %D 2023 %7 12.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has resulted in heightened levels of depression, anxiety, and other mental health issues due to sudden changes in daily life, such as economic stress, social isolation, and educational irregularity. Accurately assessing emotional and behavioral changes in response to the pandemic can be challenging, but it is essential to understand the evolving emotions, themes, and discussions surrounding the impact of COVID-19 on mental health. Objective: This study aims to understand the evolving emotions and themes associated with the impact of COVID-19 on mental health support groups (eg, r/Depression and r/Anxiety) on Reddit (Reddit Inc) during the initial phase and after the peak of the pandemic using natural language processing techniques and statistical methods. Methods: This study used data from the r/Depression and r/Anxiety Reddit communities, which consisted of posts contributed by 351,409 distinct users over a period spanning from 2019 to 2022. Topic modeling and Word2Vec embedding models were used to identify key terms associated with the targeted themes within the data set. A range of trend and thematic analysis techniques, including time-to-event analysis, heat map analysis, factor analysis, regression analysis, and k-means clustering analysis, were used to analyze the data. Results: The time-to-event analysis revealed that the first 28 days following a major event could be considered a critical window for mental health concerns to become more prominent. The theme trend analysis revealed key themes such as economic stress, social stress, suicide, and substance use, with varying trends and impacts in each community. The factor analysis highlighted pandemic-related stress, economic concerns, and social factors as primary themes during the analyzed period. Regression analysis showed that economic stress consistently demonstrated the strongest association with the suicide theme, whereas the substance theme had a notable association in both data sets. Finally, the k-means clustering analysis showed that in r/Depression, the number of posts related to the “depression, anxiety, and medication” cluster decreased after 2020, whereas the “social relationships and friendship” cluster showed a steady decrease. In r/Anxiety, the “general anxiety and feelings of unease” cluster peaked in April 2020 and remained high, whereas the “physical symptoms of anxiety” cluster showed a slight increase. Conclusions: This study sheds light on the impact of COVID-19 on mental health and the related themes discussed in 2 web-based communities during the pandemic. The results offer valuable insights for developing targeted interventions and policies to support individuals and communities in similar crises. %M 37436793 %R 10.2196/46867 %U https://www.jmir.org/2023/1/e46867 %U https://doi.org/10.2196/46867 %U http://www.ncbi.nlm.nih.gov/pubmed/37436793 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46859 %T Attitudes Toward the Adoption of 2 Artificial Intelligence–Enabled Mental Health Tools Among Prospective Psychotherapists: Cross-sectional Study %A Kleine,Anne-Kathrin %A Kokje,Eesha %A Lermer,Eva %A Gaube,Susanne %+ Department of Psychology, Ludwig Maximilian University of Munich, Geschwister-Scholl-Platz 1, Munich, 80539, Germany, 49 1709076034, Anne-Kathrin.Kleine@psy.lmu.de %K artificial intelligence %K mental health %K clinical decision support systems %K Unified Theory of Acceptance and Use of Technology %K technology acceptance model %D 2023 %7 12.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite growing efforts to develop user-friendly artificial intelligence (AI) applications for clinical care, their adoption remains limited because of the barriers at individual, organizational, and system levels. There is limited research on the intention to use AI systems in mental health care. Objective: This study aimed to address this gap by examining the predictors of psychology students’ and early practitioners’ intention to use 2 specific AI-enabled mental health tools based on the Unified Theory of Acceptance and Use of Technology. Methods: This cross-sectional study included 206 psychology students and psychotherapists in training to examine the predictors of their intention to use 2 AI-enabled mental health care tools. The first tool provides feedback to the psychotherapist on their adherence to motivational interviewing techniques. The second tool uses patient voice samples to derive mood scores that the therapists may use for treatment decisions. Participants were presented with graphic depictions of the tools’ functioning mechanisms before measuring the variables of the extended Unified Theory of Acceptance and Use of Technology. In total, 2 structural equation models (1 for each tool) were specified, which included direct and mediated paths for predicting tool use intentions. Results: Perceived usefulness and social influence had a positive effect on the intention to use the feedback tool (P<.001) and the treatment recommendation tool (perceived usefulness, P=.01 and social influence, P<.001). However, trust was unrelated to use intentions for both the tools. Moreover, perceived ease of use was unrelated (feedback tool) and even negatively related (treatment recommendation tool) to use intentions when considering all predictors (P=.004). In addition, a positive relationship between cognitive technology readiness (P=.02) and the intention to use the feedback tool and a negative relationship between AI anxiety and the intention to use the feedback tool (P=.001) and the treatment recommendation tool (P<.001) were observed. Conclusions: The results shed light on the general and tool-dependent drivers of AI technology adoption in mental health care. Future research may explore the technological and user group characteristics that influence the adoption of AI-enabled tools in mental health care. %M 37436801 %R 10.2196/46859 %U https://humanfactors.jmir.org/2023/1/e46859 %U https://doi.org/10.2196/46859 %U http://www.ncbi.nlm.nih.gov/pubmed/37436801 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e45186 %T Testing Mechanisms of Change for Text Message–Delivered Cognitive Behavioral Therapy: Randomized Clinical Trial for Young Adult Depression %A Mason,Michael J %A Coatsworth,J Douglas %A Zaharakis,Nikola %A Russell,Michael %A Brown,Aaron %A McKinstry,Sydney %+ Center for Behavioral Health Research, College of Social Work, University of Tennessee, Center for Behavioral Health Research, 202 Henson Hall, Knoxville, TN, 37996, United States, 1 18659749148, mmason29@utk.edu %K young adults %K depression %K SMS text message–delivered treatment %K cognitive behavioral therapy %K randomized clinical trial %K mobile health treatment %K mHealth treatment %K mobile phone %D 2023 %7 11.7.2023 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Current psychiatric epidemiological evidence estimates that 17% of young adults (aged 18-25 years) experienced a major depressive episode in 2020, relative to 8.4% of all adults aged ≥26 years. Young adults with a major depressive episode in the past year are the least likely to receive treatment for depression compared with other age groups. Objective: We conducted a randomized clinical trial following our initial 4-week SMS text message–delivered cognitive behavioral therapy (CBT-txt) for depression in young adults. We sought to test mechanisms of change for CBT-txt. Methods: Based on participant feedback, outcome data, and the empirical literature, we increased the treatment dosage from 4-8 weeks and tested 3 mechanisms of change with 103 young adults in the United States. Participants were from 34 states, recruited from Facebook and Instagram and presenting with at least moderate depressive symptomatology. Web-based assessments occurred at baseline prior to randomization and at 1, 2, and 3 months after enrollment. The primary outcome, the severity of depressive symptoms, was assessed using the Beck Depression Inventory II. Behavioral activation, perseverative thinking, and cognitive distortions were measured as mechanisms of change. Participants were randomized to CBT-txt or a waitlist control condition. Those assigned to the CBT-txt intervention condition received 474 fully automated SMS text messages, delivered every other day over a 64-day period and averaging 14.8 (SD 2.4) SMS text messages per treatment day. Intervention texts are delivered via TextIt, a web-based automated SMS text messaging platform. Results: Across all 3 months of the study, participants in the CBT-txt group showed significantly larger decreases in depressive symptoms than those in the control group (P<.001 at each follow-up), producing a medium-to-large effect size (Cohen d=0.76). Over half (25/47, 53%) of the treatment group moved into the “high-end functioning” category, representing no or minimal clinically significant depressive symptoms, compared with 15% (8/53) of the control condition. Mediation analysis showed that CBT-txt appeared to lead to greater increases in behavioral activation and greater decreases in cognitive distortions and perseverative thinking across the 3-month follow-up period, which were then associated with larger baseline to 3-month decreases in depression. The size of the indirect effects was substantial: 57%, 41%, and 50% of the CBT-txt effect on changes in depression were mediated by changes in behavioral activation, cognitive distortions, and perseverative thinking, respectively. Models including all 3 mediators simultaneously showed that 63% of the CBT-txt effect was mediated by the combined indirect effects. Conclusions: Results provide evidence for the efficacy of CBT-txt to reduce young adult depressive symptoms through hypothesized mechanisms. To the best of our knowledge, CBT-txt is unique in its SMS text message–delivered modality, the strong clinical evidence supporting efficacy and mechanisms of change. Trial Registration: ClinicalTrials.gov NCT05551702; https://clinicaltrials.gov/study/NCT05551702 %M 37432723 %R 10.2196/45186 %U https://mhealth.jmir.org/2023/1/e45186 %U https://doi.org/10.2196/45186 %U http://www.ncbi.nlm.nih.gov/pubmed/37432723 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45607 %T Author’s Reply to: Environmental Influence and Recruitment Bias in Studies on Internet Addiction. Comment on “Addiction Symptom Network of Young Internet Users: Network Analysis” %A Zheng,Hui %+ Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 South Wanping Road, Xuhui District, Shanghai, 200030, China, 86 18267908575, zh.dmtr@gmail.com %K internet addiction %K Internet Addiction Test %K network analysis %K adolescents %D 2023 %7 11.7.2023 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 37432733 %R 10.2196/45607 %U https://www.jmir.org/2023/1/e45607 %U https://doi.org/10.2196/45607 %U http://www.ncbi.nlm.nih.gov/pubmed/37432733 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44438 %T Environmental Influence and Recruitment Bias in Studies on Internet Addiction. Comment on “Addiction Symptom Network of Young Internet Users: Network Analysis” %A Huang,Ting Yun %A Liaw,Yung-Po %+ School of Medicine, Chung Shan Medical University, No 110, Section 1, Jianguo N Rd, South District, Taichung City, 40201, Taiwan, 886 0424730022 ext 11838, liawyp@csmu.edu.tw %K internet addiction %K Internet Addiction Test %K network analysis %K adolescents %D 2023 %7 11.7.2023 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 37432717 %R 10.2196/44438 %U https://www.jmir.org/2023/1/e44438 %U https://doi.org/10.2196/44438 %U http://www.ncbi.nlm.nih.gov/pubmed/37432717 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47656 %T Does an Internet-Based Emotion Regulation Intervention Provide Added Value for Acute Psychiatric Inpatient Care? Protocol for a Randomized Controlled Pilot Trial %A Bielinski,Laura Luisa %A Wälchli,Gwendolyn %A Nissen,Christoph %A Berger,Thomas %A Moggi,Franz %+ Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 794457768, laura.bielinski@unibe.ch %K blended treatment %K inpatient %K emotion regulation %K internet intervention %K acute psychiatric setting %K randomized controlled pilot trial %K randomized controlled trial %K RCT %K transdiagnostic %K feasibility %K emotion %K mental health %K psychiatric %K psychiatry %K randomized %K internet based %K digital health %D 2023 %7 11.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a lack of studies on internet-based interventions in inpatient settings. This is especially true for studies of internet-based interventions in acute psychiatric inpatient care. Internet-based interventions in this specific setting may provide benefits such as patient empowerment and overall improved treatment outcomes. However, there may also be specific barriers to their implementation that are unique due to the complexity of acute psychiatric inpatient care. Objective: The aim of this study is to examine the feasibility and preliminary evidence for effectiveness of a web-based emotion regulation intervention provided as an add-on to acute psychiatric inpatient care. Methods: The goal is to randomly allocate 60 patients with a range of different diagnoses in a 1:1 ratio to either treatment as usual (TAU), which consists of acute psychiatric inpatient treatment, or to the intervention group, which will receive TAU plus access to a web-based intervention that focuses on reduction of emotion regulation difficulties and improvement of emotion regulation skills. The primary outcome is symptom severity, assessed with the short form of the Brief Symptom Inventory at baseline, after 4 weeks, after 8 weeks, and at hospital discharge. Secondary outcomes include 2 emotion regulation parameters, intervention use, usability, patient satisfaction, and reasons for patient loss to follow-up. Results: Participant recruitment started in August 2021 and as of March 2023 was ongoing. First publication of study results is expected in 2024. Conclusions: This study protocol describes a study that intends to examine a web-based emotion regulation intervention in acute psychiatric inpatient care. The study will provide information on the feasibility of the intervention and possible effects on symptom severity and emotion regulation. The results will provide new insights on blended treatment, in this case the combination of a web-based intervention and face-to-face psychiatric treatment, in an understudied patient group and setting. Trial Registration: ClinicalTrials.gov NCT04990674; https://clinicaltrials.gov/ct2/show/NCT04990674 International Registered Report Identifier (IRRID): DERR1-10.2196/47656 %M 37432724 %R 10.2196/47656 %U https://www.researchprotocols.org/2023/1/e47656 %U https://doi.org/10.2196/47656 %U http://www.ncbi.nlm.nih.gov/pubmed/37432724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46781 %T Effects of an Artificial Intelligence Platform for Behavioral Interventions on Depression and Anxiety Symptoms: Randomized Clinical Trial %A Sadeh-Sharvit,Shiri %A Camp,T Del %A Horton,Sarah E %A Hefner,Jacob D %A Berry,Jennifer M %A Grossman,Eyal %A Hollon,Steven D %+ Eleos Health, 260 Charles St, Waltham, MA, 02453, United States, 1 5109848132, ssharvit@paloaltou.edu %K augmentation %K anxiety %K artificial intelligence %K cognitive-behavioral therapy %K community-based center %K depression %K evidence-based practices %K health force burnout %K depressive %D 2023 %7 10.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The need for scalable delivery of mental health care services that are efficient and effective is now a major public health priority. Artificial intelligence (AI) tools have the potential to improve behavioral health care services by helping clinicians collect objective data on patients’ progress, streamline their workflow, and automate administrative tasks. Objective: The aim of this study was to determine the feasibility, acceptability, and preliminary efficacy of an AI platform for behavioral health in facilitating better clinical outcomes for patients receiving outpatient therapy. Methods: The study was conducted at a community-based clinic in the United States. Participants were 47 adults referred for outpatient, individual cognitive behavioral therapy for a main diagnosis of a depressive or anxiety disorder. The platform provided by Eleos Health was compared to a treatment-as-usual (TAU) approach during the first 2 months of therapy. This AI platform summarizes and transcribes the therapy session, provides feedback to therapists on the use of evidence-based practices, and integrates these data with routine standardized questionnaires completed by patients. The information is also used to draft the session’s progress note. Patients were randomized to receive either therapy provided with the support of an AI platform developed by Eleos Health or TAU at the same clinic. Data analysis was carried out based on an intention-to-treat approach from December 2022 to January 2023. The primary outcomes included the feasibility and acceptability of the AI platform. Secondary outcomes included changes in depression (Patient Health Questionnaire-9) and anxiety (Generalized Anxiety Disorder-7) scores as well as treatment attendance, satisfaction, and perceived helpfulness. Results: A total of 72 patients were approached, of whom 47 (67%) agreed to participate. Participants were adults (34/47, 72% women and 13/47, 28% men; mean age 30.64, SD 11.02 years), with 23 randomized to the AI platform group, and 24 to TAU. Participants in the AI group attended, on average, 67% (mean 5.24, SD 2.31) more sessions compared to those in TAU (mean 3.14, SD 1.99). Depression and anxiety symptoms were reduced by 34% and 29% in the AI platform group versus 20% and 8% for TAU, respectively, with large effect sizes for the therapy delivered with the support of the AI platform. No group difference was found in 2-month treatment satisfaction and perceived helpfulness. Further, therapists using the AI platform submitted their progress notes, on average, 55 hours earlier than therapists in the TAU group (t=–0.73; P<.001). Conclusions: In this randomized controlled trial, therapy provided with the support of Eleos Health demonstrated superior depression and anxiety outcomes as well as patient retention, compared with TAU. These findings suggest that complementing the mental health services provided in community-based clinics with an AI platform specializing in behavioral treatment was more effective in reducing key symptoms than standard therapy. Trial Registration: ClinicalTrials.gov NCT05745103; https://classic.clinicaltrials.gov/ct2/show/NCT05745103 %M 37428547 %R 10.2196/46781 %U https://www.jmir.org/2023/1/e46781 %U https://doi.org/10.2196/46781 %U http://www.ncbi.nlm.nih.gov/pubmed/37428547 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44681 %T Factors Affecting Digital Tool Use in Client Interaction According to Mental Health Professionals: Interview Study %A Lukka,Lauri %A Karhulahti,Veli-Matti %A Palva,J Matias %+ Department of Neuroscience and Biomedical Engineering, Aalto University, Rakentajanaukio 2, Espoo, 02150, Finland, 358 440375666, lauri.lukka@aalto.fi %K clinical practice %K digital mental health interventions %K intervention design %K mental health applications %K mental health professionals %K teletherapy %K mobile phone %D 2023 %7 10.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital tools and interventions are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHPs) considerably influence their adoption in client practice. However, how MHPs use digital tools in client interaction is yet to be sufficiently understood, which poses challenges to their design, development, and implementation. Objective: This study aimed to create a contextual understanding of how MHPs use different digital tools in clinical client practice and what characterizes the use across tools. Methods: A total of 19 Finnish MHPs participated in semistructured interviews, and the data were transcribed, coded, and inductively analyzed. Results: We found that MHP digital tool use was characterized by 3 distinct functions: communication, diagnosis and evaluation, and facilitating therapeutic change. The functions were addressed using analog tools, digitized tools that mimic their analog counterparts, and digital tools that use the possibilities native to digital. The MHP-client communication included various media alongside face-to-face meetings, the MHPs increasingly used digitized tools in client evaluation, and the MHPs actively used digitized materials to facilitate therapeutic change. MHP tool use was generally characterized by adaptability—it was negotiated in client interactions. However, there was considerable variance in the breadth of MHPs’ digital toolbox. The existing clinical practices emphasized MHP-client interaction and invited incremental rather than radical developments, which challenged the achievement of the scalability benefits expected from digital tools. Conclusions: MHPs use digitized and digital tools in client practice. Our results contribute to the user-centered research, development, and implementation of new digital solutions in mental health care by classifying them according to their function and medium and describing how MHPs use and do not use them. %M 37428520 %R 10.2196/44681 %U https://humanfactors.jmir.org/2023/1/e44681 %U https://doi.org/10.2196/44681 %U http://www.ncbi.nlm.nih.gov/pubmed/37428520 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45411 %T Efficacy of an Unguided, Digital Single-Session Intervention for Internalizing Symptoms in Web-Based Workers: Randomized Controlled Trial %A Lorenzo-Luaces,Lorenzo %A Howard,Jacqueline %+ Department of Psychological and Brain Sciences, Indiana University-Bloomington, 1101 E 10th St, Room 158, Bloomington, IN, 47401, United States, 1 7872222493, lolorenz@indiana.edu %K internet-based cognitive behavioral therapy %K iCBT %K depression %K transdiagnostic processes %K emotion regulation %D 2023 %7 7.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The Common Elements Toolbox (COMET) is an unguided digital single-session intervention (SSI) based on principles of cognitive behavioral therapy and positive psychology. Although unguided digital SSIs have shown promise in the treatment of youth psychopathology, the data are more mixed regarding their efficacy in adults. Objective: This study aimed to investigate the efficacy of COMET-SSI versus a waiting list control in depression and other transdiagnostic mental health outcomes for Prolific participants with a history of psychopathology. Methods: We conducted an investigator-blinded, preregistered randomized controlled trial comparing COMET-SSI (n=409) with an 8-week waiting list control (n=419). Participants were recruited from the web-based workspace Prolific and assessed for depression, anxiety, work and social functioning, psychological well-being, and emotion regulation at baseline and at 2, 4, and 8 weeks after the intervention. The main outcomes were short-term (2 weeks) and long-term (8 weeks) changes in depression and anxiety. The secondary outcomes were the 8-week changes in work and social functioning, well-being, and emotion regulation. Analyses were conducted according to the intent-to-treat principle with imputation, without imputation, and using a per-protocol sample. In addition, we conducted sensitivity analyses to identify inattentive responders. Results: The sample comprised 61.9% (513/828) of women, with a mean age of 35.75 (SD 11.93) years. Most participants (732/828, 88.3%) met the criteria for screening for depression or anxiety using at least one validated screening scale. A review of the text data suggested that adherence to the COMET-SSI was near perfect, there were very few inattentive respondents, and satisfaction with the intervention was high. However, despite being powered to detect small effects, there were negligible differences between the conditions in the various outcomes at the various time points, even when focusing on subsets of individuals with more severe symptoms. Conclusions: Our results do not support the use of the COMET-SSI in adult Prolific participants. Future work should explore alternate ways of intervening with paid web-based participants, including matching individuals to SSIs they may be most responsive to. Trial Registration: ClinicalTrials.gov NCT05379881, https://clinicaltrials.gov/ct2/show/NCT05379881 %M 37418303 %R 10.2196/45411 %U https://www.jmir.org/2023/1/e45411 %U https://doi.org/10.2196/45411 %U http://www.ncbi.nlm.nih.gov/pubmed/37418303 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43051 %T A Multilingual Digital Mental Health and Well-Being Chatbot (ChatPal): Pre-Post Multicenter Intervention Study %A Potts,Courtney %A Lindström,Frida %A Bond,Raymond %A Mulvenna,Maurice %A Booth,Frederick %A Ennis,Edel %A Parding,Karolina %A Kostenius,Catrine %A Broderick,Thomas %A Boyd,Kyle %A Vartiainen,Anna-Kaisa %A Nieminen,Heidi %A Burns,Con %A Bickerdike,Andrea %A Kuosmanen,Lauri %A Dhanapala,Indika %A Vakaloudis,Alex %A Cahill,Brian %A MacInnes,Marion %A Malcolm,Martin %A O'Neill,Siobhan %+ School of Psychology, Ulster University, Cromore Road, Coleraine, BT52 1SA, United Kingdom, 44 28953675, c.potts@ulster.ac.uk %K conversational user interfaces %K digital interventions %K Warwick-Edinburgh Mental Well-Being Scale %K Satisfaction With Life Scale %K World Health Organization-Five Well-Being Index Scale %K mental health %K apps %K health care %K mixed methods %K conversation agent %K mental well-being %K digital health intervention %D 2023 %7 6.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, advances in technology have led to an influx of mental health apps, in particular the development of mental health and well-being chatbots, which have already shown promise in terms of their efficacy, availability, and accessibility. The ChatPal chatbot was developed to promote positive mental well-being among citizens living in rural areas. ChatPal is a multilingual chatbot, available in English, Scottish Gaelic, Swedish, and Finnish, containing psychoeducational content and exercises such as mindfulness and breathing, mood logging, gratitude, and thought diaries. Objective: The primary objective of this study is to evaluate a multilingual mental health and well-being chatbot (ChatPal) to establish if it has an effect on mental well-being. Secondary objectives include investigating the characteristics of individuals that showed improvements in well-being along with those with worsening well-being and applying thematic analysis to user feedback. Methods: A pre-post intervention study was conducted where participants were recruited to use the intervention (ChatPal) for a 12-week period. Recruitment took place across 5 regions: Northern Ireland, Scotland, the Republic of Ireland, Sweden, and Finland. Outcome measures included the Short Warwick-Edinburgh Mental Well-Being Scale, the World Health Organization-Five Well-Being Index, and the Satisfaction with Life Scale, which were evaluated at baseline, midpoint, and end point. Written feedback was collected from participants and subjected to qualitative analysis to identify themes. Results: A total of 348 people were recruited to the study (n=254, 73% female; n=94, 27% male) aged between 18 and 73 (mean 30) years. The well-being scores of participants improved from baseline to midpoint and from baseline to end point; however, improvement in scores was not statistically significant on the Short Warwick-Edinburgh Mental Well-Being Scale (P=.42), the World Health Organization-Five Well-Being Index (P=.52), or the Satisfaction With Life Scale (P=.81). Individuals that had improved well-being scores (n=16) interacted more with the chatbot and were significantly younger compared to those whose well-being declined over the study (P=.03). Three themes were identified from user feedback, including “positive experiences,” “mixed or neutral experiences,” and “negative experiences.” Positive experiences included enjoying exercises provided by the chatbot, while most of the mixed, neutral, or negative experiences mentioned liking the chatbot overall, but there were some barriers, such as technical or performance errors, that needed to be overcome. Conclusions: Marginal improvements in mental well-being were seen in those who used ChatPal, albeit nonsignificant. We propose that the chatbot could be used along with other service offerings to complement different digital or face-to-face services, although further research should be carried out to confirm the effectiveness of this approach. Nonetheless, this paper highlights the need for blended service offerings in mental health care. %M 37410537 %R 10.2196/43051 %U https://www.jmir.org/2023/1/e43051 %U https://doi.org/10.2196/43051 %U http://www.ncbi.nlm.nih.gov/pubmed/37410537 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44998 %T The Use of Virtual Reality Interventions to Promote Positive Mental Health: Systematic Literature Review %A Li Pira,Giorgio %A Aquilini,Beatrice %A Davoli,Alessandro %A Grandi,Silvana %A Ruini,Chiara %+ Department for Life Quality Studies, University of Bologna, Corso d’Augusto 237, Rimini, 47921, Italy, 39 0547 338533, chiara.ruini@unibo.it %K positive mental health %K well-being %K virtual reality %K interventions %K psychopathology %K mobile phone %D 2023 %7 6.7.2023 %9 Review %J JMIR Ment Health %G English %X Background: A large body of research has documented the efficacy of psychological interventions integrated with virtual reality (VR) therapies in treating psychiatric disorders. However, the concept of positive mental health calls for a 2-fold approach in which both symptoms and positive functioning should be addressed by modern interventions. Objective: This review aimed to summarize studies that applied VR therapies by embracing the positive mental health perspective. Methods: A literature search was conducted by entering the following keywords—“virtual reality” AND “intervention” OR “treatment” OR “therapy” AND “mental health” NOT “systematic review or meta-analysis”—and limiting it to “journal article” and the English language. To be included in this review, articles had to present at least one quantitative measure of positive functioning and one quantitative measure of symptoms or distress and had to investigate adult populations, including populations with psychiatric disorders. Results: A total of 20 articles were included. They described various VR protocols that were applied for the treatment of anxiety disorders (5/20, 25%), depression (2/20, 10%), posttraumatic stress disorder (3/20, 15%), psychosis (3/20, 15%), and stress (7/20, 35%). Most of the studies (13/20, 65%) showed the beneficial effects of VR therapies in improving stress and negative symptoms. However, 35% (7/20) of the studies showed no or a small effect on the various dimensions of positivity, particularly in clinical samples. Conclusions: VR interventions might be cost-effective and largely scalable, but further research is needed to develop existing VR software and treatments according to the modern positive mental health approach. %M 37410520 %R 10.2196/44998 %U https://mental.jmir.org/2023/1/e44998 %U https://doi.org/10.2196/44998 %U http://www.ncbi.nlm.nih.gov/pubmed/37410520 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44790 %T Psychiatric Treatment Conducted via Telemedicine Versus In-Person Modality in Posttraumatic Stress Disorder, Mood Disorders, and Anxiety Disorders: Systematic Review and Meta-Analysis %A Shaker,Ali Abbas %A Austin,Stephen F %A Storebø,Ole Jakob %A Schaug,Julie Perrine %A Ayad,Alaa %A Sørensen,John Aasted %A Tarp,Kristine %A Bechmann,Henrik %A Simonsen,Erik %+ Psychiatric Department, Region Zealand Psychiatry, Psychiatric Research Unit, Fælledvej 6, Slagelse, 4200, Denmark, 45 58536070, ashak@regionsjaelland.dk %K telemedicine %K telepsychiatry %K video consultation %K mobile health %K mHealth %K eHealth %K COVID-19 %K synchronous technology %K anxiety %K psychiatry %K patient satisfaction %K depression %K posttraumatic stress disorder %K PTSD %D 2023 %7 5.7.2023 %9 Review %J JMIR Ment Health %G English %X Background: Telemedicine has played a vital role in providing psychiatric treatment to patients during the rapid transition of services during the COVID-19 pandemic. Furthermore, the use of telemedicine is expected to expand within the psychiatric field. The efficacy of telemedicine is well described in scientific literature. However, there is a need for a comprehensive quantitative review that analyzes and considers the different clinical outcomes and psychiatric diagnoses. Objective: This paper aimed to assess whether individual psychiatric outpatient treatment for posttraumatic stress disorder, mood disorders, and anxiety disorders in adults using telemedicine is equivalent to in-person treatment. Methods: A systematic search of randomized controlled trials was conducted using recognized databases for this review. Overall, 4 outcomes were assessed: treatment efficacy, levels of patient satisfaction, working alliance, and attrition rate. The inverse-variance method was used to summarize the effect size for each outcome. Results: A total of 7414 records were identified, and 20 trials were included in the systematic review and meta-analysis. The trials included posttraumatic stress disorder (9 trials), depressive disorder (6 trials), a mix of different disorders (4 trials), and general anxiety disorder (1 trial). Overall, the analyses yielded evidence that telemedicine is comparable with in-person treatment regarding treatment efficacy (standardized mean difference −0.01, 95% CI −0.12 to 0.09; P=.84; I2=19%, 17 trials, n=1814), patient satisfaction mean difference (−0.66, 95% CI −1.60 to 0.28; P=.17; I2=44%, 6 trials, n=591), and attrition rates (risk ratio 1.07, 95% CI 0.94-1.21; P=.32; I2=0%, 20 trials, n=2804). The results also indicated that the working alliance between telemedicine and in-person modalities was comparable, but the heterogeneity was substantial to considerable (mean difference 0.95, 95% CI −0.47 to 2.38; P=.19; I2=75%, 6 trials, n=539). Conclusions: This meta-analysis provided new knowledge on individual telemedicine interventions that were considered equivalent to in-person treatment regarding efficacy, patient satisfaction, working alliance, and attrition rates across diagnoses. The certainty of the evidence regarding efficacy was rated as moderate. Furthermore, high-quality randomized controlled trials are needed to strengthen the evidence base for treatment provided via telemedicine in psychiatry, particularly for personality disorders and a range of anxiety disorders where there is a lack of studies. Individual patient data meta-analysis is suggested for future studies to personalize telemedicine. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021256357; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=256357 %M 37277113 %R 10.2196/44790 %U https://mental.jmir.org/2023/1/e44790 %U https://doi.org/10.2196/44790 %U http://www.ncbi.nlm.nih.gov/pubmed/37277113 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46135 %T Adaptive P300-Based Brain-Computer Interface for Attention Training: Protocol for a Randomized Controlled Trial %A Noble,Sandra-Carina %A Woods,Eva %A Ward,Tomas %A Ringwood,John V %+ Department of Electronic Engineering, Maynooth University, BioScience & Electronic Engineering Building, Maynooth, W23 F2H6, Ireland, 353 17084760, sandracarina.noble.2017@mumail.ie %K ADHD %K attention %K BCI %K brain-computer interface %K cognitive deficit %K cognitive disease %K cognitive training %K dementia %K EEG %K electroencephalography %K ERP %K event-related potential %K neurodegeneration %K neurofeedback training %K P300 speller %K stroke %D 2023 %7 5.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The number of people with cognitive deficits and diseases, such as stroke, dementia, or attention-deficit/hyperactivity disorder, is rising due to an aging, or in the case of attention-deficit/hyperactivity disorder, a growing population. Neurofeedback training using brain-computer interfaces is emerging as a means of easy-to-use and noninvasive cognitive training and rehabilitation. A novel application of neurofeedback training using a P300-based brain-computer interface has previously shown potential to improve attention in healthy adults. Objective: This study aims to accelerate attention training using iterative learning control to optimize the task difficulty in an adaptive P300 speller task. Furthermore, we hope to replicate the results of a previous study using a P300 speller for attention training, as a benchmark comparison. In addition, the effectiveness of personalizing the task difficulty during training will be compared to a nonpersonalized task difficulty adaptation. Methods: In this single-blind, parallel, 3-arm randomized controlled trial, 45 healthy adults will be recruited and randomly assigned to the experimental group or 1 of 2 control groups. This study involves a single training session, where participants receive neurofeedback training through a P300 speller task. During this training, the task’s difficulty is progressively increased, which makes it more difficult for the participants to maintain their performance. This encourages the participants to improve their focus. Task difficulty is either adapted based on the participants’ performance (in the experimental group and control group 1) or chosen randomly (in control group 2). Changes in brain patterns before and after training will be analyzed to study the effectiveness of the different approaches. Participants will complete a random dot motion task before and after the training so that any transfer effects of the training to other cognitive tasks can be evaluated. Questionnaires will be used to estimate the participants’ fatigue and compare the perceived workload of the training between groups. Results: This study has been approved by the Maynooth University Ethics Committee (BSRESC-2022-2474456) and is registered on ClinicalTrials.gov (NCT05576649). Participant recruitment and data collection began in October 2022, and we expect to publish the results in 2023. Conclusions: This study aims to accelerate attention training using iterative learning control in an adaptive P300 speller task, making it a more attractive training option for individuals with cognitive deficits due to its ease of use and speed. The successful replication of the results from the previous study, which used a P300 speller for attention training, would provide further evidence to support the effectiveness of this training tool. Trial Registration: ClinicalTrials.gov NCT05576649; https://clinicaltrials.gov/ct2/show/NCT05576649 International Registered Report Identifier (IRRID): DERR1-10.2196/46135 %M 37405822 %R 10.2196/46135 %U https://www.researchprotocols.org/2023/1/e46135 %U https://doi.org/10.2196/46135 %U http://www.ncbi.nlm.nih.gov/pubmed/37405822 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42260 %T Exploring the Incentive Function of Virtual Academic Degrees in a Chinese Online Smoking Cessation Community: Qualitative Content Analysis %A Qian,Yuxing %A Liu,Zhenghao %A Lee,Edmund W J %A Wang,Yixi %A Ni,Zhenni %+ School of Information Management, Wuhan University, 299 Bayi Road, Wuchang District, Wuhan, 430072, China, 86 132 0714 8568, zhenghaoliu@whu.edu.cn %K online smoking cessation community %K motivational affordances %K virtual academic degrees %K digital incentives %K content analysis %D 2023 %7 4.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies on online smoking cessation communities (OSCCs) have shown how such networks contribute to members’ health outcomes from behavior influence and social support perspectives. However, these studies rarely considered the incentive function of OSCCs. One of the ways OSCCs motivate smoking cessation behaviors is through digital incentives. Objective: This study aims to explore the incentive function of a novel digital incentive in a Chinese OSCC—the awarding of academic degrees—to promote smoking cessation. It specifically focuses on “Smoking Cessation Bar,” an OSCC in the popular web-based Chinese forum Baidu Tieba. Methods: We collected discussions about the virtual academic degrees (N= 1193) from 540 members of the “Smoking Cessation Bar.” The time frame of the data set was from November 15, 2012, to November 3, 2021. Drawing upon motivational affordances theory, 2 coders qualitatively coded the data. Results: We identified five key topics of discussion, including members’ (1) intention to get virtual academic degrees (n=38, 2.47%), (2) action to apply for the degrees (n=312, 20.27%), (3) feedback on the accomplishment of goals (n=203, 13.19%), (4) interpersonal interaction (n=794, 51.59%), and (5) expression of personal feelings (n=192, 12.48%). Most notably, the results identified underlying social and psychological motivations behind using the forum to discuss obtaining academic degrees for smoking cessation. Specifically, members were found to engage in sharing behavior (n=423, 27.49%) over other forms of interaction such as providing recommendations or encouragement. Moreover, expressions of personal feelings about achieving degrees were generally positive. It was possible that members hid their negative feelings (such as doubt, carelessness, and dislike) in the discussion. Conclusions: The virtual academic degrees in the OSCC created opportunities for self-presentation for participants. They also improved their self-efficacy to persist in smoking cessation by providing progressive challenges. They served as social bonds connecting different community members, triggering interpersonal interactions, and inducing positive feelings. They also helped realize members’ desire to influence or to be influenced by others. Similar nonfinancial rewards could be adopted in various smoking cessation projects to enhance participation and sustainability. %M 37402146 %R 10.2196/42260 %U https://www.jmir.org/2023/1/e42260 %U https://doi.org/10.2196/42260 %U http://www.ncbi.nlm.nih.gov/pubmed/37402146 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e39817 %T Dynamic Modelling of Mental Resilience in Young Adults: Protocol for a Longitudinal Observational Study (DynaM-OBS) %A Wackerhagen,Carolin %A Veer,Ilya M %A van Leeuwen,Judith M C %A Reppmann,Zala %A Riepenhausen,Antje %A Bögemann,Sophie A %A Mor,Netali %A Puhlmann,Lara M C %A Uściƚko,Aleksandra %A Zerban,Matthias %A Mituniewicz,Julian %A Lerner,Avigail %A Yuen,Kenneth S L %A Köber,Göran %A Marciniak,Marta A %A Pooseh,Shakoor %A Weermeijer,Jeroen %A Arias-Vásquez,Alejandro %A Binder,Harald %A de Raedt,Walter %A Kleim,Birgit %A Myin-Germeys,Inez %A Roelofs,Karin %A Timmer,Jens %A Tüscher,Oliver %A Hendler,Talma %A Kobylińska,Dorota %A Hermans,Erno J %A Kalisch,Raffael %A Walter,Henrik %+ Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 517 141, henrik.walter@charite.de %K resilience %K stress %K stressor reactivity %K resilience factors %K mental health %K stress disorders %K longitudinal %K prospective %K neuroimaging %K ecological momentary assessment %K mobile phone %D 2023 %7 4.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress-related mental disorders are highly prevalent and pose a substantial burden on individuals and society. Improving strategies for the prevention and treatment of mental disorders requires a better understanding of their risk and resilience factors. This multicenter study aims to contribute to this endeavor by investigating psychological resilience in healthy but susceptible young adults over 9 months. Resilience is conceptualized in this study as the maintenance of mental health or quick recovery from mental health perturbations upon exposure to stressors, assessed longitudinally via frequent monitoring of stressors and mental health. Objective: This study aims to investigate the factors predicting mental resilience and adaptive processes and mechanisms contributing to mental resilience and to provide a methodological and evidence-based framework for later intervention studies. Methods: In a multicenter setting, across 5 research sites, a sample with a total target size of 250 young male and female adults was assessed longitudinally over 9 months. Participants were included if they reported at least 3 past stressful life events and an elevated level of (internalizing) mental health problems but were not presently affected by any mental disorder other than mild depression. At baseline, sociodemographic, psychological, neuropsychological, structural, and functional brain imaging; salivary cortisol and α-amylase levels; and cardiovascular data were acquired. In a 6-month longitudinal phase 1, stressor exposure, mental health problems, and perceived positive appraisal were monitored biweekly in a web-based environment, while ecological momentary assessments and ecological physiological assessments took place once per month for 1 week, using mobile phones and wristbands. In a subsequent 3-month longitudinal phase 2, web-based monitoring was reduced to once a month, and psychological resilience and risk factors were assessed again at the end of the 9-month period. In addition, samples for genetic, epigenetic, and microbiome analyses were collected at baseline and at months 3 and 6. As an approximation of resilience, an individual stressor reactivity score will be calculated. Using regularized regression methods, network modeling, ordinary differential equations, landmarking methods, and neural net–based methods for imputation and dimension reduction, we will identify the predictors and mechanisms of stressor reactivity and thus be able to identify resilience factors and mechanisms that facilitate adaptation to stressors. Results: Participant inclusion began in October 2020, and data acquisition was completed in June 2022. A total of 249 participants were assessed at baseline, 209 finished longitudinal phase 1, and 153 finished longitudinal phase 2. Conclusions: The Dynamic Modelling of Resilience–Observational Study provides a methodological framework and data set to identify predictors and mechanisms of mental resilience, which are intended to serve as an empirical foundation for future intervention studies. International Registered Report Identifier (IRRID): DERR1-10.2196/39817 %M 37402143 %R 10.2196/39817 %U https://www.researchprotocols.org/2023/1/e39817 %U https://doi.org/10.2196/39817 %U http://www.ncbi.nlm.nih.gov/pubmed/37402143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42317 %T The Mediating Role of General and Cognitive Stress on the Effect of an App-Based Intervention on Productivity Measures in Workers: Randomized Controlled Trial %A de Miquel,Carlota %A Moneta,Maria Victoria %A Weber,Silvana %A Lorenz,Christopher %A Olaya,Beatriz %A Haro,Josep Maria %+ Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Carrer Doctor Antoni Pujadas 42, Sant Boi de Llobregat, 08830, Spain, 34 93 640 63 50 ext 1, beatriz.olaya@sjd.es %K e-mental health intervention %K work %K absenteeism %K presenteeism %K stress %K mediation %D 2023 %7 3.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Loss of productivity is a result of absence from work (absenteeism) or of working with limitations due to illness (presenteeism). Recently, occupational mental health interventions have increasingly been delivered in digital format, as this is thought to be more convenient, flexible, easily accessible, and anonymous. However, the effectiveness of electronic mental health (e-mental health) interventions in the workplace to improve presenteeism and absenteeism remains unknown, and could be potentially mediated by psychological variables such as stress levels. Objective: The aim of this study was to determine the effectiveness of an e-mental health intervention to reduce absenteeism and presenteeism in employees, as well as to investigate the mediating role of stress in this effect. Methods: Employees of six companies in two countries participated in a randomized controlled trial (n=210 in the intervention group and n=322 in the waitlist control group). Participants in the intervention group could use the Kelaa Mental Resilience app for 4 weeks. All participants were asked to complete assessments at baseline, during the intervention, postintervention, and at a 2-week follow-up. Absenteeism and presenteeism were assessed by means of the Work Productivity and Activity Impairment Questionnaire: General Health, while general and cognitive stress were assessed through the Copenhagen Psychosocial Questionnaire-Revised Version. Regression and mediation analyses were performed to evaluate the effect of the Kelaa Mental Resilience app on presenteeism and absenteeism. Results: The intervention did not have a direct effect on presenteeism or absenteeism, neither at postintervention nor at follow-up. Nevertheless, general stress significantly mediated the intervention effect on presenteeism (P=.005) but not on absenteeism (P=.92), and cognitive stress mediated the effect of the intervention on both presenteeism (P<.001) and absenteeism (P=.02) right after the intervention. At the 2-week follow-up, the mediating effect of cognitive stress on presenteeism was significant (P=.04), although this was not the case for its mediating effect on absenteeism (P=.36). Additionally, at the 2-week follow-up, general stress did not mediate the intervention effect on presenteeism (P=.25) or on absenteeism (P=.72). Conclusions: While no direct effect of the e-mental health intervention on productivity was found in this study, our findings suggest that stress reduction could mediate the effect of the intervention on presenteeism and absenteeism. As such, e-mental health interventions that address stress in employees might also indirectly reduce presenteeism and absenteeism in these employees. However, due to study limitations such as an overrepresentation of female participants in the sample and a high proportion of attrition, these results should be interpreted with caution. Future research is needed to better understand the mechanisms of interventions on productivity in the workplace. Trial Registration: ClinicalTrials.gov NCT05924542; https://clinicaltrials.gov/study/NCT05924542 %M 37399056 %R 10.2196/42317 %U https://www.jmir.org/2023/1/e42317 %U https://doi.org/10.2196/42317 %U http://www.ncbi.nlm.nih.gov/pubmed/37399056 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e48913 %T Designing High-Fidelity Mobile Health for Depression in Indonesian Adolescents Using Design Science Research: Mixed Method Approaches %A Shania,Mila %A Handayani,Putu Wuri %A Asih,Sali %+ Faculty of Psychology, University of Indonesia, Jl Kampus UI, Depok, 16424, Indonesia, 62 217863419, Putu.wuri@cs.ui.ac.id %K mobile health %K mental health %K user interface %K design science research %K Indonesia %K digital app %K mHealth %K depression %K pandemic %K adolescents %D 2023 %7 3.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 mitigation protocols, enacted to control the pandemic, have also been shown to have a negative impact on mental health, including the mental health of adolescents. The threat of being infected by SARS-CoV-2 and substantial changes in lifestyle, including limited social interaction due to stay-at-home orders, led to loneliness as well as depressive symptoms. However, offline psychological assistance is restricted, as psychologists are bounded by mitigation protocols. Further, not all adolescents’ guardians are open to their children attending or have the means to pay for psychological service; thus, adolescents remain untreated. Having a mobile health (mHealth) app for mental health that uses monitoring, provides social networks, and delivers psychoeducation may provide a solution, especially in countries that have limited health facilities and mental health workers. Objective: This study aimed to design an mHealth app to help prevent and monitor depression in adolescents. The design of this mHealth app was carried out as a high-fidelity prototype. Methods: We used a design science research (DSR) methodology with 3 iterations and 8 golden rule guidelines. The first iteration used interviews, and the second and third iterations used mixed method approaches. The DSR stages include the following: (1) identify the problem; (2) define the solution; (3) define the solution objective; (4) develop, demonstrate, and evaluate the solution; and (5) communicate the solution. This study involved students and medical experts. Results: The first iteration resulted in a wireframe and prototype for the next iteration. The second iteration resulted in a System Usability Scale score of 67.27, indicating a good fit. In the third iteration, the system usefulness, information quality, interface quality, and overall values were 2.416, 2.341, 2.597, and 2.261, respectively, indicating a good design. Key features of this mHealth app include a mood tracker, community, activity target, and meditation, and supporting features that complement the design include education articles and early detection features. Conclusions: Our findings provide guidance for health facilities and to design and implement future mHealth apps to help treat adolescent depression. %M 37399059 %R 10.2196/48913 %U https://formative.jmir.org/2023/1/e48913 %U https://doi.org/10.2196/48913 %U http://www.ncbi.nlm.nih.gov/pubmed/37399059 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46179 %T m-RESIST, a Mobile Therapeutic Intervention for Treatment-Resistant Schizophrenia: Feasibility, Acceptability, and Usability Study %A Grasa,Eva %A Seppälä,Jussi %A Alonso-Solis,Anna %A Haapea,Marianne %A Isohanni,Matti %A Miettunen,Jouko %A Caro Mendivelso,Johanna %A Almazan,Cari %A Rubinstein,Katya %A Caspi,Asaf %A Unoka,Zsolt %A Farkas,Kinga %A Usall,Judith %A Ochoa,Susana %A van der Graaf,Shenja %A Jewell,Charlotte %A Triantafillou,Anna %A Stevens,Matthias %A Reixach,Elisenda %A Berdun,Jesus %A , %A Corripio,Iluminada %+ Mental Health Division, Fundació Althaia, Xarxa Assistencial Universitaria de Manresa, Llatjos St, Manresa, 08243, Spain, 34 93 8742112, aalonso@althaia.cat %K schizophrenia %K treatment-resistant %K digital mental health %K mHealth %K mobile health %K mental health %K mental illness %K mental disorder %K psychosis %K symptom management %K adherence %K acceptability %K usability %K feasibility %K digital intervention %K mobile intervention %K mobile phone %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In the European Union, around 5 million people are affected by psychotic disorders, and approximately 30%-50% of people with schizophrenia have treatment-resistant schizophrenia (TRS). Mobile health (mHealth) interventions may be effective in preventing relapses, increasing treatment adherence, and managing some of the symptoms of schizophrenia. People with schizophrenia seem willing and able to use smartphones to monitor their symptoms and engage in therapeutic interventions. mHealth studies have been performed with other clinical populations but not in populations with TRS. Objective: The purpose of this study was to present the 3-month prospective results of the m-RESIST intervention. This study aims to assess the feasibility, acceptability, and usability of the m-RESIST intervention and the satisfaction among patients with TRS after using this intervention. Methods: A prospective multicenter feasibility study without a control group was undertaken with patients with TRS. This study was performed at 3 sites: Sant Pau Hospital (Barcelona, Spain), Semmelweis University (Budapest, Hungary), and Sheba Medical Center and Gertner Institute of Epidemiology and Health Policy Research (Ramat-Gan, Israel). The m-RESIST intervention consisted of a smartwatch, a mobile app, a web-based platform, and a tailored therapeutic program. The m-RESIST intervention was delivered to patients with TRS and assisted by mental health care providers (psychiatrists and psychologists). Feasibility, usability, acceptability, and user satisfaction were measured. Results: This study was performed with 39 patients with TRS. The dropout rate was 18% (7/39), the main reasons being as follows: loss to follow-up, clinical worsening, physical discomfort of the smartwatch, and social stigma. Patients’ acceptance of m-RESIST ranged from moderate to high. The m-RESIST intervention could provide better control of the illness and appropriate care, together with offering user-friendly and easy-to-use technology. In terms of user experience, patients indicated that m-RESIST enabled easier and quicker communication with clinicians and made them feel more protected and safer. Patients’ satisfaction was generally good: 78% (25/32) considered the quality of service as good or excellent, 84% (27/32) reported that they would use it again, and 94% (30/32) reported that they were mostly satisfied. Conclusions: The m-RESIST project has provided the basis for a new modular program based on novel technology: the m-RESIST intervention. This program was well-accepted by patients in terms of acceptability, usability, and satisfaction. Our results offer an encouraging starting point regarding mHealth technologies for patients with TRS. Trial Registration: ClinicalTrials.gov NCT03064776; https://clinicaltrials.gov/ct2/show/record/NCT03064776 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2017-021346 %M 37389933 %R 10.2196/46179 %U https://formative.jmir.org/2023/1/e46179 %U https://doi.org/10.2196/46179 %U http://www.ncbi.nlm.nih.gov/pubmed/37389933 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44126 %T Barriers to and Facilitators of Using Remote Measurement Technology in the Long-Term Monitoring of Individuals With ADHD: Interview Study %A Denyer,Hayley %A Deng,Qigang %A Adanijo,Abimbola %A Asherson,Philip %A Bilbow,Andrea %A Folarin,Amos %A Groom,Madeleine J %A Hollis,Chris %A Wykes,Til %A Dobson,Richard JB %A Kuntsi,Jonna %A Simblett,Sara %+ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 20 7848 5308, hayley.denyer@kcl.ac.uk %K attention-deficit/hyperactivity disorder %K ADHD %K remote measurement technology %K engagement %K barriers and facilitators %K qualitative analysis %K mobile phone %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Remote measurement technology (RMT) has the potential to address current research and clinical challenges of attention-deficit/hyperactivity disorder (ADHD) symptoms and its co-occurring mental health problems. Despite research using RMT already being successfully applied to other populations, adherence and attrition are potential obstacles when applying RMT to a disorder such as ADHD. Hypothetical views and attitudes toward using RMT in a population with ADHD have previously been explored; however, to our knowledge, there is no previous research that has used qualitative methods to understand the barriers to and facilitators of using RMT in individuals with ADHD following participation in a remote monitoring period. Objective: We aimed to evaluate the barriers to and facilitators of using RMT in individuals with ADHD compared with a group of people who did not have a diagnosis of ADHD. We also aimed to explore participants’ views on using RMT for 1 or 2 years in future studies. Methods: In total, 20 individuals with ADHD and 20 individuals without ADHD were followed up for 10 weeks using RMT that involved active (questionnaires and cognitive tasks) and passive (smartphone sensors and wearable devices) monitoring; 10 adolescents and adults with ADHD and 12 individuals in a comparison group completed semistructured qualitative interviews at the end of the study period. The interviews focused on potential barriers to and facilitators of using RMT in adults with ADHD. A framework methodology was used to explore the data qualitatively. Results: Barriers to and facilitators of using RMT were categorized as health-related, user-related, and technology-related factors across both participant groups. When comparing themes that emerged across the participant groups, both individuals with and without ADHD experienced similar barriers and facilitators in using RMT. The participants agreed that RMT can provide useful objective data. However, slight differences between the participant groups were identified as barriers to RMT across all major themes. Individuals with ADHD described the impact that their ADHD symptoms had on participating (health-related theme), commented on the perceived cost of completing the cognitive tasks (user-related theme), and described more technical challenges (technology-related theme) than individuals without ADHD. Hypothetical views on future studies using RMT in individuals with ADHD for 1 or 2 years were positive. Conclusions: Individuals with ADHD agreed that RMT, which uses repeated measurements with ongoing active and passive monitoring, can provide useful objective data. Although themes overlapped with previous research on barriers to and facilitators of engagement with RMT (eg, depression and epilepsy) and with a comparison group, there are unique considerations for people with ADHD, for example, understanding the impact that ADHD symptoms may have on engaging with RMT. Researchers need to continue working with people with ADHD to develop future RMT studies for longer periods. %M 37389932 %R 10.2196/44126 %U https://formative.jmir.org/2023/1/e44126 %U https://doi.org/10.2196/44126 %U http://www.ncbi.nlm.nih.gov/pubmed/37389932 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46052 %T Comparing Message-Based Psychotherapy to Once-Weekly, Video-Based Psychotherapy for Moderate Depression: Randomized Controlled Trial %A Song,Jiyoung %A Litvin,Boris %A Allred,Ryan %A Chen,Shiyu %A Hull,Thomas D %A Areán,Patricia A %+ Department of Psychology, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94720, United States, 1 9493794232, jiyoungsong@berkeley.edu %K randomized controlled trial %K message-based psychotherapy %K video-based psychotherapy %K telemedicine %K depression %K anxiety %K functional impairment, credibility, alliance, engagement %K mental health %K text mining %K message therapy %K Burden of Disease %K telehealth %K intervention %D 2023 %7 29.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the high prevalence of major depressive disorder and the related societal burden, access to effective traditional face-to-face or video-based psychotherapy is a challenge. An alternative that offers mental health care in a flexible setting is asynchronous messaging therapy. To date, no study has evaluated its efficacy and acceptability in a randomized controlled trial for depression. Objective: The aim of this study was to compare the efficacy and acceptability of message-based psychotherapy for depression to once-weekly video-based psychotherapy. Methods: In this 2-armed randomized controlled trial, individuals (N=83) with depressive symptomatology (Patient Health Questionnaire-9 ≥10) were recruited on the internet and randomly assigned to either a message-based intervention group (n=46) or a once-weekly video-based intervention group (n=37). Patients in the message-based treatment condition exchanged asynchronous messages with their therapist following an agreed-upon schedule. Patients in the video-based treatment condition met with their therapist once each week for a 45-minute video teletherapy session. Self-report data for depression, anxiety, and functional impairment were collected at pretreatment, weekly during treatment, at posttreatment, and at a 6-month follow-up. Self-reported treatment expectancy and credibility for the assigned intervention were assessed at pretreatment and therapeutic alliance at posttreatment. Results: Findings from multilevel modeling indicated significant, medium-to-large improvements in depression (d=1.04; 95% CI 0.60-1.46), anxiety (d=0.61; 95% CI 0.22-0.99), and functional impairment (d=0.66; 95% CI 0.27-1.05) for patients in the message-based treatment condition. Changes in depression (d=0.11; 95% CI –0.43 to 0.66), anxiety (d=–0.01; 95% CI –0.56 to 0.53), and functional impairment (d=0.25; 95% CI –0.30 to 0.80) in the message-based treatment condition were noninferior to those in the video-based treatment condition. There were no significant differences in treatment credibility (d=–0.09; 95% CI –0.64 to 0.45), therapeutic alliance (d=–0.15; 95% CI –0.75 to 0.44), or engagement (d=0.24; 95% CI –0.20 to 0.67) between the 2 treatment conditions. Conclusions: Message-based psychotherapy could present an effective and accessible alternative treatment modality for patients who might not be able to engage in traditional scheduled services such as face-to-face or video-based psychotherapy. Trial Registration: ClinicalTrials.gov NCT05467787; https://www.clinicaltrials.gov/ct2/show/NCT05467787 %M 37384392 %R 10.2196/46052 %U https://www.jmir.org/2023/1/e46052 %U https://doi.org/10.2196/46052 %U http://www.ncbi.nlm.nih.gov/pubmed/37384392 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47459 %T Online Mental Health Forums and Rural Resilience: Mixed Methods Study and Logic Model %A Steiner,Artur %A Farmer,Jane %A Kamstra,Peter %A Carlisle,Karen %A McCosker,Anthony %A Kilpatrick,Sue %+ Glasgow Caledonian University, Yunus Centre, M201 George Moore Building, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom, 44 141 331 8445, artur.steiner@gcu.ac.uk %K online forums %K personal resilience %K mental health %K rurality %K logic model %D 2023 %7 28.6.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Rural mental health is a growing area of concern internationally, and online mental health forums offer a potential response to addressing service gaps in rural communities. Objective: The objective of this study was to explore and identify pathways by which online peer support mental health forums help to build resilience for rural residents experiencing mental ill-health by contributing to overcoming their specific contextual challenges. Methods: We developed a Theoretical Resilience Framework and applied it to 3000 qualitative posts from 3 Australian online mental health forums and to data from 30 interviews with rural forum users. Results: Drawing on the findings and an abductive approach, a logic model was developed to illustrate links between the resilience resources built and enabling features of forums that make them spaces that facilitate resilience. Conclusions: The study demonstrated that online forums make valuable contributions to social well-being and access to a range of timely support services for rural people experiencing mental ill-health, and, while doing so, involve users in the processes of resilience building. The study provides a new way for practitioners to frame the work of and value produced by forums. It gives a logic model that can be used in evaluation and audit as it facilitates a causal framing of how forums, as an intervention, link with resilience outcomes. Ultimately, the study contributes to developing new knowledge about how rural resilience building can be conceptualized and measured while showing how forums are part of contemporary health service provision in rural places. %M 37379080 %R 10.2196/47459 %U https://mental.jmir.org/2023/1/e47459 %U https://doi.org/10.2196/47459 %U http://www.ncbi.nlm.nih.gov/pubmed/37379080 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44687 %T Differences Between Online Trial Participants Who Have Used Statutory Mental Health Services and Those Who Have Not: Analysis of Baseline Data From 2 Pragmatic Trials of a Digital Health Intervention %A Rennick-Egglestone,Stefan %A Newby,Chris %A Robinson,Clare %A Yeo,Caroline %A Ng,Fiona %A Elliott,Rachel A %A Ali,Yasmin %A Llewellyn-Beardsley,Joy %A Pomberth,Scott %A Harrison,Julian %A Gavan,Sean P %A Cuijpers,Pim %A Priebe,Stefan %A Hall,Charlotte L %A Slade,Mike %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 85 ext 30926, stefan.egglestone@nottingham.ac.uk %K open recruitment %K service use %K nonservice use %K online intervention %K online trial %K mobile phone %D 2023 %7 27.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are an established element of mental health service provision internationally. Regulators have positioned the best practice standard of evidence as an interventional study with a comparator reflective of standard care, often operationalized as a pragmatic trial. DHIs can extend health provision to those not currently using mental health services. Hence, for external validity, trials might openly recruit a mixture of people who have used mental health services and people who have not. Prior research has demonstrated phenomenological differences in mental health experience between these groups. Some differences between service users and nonservice users might influence the change created by DHIs; hence, research should systematically examine these differences to inform intervention development and evaluation work. This paper analyzes baseline data collected in the NEON (Narrative Experiences Online; ie, for people with experience of psychosis) and NEON-O (NEON for other [eg, nonpsychosis] mental health problems) trials. These were pragmatic trials of a DHI that openly recruited people who had used specialist mental health services and those who had not. All participants were experiencing mental health distress. NEON Trial participants had experienced psychosis in the previous 5 years. Objective: This study aims to identify differences in baseline sociodemographic and clinical characteristics associated with specialist mental health service use for NEON Trial and NEON-O Trial participants. Methods: For both trials, hypothesis testing was used to compare baseline sociodemographic and clinical characteristics of participants in the intention-to-treat sample who had used specialist mental health services and those who had not. Bonferroni correction was applied to significance thresholds to account for multiple testing. Results: Significant differences in characteristics were identified in both trials. Compared with nonservice users (124/739, 16.8%), NEON Trial specialist service users (609/739, 82.4%) were more likely to be female (P<.001), older (P<.001), and White British (P<.001), with lower quality of life (P<.001) and lower health status (P=.002). There were differences in geographical distribution (P<.001), employment (P<.001; more unemployment), current mental health problems (P<.001; more psychosis and personality disorders), and recovery status (P<.001; more recovered). Current service users were more likely to be experiencing psychosis than prior service users. Compared with nonservice users (399/1023, 39%), NEON-O Trial specialist service users (614/1023, 60.02%) had differences in employment (P<.001; more unemployment) and current mental health problems (P<.001; more personality disorders), with lower quality of life (P<.001), more distress (P<.001), less hope (P<.001), less empowerment (P<.001), less meaning in life (P<.001), and lower health status (P<.001). Conclusions: Mental health service use history was associated with numerous differences in baseline characteristics. Investigators should account for service use in work to develop and evaluate interventions for populations with mixed service use histories. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04428-6 %M 37368471 %R 10.2196/44687 %U https://www.jmir.org/2023/1/e44687 %U https://doi.org/10.2196/44687 %U http://www.ncbi.nlm.nih.gov/pubmed/37368471 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42641 %T Effectiveness of the SAFE eHealth Intervention for Women Experiencing Intimate Partner Violence and Abuse: Randomized Controlled Trial, Quantitative Process Evaluation, and Open Feasibility Study %A van Gelder,Nicole E %A Ligthart,Suzanne A %A van Rosmalen-Nooijens,Karin AWL %A Prins,Judith B %A Oertelt-Prigione,Sabine %+ Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Geert Grooteplein 21 – route 117, Nijmegen, 6525 EZ, Netherlands, 31 243618181, nicole.vangelder@radboudumc.nl %K domestic violence and abuse %K eHealth %K feasibility %K help seeking %K intimate partner violence and abuse %K mental health %K randomized controlled trial %K self-efficacy %K web based %K web-based intervention %D 2023 %7 27.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Intimate partner violence and abuse (IPVA) is a pervasive societal issue that impacts many women globally. Web-based help options are becoming increasingly available and have the ability to eliminate certain barriers in help seeking for IPVA, especially in improving accessibility. Objective: This study focused on the quantitative evaluation of the SAFE eHealth intervention for women IPVA survivors. Methods: A total of 198 women who experienced IPVA participated in a randomized controlled trial and quantitative process evaluation. Participants were largely recruited on the internet and signed up through self-referral. They were allocated (blinded for the participants) to (1) the intervention group (N=99) with access to a complete version of a help website containing 4 modules on IPVA, support options, mental health, and social support, and with interactive components such as a chat, or (2) the limited-intervention control group (N=99). Data were gathered about self-efficacy, depression, anxiety, and multiple feasibility aspects. The primary outcome was self-efficacy at 6 months. The process evaluation focused on themes, such as ease of use and feeling helped. In an open feasibility study (OFS; N=170), we assessed demand, implementation, and practicality. All data for this study were collected through web-based self-report questionnaires and automatically registered web-based data such as page visits and amount of logins. Results: We found no significant difference over time between groups for self-efficacy, depression, anxiety, fear of partner, awareness, and perceived support. However, both study arms showed significantly decreased scores for anxiety and fear of partner. Most participants in both groups were satisfied, but the intervention group showed significantly higher scores for suitability and feeling helped. However, we encountered high attrition for the follow-up surveys. Furthermore, the intervention was positively evaluated on multiple feasibility aspects. The average amount of logins did not significantly differ between the study arms, but participants in the intervention arm did spend significantly more time on the website. An increase in registrations during the OFS (N=170) was identified: the mean amount of registrations per month was 13.2 during the randomized controlled trial and 56.7 during the OFS. Conclusions: Our findings did not show a significant difference in outcomes between the extensive SAFE intervention and the limited-intervention control group. It is, however, difficult to quantify the real contribution of the interactive components, as the control group also had access to a limited version of the intervention for ethical reasons. Both groups were satisfied with the intervention they received, with the intervention study arm significantly more so than the control study arm. Integrated and multilayered approaches are needed to aptly quantify the impact of web-based IPVA interventions for survivors. Trial Registration: Netherlands Trial Register NL7108 NTR7313; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7313 %M 37368485 %R 10.2196/42641 %U https://www.jmir.org/2023/1/e42641 %U https://doi.org/10.2196/42641 %U http://www.ncbi.nlm.nih.gov/pubmed/37368485 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43987 %T Evaluating the Feasibility of a Multiplayer Role-Playing Game as a Behavioral Health Intervention in Adolescent Patients With Chronic Physical or Mental Conditions: Protocol for a Cohort Study %A Babichenko,Dmitriy %A Radovic,Ana %A Patel,Ravi %A Hester,Alexis %A Powell,Koehler %A Eggers,Nicholas %A Happe,David %+ School of Computing and Information, University of Pittsburgh, 135 N. Bellefield Avenue, Room 721, Pittsburgh, PA, 15213, United States, 1 4122609194, dmb72@pitt.edu %K role-playing games %K social isolation %K depression %K game-based interventions %K development %K intervention %K game %K teen %K patient %K chronic %K mental condition %K quality of life %K engagement %K symptoms %K data %K clinical %D 2023 %7 27.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Numerous studies have revealed that adolescents with chronic physical or mental conditions (CPMCs) are at an increased risk for depression and anxiety, with serious direct and indirect negative effects on treatment adherence, family functioning, and health-related quality of life. As game-based approaches are effective interventions in treating anxiety and depression, we propose to explore the use of a multiplayer role-playing game (RPG) as a potential intervention for social isolation, anxiety, and depression. Objective: The objectives of this study were to (1) determine the feasibility of using Masks, a multiplayer RPG, as an intervention for social isolation, anxiety, and depression in adolescents with CPMCs; (2) evaluate the viability of the research process; and (3) gauge participation in and engagement with RPG-based interventions. Methods: This study is a remote synchronous game-based intervention for adolescents with CPMCs aged 14-19 years. Eligible participants completed a web-based baseline survey to assess anxiety, depression, and social isolation and to identify their gaming habits. After completing the baseline survey, they participated in 5 moderated Masks game sessions. In Masks, players assume the roles of young superheroes; select their character types, superpowers; and perform actions determined by the game’s rule system and dice rolls. All game sessions were played using Discord, a communication platform commonly used by gaming communities. Games were led and moderated by game masters (GMs). After each game session, participants completed surveys to assess changes in anxiety, depression, and social isolation, and their attitude toward the game and the user experience. The participants also completed an exit survey after all 5 game sessions (modified version of the Patient Health Questionnaire and the Generalized Anxiety Disorder Questionnaire, and 17 open-ended questions). The GMs rated each game session and reported on gameplay, player behavior, comfort, and engagement levels of the players. Results: As of March 2020, six participants were recruited for the pilot study to participate in moderated web-based game sessions of Masks; 3 completed all game sessions and all required assessments. Although the number of participants was too low to draw generalizable conclusions, self-reported clinical outcomes did seem to indicate a positive change in depression, anxiety, and social isolation symptoms. Qualitative analysis of postgame survey data from participants and GMs indicated high levels of engagement and enjoyment. Furthermore, the participants provided feedback about improved mood and engagement related to weekly participation in Masks. Lastly, responses to the exit survey showed interest in future RPG-related studies. Conclusions: We established a workflow for gameplay and evaluated a research protocol for evaluating the impact of RPG participation on isolation, anxiety, and depression symptoms in adolescents with CPMCs. Preliminary data collected from the pilot study support the validity of the research protocol and the use of RPG-based interventions in larger clinical studies. International Registered Report Identifier (IRRID): RR1-10.2196/43987 %M 37368477 %R 10.2196/43987 %U https://www.researchprotocols.org/2023/1/e43987 %U https://doi.org/10.2196/43987 %U http://www.ncbi.nlm.nih.gov/pubmed/37368477 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46771 %T The Effects of Internet-Based Cognitive Behavioral Therapy for Suicidal Ideation or Behaviors on Depression, Anxiety, and Hopelessness in Individuals With Suicidal Ideation: Systematic Review and Meta-Analysis of Individual Participant Data %A Sander,Lasse B %A Beisemann,Marie %A Doebler,Philipp %A Micklitz,Hannah Moon %A Kerkhof,Ad %A Cuijpers,Pim %A Batterham,Philip %A Calear,Alison %A Christensen,Helen %A De Jaegere,Eva %A Domhardt,Matthias %A Erlangsen,Annette %A Eylem-van Bergeijk,Ozlem %A Hill,Ryan %A Mühlmann,Charlotte %A Österle,Marie %A Pettit,Jeremy %A Portzky,Gwendolyn %A Steubl,Lena %A van Spijker,Bregje %A Tighe,Joseph %A Werner-Seidler,Aliza %A Büscher,Rebekka %+ Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Hebelstraße 29, Freiburg, 79104, Germany, 49 761 203 5519, Lasse.Sander@mps.uni-freiburg.de %K meta-analysis %K internet-based cognitive behavioral therapy %K suicidal ideation %K anxiety %K depression %K hopelessness %K depressive %K mental health %K systematic review %K review method %K suicide %K suicidal %K psychotherapy %K CBT %K cognitive behavioral therapy %D 2023 %7 26.6.2023 %9 Review %J J Med Internet Res %G English %X Background: Suicide is a global public health problem. Digital interventions are considered a low-threshold treatment option for people with suicidal ideation or behaviors. Internet-based cognitive behavioral therapy (iCBT) targeting suicidal ideation has demonstrated effectiveness in reducing suicidal ideation. However, suicidal ideation often is related to additional mental health problems, which should be addressed for optimal care. Yet, the effects of iCBT on related symptoms, such as depression, anxiety, and hopelessness, remain unclear. Objective: We aimed to analyze whether digital interventions targeting suicidal ideation had an effect on related mental health symptoms (depression, anxiety, and hopelessness). Methods: We systematically searched CENTRAL, PsycInfo, Embase, and PubMed for randomized controlled trials that investigated guided or unguided iCBT for suicidal ideation or behaviors. Participants reporting baseline suicidal ideation were eligible. Individual participant data (IPD) were collected from eligible trials. We conducted a 1-stage IPD meta-analysis on the effects on depression, anxiety, and hopelessness—analyzed as 2 indices: symptom severity and treatment response. Results: We included IPD from 8 out of 9 eligible trials comprising 1980 participants with suicidal ideation. iCBT was associated with significant reductions in depression severity (b=−0.17; 95% CI −0.25 to −0.09; P<.001) and higher treatment response (ie, 50% reduction of depressive symptoms; b=0.36; 95% CI 0.12-0.60; P=.008) after treatment. We did not find significant effects on anxiety and hopelessness. Conclusions: iCBT for people with suicidal ideation revealed significant effects on depression outcomes but only minor or no effects on anxiety and hopelessness. Therefore, individuals with comorbid symptoms of anxiety or hopelessness may require additional treatment components to optimize care. Studies that monitor symptoms with higher temporal resolution and consider a broader spectrum of factors influencing suicidal ideation are needed to understand the complex interaction of suicidality and related mental health symptoms. %M 37358893 %R 10.2196/46771 %U https://www.jmir.org/2023/1/e46771 %U https://doi.org/10.2196/46771 %U http://www.ncbi.nlm.nih.gov/pubmed/37358893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46604 %T Associations Among Web-Based Civic Engagement and Discrimination, Web-Based Social Support, and Mental Health and Substance Use Risk Among LGBT Youth: Cross-Sectional Survey Study %A Tao,Xiangyu %A Fisher,Celia %+ Department of Psychology, Fordham University, 441 East Fordham Road, Dealy Hall, Bronx, NY, 10458, United States, 1 718 817 3793, fisher@fordham.edu %K lesbian, gay, bisexual, and transgender or nonbinary %K LGBT adolescents %K social media %K discrimination %K social support %K mental health %K substance use %D 2023 %7 26.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media use is ubiquitous among lesbian, gay, bisexual, and transgender or nonbinary (LGBT) adolescents. The time spent on LGBT sites and involvement in social justice–oriented web-based civic activities can increase exposure to heterosexist and transphobic posts, resulting in increases in depression, anxiety, and substance use. Collaborative social justice civic engagement may also increase LGBT adolescents’ social support on the web, which may buffer the mental health and substance use risks associated with web-based discrimination. Objective: Drawing on the minority stress and stress-buffering hypotheses, this study aimed to test time spent on LGBT sites, involvement in web-based social justice activities, the mediating effect of web-based discrimination, and the moderating effect of web-based social support on mental health and substance use. Methods: An anonymous web-based survey conducted from October 20 to November 18, 2022, analyzed data from 571 respondents (mean age 16.4, SD 1.1 years): 125 cisgender lesbian girls, 186 cisgender gay boys, 111 cisgender bisexual adolescents, and 149 transgender or nonbinary adolescents. Measures included demographics, web-based LGBT identity disclosure, hours per week spent on LGBT social media sites, engagement in web-based social justice activities (Online Civic Engagement Behavior Construct), exposure to web-based discrimination (Online Victimization Scale), web-based social support (adapted from scales examining web-based interactions), depressive and anxiety symptoms, and substance use (the Patient Health Questionnaire modified for Adolescents; Generalized Anxiety Disorder 7-item; and Car, Relax, Alone, Forget, Friends, Trouble Screening Test). Results: The time spent on LGBT social media sites was unrelated to web-based discrimination after civic engagement was accounted for (90% CI −0.007 to 0.004). Web-based social justice civic engagement was positively associated with social support (β=.4, 90% CI 0.2-0.4), exposure to discrimination (β=.6, 90% CI 0.5-0.7), and higher substance use risk (β=.2, 90% CI 0.2-0.6). Consistent with minority stress theory, exposure to web-based discrimination fully mediated the positive association between LGBT justice civic engagement and depressive (β=.3, 90% CI 0.2-0.4) and anxiety symptoms (β=.3, 90% CI 0.2-0.4). Web-based social support did not moderate the association between exposure to discrimination with depressive (90% CI −0.07 to 0.1) and anxiety symptoms (90% CI −0.06 to 0.1) and substance use (90% CI −0.04 to 0.01). Conclusions: This study highlights the importance of examining LGBT youth’s specific web-based activities and the need for future research to focus on the intersectional experiences of LGBT adolescents from racial and ethnic minoritized groups through culturally sensitive questions. This study also calls for social media platforms to implement policies that mitigate the effects of algorithms that expose youth to heterosexist and transphobic messaging, such as adopting machine learning algorithms that can efficiently recognize and remove harmful content. %M 37358882 %R 10.2196/46604 %U https://www.jmir.org/2023/1/e46604 %U https://doi.org/10.2196/46604 %U http://www.ncbi.nlm.nih.gov/pubmed/37358882 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44688 %T Barriers to and Facilitators of the Implementation of Digital Mental Health Interventions as Perceived by Primary Care Decision Makers: Content Analysis of Structured Open-Ended Survey Data %A Brantnell,Anders %A Temiz,Serdar %A Baraldi,Enrico %A Woodford,Joanne %A von Essen,Louise %+ Division of Industrial Engineering and Management, Department of Civil and Industrial Engineering, Uppsala University, Box 169, Uppsala, 751 04, Sweden, 46 729999825, anders.brantnell@angstrom.uu.se %K digital mental health %K implementation %K barriers %K facilitators %K internet-based cognitive behavioral therapy %K survey %K decision makers %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital mental health represents a way to increase access to evidence-based psychological support. However, the implementation of digital mental health in routine health care practice is limited, with few studies focusing on implementation. Accordingly, there is a need to better understand the barriers to and facilitators of implementing digital mental health. Existing studies have mainly focused on the viewpoints of patients and health professionals. Currently, there are few studies about barriers and facilitators from the perspective of primary care decision makers, that is, the persons responsible for deciding whether a given digital mental health intervention should be implemented in a primary care organization. Objective: The objectives were to identify and describe barriers to and facilitators of the implementation of digital mental health as perceived by primary care decision makers, evaluate the relative importance of different barriers and facilitators, and compare barriers and facilitators reported by primary care decision makers who have versus have not implemented digital mental health interventions. Methods: A web-based self-report survey was conducted with primary care decision makers responsible for the implementation of digital mental health in primary care organizations in Sweden. Answers to 2 open-ended questions about barriers and facilitators were analyzed through summative and deductive content analysis. Results: The survey was completed by 284 primary care decision makers—59 (20.8%) decision makers representing implementers (ie, organizations that offered digital mental health interventions) and 225 (79.2%) respondents representing nonimplementers (ie, organizations that did not offer digital mental health interventions). Overall, 90% (53/59) of the implementers and 98.7% (222/225) of the nonimplementers identified barriers, and 97% (57/59) of the implementers and 93.3% (210/225) of the nonimplementers identified facilitators. Altogether, 29 barriers and 20 facilitators of implementation were identified related to guidelines; patients; health professionals; incentives and resources; capacity for organizational change; and social, political, and legal factors. The most prevalent barriers were related to incentives and resources, whereas the most prevalent facilitators were related to the capacity for organizational change. Conclusions: A number of barriers and facilitators were identified that could influence the implementation of digital mental health from the perspective of primary care decision makers. Implementers and nonimplementers identified many common barriers and facilitators, but they differ in terms of certain barriers and facilitators. Common and differing barriers and facilitators identified by implementers and nonimplementers may be important to address when planning for the implementation of digital mental health interventions. For instance, financial incentives and disincentives (eg, increased costs) are the most frequently mentioned barrier and facilitator, respectively, by nonimplementers, but not by implementers. One way to facilitate implementation could be to provide more information to nonimplementers about the actual costs related to the implementation of digital mental health. %M 37358902 %R 10.2196/44688 %U https://humanfactors.jmir.org/2023/1/e44688 %U https://doi.org/10.2196/44688 %U http://www.ncbi.nlm.nih.gov/pubmed/37358902 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45852 %T A Digital Mental Health App Incorporating Wearable Biosensing for Teachers of Children on the Autism Spectrum to Support Emotion Regulation: Protocol for a Pilot Randomized Controlled Trial %A Palermo,Emma H %A Young,Amanda V %A Deswert,Sky %A Brown,Alyssa %A Goldberg,Miranda %A Sultanik,Evan %A Tan,Jessica %A Mazefsky,Carla A %A Brookman-Frazee,Lauren %A McPartland,James C %A Goodwin,Matthew S %A Pennington,Jeffrey %A Marcus,Steven C %A Beidas,Rinad S %A Mandell,David S %A Nuske,Heather J %+ Penn Center for Mental Health, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd Fl., Philadelphia, PA, 19104, United States, 1 215 746 6041, heather.nuske@pennmedicine.upenn.edu %K digital mental health %K just-in-time adaptive intervention augmentation %K JITAI %K autism %K heart rate tracking %K emotion dysregulation %K challenging behavior %K evidence-based strategies %K student progress monitoring %K mobile phone %D 2023 %7 26.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: As much as 80% of children on the autism spectrum exhibit challenging behaviors (ie, behaviors dangerous to the self or others, behaviors that interfere with learning and development, and behaviors that interfere with socialization) that can have a devastating impact on personal and family well-being, contribute to teacher burnout, and even require hospitalization. Evidence-based practices to reduce these behaviors emphasize identifying triggers (events or antecedents that lead to challenging behaviors); however, parents and teachers often report that challenging behaviors surface with little warning. Exciting recent advances in biometric sensing and mobile computing technology allow the measurement of momentary emotion dysregulation using physiological indexes. Objective: We present the framework and protocol for a pilot trial that will test a mobile digital mental health app, the KeepCalm app. School-based approaches to managing challenging behaviors in children on the autism spectrum are limited by 3 key factors: children on the autism spectrum often have difficulties in communicating their emotions; it is challenging to implement evidence-based, personalized strategies for individual children in group settings; and it is difficult for teachers to track which strategies are successful for each child. KeepCalm aims to address those barriers by communicating children’s stress to their teachers using physiological signaling (emotion dysregulation detection), supporting the implementation of emotion regulation strategies via smartphone pop-up notifications of top strategies for each child according to their behavior (emotion regulation strategy implementation), and easing the task of tracking outcomes by providing the child’s educational team with a tool to track the most effective emotion regulation strategies for that child based on physiological stress reduction data (emotion regulation strategy evaluation). Methods: We will test KeepCalm with 20 educational teams of students on the autism spectrum with challenging behaviors (no exclusion based on IQ or speaking ability) in a pilot randomized waitlist-controlled field trial over a 3-month period. We will examine the usability, acceptability, feasibility, and appropriateness of KeepCalm as primary outcomes. Secondary preliminary efficacy outcomes include clinical decision support success, false positives or false negatives of stress alerts, and the reduction of challenging behaviors and emotion dysregulation. We will also examine technical outcomes, including the number of artifacts and the proportion of time children are engaged in high physical movement based on accelerometry data; test the feasibility of our recruitment strategies; and test the response rate and sensitivity to change of our measures, in preparation for a future fully powered large-scale randomized controlled trial. Results: The pilot trial will begin by September 2023. Conclusions: Results will provide key data about important aspects of implementing KeepCalm in preschools and elementary schools and will provide preliminary data about its efficacy to reduce challenging behaviors and support emotion regulation in children on the autism spectrum. Trial Registration: ClinicalTrials.gov NCT05277194; https://www.clinicaltrials.gov/ct2/show/NCT05277194 International Registered Report Identifier (IRRID): PRR1-10.2196/45852 %M 37358908 %R 10.2196/45852 %U https://www.researchprotocols.org/2023/1/e45852 %U https://doi.org/10.2196/45852 %U http://www.ncbi.nlm.nih.gov/pubmed/37358908 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46431 %T User Satisfaction With a Daily Supportive Text Message Program (Text4PTSI) for Public Safety Personnel: Longitudinal Cross-Sectional Study %A Obuobi-Donkor,Gloria %A Eboreime,Ejemai %A Shalaby,Reham %A Agyapong,Belinda %A Phung,Natalie %A Eyben,Scarlett %A Wells,Kristopher %A Dias,Raquel da Luz %A Hilario,Carla %A Jones,Chelsea %A Brémault-Phillips,Suzette %A Zhang,Yanbo %A Greenshaw,Andrew J %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, agyapong@ualberta.ca %K public safety personnel %K Text4PTSI %K text messaging %K satisfaction %K occupational health %K work safety %K public safety %K digital health intervention %K mental health service %K user satisfaction %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Public safety personnel (PSP) are exposed to traumatic events due to their work environments, which increases the risk of mental health challenges. Providing effective and evidence-based interventions, such as SMS text messaging programs, can improve PSP's overall mental well-being with high user satisfaction rates. Objective: This study aims to evaluate users’ satisfaction, receptiveness, and perceptions of a cognitive behavioral therapy (CBT)–based supportive SMS text messaging intervention (Text4PTSI). Methods: Participants self-subscribed to Text4PTSI and received unidirectional cognitive behavioral–based supportive text messages for 6 months. Participants completed a web-based survey delivered via SMS text message at enrollment, and 6 weeks, 3 months, and 6 months post enrollment. Respondents’ perception and receptivity of the program were assessed using a questionnaire measured on a 5-point Likert scale. Data were collected as categorical variables, and overall satisfaction with the Text4PTSI program was measured on a scale from 0 to 100. Results: There were 131 subscribers to the Text4PTSI program; however, only 81 subscribers responded to the survey, producing 100 survey responses across the 3 follow-up time points. The overall mean score of satisfaction was 85.12 (SD 13.35). More than half of the survey responses agreed or strongly agreed that Text4PTSI helped participants cope with anxiety (79/100 responses, 79%), depressive symptoms (72/100 responses, 72%), and loneliness (54/100 responses, 54%). Similarly, most of the survey responses agreed or strongly agreed that the Text4PTSI program made respondents feel connected to a support system, improved their overall mental well-being (84/100 responses, 84%), felt more hopeful about managing concerns about their mental health or substance use (82 out of responses, 82%), and helped enhance their overall quality of life (77/100 responses, 77%). The available survey responses suggest that the majority always read the supportive text messages (84/100 responses, 84%), took time to reflect on each message (75/100 responses, 75%), and returned to read the text messages more than once (76/100 responses, 76%). Conclusions: PSP who responded to the follow-up surveys reported high user satisfaction and appreciation for receiving the Text4PTSI intervention during the 6-month program. The reported satisfaction with the service provided could pave the way to ensuring a better uptake of the service with potential effectiveness to end users. %M 37351940 %R 10.2196/46431 %U https://formative.jmir.org/2023/1/e46431 %U https://doi.org/10.2196/46431 %U http://www.ncbi.nlm.nih.gov/pubmed/37351940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45254 %T Mobile Assessments of Mood, Cognition, Smartphone-Based Sensor Activity, and Variability in Craving and Substance Use in Patients With Substance Use Disorders in Norway: Prospective Observational Feasibility Study %A Lauvsnes,Anders Dahlen Forsmo %A Hansen,Tor Ivar %A Ankill,Sebastian Øiungen %A Bae,Sang Won %A Gråwe,Rolf W %A Braund,Taylor A %A Larsen,Mark %A Langaas,Mette %+ Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, PO Box 8905, Trondheim, 7491, Norway, 47 99592222, anders.d.f.lauvsnes@ntnu.no %K executive functioning %K substance use disorder %K ecological momentary assessment %K clinical inference %K substance use %K pilot study %K mood %K mental health %K neurocognitive functioning %K smartphone use %K mobile sensor %K sensor %K decision support %K mobile phone %D 2023 %7 23.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with substance use disorders (SUDs) are at increased risk for symptom deterioration following treatment, with up to 60% resuming substance use within the first year posttreatment. Substance use craving together with cognitive and mental health variables play important roles in the understanding of the trajectories from abstinence to substance use. Objective: This prospective observational feasibility study aims to improve our understanding of specific profiles of variables explaining SUD symptom deterioration, in particular, how individual variability in mental health, cognitive functioning, and smartphone use is associated with craving and substance use in a young adult clinical population. Methods: In this pilot study, 26 patients with SUDs were included at about 2 weeks prior to discharge from inpatient SUD treatment from 3 different treatment facilities in Norway. Patients underwent baseline neuropsychological and mental health assessments; they were equipped with smartwatches and they downloaded an app for mobile sensor data collection in their smartphones. Every 2 days for up to 8 weeks, the patients were administered mobile ecological momentary assessments (EMAs) to evaluate substance use, craving, mental health, cognition, and a mobile Go/NoGo performance task. Repeated EMAs as well as the smartphone’s battery use data were averaged across all days per individual and used as candidate input variables together with the baseline measures in models of craving intensity and the occurrence of any substance use episodes. Results: A total of 455 momentary assessments were completed out of a potential maximum of 728 assessments. Using EMA and baseline data as candidate input variables and craving and substance use as responses, model selection identified mean craving intensity as the most important predictor of having one or more substance use episodes and with variabilities in self-reported impulsivity, mental health, and battery use as significant explanatory variables of craving intensity. Conclusions: This prospective observational feasibility study adds novelty by collecting high-intensity data for a considerable period of time, including mental health data, mobile cognitive assessments, and mobile sensor data. Our study also contributes to our knowledge about a clinical population with the most severe SUD presentations in a vulnerable period during and after discharge from inpatient treatment. We confirmed the importance of variability in cognitive function and mood in explaining variability in craving and that smartphone usage may possibly add to this understanding. Further, we found that craving intensity is an important explanatory variable in understanding substance use episodes. %M 37351934 %R 10.2196/45254 %U https://formative.jmir.org/2023/1/e45254 %U https://doi.org/10.2196/45254 %U http://www.ncbi.nlm.nih.gov/pubmed/37351934 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45334 %T Graded Response Model Analysis and Computer Adaptive Test Simulation of the Depression Anxiety Stress Scale 21: Evaluation and Validation Study %A Kraska,Jake %A Bell,Karen %A Costello,Shane %+ School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, 3800, Australia, 61 399052896, jake.kraska@gmail.com %K graded response model %K DASS-21 %K CAT %K computer adaptive testing %K simulation %K psychological distress %K depression %K anxiety %K stress %K simulation %K mental health %K screening tool %K tool %K reliability %K development %K model %D 2023 %7 22.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The Depression Anxiety Stress Scale 21 (DASS-21) is a mental health screening tool with conflicting studies regarding its factor structure. No studies have yet attempted to develop a computer adaptive test (CAT) version of it. Objective: This study calibrated items for, and simulated, a DASS-21 CAT using a nonclinical sample. Methods: An evaluation sample (n=580) was used to evaluate the DASS-21 scales via confirmatory factor analysis, Mokken analysis, and graded response modeling. A CAT was simulated with a validation sample (n=248) and a simulated sample (n=10,000) to confirm the generalizability of the model developed. Results: A bifactor model, also known as the “quadripartite” model (1 general factor with 3 specific factors) in the context of the DASS-21, displayed good fit. All scales displayed acceptable fit with the graded response model. Simulation of 3 unidimensional (depression, anxiety, and stress) CATs resulted in an average 17% to 48% reduction in items administered when a reliability of 0.80 was acceptable. Conclusions: This study clarifies previous conflicting findings regarding the DASS-21 factor structure and suggests that the quadripartite model for the DASS-21 items fits best. Item response theory modeling suggests that the items measure their respective constructs best between 0θ and 3θ (mild to moderate severity). %M 37347530 %R 10.2196/45334 %U https://www.jmir.org/2023/1/e45334 %U https://doi.org/10.2196/45334 %U http://www.ncbi.nlm.nih.gov/pubmed/37347530 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47627 %T Culturally Adapting a Digital Intervention to Reduce Suicidal Ideation for Syrian Asylum Seekers and Refugees in the United Kingdom: Protocol for a Qualitative Study %A Beuthin,Oliver %A Bhui,Kamaldeep %A Yu,Ly-Mee %A Shahid,Sadiya %A Almidani,Louay %A Bilalaga,Mariah Malak %A Hussein,Roshan %A Harba,Alnarjes %A Nasser,Yasmine %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Ln, Headington, Oxford, OX3 7JX, United Kingdom, 44 1865 618200, oliver.beuthin@linacre.ox.ac.uk %K cultural adaptation %K digital mental health %K suicidal ideation %K refugee mental health %K Syrian refugee %K experience-based co-design %K mental health %K suicide %K suicidal %K refugee %K immigrant %K ethnic minority %K asylum %K user experience %K cultural %K Syria %K Syrian %K refugees %D 2023 %7 22.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The conflict in Syria has produced the largest forced displacement crisis since the Second World War. As a result, Syrians have experienced various stressors across the migratory process, putting them at an increased risk of developing mental health issues, including, crucially, suicidal ideation (SI). Despite their high rates of SI across Europe, there remain various barriers to accessing treatment. One way to increase access is the use of culturally adapted digital interventions, which have already shown potential for other minority populations. To culturally adapt the intervention, further research is needed to better understand Syrian asylum seekers’ and refugees’ cultural conceptualizations, coping strategies, and help-seeking behavior for SI. To do so, this study will use a unique cultural adaptation framework to intervene at points of lived experience with the migratory process where Syrian culture and signs of psychopathology converge. Likewise, co-design events will be used to adapt points of experience with the intervention where Syrian culture and the intervention conflict. As the first cultural adaption of a digital SI intervention for Syrian asylum seekers and refugees, this study will hopefully encourage further development of culturally sensitive interventions for the largest refugee population in the United Kingdom and the world. Objective: The objective of the study is to increase access to mental health treatment for Syrian asylum seekers and refugees in the United Kingdom by culturally adapting a digital intervention to reduce SI. Methods: The study will use experience-based co-design, an action research method, to culturally adapt a digital intervention to reduce SI for Syrian asylum seekers and refugees in the United Kingdom. This will involve conducting 20-30 interviews to understand their lived experiences with the migratory process, cultural conceptualizations of mental health and SI, coping strategies, mental health help-seeking behavior, and perceptions of digital mental health interventions. In addition, 3 co-design events with 6 participants in each will be held to collaboratively adapt the intervention. Touchpoints and themes extracted from each phase will be prioritized by a community panel before adapting the intervention. Results: The study began in November 2022 and will continue until the last co-design event in August 2023. The results of the study will then be published by December 2023. Conclusions: Access to treatment for some of the most severe mental health issues is still limited for Syrian asylum seekers and refugees in the United Kingdom. Cultural adaptations of digital interventions developed for general populations have the potential to increase access to treatment for this population. Specifically, adapting the intervention for Syrian asylum seekers’ and refugees’ experiences with SI in relation to their lived experience with the migratory process may enable greater recruitment and adherence for users of various cultural and ethnic subgroups and levels of SI. International Registered Report Identifier (IRRID): DERR1-10.2196/47627 %M 37347522 %R 10.2196/47627 %U https://www.researchprotocols.org/2023/1/e47627 %U https://doi.org/10.2196/47627 %U http://www.ncbi.nlm.nih.gov/pubmed/37347522 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44346 %T Prevention and Treatment of Social Anxiety Disorder in Adolescents: Protocol for a Randomized Controlled Trial of the Online Guided Self-Help Intervention SOPHIE %A Walder,Noemi %A Berger,Thomas %A Schmidt,Stefanie J %+ Division of Clinical Child and Adolescent Psychology, Institute of Psychology, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 316843691, noemi.walder@unibe.ch %K prevention %K treatment %K social anxiety disorder %K internet-based %K adolescent %K online intervention %K anxiety %K psychotherapy %K youth %K child %K comorbid %K mental health %K social phobia %K mobile phone %D 2023 %7 21.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social anxiety symptoms are highly prevalent among adolescents and are associated with poor quality of life and low psychosocial functioning. If untreated, social anxiety often persists into adulthood and increases the risk for comorbid disorders. Therefore, early interventions for social anxiety to prevent negative long-term consequences are critical. However, adolescents rarely seek help and often avoid face-to-face psychotherapeutic interventions due to the perceived lack of autonomy and anonymity. Thus, online interventions represent a promising opportunity to reach adolescents who have social anxiety but do not seek help yet. Objective: This study aims to evaluate the efficacy, moderators, and mediators of an online intervention developed to reduce social anxiety in adolescents. Methods: A total of 222 adolescents aged 11-17 years with subclinical social anxiety (N=166) or with a diagnosis of social anxiety disorder (N=56) are randomly assigned to the online intervention or a care-as-usual control group. The 8-week guided online intervention is based on the Cognitive Model of Social Phobia and evidence-based online interventions for social anxiety adapted to the specific needs of adolescents. The care-as-usual group will be given access to the online intervention after the follow-up assessment. Participants are assessed at baseline, at 4 and 8 weeks post intervention, and at 3-month follow-up assessment on the primary outcome, that is, social anxiety, on secondary outcomes (eg, level of functioning, fear and avoidance, general anxiety, depression, quality of life, self-esteem, and negative effects of the intervention), on potential moderators (eg, therapy motivation, therapy expectancy, and satisfaction with the intervention), and potential mediators (eg, therapeutic alliance and adherence to the intervention). Data will be analyzed based on an intention-to-treat approach and both groups (intervention and care-as-usual) will be compared at each assessment time point. Furthermore, potential mechanisms of change and generalization of intervention effects on daily life are assessed using an ecological momentary assessment procedure that includes items on maintaining mechanisms of social anxiety, social context, and affect. Participants are prompted 3 times a day during the first 8 weeks of the study and again for 2 weeks following the follow-up assessment. Results: Recruitment is ongoing; initial results are expected in 2024. Conclusions: Results are discussed considering the potential of online interventions as a low-threshold prevention and treatment option for adolescents with social anxiety and in light of current advances in dynamic modeling of change processes and mechanisms in early intervention and psychotherapy in adolescents. Trial Registration: ClinicalTrials.gov NCT04782102; https://clinicaltrials.gov/ct2/show/NCT04782102 International Registered Report Identifier (IRRID): DERR1-10.2196/44346 %M 37342086 %R 10.2196/44346 %U https://www.researchprotocols.org/2023/1/e44346 %U https://doi.org/10.2196/44346 %U http://www.ncbi.nlm.nih.gov/pubmed/37342086 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46062 %T Understanding Users’ Experiences of a Novel Web-Based Cognitive Behavioral Therapy Platform for Depression and Anxiety: Qualitative Interviews From Pilot Trial Participants %A Shkel,Jane %A Green,Gavin %A Le,Stacey %A Kaveladze,Benjamin %A Marcotte,Veronique %A Rushton,Kevin %A Nguyen,Theresa %A Schueller,Stephen M %+ Department of Psychological Science, University of California, Irvine, 4341 Social and Behavioral Sciences Gateway, Irvine, CA, 92697, United States, 1 949 824 3850, s.schueller@uci.edu %K anxiety %K depression %K cognitive behavioral therapy %K clinical trial %K intervention %K qualitative research %K digital mental health intervention %D 2023 %7 20.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions (DMHIs) can help bridge the gap between the demand for mental health care and availability of treatment resources. The affordances of DMHIs have been proposed to overcome barriers to care such as accessibility, cost, and stigma. Despite these proposals, most evaluations of the DMHI focus on clinical effectiveness, with less consideration of users’ perspectives and experiences. Objective: We conducted a pilot randomized controlled trial of “Overcoming Thoughts,” a web-based platform that uses cognitive and behavioral principles to address depression and anxiety. The “Overcoming Thoughts” platform included 2 brief interventions—cognitive restructuring and behavioral experimentation. Users accessed either a version that included asynchronous interactions with other users (“crowdsourced” platform) or a completely self-guided version (control condition). We aimed to understand the users’ perspectives and experiences by conducting a subset of interviews during the follow-up period of the trial. Methods: We used purposive sampling to select a subset of trial participants based on group assignment (treatment and control) and symptom improvement (those who improved and those who did not on primary outcomes). We conducted semistructured interviews with 23 participants during the follow-up period that addressed acceptability, usability, and impact. We conducted a thematic analysis of the interviews until saturation was reached. Results: A total of 8 major themes were identified: possible opportunities to expand the platform; improvements in mental health because of using the platform; increased self-reflection skills; platform being more helpful for certain situations or domains; implementation of skills into users’ lives, even without direct platform use; increased coping skills because of using the platform; repetitiveness of platform exercises; and use pattern. Although no differences in themes were found among groups based on improvement status (all P values >.05, ranging from .12 to .86), there were 4 themes that differed based on conditions (P values from .01 to .046): helpfulness of self-reflection supported by an exercise summary (greater in control); aiding in slowing thoughts and feeling calmer (greater in control); overcoming patterns of avoidance (greater in control); and repetitiveness of content (greater in the intervention). Conclusions: We identified the different benefits that users perceived from a novel DMHI and opportunities to improve the platform. Interestingly, we did not note any differences in themes between those who improved and those who did not, but we did find some differences between those who received the control and intervention versions of the platform. Future research should continue to investigate users’ experiences with DMHIs to better understand the complex dynamics of their use and outcomes. %M 37338967 %R 10.2196/46062 %U https://formative.jmir.org/2023/1/e46062 %U https://doi.org/10.2196/46062 %U http://www.ncbi.nlm.nih.gov/pubmed/37338967 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46448 %T Providing Self-Led Mental Health Support Through an Artificial Intelligence–Powered Chat Bot (Leora) to Meet the Demand of Mental Health Care %A van der Schyff,Emma L %A Ridout,Brad %A Amon,Krestina L %A Forsyth,Rowena %A Campbell,Andrew J %+ Cyberpsychology Research Group, Biomedical Informatics and Digital Health Theme, School of Medical Sciences, The University of Sydney, Fisher Road, Sydney, 2006, Australia, 61 477179944, emma.vanderschyff@sydney.edu.au %K mental health %K chatbots %K conversational agents %K anxiety %K depression %K AI %K support %K web-based service %K web-based %K deployment %K stigma %K users %K symptoms %K mental health care %K self-led %D 2023 %7 19.6.2023 %9 Viewpoint %J J Med Internet Res %G English %X Digital mental health services are becoming increasingly valuable for addressing the global public health burden of mental ill-health. There is significant demand for scalable and effective web-based mental health services. Artificial intelligence (AI) has the potential to improve mental health through the deployment of chatbots. These chatbots can provide round-the-clock support and triage individuals who are reluctant to access traditional health care due to stigma. The aim of this viewpoint paper is to consider the feasibility of AI-powered platforms to support mental well-being. The Leora model is considered a model with the potential to provide mental health support. Leora is a conversational agent that uses AI to engage in conversations with users about their mental health and provide support for minimal-to-mild symptoms of anxiety and depression. The tool is designed to be accessible, personalized, and discreet, offering strategies for promoting well-being and acting as a web-based self-care coach. Across all AI-powered mental health services, there are several challenges in the ethical development and deployment of AI in mental health treatment, including trust and transparency, bias and health inequity, and the potential for negative consequences. To ensure the effective and ethical use of AI in mental health care, researchers must carefully consider these challenges and engage with key stakeholders to provide high-quality mental health support. Validation of the Leora platform through rigorous user testing will be the next step in ensuring the model is effective. %M 37335608 %R 10.2196/46448 %U https://www.jmir.org/2023/1/e46448 %U https://doi.org/10.2196/46448 %U http://www.ncbi.nlm.nih.gov/pubmed/37335608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42573 %T Computerized Cognitive Behavioral Therapy for Anxiety and Depression in Farming Communities: Mixed Methods Feasibility Study of Participant Use and Acceptability %A Bowyer,Harriet L %A Pegler,Ruth %A Williams,Christopher %+ Department of Psychology, Glasgow Caledonian University, Cowcaddens Rd, Glasgow, G4 0BA, United Kingdom, 44 1413318630, harriet.bowyer@gcu.ac.uk %K computerized cognitive behavioral therapy %K cCBT %K cognitive behavioral therapy %K CBT %K farmer %K depression %D 2023 %7 19.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Farmers have higher rates of depression than nonfarmers and higher rates of suicide than the general population. Several barriers to help seeking have been identified in farmers, which may be overcome by offering web-based mental health support. Computerized cognitive behavioral therapy (cCBT) is an effective intervention used to prevent and treat mild to moderate depression but has not been evaluated in the farming community. Objective: This study explored the feasibility of delivering a cCBT course tailored to farmers using a mixed methods approach. Methods: Farmers (aged ≥18 years) with no, minimal, or moderately severe depressive symptoms (Patient Health Questionnaire–9 [PHQ-9] score <20) were recruited using web-based and offline advertisements and given access to a cCBT course consisting of 5 core modules and automated and personalized email support. Depression (PHQ-9), anxiety (General Anxiety Disorder–7), and social functioning (Work and Social Adjustment Scale) were measured at baseline and the 8-week follow-up. Wilcoxon signed rank tests assessed changes in scores for all outcome measures over time. Telephone interviews focusing on participant use and satisfaction with the course were analyzed using thematic analysis. Results: Overall, 56 participants were recruited; 27 (48%) through social media. Overall, 62% (35/56) of participants logged into the course. At baseline, almost half of the participants reported experiencing minimal depressive symptoms (25/56, 45%) and mild anxiety (25/56, 45%), and just over half (30/56, 54%) reported mild to moderate functional impairment. Posttreatment data were available for 27% (15/56) of participants (41/56, 73% attrition rate). On average, participants experienced fewer depressive symptoms (P=.38) and less functional impairment (P=.26) at the 8-week follow-up; these results were not statistically significant. Participants experienced significantly fewer symptoms of anxiety at the 8-week follow-up (P=.02). Most participants (13/14, 93%) found the course helpful and easy to access (10/13, 77%) and the email support helpful (12/14, 86%). Qualitative interviews identified heavy workloads and mental health stigma within the farming community as barriers to help seeking. Participants thought that web-based support would be helpful, being convenient and anonymous. There were concerns that older farmers and those with limited internet connections may have difficulty accessing the course. Improvements regarding the layout and content of the course were suggested. Dedicated support from someone with farming knowledge was recommended to improve retention. Conclusions: cCBT may be a convenient way of supporting mental health within farming communities. However, challenges in recruiting and retaining farmers may indicate that cCBT supported only by email may not be an acceptable mode of mental health care delivery for many; however, it was valued by respondents. Involving farming organizations in planning, recruitment, and support may address these issues. Mental health awareness campaigns targeting farming communities may also help reduce stigma and improve recruitment and retention. %M 37335597 %R 10.2196/42573 %U https://formative.jmir.org/2023/1/e42573 %U https://doi.org/10.2196/42573 %U http://www.ncbi.nlm.nih.gov/pubmed/37335597 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44429 %T A Gamified Mobile App That Helps People Develop the Metacognitive Skills to Cope With Stressful Situations and Difficult Emotions: Formative Assessment of the InsightApp %A Amo,Victoria %A Prentice,Mike %A Lieder,Falk %+ Max Planck Institute for Intelligent Systems, Max Planck Ring 4, Tübingen, 72076, Germany, 49 15730645508, victoria.amo@tuebingen.mpg.de %K ecological momentary interventions %K serious games %K mindfulness-based interventions %K acceptance and commitment therapy %K cognitive behavioral therapy %K mobile phone %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary interventions open up new and exciting possibilities for delivering mental health interventions and conducting research in real-life environments via smartphones. This makes designing psychotherapeutic ecological momentary interventions a promising step toward cost-effective and scalable digital solutions for improving mental health and understanding the effects and mechanisms of psychotherapy. Objective: The first objective of this study was to formatively assess and improve the usability and efficacy of a gamified mobile app, the InsightApp, for helping people learn some of the metacognitive skills taught in cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness-based interventions. The app aims to help people constructively cope with stressful situations and difficult emotions in everyday life. The second objective of this study was to test the feasibility of using the InsightApp as a research tool for investigating the efficacy of psychological interventions and their underlying mechanisms. Methods: We conducted 2 experiments. In experiment 1 (n=65; completion rate: 63/65, 97%), participants (mean age 27, SD 14.9; range 19-55 years; 41/60, 68% female) completed a single session with the InsightApp. The intervention effects on affect, belief endorsement, and propensity for action were measured immediately before and after the intervention. Experiment 2 (n=200; completion rate: 142/200, 71%) assessed the feasibility of conducting a randomized controlled trial using the InsightApp. We randomly assigned participants to an experimental or a control condition, and they interacted with the InsightApp for 2 weeks (mean age 37, SD 12.16; range 20-78 years; 78/142, 55% female). Experiment 2 included all the outcome measures of experiment 1 except for the self-reported propensity to engage in predefined adaptive and maladaptive behaviors. Both experiments included user experience surveys. Results: In experiment 1, a single session with the app seemed to decrease participants’ emotional struggle, the intensity of their negative emotions, their endorsement of negative beliefs, and their self-reported propensity to engage in maladaptive coping behaviors (P<.001 in all cases; average effect size=−0.82). Conversely, participants’ endorsement of adaptive beliefs and their self-reported propensity to act in accordance with their values significantly increased (P<.001 in all cases; average effect size=0.48). Experiment 2 replicated the findings of experiment 1 (P<.001 in all cases; average effect size=0.55). Moreover, experiment 2 identified a critical obstacle to conducting a randomized controlled trial (ie, asymmetric attrition) and how it might be overcome. User experience surveys suggested that the app’s design is suitable for helping people apply psychotherapeutic techniques to cope with everyday stress and anxiety. User feedback provided valuable information on how to further improve app usability. Conclusions: In this study, we tested the first prototype of the InsightApp. Our encouraging preliminary results show that it is worthwhile to continue developing the InsightApp and further evaluate it in a randomized controlled trial. %M 37327040 %R 10.2196/44429 %U https://formative.jmir.org/2023/1/e44429 %U https://doi.org/10.2196/44429 %U http://www.ncbi.nlm.nih.gov/pubmed/37327040 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43037 %T Exploring the Impact of Social Media on Anxiety Among University Students in the United Kingdom: Qualitative Study %A Anto,Ailin %A Asif,Rafey Omar %A Basu,Arunima %A Kanapathipillai,Dylan %A Salam,Haadi %A Selim,Rania %A Zaman,Jahed %A Eisingerich,Andreas Benedikt %+ Faculty of Medicine, Imperial College London, Sir Alexander Fleming Building, South Kensington, London, SW7 2AZ, United Kingdom, 44 020 7589 5111, rania.selim18@imperial.ac.uk %K social media %K anxiety %K university student %K university %K college %K student %K qualitative %K mental health %K mental well-being %K thematic analysis %K stress %K health care professional %K humanistic %K social science %K undergraduate %K narrative inquiry %K narrative inquiry %K social network %K United Kingdom %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid surge in social media platforms has significant implications for users’ mental health, particularly anxiety. In the case of social media, the impact on mental well-being has been highlighted by multiple stakeholders as a cause for concern. However, there has been limited research into how the association between social media and anxiety arises, specifically among university students—the generation that has seen the introduction and evolution of social media, and currently lives through the medium. Extant systematic literature reviews within this area of research have not yet focused on university students or anxiety, rather predominantly investigating adolescents or generalized mental health symptoms and disorders. Furthermore, there is little to no qualitative data exploring the association between social media and anxiety among university students. Objective: The purpose of this study is to conduct a systematic literature review of the existing literature and a qualitative study that aims to develop foundational knowledge around the association of social media and anxiety among university students and enhance extant knowledge and theory. Methods: A total of 29 semistructured interviews were conducted, comprising 19 male students (65.5%) and 10 female students (34.5%) with a mean age of 21.5 years. All students were undergraduates from 6 universities across the United Kingdom, with most students studying in London (89.7%). Participants were enrolled through a homogenous purposive sampling technique via social media channels, word of mouth, and university faculties. Recruitment was suspended at the point of data saturation. Participants were eligible for the study if they were university students in the United Kingdom and users of social media. Results: Thematic analysis resulted in 8 second-order themes: 3 mediating factors that decrease anxiety levels and 5 factors that increase anxiety levels. Social media decreased anxiety through positive experiences, social connectivity, and escapism. Social media increased anxiety through stress, comparison, fear of missing out, negative experiences, and procrastination. Conclusions: This qualitative study sheds critical light on how university students perceive how social media affects their anxiety levels. Students revealed that social media did impact their anxiety levels and considered it an important factor in their mental health. Thus, it is essential to educate stakeholders, including students, university counselors, and health care professionals, about the potential impact of social media on students’ anxiety levels. Since anxiety is a multifactorial condition, pinpointing the main stressors in a person’s life, such as social media use, may help manage these patients more effectively. The current research highlights that there are also many benefits to social media, and uncovering these may help in producing more holistic management plans for anxiety, reflective of the students’ social media usage. %M 37327030 %R 10.2196/43037 %U https://formative.jmir.org/2023/1/e43037 %U https://doi.org/10.2196/43037 %U http://www.ncbi.nlm.nih.gov/pubmed/37327030 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41590 %T Feasibility and Preliminary Efficacy of Digital Interventions for Depressive Symptoms in Working Adults: Multiarm Randomized Controlled Trial %A Taylor,Rachael Wallis %A Male,Rhian %A Economides,Marcos %A Bolton,Heather %A Cavanagh,Kate %+ Unmind Ltd, 180 Borough High Street, London, SE1 1LB, United Kingdom, 44 7814522979, rachaelwtaylor@gmail.com %K depression %K digital intervention %K randomized controlled trial %K RCT %K cognitive behavioral therapy %K CBT %K acceptance and commitment therapy %K ACT %K behavioral activation %K BA %K mobile phone %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Depressive symptoms are highly prevalent and have broad-ranging negative implications. Digital interventions are increasingly available in the workplace context, but supporting evidence is limited. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary efficacy of 3 digital interventions for depressive symptoms in a sample of UK-based working adults experiencing mild to moderate symptoms. Methods: This was a parallel, multiarm, pilot randomized controlled trial. Participants were allocated to 1 of 3 digital interventions or a waitlist control group and had 3 weeks to complete 6 to 8 short self-guided sessions. The 3 interventions are available on the Unmind mental health app for working adults and draw on behavioral activation, cognitive behavioral therapy, and acceptance and commitment therapy. Web-based assessments were conducted at baseline, postintervention (week 3), and at 1-month follow-up (week 7). Participants were recruited via Prolific, a web-based recruitment platform, and the study was conducted entirely on the web. Feasibility and acceptability were assessed using objective engagement data and self-reported feedback. Efficacy outcomes were assessed using validated self-report measures of mental health and functioning and linear mixed models with intention-to-treat principles. Results: In total, 2003 individuals were screened for participation, of which 20.22% (405/2003) were randomized. A total of 92% (373/405) of the participants were retained in the study, 97.4% (295/303) initiated their allocated intervention, and 66.3% (201/303) completed all sessions. Moreover, 80.6% (229/284) of the participants rated the quality of their allocated intervention as excellent or good, and 79.6% (226/284) of the participants were satisfied or very satisfied with their intervention. All active groups showed improvements in well-being, functioning, and depressive and anxiety symptoms compared with the control group, which were maintained at 4 weeks. Hedges g effect sizes for depressive symptoms ranged from −0.53 (95% CI −0.25 to −0.81) to −0.74 (95% CI −0.45 to −1.03). Conclusions: All interventions were feasible and acceptable, and the preliminary efficacy findings indicated that their use may improve depressive symptoms, well-being, and functioning. The predefined criteria for a definitive trial were met. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) ISRCTN13067492; https://www.isrctn.com/ISRCTN13067492 %M 37327027 %R 10.2196/41590 %U https://formative.jmir.org/2023/1/e41590 %U https://doi.org/10.2196/41590 %U http://www.ncbi.nlm.nih.gov/pubmed/37327027 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41981 %T Coach-Supported Versus Self-guided Digital Training Course for a Problem-solving Psychological Intervention for Nonspecialists: Protocol for a Pre-Post Nested Randomized Controlled Trial %A Mathur,Sonal %A Weiss,Helen A %A Neuman,Melissa %A Field,Andy P %A Leurent,Baptiste %A Shetty,Tejaswi %A J,James E %A Nair,Pooja %A Mathews,Rhea %A Malik,Kanika %A Michelson,Daniel %A Patel,Vikram %+ Department of Global Health and Social Medicine, Harvard Medical School, 641, Huntington Avenue, Boston, MA, 02115, United States, 1 9822132038, vikram_patel@hms.harvard.edu %K adolescent mental health %K capacity building %K digital training %K India %K problem-solving intervention %K randomized controlled trial %D 2023 %7 13.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychosocial interventions delivered by nonspecialists can be effective at reducing common adolescent mental health problems in low-resource settings. However, there is a lack of evidence on resource-efficient methods for building capacity to deliver these interventions. Objective: The objective of this study is to evaluate the effects of a digital training (DT) course, delivered in a self-guided format or with coaching, on nonspecialists’ competency to deliver a problem-solving intervention intended for adolescents with common mental health problems in India. Methods: We will conduct a pre-post study with a nested parallel, 2-arm, individually randomized controlled trial. The study aims to recruit 262 participants, randomized 1:1 to receive either a self-guided DT course or a DT course with weekly individualized coaching provided remotely by telephone. In both arms, the DT will be accessed over 4 to 6 weeks. Participants will be nonspecialists (ie, without prior practice-based training in psychological therapies) recruited from among university students and affiliates of nongovernmental organizations in Delhi and Mumbai, India. Results: Outcomes will be assessed at baseline and 6 weeks post randomization using a knowledge-based competency measure that incorporates a multiple-choice quiz format. The primary hypothesis is that self-guided DT will lead to increased competency scores among novices with no prior experience of delivering psychotherapies. The secondary hypothesis is that digital training with coaching will have an incremental effect on competency scores compared with DT alone. The first participant was enrolled on April 4, 2022. Conclusions: The study will address an evidence gap on the effectiveness of training methods for nonspecialist providers of adolescent mental health interventions in low-resource settings. The findings from this study will be used to support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT05290142; https://clinicaltrials.gov/ct2/show/NCT05290142 International Registered Report Identifier (IRRID): DERR1-10.2196/41981 %M 37310781 %R 10.2196/41981 %U https://www.researchprotocols.org/2023/1/e41981 %U https://doi.org/10.2196/41981 %U http://www.ncbi.nlm.nih.gov/pubmed/37310781 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45135 %T Efficacy of a Digital Mental Health Biopsychosocial Transdiagnostic Intervention With or Without Therapist Assistance for Adults With Anxiety and Depression: Adaptive Randomized Controlled Trial %A Andrews,Brooke %A Klein,Britt %A Van Nguyen,Huy %A Corboy,Denise %A McLaren,Suzanne %A Watson,Shaun %+ Health Innovation & Transformation Centre, Federation University Australia, University Drive, Mt Helen Victoria, Ballarat, 3350, Australia, 61 53279623 ext 9623, b.andrews@federation.edu.au %K video chat therapy %K therapist assistance %K self-help %K transdiagnostic %K digital intervention %K anxiety %K depression %K comorbidity %D 2023 %7 12.6.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital mental health (DMH) interventions incorporating elements that adapt to the evolving needs of consumers have the potential to further our understanding of the optimal intensity of therapist assistance and inform stepped-care models. Objective: The primary objective was to compare the efficacy of a transdiagnostic biopsychosocial DMH program, with or without therapist assistance for adults with subthreshold symptoms or a diagnosis of anxiety or depression. Methods: In a randomized adaptive clinical trial design, all participants had access to the DMH program, with eligibility to have their program augmented with therapist assistance determined by program engagement or symptom severity. Participants who met stepped-care criteria were randomized to have their treatment program augmented with either low-intensity (10 min/week of video chat support for 7 weeks) or high-intensity (50 min/week of video chat support for 7 weeks) therapist assistance. A total of 103 participants (mean age 34.17, SD 10.50 years) were assessed before (week 0), during (weeks 3 and 6), and after the intervention (week 9) and at the 3-month follow-up (week 21). The effects of 3 treatment conditions (DMH program only, DMH program+low-intensity therapist assistance, and DMH program+high-intensity therapist assistance) on changes in the 2 primary outcomes of anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were assessed using the Cohen d, reliable change index, and mixed-effects linear regression analyses. Results: There were no substantial differences in the outcome measures among intervention conditions. However, there were significant time effect changes in most outcomes over time. All 3 intervention conditions demonstrated strong and significant treatment effect changes in GAD-7 and PHQ-9 scores, with absolute Cohen d values ranging from 0.82 to 1.79 (all P<.05). The mixed-effects models revealed that, in the Life Flex program–only condition at week 3, mean GAD-7 and PHQ-9 scores significantly decreased from baseline by 3.54 and 4.38 (all P<.001), respectively. At weeks 6, 9, and 21, GAD-7 and PHQ-9 scores significantly decreased from baseline by at least 6 and 7 points (all P<.001), respectively. Nonresponders at week 3 who were stepped up to therapist assistance increased program engagement and treatment response. At the postintervention time point and 3-month follow-up, 67% (44/65) and 69% (34/49) of the participants, respectively, no longer met diagnostic criteria for anxiety or depression. Conclusions: The findings highlight that early detection of low engagement and non–treatment response presents an opportunity to effectively intervene by incorporating an adaptive design. Although the study findings indicate that therapist assistance was no more effective than the DMH intervention program alone for reducing symptoms of anxiety or depression, the data highlight the potential influence of participant selection bias and participant preferences within stepped-care treatment models. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000422921; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378317&isReview=true International Registered Report Identifier (IRRID): RR2-10.2196/45040 %M 37307046 %R 10.2196/45135 %U https://www.jmir.org/2023/1/e45135 %U https://doi.org/10.2196/45135 %U http://www.ncbi.nlm.nih.gov/pubmed/37307046 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e42349 %T Implementing a Digital Depression Prevention Program in Australian Secondary Schools: Cross-Sectional Qualitative Study %A Beames,Joanne R %A Werner-Seidler,Aliza %A Hodgins,Michael %A Brown,Lyndsay %A Fujimoto,Hiroko %A Bartholomew,Alexandra %A Maston,Kate %A Huckvale,Kit %A Zbukvic,Isabel %A Torok,Michelle %A Christensen,Helen %A Batterham,Philip J %A Calear,Alison L %A Lingam,Raghu %A Boydell,Katherine M %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, NSW, 2031, Australia, 61 02 9382 ext 4530, z3330693@zmail.unsw.edu.au %K implementation %K youth %K digital %K depression %K secondary school %K qualitative %K consolidated framework for implementation research %K teacher %K educator %K perspective %K mental health %K student %K child %K adolescent %K adolescence %K school %K social work %D 2023 %7 12.6.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Depression is common during adolescence and is associated with adverse educational, employment, and health outcomes in later life. Digital programs are increasingly being implemented in schools to improve and protect adolescent mental health. Although digital depression prevention programs can be effective, there is limited knowledge about how contextual factors influence real-world delivery at scale in schools. Objective: The purpose of this study was to examine the contextual factors that influence the implementation of the Future Proofing Program (FPP) from the perspectives of school staff. The FPP is a 2-arm hybrid type 1 effectiveness-implementation trial evaluating whether depression can be prevented at scale in schools, using an evidence-based smartphone app delivered universally to year 8 students (13-14 years of age). Methods: Qualitative interviews were conducted with 23 staff from 20 schools in New South Wales, Australia, who assisted with the implementation of the FPP. The interviews were guided by our theory-driven logic model. Reflexive thematic analysis, using both deductive and inductive coding, was used to analyze responses. Results: Staff perceived the FPP as a novel (“innovative approach”) and appropriate way to address an unmet need within schools (“right place at the right time”). Active leadership and counselor involvement were critical for planning and engaging; teamwork, communication, and staff capacity were critical for execution (“ways of working within schools”). Low student engagement and staffing availability were identified as barriers for future adoption and implementation by schools (“reflecting on past experiences”). Conclusions: Four superordinate themes pertaining to the program, implementation processes, and implementation barriers were identified from qualitative responses by school staff. On the basis of our findings, we proposed a select set of recommendations for future implementation of digital prevention programs delivered at scale in schools. These recommendations were designed to facilitate an organizational change and help staff to implement digital mental health programs within their schools. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-042133 %M 37307051 %R 10.2196/42349 %U https://pediatrics.jmir.org/2023/1/e42349 %U https://doi.org/10.2196/42349 %U http://www.ncbi.nlm.nih.gov/pubmed/37307051 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43036 %T An Entertainment-Education Video and Written Messages to Alleviate Loneliness in Germany: Pilot Randomized Controlled Study %A Liu,Shuyan %A Wegner,Luisa %A Haucke,Matthias %A Gates,Jennifer %A Adam,Maya %A Bärnighausen,Till %+ Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 622156534, till.baernighausen@uni-heidelberg.de %K entertainment media %K perceived social isolation %K health communication %K digital knowledge %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: More than half of adults in Germany have felt lonely during the COVID-19 pandemic. Previous studies highlight the importance of boosting positive emotions and social connectedness to combat loneliness. However, interventions targeting these protective psychosocial resources remain largely untested. Objective: In this study, we aim to test the feasibility of a short animated storytelling video, written messages boosting social connectedness, and a combination of both for alleviating loneliness. Methods: We enrolled 252 participants who were 18 years or older and spoke fluent German. Participants were recruited from a previous study on loneliness in Germany. We measured the effects of a combination of an animated video and written messages (intervention A), an animated video (intervention B), and written messages (intervention C) on loneliness, self-esteem, self-efficacy, and hope. We compared these with a control arm, which did not receive any intervention. The animated video was developed by Stanford University School of Medicine to reflect experiences of social isolation during the COVID-19 pandemic and convey messages of hope and solidarity. The written messages communicate four findings from recent studies on loneliness in Germany: (1) over a period of 6 months, 66% of respondents in Germany reported feeling lonely (feelings of loneliness are surprisingly common); (2) physical activity can ease feelings of loneliness; (3) focusing on “what really matters” in one’s life can help to ease feelings of loneliness; and (4) turning to friends for companionship and support can ease feelings of loneliness. Participants were randomized 1:1:1:1 to interventions A, B, C, and the control condition, using the randomization feature of the web-based platform “Unipark,” on which our trial takes place. Both the study investigators and analysts were blinded to the trial assignments. The primary outcome, loneliness, was measured using the short-form UCLA Loneliness Scale (ULS-8). Our secondary outcomes included the scores of the Coping with Loneliness Questionnaire, the 10-item Rosenberg Self-Esteem Scale (RSE), the 10-item General Self-Efficacy Scale, and the 12-item Adult Hope Scale (AHS). Results: We observed no statistically significant effect of the tested interventions on loneliness scores, controlling for the baseline loneliness score before an intervention (all P values >.11). However, we observed significantly greater intention to cope with loneliness after exposure to an animated video when compared with the control (β=4.14; t248=1.74; 1-tailed P=.04). Conclusions: Our results provide meaningful evidence for the feasibility of a full-scale study. Our study sheds light on the intention to cope with loneliness and explores the potential for creative digital interventions to enhance this psychological precursor, which is integral to overcoming loneliness. Trial Registration: German Clinical Trials Register DRKS00027116; https://drks.de/search/en/trial/DRKS00027116 %M 37285206 %R 10.2196/43036 %U https://formative.jmir.org/2023/1/e43036 %U https://doi.org/10.2196/43036 %U http://www.ncbi.nlm.nih.gov/pubmed/37285206 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41890 %T Internet-Delivered Dialectical Behavioral Therapy Skills Training for Chronic Pain: Protocol for a Randomized Controlled Trial %A Norman-Nott,Nell %A Hesam-Shariati,Negin %A Wilks,Chelsey R %A Schroeder,Jessica %A Suh,Jina %A Briggs,Nancy E %A McAuley,James H %A Quidé,Yann %A Gustin,Sylvia M %+ NeuroRecovery Research Hub, School of Psychology, University of New South Wales, BioLink Building, Level 1, High Street, Kensington, Sydney, 2052, Australia, 61 293480846, n.normannott@unsw.edu.au %K internet-delivered %K dialectical behavioral therapy %K chronic pain %K emotion dysregulation %K emotion-centric intervention %K mobile phone %D 2023 %7 7.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Emotion dysregulation is key to the development and maintenance of chronic pain, feeding into a cycle of worsening pain and disability. Dialectical behavioral therapy (DBT), an evidence-based treatment for complex transdiagnostic conditions presenting with high emotion dysregulation, may be beneficial to manage and mitigate the emotional and sensory aspects of chronic pain. Increasingly, DBT skills training as a key component of standard DBT is being delivered as a stand-alone intervention without concurrent therapy to help develop skills for effective emotion regulation. A previous repeated-measure single-case trial investigating a novel technologically driven DBT skills training, internet-delivered DBT skills training for chronic pain (iDBT-Pain), revealed promising findings to improve both emotion dysregulation and pain intensity. Objective: This randomized controlled trial aims to examine the efficacy of iDBT-Pain in comparison with treatment as usual to reduce emotion dysregulation (primary outcome) for individuals with chronic pain after 9 weeks and at the 21-week follow-up. The secondary outcomes include pain intensity, pain interference, anxiety symptoms, depressive symptoms, perceived stress, posttraumatic stress, harm avoidance, social cognition, sleep quality, life satisfaction, and well-being. The trial also examines the acceptability of the iDBT-Pain intervention for future development and testing. Methods: A total of 48 people with chronic pain will be randomly assigned to 1 of 2 conditions: treatment and treatment as usual. Participants in the treatment condition will receive iDBT-Pain, consisting of 6 live web-based group sessions led by a DBT skills trainer and supervised by a registered psychologist and the iDBT-Pain app. Participants in the treatment-as-usual condition will not receive iDBT-Pain but will still access their usual medication and health interventions. We predict that iDBT-Pain will improve the primary outcome of emotion dysregulation and the secondary outcomes of pain intensity, pain interference, anxiety symptoms, depressive symptoms, perceived stress, harm avoidance, social cognition, sleep quality, life satisfaction, and well-being. A linear mixed model with random effects of individuals will be conducted to investigate the differences between the baseline, 9-week (primary end point), and 21-week (follow-up) assessments as a function of experimental condition. Results: Recruitment started in February 2023, and the clinical trial started in March 2023. Data collection for the final assessment is planned to be completed by July 2024. Conclusions: If our hypothesis is confirmed, our findings will contribute to the evidence for the efficacy and acceptability of a viable intervention that may be used by health care professionals for people with chronic pain. The results will add to the chronic pain literature to inform about the potential benefits of DBT skills training for chronic pain and will contribute evidence about technologically driven interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000113752; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383208&isReview=true International Registered Report Identifier (IRRID): PRR1-10.2196/41890 %M 37285187 %R 10.2196/41890 %U https://www.researchprotocols.org/2023/1/e41890 %U https://doi.org/10.2196/41890 %U http://www.ncbi.nlm.nih.gov/pubmed/37285187 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45234 %T Promoting Engagement With Smartphone Apps for Suicidal Ideation in Young People: Development of an Adjunctive Strategy Using a Lived Experience Participatory Design Approach %A Gan,Daniel Z Q %A McGillivray,Lauren %A Larsen,Mark Erik %A Bloomfield,Taylor %A Torok,Michelle %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, NSW 2031, Australia, 61 423828945, danielzqgan@gmail.com %K eHealth %K digital mental health %K smartphone app %K engagement %K youth suicide prevention %K qualitative methods %K suicide %K development %K youth %K mental health %K support %K user-centered %K design %K survey %K interview %K prototype %K prevention %K participatory design %K mobile phone %D 2023 %7 6.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide among young people is a worrying public health concern. Despite this, there is a lack of suitable interventions aligned with the needs of this priority population. Emerging evidence supports the effectiveness of digital interventions in alleviating the severity of suicidal thoughts. However, their efficacy may be undermined by poor engagement. Technology-supported strategies (eg, electronic prompts and reminders) have been deployed alongside digital interventions to increase engagement with the latter. However, evidence of their efficacy is inconclusive. User-centered design approaches may be key to developing feasible and effective engagement strategies. Currently, no study has been published on how such an approach might be expressly applied toward developing strategies for promoting engagement with digital interventions. Objective: This study aimed to detail the processes and activities involved in developing an adjunctive strategy for promoting engagement with LifeBuoy—a smartphone app that helps young people manage suicidal thoughts. Methods: Development of the engagement strategy took place in 2 phases. The discovery phase aimed to create an initial prototype by synthesizing earlier findings—from 2 systematic reviews and a cross-sectional survey of the broader mental health app user population—with qualitative insights from LifeBuoy users. A total of 16 web-based interviews were conducted with young people who participated in the LifeBuoy trial. Following the discovery phase, 3 interviewees were invited by the research team to take part in the workshops in the design phase, which sought to create a final prototype by making iterative improvements to the initial prototype. These improvements were conducted over 2 workshops. Thematic analysis was used to analyze the qualitative data obtained from the interviews and workshops. Results: Main themes from the interviews centered around the characteristics of the strategy, timing of notifications, and suitability of social media platforms. Subsequently, themes that emerged from the design workshops emphasized having a wider variety of content, greater visual consistency with LifeBuoy, and a component with more detailed information to cater to users with greater informational needs. Thus, refinements to the prototype were focused on (1) improving the succinctness, variety, and practical value of Instagram content, (2) creating a blog containing articles contributed by mental health professionals and young people with lived experience of suicide, and (3) standardizing the use of marine-themed color palettes across the Instagram and blog components. Conclusions: This is the first study to describe the development of a technology-supported adjunctive strategy for promoting engagement with a digital intervention. It was developed by integrating perspectives from end users with lived experience of suicide with evidence from the existing literature. The development process documented in this study may be useful for guiding similar projects aimed at supporting the use of digital interventions for suicide prevention or mental health. %M 37279058 %R 10.2196/45234 %U https://formative.jmir.org/2023/1/e45234 %U https://doi.org/10.2196/45234 %U http://www.ncbi.nlm.nih.gov/pubmed/37279058 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e45949 %T Mental Health Professionals’ Attitudes Toward Digital Mental Health Apps and Implications for Adoption in Portugal: Mixed Methods Study %A Nogueira-Leite,Diogo %A Diniz,José Miguel %A Cruz-Correia,Ricardo %+ Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal, 351 225513600, diogo.fdnl@gmail.com %K mobile health %K mHealth %K health policy %K mental health %K digital health %K apps %K psychiatrists %K psychologists %K technology acceptance %K adoption %K government regulation %D 2023 %7 2.6.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital health apps are among the most visible facets of the ongoing digital transition in health care, with mental health–focused apps as one of the main therapeutic areas. However, concerns regarding their scientific robustness drove regulators to establish evaluation procedures, with Germany’s Digitale Gesundheitsanwendungen program pioneering in app prescription with costs covered by statutory health insurance. Portugal gathers a set of conditions and requirements that position it as an excellent test bed for digital health apps. Its daunting mental health landscape reinforces the potential interest in new interventions. To understand if they would be acceptable, we need to understand the supply side’s attitudes and perceptions toward them, that is, those of psychiatrists and psychologists. Objective: This study aims to understand the attitudes and expectations of psychiatrists and psychologists toward digital mental health apps (DMHAs) in the Portuguese context, as well as perceived benefits, barriers, and actions to support their adoption. Methods: We conducted a 2-stage sequential mixed methods study. Stage 1 consisted of a cross-sectional web survey adapted to the Portuguese context that was delivered to mental health professionals and psychologists. Stage 2 complemented the insights of the web survey results with a key opinion leader analysis. Results: A total of 160 complete survey responses were recorded, most of which were from psychologists. This is the most extensive study on mental health professionals’ attitudes and perceptions of DMHAs in Portugal. A total of 87.2% (136/156) of the respondents supported the opportunity to prescribe DMHAs. Increased health literacy (139/160, 86.9%), wider adherence to treatment (137/160, 85.6%), and proper disease management (127/160, 79.4%) were the most frequently agreed upon benefits of DMHAs. However, only less than half (68/156, 43.6%) of the respondents planned to prescribe or recommend DMHAs, with psychologists being more favorable than psychiatrists. Professionals faced substantial barriers, such as a lack of information on DMHAs (154/160, 96.3%), the level of initial training effort (115/160, 71.9%), and the need for adjustments of clinical processes and records (113/160, 70.6%). Professionals reported that having more information on the available apps and their suitability for health objectives (151/160, 94.4%), more scientific evidence of the validity of the apps as a health intervention (147/160, 91.9%), and established recommendations of apps by specific clinical guidelines or professional societies (145/160, 90.6%) would be essential to foster adoption. Conclusions: More information about DMHAs regarding their clinical validity and how they work is necessary so that such an intervention can be adopted in Portugal. Recommendations from professional and scientific societies, as well as from governmental bodies, are strongly encouraged. Although the benefits of and the barriers to using these apps are consensual, more evidence, along with further promotion of mental health professionals’ digital literacy, is needed. International Registered Report Identifier (IRRID): RR2-10.2196/41040 %M 37266977 %R 10.2196/45949 %U https://humanfactors.jmir.org/2023/1/e45949 %U https://doi.org/10.2196/45949 %U http://www.ncbi.nlm.nih.gov/pubmed/37266977 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45102 %T Evaluating the Mental Health of Physician-Trainees Using an SMS Text Message–Based Assessment Tool: Longitudinal Pilot Study %A Goldhaber,Nicole H %A Chea,Annie %A Hekler,Eric B %A Zhou,Wenjia %A Fergerson,Byron %+ Department of Surgery, School of Medicine, University of California, San Diego Health, 9300 Campus Point Drive, #7220, La Jolla, CA, 92037, United States, 1 310 889 8678, nhgoldhaber@health.ucsd.edu %K physician burnout %K mental health %K text-message assessment %K text %K mobile text %K stress assessment %K text message %K pilot study %K physician %K burnout %K United States %K survey %K trainee %K stress %K engagement %K users %K tracking %D 2023 %7 2.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Physician burnout is a multibillion-dollar issue in the United States. Despite its prevalence, burnout is difficult to accurately measure. Institutions generally rely on periodic surveys that are subject to recall bias. SMS text message–based surveys or assessments have been used in health care and have the advantage of easy accessibility and high response rates. Objective: In this pilot project, we evaluated the utility of and participant engagement with a simple, longitudinal, and SMS text message–based mental health assessment system for physician-trainees at the study institution. The goal of the SMS text message–based assessment system was to track stress, burnout, empathy, engagement, and work satisfaction levels faced by users in their normal working conditions. Methods: Three SMS text message-based questions per week for 5 weeks were sent to each participant. All data received were deidentified. Additionally, each participant had a deidentified personal web page to follow their scores as well as the aggregated scores of all participants over time. A 13-question optional survey was sent at the conclusion of the study to evaluate the usability of the platform. Descriptive statistics were performed. Results: In all, 81 participants were recruited and answered at least six (mean 14; median 14; range 6-16) questions for a total of 1113 responses. Overall, 10 (17%) out of 59 participants responded “Yes” to having experienced a traumatic experience during the study period. Only 3 participants ever answered being “Not at all satisfied” with their job. The highest number of responses indicating that participants were stressed or burnt out came on day 25 in the 34-day study period. There were mixed levels of concern for the privacy of responses. No substantial correlations were noted between responses and having experienced a traumatic experience during the study period. Furthermore, 12 participants responded to the optional feedback survey, and all either agreed or strongly agreed that the SMS text message–based assessment system was easy to use and the number of texts received was reasonable. None of the 12 respondents indicated that using the SMS text message–based assessment system caused stress. Conclusions: Responses demonstrated that SMS text message–based mental health assessments are potentially useful for recording physician-trainee mental health levels in real time with minimal burden, but further study of SMS text message–based mental health assessments should address limitations such as improving response rates and clarifying participants’ sense of privacy when using the SMS text message–based assessment system. The findings of this pilot study can inform the development of institution-wide tools for assessing physician burnout and protecting physicians from occupational stress. %M 37266985 %R 10.2196/45102 %U https://formative.jmir.org/2023/1/e45102 %U https://doi.org/10.2196/45102 %U http://www.ncbi.nlm.nih.gov/pubmed/37266985 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45171 %T Web-Based Social Networks of Individuals With Adverse Childhood Experiences: Quantitative Study %A Cao,Yiding %A Rajendran,Suraj %A Sundararajan,Prathic %A Law,Royal %A Bacon,Sarah %A Sumner,Steven A %A Masuda,Naoki %+ Department of Mathematics, State University of New York at Buffalo, North Campus, Buffalo, NY, 14260, United States, 1 716 645 8804, naokimas@gmail.com %K adverse childhood experience %K ACE %K social networks %K Twitter %K Reddit %K childhood %K abuse %K neglect %K violence %K substance use %K coping strategy %K coping %K interpersonal connection %K web-based connection %K behavior %K social connection %K resilience %D 2023 %7 30.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Adverse childhood experiences (ACEs), which include abuse and neglect and various household challenges such as exposure to intimate partner violence and substance use in the home, can have negative impacts on the lifelong health of affected individuals. Among various strategies for mitigating the adverse effects of ACEs is to enhance connectedness and social support for those who have experienced them. However, how the social networks of those who experienced ACEs differ from the social networks of those who did not is poorly understood. Objective: In this study, we used Reddit and Twitter data to investigate and compare social networks between individuals with and without ACE exposure. Methods: We first used a neural network classifier to identify the presence or absence of public ACE disclosures in social media posts. We then analyzed egocentric social networks comparing individuals with self-reported ACEs with those with no reported history. Results: We found that, although individuals reporting ACEs had fewer total followers in web-based social networks, they had higher reciprocity in following behavior (ie, mutual following with other users), a higher tendency to follow and be followed by other individuals with ACEs, and a higher tendency to follow back individuals with ACEs rather than individuals without ACEs. Conclusions: These results imply that individuals with ACEs may try to actively connect with others who have similar previous traumatic experiences as a positive connection and coping strategy. Supportive interpersonal connections on the web for individuals with ACEs appear to be a prevalent behavior and may be a way to enhance social connectedness and resilience in those who have experienced ACEs. %M 37252791 %R 10.2196/45171 %U https://www.jmir.org/2023/1/e45171 %U https://doi.org/10.2196/45171 %U http://www.ncbi.nlm.nih.gov/pubmed/37252791 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43385 %T A Fully Automated Self-help Biopsychosocial Transdiagnostic Digital Intervention to Reduce Anxiety and/or Depression and Improve Emotional Regulation and Well-being: Pre–Follow-up Single-Arm Feasibility Trial %A Klein,Britt %A Nguyen,Huy %A McLaren,Suzanne %A Andrews,Brooke %A Shandley,Kerrie %+ Health Innovation & Transformation Centre, Federation University Australia, PO Box 663, Ballarat, 3353, Australia, 61 353276717, b.klein@federation.edu.au %K anxiety %K depression %K fully automated %K self-help %K digital intervention %K transdiagnostic %K biopsychosocial %K emotion regulation %K allostatic load %K brain plasticity %K positive affect %K comorbidity %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety disorders and depression are prevalent disorders with high comorbidity, leading to greater chronicity and severity of symptoms. Given the accessibility to treatment issues, more evaluation is needed to assess the potential benefits of fully automated self-help transdiagnostic digital interventions. Innovating beyond the current transdiagnostic one-size-fits-all shared mechanistic approach may also lead to further improvements. Objective: The primary objective of this study was to explore the preliminary effectiveness and acceptability of a new fully automated self-help biopsychosocial transdiagnostic digital intervention (Life Flex) aimed at treating anxiety and/or depression, as well as improving emotional regulation; emotional, social, and psychological well-being; optimism; and health-related quality of life. Methods: This was a real-world pre-during-post-follow-up feasibility trial design evaluation of Life Flex. Participants were assessed at the preintervention time point (week 0), during intervention (weeks 3 and 5), at the postintervention time point (week 8), and at 1- and 3-month follow-ups (weeks 12 and 20, respectively). Results: The results provided early support for the Life Flex program in reducing anxiety (Generalized Anxiety Disorder 7), depression (Patient Health Questionnaire 9), psychological distress (Kessler 6), and emotional dysregulation (Difficulties in Emotional Regulation 36) and increasing emotional, social, and psychological well-being (Mental Health Continuum—Short Form); optimism (Revised Life Orientation Test); and health-related quality of life (EQ-5D-3L Utility Index and Health Rating; all false discovery rate [FDR]<.001). Large within-group treatment effect sizes (range |d|=0.82 to 1.33) were found for most variables from pre- to postintervention assessments and at the 1- and 3-month follow-up. The exceptions were medium treatment effect sizes for EQ-5D-3L Utility Index (range Cohen d=−0.50 to −0.63) and optimism (range Cohen d=−0.72 to −0.79) and small-to-medium treatment effect size change for EQ-5D-3L Health Rating (range Cohen d=−0.34 to −0.58). Changes across all outcome variables were generally strongest for participants with preintervention clinical comorbid anxiety and depression presentations (range |d|=0.58 to 2.01) and weakest for participants presenting with nonclinical anxiety and/or depressive symptoms (|d|=0.05 to 0.84). Life Flex was rated as acceptable at the postintervention time point, and participants indicated that they enjoyed the transdiagnostic program and biological, wellness, and lifestyle-focused content and strategies. Conclusions: Given the paucity of evidence on fully automated self-help transdiagnostic digital interventions for anxiety and/or depressive symptomatology and general treatment accessibility issues, this study provides preliminary support for biopsychosocial transdiagnostic interventions, such as Life Flex, as a promising future mental health service delivery gap filler. Following large-scale, randomized controlled trials, the potential benefits of fully automated self-help digital health programs, such as Life Flex, could be considerable. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN12615000480583; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368007 %M 37252790 %R 10.2196/43385 %U https://formative.jmir.org/2023/1/e43385 %U https://doi.org/10.2196/43385 %U http://www.ncbi.nlm.nih.gov/pubmed/37252790 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 6 %N %P e47152 %T The Experiences of Informal Caregivers of People With Dementia in Web-Based Psychoeducation Programs: Systematic Review and Metasynthesis %A Yu,Ying %A Xiao,Lily %A Ullah,Shahid %A Meyer,Claudia %A Wang,Jing %A Pot,Anne Margriet %A Shifaza,Fathimath %+ College of Nursing and Health Sciences, Flinders University, Sturt Rd, Bedford Park, South Australia, 5042, Australia, 61 8 82013419, lily.xiao@flinders.edu.au %K informal caregivers %K dementia %K psychoeducation %K online %K web based %K qualitative research %K systematic review %K metasynthesis %D 2023 %7 29.5.2023 %9 Review %J JMIR Aging %G English %X Background: Informal caregivers of people living with dementia experience a higher level of physical and mental stress compared with other types of caregivers. Psychoeducation programs are viewed as beneficial for building caregivers’ knowledge and skills and for decreasing caregiver stress. Objective: This review aimed to synthesize the experiences and perceptions of informal caregivers of people with dementia when participating in web-based psychoeducation programs and the factors that enable and impede informal caregivers’ engagement in web-based psychoeducation programs. Methods: This review followed the Joanna Briggs Institute protocol of systematic review and meta-aggregation of qualitative studies. We searched 4 English databases, 4 Chinese databases, and 1 Arabic database in July 2021. Results: A total of 9 studies written in English were included in this review. From these studies, 87 findings were extracted and grouped into 20 categories. These categories were further synthesized into 5 findings: web-based learning as an empowering experience, peer support, satisfactory and unsatisfactory program content, satisfactory and unsatisfactory technical design, and challenges encountered in web-based learning. Conclusions: High-quality and carefully designed web-based psychoeducation programs offered positive experiences for informal caregivers of people living with dementia. To meet broader caregiver education and support needs, program developers should consider information quality and relevancy, the support offered, individual needs, flexibility in delivery, and connectedness between peers and program facilitators. %M 37247218 %R 10.2196/47152 %U https://aging.jmir.org/2023/1/e47152 %U https://doi.org/10.2196/47152 %U http://www.ncbi.nlm.nih.gov/pubmed/37247218 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45894 %T Preliminary Evaluation of a Conversational Agent to Support Self-management of Individuals Living With Posttraumatic Stress Disorder: Interview Study With Clinical Experts %A Han,Hee Jeong %A Mendu,Sanjana %A Jaworski,Beth K %A Owen,Jason E %A Abdullah,Saeed %+ College of Information Sciences and Technology, Pennsylvania State University, Westgate Building, University Park, PA, 16802, United States, 1 (814) 865 8947, heejeonghan@psu.edu %K conversational agent %K PTSD %K self-management %K clinical experts %K evaluation %K support system %K mental health %K trauma %D 2023 %7 29.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Posttraumatic stress disorder (PTSD) is a serious public health concern. However, individuals with PTSD often do not have access to adequate treatment. A conversational agent (CA) can help to bridge the treatment gap by providing interactive and timely interventions at scale. Toward this goal, we have developed PTSDialogue—a CA to support the self-management of individuals living with PTSD. PTSDialogue is designed to be highly interactive (eg, brief questions, ability to specify preferences, and quick turn-taking) and supports social presence to promote user engagement and sustain adherence. It includes a range of support features, including psychoeducation, assessment tools, and several symptom management tools. Objective: This paper focuses on the preliminary evaluation of PTSDialogue from clinical experts. Given that PTSDialogue focuses on a vulnerable population, it is critical to establish its usability and acceptance with clinical experts before deployment. Expert feedback is also important to ensure user safety and effective risk management in CAs aiming to support individuals living with PTSD. Methods: We conducted remote, one-on-one, semistructured interviews with clinical experts (N=10) to gather insight into the use of CAs. All participants have completed their doctoral degrees and have prior experience in PTSD care. The web-based PTSDialogue prototype was then shared with the participant so that they could interact with different functionalities and features. We encouraged them to “think aloud” as they interacted with the prototype. Participants also shared their screens throughout the interaction session. A semistructured interview script was also used to gather insights and feedback from the participants. The sample size is consistent with that of prior works. We analyzed interview data using a qualitative interpretivist approach resulting in a bottom-up thematic analysis. Results: Our data establish the feasibility and acceptance of PTSDialogue, a supportive tool for individuals with PTSD. Most participants agreed that PTSDialogue could be useful for supporting self-management of individuals with PTSD. We have also assessed how features, functionalities, and interactions in PTSDialogue can support different self-management needs and strategies for this population. These data were then used to identify design requirements and guidelines for a CA aiming to support individuals with PTSD. Experts specifically noted the importance of empathetic and tailored CA interactions for effective PTSD self-management. They also suggested steps to ensure safe and engaging interactions with PTSDialogue. Conclusions: Based on interviews with experts, we have provided design recommendations for future CAs aiming to support vulnerable populations. The study suggests that well-designed CAs have the potential to reshape effective intervention delivery and help address the treatment gap in mental health. %M 37247220 %R 10.2196/45894 %U https://formative.jmir.org/2023/1/e45894 %U https://doi.org/10.2196/45894 %U http://www.ncbi.nlm.nih.gov/pubmed/37247220 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47008 %T Mental Health Client Experiences of Telehealth in Aotearoa New Zealand During the COVID-19 Pandemic: Lessons and Implications %A Officer,Tara N %A Tait,Marika %A McBride-Henry,Karen %A Burnet,Laura %A Werkmeister,Benjamin J %+ School of Nursing, Midwifery, and Health Practice, Te Herenga Waka - Victoria University of Wellington, PO Box 600, Wellington, 6140, New Zealand, 64 463 6575, tara.officer@vuw.ac.nz %K telehealth %K mental health service delivery %K COVID-19 %K Aotearoa New Zealand %K clients %K patient-centered care %K telemedicine %K mental health %K experience %K satisfaction %K perception %K perspective %K attitude %D 2023 %7 26.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic and consequent lockdowns disrupted mental health service delivery worldwide, accelerating the adoption of telehealth services to provide care continuity. Telehealth-based research largely highlights the value of this service delivery method for a range of mental health conditions. However, only limited research exists exploring client perspectives of mental health services delivered via telehealth during the pandemic. Objective: This study aimed to increase understanding of the perspectives of mental health clients around services provided via telehealth over the 2020 COVID-19 lockdown in Aotearoa New Zealand. Methods: Interpretive description methodology underpinned this qualitative inquiry. Semistructured interviews were conducted with 21 individuals (15 clients and 7 support people; 1 person was both a client and support person) to explore their experiences of outpatient mental health care delivered via telehealth during the COVID-19 pandemic in Aotearoa New Zealand. A thematic analysis approach supported by field notes was used to analyze interview transcripts. Results: The findings reveal that mental health services delivered via telehealth differed from those provided in person and led some participants to feel they need to manage their own care more actively. Participants highlighted several factors affecting their telehealth journey. These included the importance of maintaining and building relationships with clinicians, the creation of safe spaces within client and clinician home environments, and clinician readiness in facilitating care for clients and their support people. Participants noted weaknesses in the ability of clients and clinicians to discern nonverbal cues during telehealth conversations. Participants also emphasized that telehealth was a viable option for service delivery but that the reason for telehealth consultations and the technicalities of service delivery needed to be addressed. Conclusions: Successful implementation requires ensuring solid relationship foundations between clients and clinicians. To safeguard minimum standards in delivering telehealth-based care, health professionals must ensure that the intent behind telehealth appointments is clearly articulated and documented for each person. In turn, health systems must ensure that health professionals have access to training and professional guidance to deliver effective telehealth consultations. Future research should aim to identify how therapeutic engagement with mental health services has changed, following a return to usual service delivery processes. %M 37234041 %R 10.2196/47008 %U https://formative.jmir.org/2023/1/e47008 %U https://doi.org/10.2196/47008 %U http://www.ncbi.nlm.nih.gov/pubmed/37234041 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41643 %T Internet-Based Behavioral Activation for Depression: Systematic Review and Meta-Analysis %A Alber,Carolin Sophie %A Krämer,Lena Violetta %A Rosar,Sophia Marie %A Mueller-Weinitschke,Claudia %+ Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstraße 41, Freiburg, 79085, Germany, 49 (0)761 203 9439, claudia.mueller-weinitschke@psychologie.uni-freiburg.de %K behavioral activation %K depression %K systematic review %K meta-analysis %K internet- and mobile-based intervention %D 2023 %7 25.5.2023 %9 Review %J J Med Internet Res %G English %X Background: Behavioral activation is an effective treatment for reducing depression. As depressive disorders affect many people worldwide, internet-based behavioral activation (iBA) could provide enhanced treatment access. Objective: This study aimed to investigate whether iBA is effective in reducing depressive symptoms and to assess the impact on secondary outcomes. Methods: We systematically searched MEDLINE, PsycINFO, PSYNDEX, and CENTRAL up to December 2021 for eligible randomized controlled trials. In addition, a reference search was conducted. Title and abstract screening, as well as a full-text screening, was conducted by 2 independent reviewers. Randomized controlled trials that investigated the effectiveness of iBA for depression as a treatment or main component were included. Randomized controlled trials had to report depressive symptoms, with a quantitative outcome measure and assess an adult population with depressive symptoms above cutoff. Two independent reviewers performed the data extraction and risk of bias assessment. Data were pooled in random-effects meta-analyses. The primary outcome was self-reported depressive symptoms posttreatment. This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. Results: A total of 12 randomized controlled trials, with 3274 participants (88% female, 43.61 years) were included. iBA was more effective in reducing depressive symptom severity posttreatment than inactive control groups (standardized mean difference −0.49; 95% CI −0.63 to −0.34; P<.001). The overall level of heterogeneity was moderate to substantial (I2=53%). No significant effect of iBA on depressive symptoms could be found at 6-month follow-up. Participants assigned to iBA also experienced a significant reduction of anxiety and a significant increase in quality of life and activation compared to the inactive control groups. The results remained robust in multiple sensitivity analyses. The risk of bias assessment revealed at least some concerns for all studies, and there was evidence of slight publication bias. Conclusions: This systematic review and meta-analysis implies that iBA is effective in reducing depressive symptoms. It represents a promising treatment option, providing treatment access where no treatment is available yet. Trial Registration: International Prospective Register of Systematic Reviews CRD42021236822; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=236822 %M 37227760 %R 10.2196/41643 %U https://www.jmir.org/2023/1/e41643 %U https://doi.org/10.2196/41643 %U http://www.ncbi.nlm.nih.gov/pubmed/37227760 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41283 %T Efficacy and Cost-Effectiveness Analysis of Internet-Based Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: Randomized Controlled Trial %A Wu,Yiwen %A Li,Xin %A Zhou,Yuxin %A Gao,Rui %A Wang,Kaifeng %A Ye,Huiling %A Lyu,Na %A Wang,Chun %A Zhang,Ning %A Wang,Zhen %A Fan,Qing %+ Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, China, 86 18017311322, fanqing@smhc.org.cn %K obsessive-compulsive disorder %K cognitive behavioral therapy %K internet-based cognitive behavioral therapy %K cost-effectiveness %K randomized controlled trial %D 2023 %7 24.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Obsessive-compulsive disorder (OCD) is a common and chronic mental illness with a high rate of disability. Internet-based cognitive behavioral therapy (ICBT) makes online treatment available to patients and has been shown to be effective. However, 3-arm trials on ICBT, face-to-face cognitive behavioral group therapy (CBGT), and only medication are still lacking. Objective: This study is a randomized, controlled, assessor-blinded trial of 3 groups for OCD: ICBT combined with medication, CBGT combined with medication, and conventional medical treatment (ie, treatment as usual [TAU]). The study aims to investigate the efficacy and cost-effectiveness of ICBT related to CBGT and TAU for adults with OCD in China. Methods: In total, 99 patients with OCD were selected and randomly assigned to the ICBT, CBGT, and TAU groups for treatment for 6 weeks. The primary outcomes were the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the self-rating Florida Obsessive-Compulsive Inventory (FOCI), compared at baseline, during treatment (3 weeks), and after treatment (6 weeks), to analyze efficacy. The secondary outcome was the EuroQol Visual Analogue Scale (EQ-VAS) scores of the EuroQol 5D Questionnaire (EQ-5D). The cost questionnaires were recorded to analyze cost-effectiveness. Results: Repeated-measures ANOVA was used for data analysis, and the final effective sample size was 93 (ICBT: n=32, 34.4%; CBGT: n=28, 30.1%; TAU: n=33, 35.5%). After 6-week treatment, the YBOCS scores of the 3 groups significantly decreased (P<.001), and there were no significant differences among groups. The FOCI score of the ICBT (P=.001) and CBGT (P=.035) groups was significantly lower than that of the TAU group after treatment. The total cost of the CBGT group (renminbi [RMB] 6678.45, 95% CI 4460.88-8896.01 [US $1010.36, 95% CI 678.87-1345.84]) was significantly higher than that of the ICBT group (RMB 3308.81, 95% CI 2476.89-4140.73[US $500.58, 95% CI 374.72-626.43], P<.001) and the TAU group (RMB 2259.61, 95% CI 2074.16-2445.05 [US $341.85, 95% CI 313.79-369.90], P<.001) after treatment. The ICBT group spent RMB 303.19 (US $45.97) less than the CBGT group and RMB 11.57 (US $1.75) less than the TAU group for each unit reduction in the YBOCS score. Conclusions: Therapist-guided ICBT combined with medication is as effective as face-to-face CBGT combined with medication for OCD. ICBT combined with medication is more cost-effective than CBGT combined with medication and conventional medical treatment. It is expected to become an efficacious and economic alternative for adults with OCD when face-to-face CBGT is not available. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900023840; https://www.chictr.org.cn/showproj.html?proj=39294 %M 37223977 %R 10.2196/41283 %U https://www.jmir.org/2023/1/e41283 %U https://doi.org/10.2196/41283 %U http://www.ncbi.nlm.nih.gov/pubmed/37223977 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45991 %T Prediction of Diagnosis and Treatment Response in Adolescents With Depression by Using a Smartphone App and Deep Learning Approaches: Usability Study %A Kim,Jae Sung %A Wang,Bohyun %A Kim,Meelim %A Lee,Jung %A Kim,Hyungjun %A Roh,Danyeul %A Lee,Kyung Hwa %A Hong,Soon-Beom %A Lim,Joon Shik %A Kim,Jae-Won %A Ryan,Neal %+ Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 3648, kimjw412@snu.ac.kr %K major depressive disorder %K adolescent %K deep learning %K smart health care %K suicide %K risk factor %K antidepressant treatment %K depression %K machine learning %K smartphone %K mobile health %K mHealth %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Lack of quantifiable biomarkers is a major obstacle in diagnosing and treating depression. In adolescents, increasing suicidality during antidepressant treatment further complicates the problem. Objective: We sought to evaluate digital biomarkers for the diagnosis and treatment response of depression in adolescents through a newly developed smartphone app. Methods: We developed the Smart Healthcare System for Teens At Risk for Depression and Suicide app for Android-based smartphones. This app passively collected data reflecting the social and behavioral activities of adolescents, such as their smartphone usage time, physical movement distance, and the number of phone calls and text messages during the study period. Our study consisted of 24 adolescents (mean age 15.4 [SD 1.4] years, 17 girls) with major depressive disorder (MDD) diagnosed with Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version and 10 healthy controls (mean age 13.8 [SD 0.6] years, 5 girls). After 1 week’s baseline data collection, adolescents with MDD were treated with escitalopram in an 8-week, open-label trial. Participants were monitored for 5 weeks, including the baseline data collection period. Their psychiatric status was measured every week. Depression severity was measured using the Children’s Depression Rating Scale-Revised and Clinical Global Impressions-Severity. The Columbia Suicide Severity Rating Scale was administered in order to assess suicide severity. We applied the deep learning approach for the analysis of the data. Deep neural network was employed for diagnosis classification, and neural network with weighted fuzzy membership functions was used for feature selection. Results: We could predict the diagnosis of depression with training accuracy of 96.3% and 3-fold validation accuracy of 77%. Of the 24 adolescents with MDD, 10 responded to antidepressant treatments. We predicted the treatment response of adolescents with MDD with training accuracy of 94.2% and 3-fold validation accuracy of 76%. Adolescents with MDD tended to move longer distances and use smartphones for longer periods of time compared to controls. The deep learning analysis showed that smartphone usage time was the most important feature in distinguishing adolescents with MDD from controls. Prominent differences were not observed in the pattern of each feature between the treatment responders and nonresponders. The deep learning analysis revealed that the total length of calls received as the most important feature predicting antidepressant response in adolescents with MDD. Conclusions: Our smartphone app demonstrated preliminary evidence of predicting diagnosis and treatment response in depressed adolescents. This is the first study to predict the treatment response of adolescents with MDD by examining smartphone-based objective data with deep learning approaches. %M 37223978 %R 10.2196/45991 %U https://formative.jmir.org/2023/1/e45991 %U https://doi.org/10.2196/45991 %U http://www.ncbi.nlm.nih.gov/pubmed/37223978 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44812 %T Understanding What Drives Long-term Engagement in Digital Mental Health Interventions: Secondary Causal Analysis of the Relationship Between Social Networking and Therapy Engagement %A O'Sullivan,Shaunagh %A van Berkel,Niels %A Kostakos,Vassilis %A Schmaal,Lianne %A D'Alfonso,Simon %A Valentine,Lee %A Bendall,Sarah %A Nelson,Barnaby %A Gleeson,John F %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Road, Parkville, 3052, Australia, 61 428282470, shaunagh.osullivan@orygen.org.au %K digital intervention %K digital health %K youth mental health %K psychotic disorders %K usage metrics %K log data %K social networking %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Low engagement rates with digital mental health interventions are a major challenge in the field. Multicomponent digital interventions aim to improve engagement by adding components such as social networks. Although social networks may be engaging, they may not be sufficient to improve clinical outcomes or lead users to engage with key therapeutic components. Therefore, we need to understand what components drive engagement with digital mental health interventions overall and what drives engagement with key therapeutic components. Objective: Horyzons was an 18-month digital mental health intervention for young people recovering from first-episode psychosis, incorporating therapeutic content and a private social network. However, it is unclear whether use of the social network leads to subsequent use of therapeutic content or vice versa. This study aimed to determine the causal relationship between the social networking and therapeutic components of Horyzons. Methods: Participants comprised 82 young people (16-27 years) recovering from first-episode psychosis. Multiple convergent cross mapping was used to test causality, as a secondary analysis of the Horyzons intervention. Multiple convergent cross mapping tested the direction of the relationship between each pair of social and therapeutic system usage variables on Horyzons, using longitudinal usage data. Results: Results indicated that the social networking aspects of Horyzons were most engaging. Posting on the social network drove engagement with all therapeutic components (r=0.06-0.36). Reacting to social network posts drove engagement with all therapeutic components (r=0.39-0.65). Commenting on social network posts drove engagement with most therapeutic components (r=0.11-0.18). Liking social network posts drove engagement with most therapeutic components (r=0.09-0.17). However, starting a therapy pathway led to commenting on social network posts (r=0.05) and liking social network posts (r=0.06), and completing a therapy action led to commenting on social network posts (r=0.14) and liking social network posts (r=0.15). Conclusions: The online social network was a key driver of long-term engagement with the Horyzons intervention and fostered engagement with key therapeutic components and ingredients of the intervention. Online social networks can be further leveraged to engage young people with therapeutic content to ensure treatment effects are maintained and to create virtuous cycles between all intervention components to maintain engagement. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12614000009617; https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12614000009617 %M 37213197 %R 10.2196/44812 %U https://mental.jmir.org/2023/1/e44812 %U https://doi.org/10.2196/44812 %U http://www.ncbi.nlm.nih.gov/pubmed/37213197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46537 %T Global Trends in Social Prescribing: Web-Based Crawling Approach %A Lee,Hocheol %A Koh,Sang Baek %A Jo,Heui Sug %A Lee,Tae Ho %A Nam,Hae Kweun %A Zhao,Bo %A Lim,Subeen %A Lim,Joo Aeh %A Lee,Ho Hee %A Hwang,Yu Seong %A Kim,Dong Hyun %A Nam,Eun Woo %+ Department of Health Administration, Software Digital Healthcare Convergence College, Yonsei University, Changjogwan 412Ho, Yonseidae-gil 1, Wonju, 26493, Republic of Korea, 82 010 3867 9569, ewnam@yonsei.ac.kr %K social prescribing %K social loneliness %K National Health Service %K aging population %K web crawling %K sustainable model %K Google Trend %K web-based data %K NPI %K health care model %K primary care %K digital health intervention %K implementation %K health care professional %D 2023 %7 22.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social loneliness is a prevalent issue in industrialized countries that can lead to adverse health outcomes, including a 26% increased risk of premature mortality, coronary heart disease, stroke, depression, cognitive impairment, and Alzheimer disease. The United Kingdom has implemented a strategy to address loneliness, including social prescribing—a health care model where physicians prescribe nonpharmacological interventions to tackle social loneliness. However, there is a need for evidence-based plans for global social prescribing dissemination. Objective: This study aims to identify global trends in social prescribing from 2018. To this end, we intend to collect and analyze words related to social prescribing worldwide and evaluate various trends of related words by classifying the core areas of social prescribing. Methods: Google’s searchable data were collected to analyze web-based data related to social prescribing. With the help of web crawling, 3796 news items were collected for the 5-year period from 2018 to 2022. Key topics were selected to identify keywords for each major topic related to social prescribing. The topics were grouped into 4 categories, namely Healthy, Program, Governance, and Target, and keywords for each topic were selected thereafter. Text mining was used to determine the importance of words collected from new data. Results: Word clouds were generated for words related to social prescribing, which collected 3796 words from Google News databases, including 128 in 2018, 432 in 2019, 566 in 2020, 748 in 2021, and 1922 in 2022, increasing nearly 15-fold between 2018 and 2022 (5 years). Words such as health, prescribing, and GPs (general practitioners) were the highest in terms of frequency in the list for all the years. Between 2020 and 2021, COVID, gardening, and UK were found to be highly related words. In 2022, NHS (National Health Service) and UK ranked high. This dissertation examines social prescribing–related term frequency and classification (2018-2022) in Healthy, Program, Governance, and Target categories. Key findings include increased “Healthy” terms from 2020, “gardening” prominence in “Program,” “community” growth across categories, and “Target” term spikes in 2021. Conclusions: This study’s discussion highlights four key aspects: (1) the “Healthy” category trends emphasize mental health, cancer, and sleep; (2) the “Program” category prioritizes gardening, community, home-schooling, and digital initiatives; (3) “Governance” underscores the significance of community resources in social prescribing implementation; and (4) “Target” focuses on 4 main groups: individuals with long-term conditions, low-level mental health issues, social isolation, or complex social needs impacting well-being. Social prescribing is gaining global acceptance and is becoming a global national policy, as the world is witnessing a sharp rise in the aging population, noncontagious diseases, and mental health problems. A successful and sustainable model of social prescribing can be achieved by introducing social prescribing schemes based on the understanding of roles and the impact of multisectoral partnerships. %M 37086427 %R 10.2196/46537 %U https://www.jmir.org/2023/1/e46537 %U https://doi.org/10.2196/46537 %U http://www.ncbi.nlm.nih.gov/pubmed/37086427 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42365 %T Physical Versus Virtual Reality–Based Calm Rooms for Psychiatric Inpatients: Quasi-Randomized Trial %A Ilioudi,Maria %A Lindner,Philip %A Ali,Lilas %A Wallström,Sara %A Thunström,Almira Osmanovic %A Ioannou,Michael %A Anving,Nicole %A Johansson,Viktor %A Hamilton,William %A Falk,Örjan %A Steingrimsson,Steinn %+ Psychiatric Department, Sahlgrenska University Hospital, Region Västra Götaland, Journalvägen 5, Gothenburg, 41650, Sweden, 46 722448372, steinn.steingrimsson@vgregion.se %K psychiatry %K psychiatric inpatient care %K relaxation %K sensory room %K virtual reality %D 2023 %7 19.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Interest in sensory rooms or so-called “calm rooms” in psychiatric inpatient care has increased significantly. In a hospital setting, their purpose is to introduce a relaxing environment to increase well-being as well as to decrease anxiety and aggressive behaviors. Calm rooms can also be used as a tool to provide self-help through a convenient environment for the patients and, at the same time, strengthen the therapeutic relationship between the patient and the professional. Recent developments in virtual reality (VR) have made virtual calm rooms possible, but these have not yet been evaluated in psychiatric inpatient care. Objective: This study aimed to compare the effects of VR and physical calm rooms on self-reported well-being and physiological markers of arousal. Methods: The study was conducted in 2 inpatient psychiatric wards specializing in bipolar disorder from March 2019 to February 2021. Patients who were already admitted were asked if they were interested in using a calm room and willing to provide ratings. This study relied on the quasi-randomized allocation of patients to the wards, which either had a physical or VR calm room. Self-assessment scales (Montgomery-Åsberg Depression Rating Scale-Self Assessment [MADRS-S], Beck Anxiety Scale, and Clinical Global Impression) were used to determine the participants' baseline level of depressive and anxiety symptoms before their use of the physical or VR calm room. The study determined the state of well-being measured using an 11-point visual analog scale (VAS) as well as arousal measured by blood pressure (systolic and diastolic) and heart rate before and after the use of the calm rooms. The primary end point was self-reported well-being using the VAS. Results: A total of 60 participants were included—40 used the VR calm room and 20 used the physical calm room. The mean age of participants was 39 years and the majority were women (35/60, 58%). Analysis of VAS measurement showed improved well-being at the group level from before to after the intervention (P<.05), with no statistically significant difference in effects between the 2 different interventions. Effects were not moderated by baseline depression levels (dichotomized as MADRS-S >20 or ≤20) despite an overall difference in reported well-being between subgroups. Conclusions: Although the power in this study was low, the findings of this first study indicate comparable effects with respect to well-being and arousal of a VR calm room and a physical calm room. This suggests that a VR calm room can be a viable alternative when the use of a physical calm room is not an option for logistic or other reasons. Trial Registration: ClinicalTrials.gov NCT03918954; https://clinicaltrials.gov/ct2/show/NCT03918954 %M 37204858 %R 10.2196/42365 %U https://www.jmir.org/2023/1/e42365 %U https://doi.org/10.2196/42365 %U http://www.ncbi.nlm.nih.gov/pubmed/37204858 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44535 %T Acceptability and Potential Impact of the #chatsafe Suicide Postvention Response Among Young People Who Have Been Exposed to Suicide: Pilot Study %A La Sala,Louise %A Pirkis,Jane %A Cooper,Charlie %A Hill,Nicole T M %A Lamblin,Michelle %A Rajaram,Gowri %A Rice,Simon %A Teh,Zoe %A Thorn,Pinar %A Zahan,Rifat %A Robinson,Jo %+ Orygen, Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, 3052, Australia, 61 3 9966 9512, louise.lasala@orygen.org.au %K youth %K suicide %K social media %K suicide postvention %K suicide prevention %K contagion %K postvention %D 2023 %7 19.5.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Young people are more likely to be affected by suicide contagion, and there are concerns about the role social media plays in the development and maintenance of suicide clusters or in facilitating imitative suicidal behavior. However, social media also presents an opportunity to provide real-time and age-appropriate suicide prevention information, which could be an important component of suicide postvention activities. Objective: This study aimed to test an intervention designed to equip young people to communicate safely online about suicide (#chatsafe) with a sample of young people who had recently been exposed to a suicide or suicide attempt, with a view to determining the role social media can play as part of a postvention response. Methods: A sample of 266 young people from Australia, aged 16 to 25 years, were recruited to participate in the study. They were eligible if they had been exposed to a suicide or knew of a suicide attempt in the past 2 years. All participants received the #chatsafe intervention, which comprised 6 pieces of social media content that were sent to them weekly via direct message through Instagram, Facebook, or Snapchat. Participants were assessed on a range of outcome measures (social media use, willingness to intervene against suicide, internet self-efficacy, confidence, and safety when communicating about suicide on social media platforms) at baseline, immediately after the intervention, and at 4-week follow-up. Results: After the 6-week #chatsafe intervention, participants reported substantial improvements in their willingness to intervene against suicide online, their internet self-efficacy, and their perceived confidence and safety when communicating about suicide online. Overall, the participants reported that it was appropriate to receive the #chatsafe intervention via social media, and no iatrogenic effects were recorded. Conclusions: The findings suggest that it is safe and acceptable to disseminate suicide prevention information entirely via social media among young people who have recently been exposed to a suicide or suicide attempt. Interventions such as #chatsafe could potentially mitigate the risk of distress and future suicidal behavior in young people by improving the quality and safety of online communication about suicide and, as such, can be an important component of delivering a postvention response to young people. %M 37204854 %R 10.2196/44535 %U https://humanfactors.jmir.org/2023/1/e44535 %U https://doi.org/10.2196/44535 %U http://www.ncbi.nlm.nih.gov/pubmed/37204854 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46157 %T Evaluating the Efficacy of Web-Based Cognitive Behavioral Therapy for the Treatment of Patients With Bipolar II Disorder and Residual Depressive Symptoms: Protocol for a Randomized Controlled Trial %A Gutierrez,Gilmar %A Stephenson,Callum %A Eadie,Jazmin %A Moghimi,Elnaz %A Omrani,Mohsen %A Groll,Dianne %A Soares,Claudio N %A Milev,Roumen %A Vazquez,Gustavo %A Yang,Megan %A Alavi,Nazanin %+ Department of Psychiatry, Queen's University, 166 Brock St, Kingston, ON, K7L5G2, Canada, 1 6135443310, nazanin.alavitabari@kingstonhsc.ca %K bipolar disorder %K cognitive behavioral therapy %K depression %K eHealth %K electronic care %K internet %K mental health %K psychotherapy %K treatment %K web-based therapy %D 2023 %7 19.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bipolar disorder (BD) is a highly prevalent psychiatric condition that can significantly impact every aspect of a person’s life if left untreated. A subtype of BD, bipolar disorder type II (BD-II), is characterized by long depressive episodes and residual depression symptoms, with short-lived hypomanic episodes. Medication and psychotherapy, such as cognitive behavioral therapy (CBT), are the main treatment options for BD-II. CBT specific for BD-II involves the recognition of warning signs, potentially triggering stimuli, and the development of coping skills to increase euthymic periods and improve global functioning. However, access to in-person CBT may be limited by several barriers, including low availability, high costs, and geographical limitations. Thus, web-based adaptations of CBT (e-CBT) have become a promising solution to address these treatment barriers. Nevertheless, e-CBT for the treatment of BD-II remains understudied. Objective: The proposed study aims to establish the first e-CBT program specific for the treatment of BD-II with residual depressive symptoms. The primary objective of this study will be to determine the effect of e-CBT in managing BD symptomatology. The secondary objective will be to assess the effects of this e-CBT program on quality of life and resilience. The tertiary objective will involve gathering user feedback using a posttreatment survey to support the continuous improvement and optimization of the proposed program. Methods: Adult participants (N=170) with a confirmed diagnosis of BD-II experiencing residual depressive symptoms will be randomly assigned to either the e-CBT and treatment as usual (TAU; n=85) group or the TAU (n=85) control group. Participants in the control group will be able to participate in the web-based program after the first 13 weeks. The e-CBT program will consist of 13 weekly web-based modules designed following a validated CBT framework. Participants will complete module-related homework and receive asynchronous personalized feedback from a therapist. TAU will consist of standard treatment services conducted outside of this research study. Depression and manic symptoms, quality of life, and resiliency will be assessed using clinically validated symptomatology questionnaires at baseline, week 6, and week 13. Results: The study received ethics approval in March 2020, and participant recruitment is expected to begin in February 2023 through targeted advertisements and physician referrals. Data collection and analysis are expected to conclude by December 2024. Linear and binomial regression (continuous and categorical outcomes, respectively) will be conducted along with qualitative interpretive methods. Conclusions: The findings will be the first on the effectiveness of delivering e-CBT for patients with BD-II with residual depressive symptoms. This approach can provide an innovative method to address barriers to in-person psychotherapy by increasing accessibility and decreasing costs. Trial Registration: ClinicalTrials.gov NCT04664257; https://clinicaltrials.gov/ct2/show/NCT04664257 International Registered Report Identifier (IRRID): PRR1-10.2196/46157 %M 37140460 %R 10.2196/46157 %U https://www.researchprotocols.org/2023/1/e46157 %U https://doi.org/10.2196/46157 %U http://www.ncbi.nlm.nih.gov/pubmed/37140460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39933 %T Cybervictimization of Adults With Long-term Conditions: Cross-sectional Study %A Alhaboby,Zhraa A %A Barnes,James %A Evans,Hala %A Short,Emma %+ The Open University, School of Life, Health & Chemical Sciences, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 1908 65 ext 4987, zhraa.alhaboby@open.ac.uk %K cyberharassment %K chronic conditions %K disability %K social media %K cyberbullying %K web-based hate %D 2023 %7 17.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: People living with chronic conditions and disabilities experience harassment both offline and on the web. Cybervictimization is an umbrella term for negative web-based experiences. It has distressing consequences on physical health, mental well-being, and social relationships. These experiences have mostly been documented among children and adolescents. However, the scope of such experiences is not well documented among adults with long-term conditions, and the potential impact has not been examined from a public health perspective. Objective: This study aimed to examine the scope of cybervictimization among adults living with long-term conditions in the United Kingdom and the perceived impact on self-management of chronic conditions. Methods: This paper reports the findings of the quantitative phase of a mixed methods study in the United Kingdom. This cross-sectional study targeted adults aged ≥18 years with long-term conditions. Using a web-based link, the survey was shared on the web via 55 victim support groups, health support organizations, and social media accounts of nongovernmental organizations and activists such as journalists and disability campaigners. People with long-term conditions were asked about their health conditions, comorbidities, self-management, negative web-based experiences, their impact on them, and support sought to mitigate the experiences. The perceived impact of cybervictimization was measured using a set of questions on a Likert scale, frequency tables, and the Stanford Self-Efficacy for Managing Chronic Diseases Scale. Demographic data and the impact on self-management were cross-tabulated to identify the demographic characteristics of the targeted individuals and potential conditions with complications and highlight directions for future research. Results: Data from 152 participants showed that almost 1 in every 2 adults with chronic conditions was cybervictimized (69/152, 45.4%). Most victims (53/69, 77%) had disabilities; the relationship between cybervictimization and disability was statistically significant (P=.03). The most common means of contacting the victims was Facebook (43/68, 63%), followed by personal email or SMS text messaging, each accounting for 40% (27/68). Some participants (9/68, 13%) were victimized in web-based health forums. Furthermore, 61% (33/54) of victims reported that experiencing cybervictimization had affected their health condition self-management plan. The highest impact was on lifestyle changes such as exercise, diet, avoiding triggers, and avoiding excessive smoking and alcohol consumption. This was followed by changes to medications and follow-ups with health care professionals. Most victims (38/55, 69%) perceived a worsened self-efficacy on the Self-Efficacy for Managing Chronic Diseases Scale. Formal support was generally rated as poor, with only 25% (13/53) of victims having disclosed this experience to their physicians. Conclusions: Cybervictimization of people with chronic conditions is a public health issue with worrying consequences. This triggered considerable fear and negatively influenced the self-management of different health conditions. Further context- and condition-specific research is needed. Global collaborations to address inconsistencies in research are recommended. %M 37195761 %R 10.2196/39933 %U https://www.jmir.org/2023/1/e39933 %U https://doi.org/10.2196/39933 %U http://www.ncbi.nlm.nih.gov/pubmed/37195761 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43439 %T Exploring the Behavior of Users With Attention-Deficit/Hyperactivity Disorder on Twitter: Comparative Analysis of Tweet Content and User Interactions %A Chen,Liuliu %A Jeong,Jiwon %A Simpkins,Bridgette %A Ferrara,Emilio %+ Department of Electrical and Computer Engineering, Viterbi School of Engineering, University of Southern California, 3650 McClintock Ave, Los Angeles, CA, 90007-5325, United States, 1 2138060451, liuliuc@usc.edu %K social media %K mental health %K attention-deficit/hyperactivity disorder %K ADHD %K Twitter %K behaviors %K interactions %D 2023 %7 17.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: With the widespread use of social media, people share their real-time thoughts and feelings via interactions on these platforms, including those revolving around mental health problems. This can provide a new opportunity for researchers to collect health-related data to study and analyze mental disorders. However, as one of the most common mental disorders, there are few studies regarding the manifestations of attention-deficit/hyperactivity disorder (ADHD) on social media. Objective: This study aims to examine and identify the different behavioral patterns and interactions of users with ADHD on Twitter through the text content and metadata of their posted tweets. Methods: First, we built 2 data sets: an ADHD user data set containing 3135 users who explicitly reported having ADHD on Twitter and a control data set made up of 3223 randomly selected Twitter users without ADHD. All historical tweets of users in both data sets were collected. We applied mixed methods in this study. We performed Top2Vec topic modeling to extract topics frequently mentioned by users with ADHD and those without ADHD and used thematic analysis to further compare the differences in contents that were discussed by the 2 groups under these topics. We used a distillBERT sentiment analysis model to calculate the sentiment scores for the emotion categories and compared the sentiment intensity and frequency. Finally, we extracted users’ posting time, tweet categories, and the number of followers and followings from the metadata of tweets and compared the statistical distribution of these features between ADHD and non-ADHD groups. Results: In contrast to the control group of the non-ADHD data set, users with ADHD tweeted about the inability to concentrate and manage time, sleep disturbance, and drug abuse. Users with ADHD felt confusion and annoyance more frequently, while they felt less excitement, caring, and curiosity (all P<.001). Users with ADHD were more sensitive to emotions and felt more intense feelings of nervousness, sadness, confusion, anger, and amusement (all P<.001). As for the posting characteristics, compared with controls, users with ADHD were more active in posting tweets (P=.04), especially at night between midnight and 6 AM (P<.001); posting more tweets with original content (P<.001); and following fewer people on Twitter (P<.001). Conclusions: This study revealed how users with ADHD behave and interact differently on Twitter compared with those without ADHD. On the basis of these differences, researchers, psychiatrists, and clinicians can use Twitter as a potentially powerful platform to monitor and study people with ADHD, provide additional health care support to them, improve the diagnostic criteria of ADHD, and design complementary tools for automatic ADHD detection. %M 37195757 %R 10.2196/43439 %U https://www.jmir.org/2023/1/e43439 %U https://doi.org/10.2196/43439 %U http://www.ncbi.nlm.nih.gov/pubmed/37195757 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40213 %T Social Prescription Interventions Addressing Social Isolation and Loneliness in Older Adults: Meta-Review Integrating On-the-Ground Resources %A Paquet,Catherine %A Whitehead,Jocelyne %A Shah,Rishabh %A Adams,Alayne Mary %A Dooley,Damion %A Spreng,R Nathan %A Aunio,Anna-Liisa %A Dubé,Laurette %+ Département de Marketing, Faculté des Sciences de l'Administration, Université Laval, 2325, rue de la Terrasse, Québec, QC, G1V 0A6, Canada, 1 418 656 2131 ext 404122, catherine.paquet@fsa.ulaval.ca %K social prescription %K social isolation %K loneliness %K intervention %K older adults %K knowledge mobilization %K database management %K ontology %D 2023 %7 17.5.2023 %9 Review %J J Med Internet Res %G English %X Background: Social prescription programs represent a viable solution to linking primary care patients to nonmedical community resources for improving patient well-being. However, their success depends on the integration of patient needs with local resources. This integration could be accelerated by digital tools that use expressive ontology to organize knowledge resources, thus enabling the seamless navigation of diverse community interventions and services tailored to the needs of individual users. This infrastructure bears particular relevance for older adults, who experience a range of social needs that impact their health, including social isolation and loneliness. An essential first step in enabling knowledge mobilization and the successful implementation of social prescription initiatives to meet the social needs of older adults is to incorporate the evidence-based academic literature on what works, with on-the-ground solutions in the community. Objective: This study aims to integrate scientific evidence with on-the-ground knowledge to build a comprehensive list of intervention terms and keywords related to reducing social isolation and loneliness in older adults. Methods: A meta-review was conducted using a search strategy combining terms related to older adult population, social isolation and loneliness, and study types relevant to reviews using 5 databases. Review extraction included intervention characteristics, outcomes (social [eg, loneliness, social isolation, and social support] or mental health [eg, psychological well-being, depression, and anxiety]), and effectiveness (reported as consistent, mixed, or not supported). Terms related to identified intervention types were extracted from the reviewed literature as well as descriptions of corresponding community services in Montréal, Canada, available from web-based regional, municipal, and community data sources. Results: The meta-review identified 11 intervention types addressing social isolation and loneliness in older adults by either increasing social interactions, providing instrumental support, promoting mental and physical well-being, or providing home and community care. Group-based social activities, support groups with educational elements, recreational activities, and training or use of information and communication technologies were the most effective in improving outcomes. Examples of most intervention types were found in community data sources. Terms derived from the literature that were the most commonly congruent with those describing existing community services were related to telehealth, recreational activities, and psychological therapy. However, several discrepancies were observed between review-based terms and those addressing the available services. Conclusions: A range of interventions found to be effective at addressing social isolation and loneliness or their impact on mental health were identified from the literature, and many of these interventions were represented in services available to older residents in Montréal, Canada. However, different terms were occasionally used to describe or categorize similar services across data sources. Establishing an efficient means of identifying and structuring such sources is important to facilitate referrals and help-seeking behaviors of older adults and for strategic planning of resources. %M 37195738 %R 10.2196/40213 %U https://www.jmir.org/2023/1/e40213 %U https://doi.org/10.2196/40213 %U http://www.ncbi.nlm.nih.gov/pubmed/37195738 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43780 %T The Impact of a Messenger-Based Psychosocial Chat Counseling Service on Further Help-Seeking Among Children and Young Adults: Longitudinal Study %A Baldofski,Sabrina %A Kohls,Elisabeth %A Efe,Zeki %A Eckert,Melanie %A Saee,Shadi %A Thomas,Julia %A Wundrack,Richard %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Semmelweisstr 10, Haus 13, Leipzig, 04103, Germany, 49 3419724464, christine.rummel-kluge@medizin.uni-leipzig.de %K online intervention %K e-mental health %K online chat %K hotline %K text-based %K children %K adolescents %K young adults %K psychopathology %K help-seeking %D 2023 %7 17.5.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental crises have high prevalences in adolescence. Early interventions appear to be highly important to diminish the risk of the deterioration, recurrence, or chronification of symptoms. In recent years, various providers have started offering live chat support in psychological crises. The messenger-based psychological counseling service krisenchat aims to support young people in crises and, if necessary, provide a recommendation for a referral to the health care system or to seek further help from a trusted adult person. Objective: This study aimed to investigate the impact of using the counseling service of krisenchat on the further help-seeking behavior of young people, and to identify associated factors of further help-seeking. Methods: This longitudinal study analyzed anonymous data from 247 individuals who used krisenchat between October 2021 and March 2022, and received a recommendation for further help-seeking. An online survey directly after the chat assessed the perceived helpfulness of the chat and well-being after the chat. After 4 weeks, further help-seeking, facilitators and barriers to help-seeking, and self-efficacy were assessed in an online follow-up survey. Results: The most frequently recommended services or persons to seek further help from included a psychotherapist or social psychiatric service (75/225, 33.3%), a school psychologist or school social worker (52/225, 23.1%), and the user’s parents (45/225, 20.0%). Of the 247 users, 120 (48.6%) indicated that they contacted the recommended service or person, and of these, 87 (72.5%) stated that they already had an appointment (or talk) with the respective service or person or that an appointment (or talk) was scheduled. The most frequently reported facilitators for further help-seeking were mental health literacy (54/120, 45.0%), improvement of self-efficacy (55/120, 45.8%), and symptom recognition (40/120, 33.3%). In users not displaying further help-seeking behavior, the most frequent barriers included stigmatization (60/127, 47.2%), lack of mental health literacy (59/127, 46.5%), need for self-reliance and autonomy (53/127, 41.7%), and negative family beliefs regarding help services (53/127, 41.7%). Subgroup comparisons indicated significantly higher levels of self-efficacy in users displaying further help-seeking behavior than in those not displaying further help-seeking behavior. Both subgroups did not differ in gender, age, recommended service or person, chat topics, perceived helpfulness, and well-being. Conclusions: The findings of this study indicate that children and young adults receiving counseling on krisenchat benefit in terms of seeking further help. Further help-seeking seems to be associated with higher levels of self-efficacy. Trial Registration: Deutsches Register Klinischer Studien DRKS00026671; https://tinyurl.com/4fm5xe68 %M 37195747 %R 10.2196/43780 %U https://mental.jmir.org/2023/1/e43780 %U https://doi.org/10.2196/43780 %U http://www.ncbi.nlm.nih.gov/pubmed/37195747 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44986 %T Associations Between Smartphone Keystroke Metadata and Mental Health Symptoms in Adolescents: Findings From the Future Proofing Study %A Braund,Taylor A %A O’Dea,Bridianne %A Bal,Debopriyo %A Maston,Kate %A Larsen,Mark %A Werner-Seidler,Aliza %A Tillman,Gabriel %A Christensen,Helen %+ Faculty of Medicine and Health, University of New South Wales, High St, Kensington, 2052, Australia, 61 290659255, t.braund@blackdog.org.au %K adolescents %K anxiety %K depression %K digital phenotype %K keystroke dynamics %K keystroke metadata %K smartphone %K students %D 2023 %7 15.5.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental disorders are prevalent during adolescence. Among the digital phenotypes currently being developed to monitor mental health symptoms, typing behavior is one promising candidate. However, few studies have directly assessed associations between typing behavior and mental health symptom severity, and whether these relationships differs between genders. Objective: In a cross-sectional analysis of a large cohort, we tested whether various features of typing behavior derived from keystroke metadata were associated with mental health symptoms and whether these relationships differed between genders. Methods: A total of 934 adolescents from the Future Proofing study undertook 2 typing tasks on their smartphones through the Future Proofing app. Common keystroke timing and frequency features were extracted across tasks. Mental health symptoms were assessed using the Patient Health Questionnaire-Adolescent version, the Children’s Anxiety Scale-Short Form, the Distress Questionnaire 5, and the Insomnia Severity Index. Bivariate correlations were used to test whether keystroke features were associated with mental health symptoms. The false discovery rates of P values were adjusted to q values. Machine learning models were trained and tested using independent samples (ie, 80% train 20% test) to identify whether keystroke features could be combined to predict mental health symptoms. Results: Keystroke timing features showed a weak negative association with mental health symptoms across participants. When split by gender, females showed weak negative relationships between keystroke timing features and mental health symptoms, and weak positive relationships between keystroke frequency features and mental health symptoms. The opposite relationships were found for males (except for dwell). Machine learning models using keystroke features alone did not predict mental health symptoms. Conclusions: Increased mental health symptoms are weakly associated with faster typing, with important gender differences. Keystroke metadata should be collected longitudinally and combined with other digital phenotypes to enhance their clinical relevance. Trial Registration: Australian and New Zealand Clinical Trial Registry, ACTRN12619000855123; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377664&isReview=true %M 37184904 %R 10.2196/44986 %U https://mental.jmir.org/2023/1/e44986 %U https://doi.org/10.2196/44986 %U http://www.ncbi.nlm.nih.gov/pubmed/37184904 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43065 %T Mobile Acceptance and Commitment Therapy With Distressed First-Generation College Students: Microrandomized Trial %A Thomas,Emily Brenny Kroska %A Sagorac Gruichich,Tijana %A Maronge,Jacob M %A Hoel,Sydney %A Victory,Amanda %A Stowe,Zachary N %A Cochran,Amy %+ Department of Psychological and Brain Sciences, University of Iowa, 340 Iowa Avenue, G60 PBSB, Iowa City, IA, 52242, United States, 1 319 467 1691, emily-kroska@uiowa.edu %K acceptance and commitment therapy %K randomized controlled trials %K mobile health %K mHealth %K first-generation college students %K psychological flexibility %K distress %K depression %D 2023 %7 15.5.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Extant gaps in mental health services are intensified among first-generation college students. Improving access to empirically based interventions is critical, and mobile health (mHealth) interventions are growing in support. Acceptance and commitment therapy (ACT) is an empirically supported intervention that has been applied to college students, via mobile app, and in brief intervals. Objective: This study evaluated the safety, feasibility, and effectiveness of an ACT-based mHealth intervention using a microrandomized trial (MRT) design. Methods: Participants (N=34) were 18- to 19-year-old first-generation college students reporting distress, who participated in a 6-week intervention period of twice-daily assessments and randomization to intervention. Participants logged symptoms, moods, and behaviors on the mobile app Lorevimo. After the assessment, participants were randomized to an ACT-based intervention or no intervention. Analyses examined proximal change after randomization using a weighted and centered least squares approach. Outcomes included values-based and avoidance behavior, as well as depressive symptoms and perceived stress. Results: The findings indicated the intervention was safe and feasible. The intervention increased values-based behavior but did not decrease avoidance behavior. The intervention reduced depressive symptoms but not perceived stress. Conclusions: An MRT of an mHealth ACT-based intervention among distressed first-generation college students suggests that a larger MRT is warranted. Future investigations may tailor interventions to contexts where intervention is most impactful. Trial Registration: ClinicalTrials.gov NCT04081662; https://clinicaltrials.gov/show/NCT04081662 International Registered Report Identifier (IRRID): RR2-10.2196/17086 %M 37184896 %R 10.2196/43065 %U https://mental.jmir.org/2023/1/e43065 %U https://doi.org/10.2196/43065 %U http://www.ncbi.nlm.nih.gov/pubmed/37184896 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42986 %T Screening for Media Use in the Emergency Department Among Young Australians: Cross-sectional Study %A Dullur,Pravin %A Joseph,Joanne %A Diaz,Antonio Mendoza %A Lin,Ping-I %A Jairam,Rajeev %A Davies,Rhian %A Masi,Anne %A Shulruf,Boaz %A Eapen,Valsamma %+ Discipline of Psychiatry and Mental Health, University of New South Wales, High St Kensington, NSW 2052, Sydney, Australia, 61 9385 1000, z5173736@ad.unsw.edu.au %K internet %K mental illness %K overuse %K problematic internet behaviors %K emergency department %K screening %K adolescent %K youth %K internet use %K mental health %K technology use %K young people %K internet behavior %D 2023 %7 15.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Research on problematic internet use has largely adhered to addiction paradigms, possibly impeding the identification of specific internet behaviors related to psychopathology. This study presents a novel approach to screening for specific problematic internet behaviors by using a new measure, the emergency department media use screener (EDMUS). Objective: The purpose of this study was to identify patterns of internet use in young people presenting with mental health concerns to the emergency department (ED), ascertain associations with their mental health, and evaluate whether the EDMUS can be used to predict subsequent ED presentations within 3 months. Methods: This cross-sectional retrospective study of Australian young people (N=149, aged 11-25 years; female: n=92, 61.7%) sought to use the EDMUS, a 24-item questionnaire, to identify problematic internet behaviors, including accessing or posting prosuicidal or proeating disorder content, cyberbullying, and inappropriate digital content. Data on each person’s mental health were extracted from electronic medical records to look for associations with EDMUS responses and ED re-presentation over 3 months. EDMUS items were grouped into clusters for analysis using chi-square tests, binary logistic regression, and path analyses. Results: Sharing suicidal digital content was the most common problematic internet use pattern identified by the EDMUS. However, this did not correlate with having a prior mental health diagnosis or predict readmission. Most participants had families with a concern for their internet use; however, this was less likely in participants with a diagnosis of personality disorder. Diagnoses of personality disorder or posttraumatic stress disorder were independent predictors of readmission (P=.003; P=.048). Conclusions: Although a history of complex psychopathology increases the likelihood of subsequent ED presentations, its links to internet use–related behaviors are still unclear. The EDMUS has potential for identifying young people who are most vulnerable to problematic internet behaviors and offers the opportunity for early intervention and potential prevention of more entrenched difficulties. %M 37184914 %R 10.2196/42986 %U https://formative.jmir.org/2023/1/e42986 %U https://doi.org/10.2196/42986 %U http://www.ncbi.nlm.nih.gov/pubmed/37184914 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37742 %T Effects of Music on Attention-Deficit/Hyperactivity Disorder (ADHD) and Potential Application in Serious Video Games: Systematic Review %A Martin-Moratinos,Marina %A Bella-Fernández,Marcos %A Blasco-Fontecilla,Hilario %+ Department of Psychiatry, Puerta de Hierro University Hospital - Majadahonda, C/ Joaquín Rodrigo, Majadahonda, 28222, Spain, 34 911911690, hmblasco@yahoo.es %K attention-deficit/hyperactivity disorder %K music therapy %K music %K video games %K rhythm %K timing deficits %D 2023 %7 12.5.2023 %9 Review %J J Med Internet Res %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) has a considerable impact on an individual’s daily life. Some difficulties with timing deficits may be associated with deficiencies in attention, reading, language skills, or executive function. Music therapy, either active (playing an instrument) or passive (listening to music) has demonstrated its efficacy in reducing symptomatology in many disorders. Video games may prove to be a useful assessment and treatment tool in compensating for the difficulties with multimodal treatment in ADHD. Objective: The aim of the study is to (1) analyze the evidence that music is beneficial in reducing the symptomatology of ADHD using systematic review and (2) propose the application of music in video games following music therapy strategies. Methods: Searches were conducted in PubMed, Embase, PsycINFO, Cochrane, and gray literature (Google Scholar and WorldCat). We used the following search syntax: ((music[Title/Abstract]) or (music therapy[Title/Abstract])) and (attention deficit disorder[MeSH or thesaurus term]). Results: Of the 70 records identified, 17 provided findings that music can be beneficial in various domains of ADHD. Active music therapy improves hemispheric synchrony, social skills, aggressivity, and impulsivity. Passive music therapy improves academic skills like arithmetic, drawing, and reading comprehension, as well as attention and disruptive behaviors. The effects depend on the music genre, tempo, or task difficulty. Music in video games was generally found to be beneficial for people with ADHD. Music improves immersion and flow while playing video games. Using rhythm may also improve timing skills and immersion in patients with ADHD. Regarding the proposed application of aspects of music to therapeutic video games for ADHD, some paradigms in timing and music therapy were considered in the proposed design of video games. Conclusions: Improving ADHD treatment through the application of music in video games is proposed. Trial Registration: PROSPERO CRD42021288226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=288226 %M 37171837 %R 10.2196/37742 %U https://www.jmir.org/2023/1/e37742 %U https://doi.org/10.2196/37742 %U http://www.ncbi.nlm.nih.gov/pubmed/37171837 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e41638 %T Gamifying Cognitive Behavioral Therapy Techniques on Smartphones for Bangkok’s Millennials With Depressive Symptoms: Interdisciplinary Game Development %A Sriwatanathamma,Poe %A Sirivesmas,Veerawat %A Simatrang,Sone %A Bhowmik,Nobonita Himani %+ Doctor of Philosophy Program in Design Arts (International Program), Faculty of Decorative Arts, Silpakorn University, 22 Borommaratchachonnani Rd, Khwaeng Taling Chan, Khet Taling Chan, Bangkok, 10170, Thailand, 66 917655317, poesriwatana@gmail.com %K cognitive behavioral therapy %K gamification %K Bangkok’s millennials %K depressive symptoms %K mobile phone %D 2023 %7 12.5.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: There is serious concern over the annual increase in depressive symptoms among millennials in Bangkok, Thailand. Their daily routine revolves around the use of their smartphones for work and leisure. Although accessibility to mental health care is expanding, it cannot keep up with the demand for mental health treatment. Outside Thailand, multiple projects and studies have attempted to merge gamification mechanisms and cognitive behavioral therapy (CBT) to create mobile health intervention apps and serious games with positive feedback. This presents an opportunity to explore the same approach in Thailand. Objective: This study investigated the development process of gamifying CBT techniques to support game mechanics in a visual narrative serious game, BlueLine. The primary target of this research is Bangkok’s millennials. In the game, players play as Blue, a Bangkok millennial who struggles to live through societal norms that influence his digital life and relationships. Through in-game scenarios, players will learn and understand how to lessen the impact of depressive symptoms via gamified interactions on their smartphones. Methods: First, this paper follows each development step of solidifying BlueLine’s game structure by integrating the Activating Events, Beliefs, Consequences, Disputation of Beliefs and Effective New Approaches (ABCDE) model and narrative in games. Second, the approach to select CBT and related therapeutic elements for gamification is based on suitability to the game structure. Throughout the process, CBT experts in Thailand have reviewed these scenarios. The approach forms the base of the player’s interactions throughout the scenarios in BlueLine, broken down into 4 types of gamified mechanisms: narrative, verbal interactions, physical interactions, and social media interactions. Results: With the game structure based on the ABCDE model, BlueLine scenarios implement gamified mechanisms in conjunction with the following CBT and related therapeutic elements: behavioral activation, self-monitoring, interpersonal skills, positive psychology, relaxation and mindful activities, and problem-solving. In each scenario, players guide Blue to overcome his triggered dysfunctional beliefs. During this process, players can learn and understand how to lessen the impact of depressive symptoms through gamified interactions. Conclusions: This paper presents the development process of gamifying CBT and related therapeutic techniques in BlueLine game scenarios. A scenario can harbor multiple techniques, including behavioral activation, self-monitoring, interpersonal skills, positive psychology, relaxation and mindful activities, and problem-solving. BlueLine’s game structure does not limit the fact that the same combination of CBT elements ties each gamified mechanism. %M 37171845 %R 10.2196/41638 %U https://games.jmir.org/2023/1/e41638 %U https://doi.org/10.2196/41638 %U http://www.ncbi.nlm.nih.gov/pubmed/37171845 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38552 %T Clinical Assessment of Eye Movement Desensitization and Reprocessing in Memory Distress: Protocol for a Double-Blinded Randomized Controlled Trial %A Babaei,Nazanin %A Kerry,Camrie %A Goode,Kisha %A Dang,Kevin %A Mirzadeh,Parsa %A Pirbaglou,Meysam %A Kirk,Megan A %A Ritvo,Paul %+ School of Kinesiology and Health Science, York University, 4700 Keele St,, Toronto, ON, M3J1P3, Canada, 1 416 580 8021, pritvo@yorku.ca %K EMDR variants %K eye movement desensitization reprocessing %K flash technique-EMDR %K posttraumatic stress disorder %D 2023 %7 12.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Exposures to “traumatic” events are widespread and can cause posttraumatic stress disorder (PTSD). Cognitive behavioral therapy and eye movement desensitization and reprocessing (EMDR) are frequently used and validated behavioral PTSD treatments. Despite demonstrated effectiveness, highly upsetting memory reactions can be evoked, resulting in extensive distress and, sometimes, treatment dropout. In recent years, multiple treatment approaches have aimed at reducing such upsetting memory reactions to traumatic memories while therapeutic progress proceeds. One of these methods, the flash technique (FT), a modification of standard EMDR (S-EMDR), appears effective in distressing memory reduction. This study will examine FT-EMDR and S-EMDR efficacies when both methods are delivered via web-based video. Objective: This study aims to assess the relative efficacy of (web-based) FT-EMDR versus S-EMDR in reducing the PTSD symptoms, anxieties, and depression associated with traumatic memories at postintervention and 1-month follow-up. Methods: This double-blinded, web-based, 2-arm randomized controlled trial will employ self-report outcomes. A total of 90 participants will be identified from the web-based CloudResearch platform and randomly allocated to the experimental or comparison group. Inclusion criteria are as follows: (1) approved for engagement by the CloudResearch platform; (2) 25-60 years of age; (3) residing in Canada or the United States; (4) a recalled disturbing memory of an event >2 years ago that has not repeated and was moderately or more upsetting during occurrence; (5) memory moderately or more upsetting at baseline and not linked to an earlier memory that is equally or more than equally disturbing. Exclusion criteria are bipolar disorder, borderline personality disorder, obsessive-compulsive disorder, schizophrenia, substance abuse or addiction in the past 3 months, suicidal ideation, and suicide attempt in the past 6 months. Interventions include guided video instruction of full FT or guided video of EMDR. Outcome measures are as follows: Primary outcome is PTSD symptoms that are measured by the PTSD Checklist for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders-5) at 1-month follow-up. Secondary outcomes are State Anxiety subscale of State-Trait Anxiety Inventory at baseline, postintervention, and 1-month follow-up; Trait Anxiety subscale of State-Trait Anxiety Inventory; depression (Patient Health Questionnaire-9); and Positive and Negative Affect Schedule measured at 1-month follow-up. Results: If, at 1-month follow-up, the web-based FT-EMDR intervention is more effective in reducing PTSD symptoms (as measured by the PTSD Checklist for DSM-5) than EMDR, it may help reduce traumatic memory distress in multiple contexts. Conclusions: This randomized controlled trial will advance current understandings of PTSD symptoms and interventions that target traumatic memory–related distress. Trial Registration: ClinicalTrials.gov NCT05262127; https://clinicaltrials.gov/ct2/show/NCT05262127 %M 37171869 %R 10.2196/38552 %U https://www.researchprotocols.org/2023/1/e38552 %U https://doi.org/10.2196/38552 %U http://www.ncbi.nlm.nih.gov/pubmed/37171869 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 11 %N %P e41345 %T Mental Health in Urban Environments: Uncovering the Black Box of Person-Place Interactions Requires Interdisciplinary Approaches %A Kanning,Martina %A Yi,Li %A Yang,Chih-Hsiang %A Niermann,Christina %A Fina,Stefan %+ Department of Sport Science, University of Konstanz, Univeristätsstraße 10, Konstanz, 78464, Germany, 49 7531 88 3154, martina.kanning@uni-konstanz.de %K physical activity %K urban health %K ambulatory assessment %K environment %K mental health %K real-time data %K within-subject association %D 2023 %7 11.5.2023 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Living in urban environments affects individuals’ mental health through different pathways. For instance, physical activity and social participation are seen as mediators. However, aiming to understand underlying mechanisms, it is necessary to consider that the individual is interacting with its environment. In this regard, this viewpoint discusses how urban health research benefits from integration of socioecological and interdisciplinary perspectives, combined with innovative ambulatory data assessments that enable researchers to integrate different data sources. It is stated that neither focusing on the objective and accurate assessment of the environment (from the perspective of spatial sciences) nor focusing on subjectively measured individual variables (from the public health as well as a psychosocial perspective) alone is suitable to further develop the field. Addressing person-place interactions requires an interdisciplinary view on the level of theory (eg, which variables should be focused on?), assessment methods (eg, combination of time-varying objective and subjective measures), as well as data analysis and interpretation. Firstly, this viewpoint gives an overview on previous findings addressing the relationship of environmental characteristics to physical activity and mental health outcomes. We emphasize the need for approaches that allow us to appropriately assess the real-time interaction between a person and a specific environment and examine within-subject associations. This requires the assessment of environmental features, the spatial-temporal behavior of the individual, and the subjective experiences of the situation together with other individual factors, such as momentary affective states. Therefore, we finally focused on triggered study designs as an innovative ambulatory data assessment approach that allows us to capture real-time data in predefined situations (eg, while walking through a specific urban area). %M 37166963 %R 10.2196/41345 %U https://mhealth.jmir.org/2023/1/e41345 %U https://doi.org/10.2196/41345 %U http://www.ncbi.nlm.nih.gov/pubmed/37166963 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43191 %T Conceptualizing and Measuring Social Media Use in Health and Well-being Studies: Systematic Review %A Bekalu,Mesfin Awoke %A Sato,Taisuke %A Viswanath,K %+ Lee Kum Sheung Center for Health and Happiness, Harvard TH Chan School of Public Health, 450 Brookline Ave LW601, Boston, MA, 02215, United States, 1 8574529481, bekalu@hsph.harvard.edu %K social media %K health %K well-being %K conceptualization %K measurement %K technology use %K screen time %K computer use %K usage %K addict %D 2023 %7 10.5.2023 %9 Review %J J Med Internet Res %G English %X Background: Despite an increasing number of studies revealing both the benefits and harms of social media use on well-being, there is heterogeneity and a lack of consensus on how social media use is conceptualized, defined, and measured. Additionally, little is known whether existing literature focuses on ill-being or well-being outcomes and whether studies use theories. Objective: The main objective of this review was to examine (1) how social media use has been conceptualized and measured, (2) what health and well-being outcomes have been focused on, and (3) whether studies used theories. Methods: Studies were located through a comprehensive search strategy involving 4 steps. First, keyword searches were conducted on 6 major databases: PubMed, Web of Science, PsycINFO, Embase, ProQuest, and Annual Reviews. Second, a search was conducted on Google Scholar using the same sets of search terms, and the first 100 results were examined. Third, the reference sections of reviews identified in the first 2 rounds of searches were examined, and finally, the reference lists of the final set of papers included in the review were searched. Through a multistage screening, papers that met our inclusion criteria were analyzed. Results: The review included a total of 233 papers published between 2007 and 2020 in 51 different countries. While 66 (28%) of the studies investigated the effects of the problematic use or addiction of social media on health and well-being, 167 (72%) studied the effects of social media use as a “normal” behavior. Most of the studies used measures assessing the time users spend using social media. Most of the studies that examined the effects of problematic social media use or addiction used addiction scales. Most studies examined the association of social media use with mental illnesses such as depression, anxiety, self-esteem, and loneliness. While there are a considerable number of studies investigating physical health outcomes such as self-rated health, sleep, and sitting time or lack of physical activity, relatively a small number of studies examined social, psychological, and emotional well-being. Most of the studies 183 (79%) did not use any theory. Conclusions: Most studies conceptualized social media use as a “normal” behavior and mostly used time-spent measures, whereas a considerable number of studies conceptualized social media use as an addiction and used various addiction measures. The studies disproportionately focused on investigating the associations of social media use with negative health and well-being outcomes. The findings suggest the need for going beyond time spent to more sophisticated measurement approaches that consider the multiplicity of activities that users perform on social media platforms and the need for more theory-based studies on the association of social media use with not only negative well-being or “ill-being” but also with positive health and well-being outcomes. %M 37163319 %R 10.2196/43191 %U https://www.jmir.org/2023/1/e43191 %U https://doi.org/10.2196/43191 %U http://www.ncbi.nlm.nih.gov/pubmed/37163319 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42734 %T Methodologies for Monitoring Mental Health on Twitter: Systematic Review %A Di Cara,Nina H %A Maggio,Valerio %A Davis,Oliver S P %A Haworth,Claire M A %+ School of Psychological Science, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom, 44 117 374 6633, nina.dicara@bristol.ac.uk %K social media %K mental health %K mental illness %K machine learning %D 2023 %7 8.5.2023 %9 Review %J J Med Internet Res %G English %X Background: The use of social media data to predict mental health outcomes has the potential to allow for the continuous monitoring of mental health and well-being and provide timely information that can supplement traditional clinical assessments. However, it is crucial that the methodologies used to create models for this purpose are of high quality from both a mental health and machine learning perspective. Twitter has been a popular choice of social media because of the accessibility of its data, but access to big data sets is not a guarantee of robust results. Objective: This study aims to review the current methodologies used in the literature for predicting mental health outcomes from Twitter data, with a focus on the quality of the underlying mental health data and the machine learning methods used. Methods: A systematic search was performed across 6 databases, using keywords related to mental health disorders, algorithms, and social media. In total, 2759 records were screened, of which 164 (5.94%) papers were analyzed. Information about methodologies for data acquisition, preprocessing, model creation, and validation was collected, as well as information about replicability and ethical considerations. Results: The 164 studies reviewed used 119 primary data sets. There were an additional 8 data sets identified that were not described in enough detail to include, and 6.1% (10/164) of the papers did not describe their data sets at all. Of these 119 data sets, only 16 (13.4%) had access to ground truth data (ie, known characteristics) about the mental health disorders of social media users. The other 86.6% (103/119) of data sets collected data by searching keywords or phrases, which may not be representative of patterns of Twitter use for those with mental health disorders. The annotation of mental health disorders for classification labels was variable, and 57.1% (68/119) of the data sets had no ground truth or clinical input on this annotation. Despite being a common mental health disorder, anxiety received little attention. Conclusions: The sharing of high-quality ground truth data sets is crucial for the development of trustworthy algorithms that have clinical and research utility. Further collaboration across disciplines and contexts is encouraged to better understand what types of predictions will be useful in supporting the management and identification of mental health disorders. A series of recommendations for researchers in this field and for the wider research community are made, with the aim of enhancing the quality and utility of future outputs. %M 37155236 %R 10.2196/42734 %U https://www.jmir.org/2023/1/e42734 %U https://doi.org/10.2196/42734 %U http://www.ncbi.nlm.nih.gov/pubmed/37155236 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44412 %T A New Podcast for Reducing Stigma Against People Living With Complex Mental Health Issues: Co-design Study %A Carrotte,Elise %A Hopgood,Fincina %A Blanchard,Michelle %A Groot,Christopher %A Phillips,Lisa %+ Melbourne School of Psychological Sciences, The University of Melbourne, 12th Floor Redmond Barry Building, Parkville, 3010, Australia, 61 0383446377, elise.carrotte@student.unimelb.edu.au %K mental illness stigma %K co-design %K podcasting %K participatory methods %K attitude change %D 2023 %7 5.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental illness stigma refers to damaging stereotypes and emotional responses around the experience of mental health issues. Media-based interventions have the potential to reduce the public’s stigmatizing attitudes by improving mental health literacy, emotional appeal, and the intimacy of address. As audio-based media facilitating storytelling, podcasts show potential for reducing stigma; however, it is unclear what features could make a podcast effective or engaging. Objective: The Co-Design and Anti-Stigma Podcast Research (CASPR) study aimed to collaborate with key target audience members to inform the development of a new podcast. This podcast primarily aims to reduce listeners’ stigmatizing attitudes toward people living with complex mental health issues. Methods: This study was adapted from Experience-Based Co-Design methodology. The first part, information gathering, involved a web-based mixed methods survey with 629 Australian podcast listeners to explore their interest and concerns around podcasts. Then, a series of focus groups were held with a purposive sample of 25 participants to explore the potential benefits and challenges of the podcast format. Focus group participants included people with lived experience of complex mental health issues, media and communications professionals, health care professionals, and people interested in workplace mental health. The second part, co-design, constituted 3 meetings of a co-design committee with 10 participants drawn from the focus groups to design the podcast using brainstorming and decision-making activities. Results: Most survey respondents (537/629, 85.3%) indicated a willingness to listen to a podcast about experiences of mental illness stigma; participants indicated preference for semistructured episodes and a mixture of light and serious content. Focus group participants identified potential challenges with appealing to listeners, making the content emotionally resonant and engaging, and translation to listeners’ attitude change. The co-design committee collaborated to achieve consensus on the focus of individual episodes: domains where stigma and discrimination are common, such as workplaces and health care settings; the structure of individual episodes: storyboards that centralize guests with lived experience, featuring explicit discussions around stigma and discrimination; and overarching content principles, including a sincere, empathetic, and hopeful tone; using plain language; having clear calls to action; and providing listener resources. Conclusions: The co-design process informed a podcast design that features lived experience narratives with an explicit focus on stigma and discrimination, highlighting the realities of stigma while acknowledging progress in the space and how listeners can contribute toward social change. This study allowed for an in-depth discussion around the strengths and limitations of such a podcast according to different target audience members. The co-design committee designed key elements of a podcast that has the potential to minimize the limitations of the format while embracing the benefits of podcast-based storytelling. Once produced, the podcast will be evaluated for its impact on attitude change. %M 37145860 %R 10.2196/44412 %U https://formative.jmir.org/2023/1/e44412 %U https://doi.org/10.2196/44412 %U http://www.ncbi.nlm.nih.gov/pubmed/37145860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45136 %T Preliminary Evaluation of Translated and Culturally Adapted Internet-Delivered Cognitive Therapy for Social Anxiety Disorder: Multicenter, Single-Arm Trial in Japan %A Yoshinaga,Naoki %A Thew,Graham R %A Hayashi,Yuta %A Matsuoka,Jun %A Tanoue,Hiroki %A Takanashi,Rieko %A Araki,Mutsumi %A Kanai,Yoshihiro %A Smith,Alisha %A Grant,Sophie H L %A Clark,David M %+ School of Nursing, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan, 81 985 85 9784, naoki-y@med.miyazaki-u.ac.jp %K benchmarking %K anxiety %K social anxiety %K social phobia %K cognitive behavioral therapy %K cognitive therapy %K cross-cultural comparison %K Japan %K mental disorders %K internet-based intervention %K mobile phone %D 2023 %7 5.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-delivered cognitive therapy for social anxiety disorder (iCT-SAD), which is a therapist-guided modular web-based treatment, has shown strong efficacy and acceptability in English-language randomized controlled trials in the United Kingdom and Hong Kong. However, it is not yet known whether iCT-SAD can retain its efficacy following linguistic translation and cultural adaptation of treatment contents and implementation in other countries such as Japan. Objective: This study aimed to examine the preliminary efficacy and acceptability of the translated and culturally adapted iCT-SAD in Japanese clinical settings. Methods: This multicenter, single-arm trial recruited 15 participants with social anxiety disorder. At the time of recruitment, participants were receiving usual psychiatric care but had not shown improvement in their social anxiety and required additional treatment. iCT-SAD was provided in combination with usual psychiatric care for 14 weeks (treatment phase) and for a subsequent 3-month follow-up phase that included up to 3 booster sessions. The primary outcome measure was the self-report version of the Liebowitz Social Anxiety Scale. The secondary outcome measures examined social anxiety–related psychological processes, taijin kyofusho (the fear of offending others), depression, generalized anxiety, and general functioning. The assessment points for the outcome measures were baseline (week 0), midtreatment (week 8), posttreatment (week 15; primary assessment point), and follow-up (week 26). Acceptability was measured using the dropout rate from the treatment, the level of engagement with the program (the rate of module completion), and participants’ feedback about their experience with the iCT-SAD. Results: Evaluation of the outcome measures data showed that iCT-SAD led to significant improvements in social anxiety symptoms during the treatment phase (P<.001; Cohen d=3.66), and these improvements were maintained during the follow-up phase. Similar results were observed for the secondary outcome measures. At the end of the treatment phase, 80% (12/15) of participants demonstrated reliable improvement, and 60% (9/15) of participants demonstrated remission from social anxiety. Moreover, 7% (1/15) of participants dropped out during treatment, and 7% (1/15) of participants declined to undergo the follow-up phase after completing the treatment. No serious adverse events occurred. On average, participants completed 94% of the modules released to them. Participant feedback was positive and highlighted areas of strength in treatment, and it included further suggestions to improve suitability for Japanese settings. Conclusions: Translated and culturally adapted iCT-SAD demonstrated promising initial efficacy and acceptability for Japanese clients with social anxiety disorder. A randomized controlled trial is required to examine this more robustly. %M 37145850 %R 10.2196/45136 %U https://formative.jmir.org/2023/1/e45136 %U https://doi.org/10.2196/45136 %U http://www.ncbi.nlm.nih.gov/pubmed/37145850 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45509 %T Understanding Treatment Needs of Youth in a Remote Intensive Outpatient Program Through Solicited Journals: Quality Improvement Analysis %A Evans-Chase,Michelle %A Kornmann,Rachel %A Peralta,Bethany %A Gliske,Kate %A Berry,Katie %A Solomon,Phyllis %A Fenkel,Caroline %+ School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, United States, 1 609 602 3792, meva@upenn.edu %K youth %K young adults %K recovery %K intensive outpatient programming %K telehealth %K qualitative methods %D 2023 %7 3.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth experiencing high-acuity mental health symptoms often require highly restrictive levels of care (ie, inpatient care) that removes them from the relationships and activities essential for healthy development. An alternative treatment gaining evidence in its ability to support this population is the intensive outpatient programming (IOP) model. Understanding the experiences of adolescents and young adults during IOP treatment episodes may enhance clinical responsiveness to changing needs and protect against transfer to inpatient care. Objective: The objective of the analysis reported here was to identify heretofore unrecognized treatment needs of adolescents and young adults attending a remote IOP to help the program make clinical and programmatic decisions that increase its ability to support the recovery of program participants. Methods: Treatment experiences are collected weekly via electronic journals as part of ongoing quality improvement efforts. The journals are used by clinicians proximally to help them identify youth in crisis and distally to help them better understand and respond to the needs and experiences of program participants. Journal entries are downloaded each week, reviewed by program staff for evidence of the need for immediate intervention, and later deidentified and shared with quality improvement partners via monthly uploads to a secure folder. A total of 200 entries were chosen based on inclusion criteria that focused primarily on having at least one entry at 3 specified time points across the treatment episode. Overall, 3 coders analyzed the data using open-coding thematic analysis from an essentialist perspective such that the coders sought to represent the data and thus the essential experience of the youth as closely as possible. Results: Three themes emerged: mental health symptoms, peer relations, and recovery. The mental health symptoms theme was not surprising, given the context within which the journals were completed and the journal instructions asking that they write about how they are feeling. The peer relations and recovery themes provided novel insight, with entries included in the peer relations theme demonstrating the central importance of peer relationships, both within and outside of the therapeutic setting. The entries contained under the recovery theme described experience of recovery in terms of increases in function and self-acceptance versus reductions in clinical symptoms. Conclusions: These findings support the conceptualization of this population as youth with both mental health and developmental needs. In addition, these findings suggest that current definitions of recovery may inadvertently miss supporting and documenting treatment gains considered most important to the youth and young adults receiving care. Taken together, youth-serving IOPs may be better positioned to treat youth and assess program impact through the inclusion of functional measures and attention to fundamental tasks of the adolescent and young adult developmental periods. %M 37133910 %R 10.2196/45509 %U https://formative.jmir.org/2023/1/e45509 %U https://doi.org/10.2196/45509 %U http://www.ncbi.nlm.nih.gov/pubmed/37133910 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43102 %T Attitudes of Children, Adolescents, and Their Parents Toward Digital Health Interventions: Scoping Review %A d'Halluin,Arnaud %A Costa,Marie %A Morgiève,Margot %A Sebbane,Déborah %+ WHO Collaborating Centre for Research and Training in Mental Health, EPSM Lille Métropole, 211 Rue Roger Salengro, Lille - Hellemmes, 59260, France, 33 3 20 43 71 00, arndhalluin59@gmail.com %K eHealth %K mental health %K children and adolescents %K attitude %K scoping review %K mobile phone %K digital health intervention %K DHI %D 2023 %7 2.5.2023 %9 Review %J J Med Internet Res %G English %X Background: The prevalence of mental health problems in children and adolescents is high. As these problems can impact this population’s developmental trajectories, they constitute a public health concern. This situation is accentuated by the fact that children and adolescents infrequently seek help. Digital health interventions (DHIs) offer an opportunity to bridge the treatment gap between health care needs and patient engagement in care. Additional detailed research is needed to identify how children and adolescents can be empowered to access help through DHIs. In this context, an understanding of their attitudes toward digital health appears to be a necessary first step in facilitating the effective implementation of DHIs. Objective: This study aimed to establish an inventory of children’s, adolescents’, and their parents’ attitudes toward DHIs. Methods: A scoping review following PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) recommendations was performed using the MEDLINE, Embase, and PsycINFO databases. This research was conducted using 3 key concepts: “child and adolescent mental health service users,” “digital health interventions,” and “attitudes.” Data extracted included the name of the publishing journal, the methodology used, the target population, the DHI studied, and the principal results. Results: Of 1548 studies found, 30 (1.94%) were included in our analysis. Among these, 13 concerned satisfaction, 24 concerned preferences, 22 concerned the use of DHI, 11 concerned perception, and 10 concerned needs. Conclusions: The results of this study provide a better understanding of the factors influencing children’s and adolescents’ attitudes toward digital health and DHIs. The continued growth of DHIs can help reduce barriers to mental health care. Future research on these interventions should investigate the needs of the targeted populations to increase their engagement in care. %M 37129931 %R 10.2196/43102 %U https://www.jmir.org/2023/1/e43102 %U https://doi.org/10.2196/43102 %U http://www.ncbi.nlm.nih.gov/pubmed/37129931 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40472 %T Efficacy of Web-Based, Guided Self-help Cognitive Behavioral Therapy–Enhanced for Binge Eating Disorder: Randomized Controlled Trial %A Melisse,Bernou %A Berg,Elske van den %A Jonge,Margo de %A Blankers,Matthijs %A Furth,Eric van %A Dekker,Jack %A Beurs,Edwin de %+ Novarum Center for Eating Disorders, Laan van de Helende Meesters 2, Amstelveen, 1186 AM, Netherlands, 31 621958289, bernou.melisse@novarum.nl %K randomized controlled trial %K RCT %K binge eating disorder %K BED %K guided self-help %K cognitive behavioral therapy–enhanced %K CBT-E %D 2023 %7 1.5.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Owing to the gap between treatment supply and demand, there are long waiting periods for patients with binge eating disorder, and there is an urgent need to increase their access to specialized treatment. Guided self-help cognitive behavioral therapy–enhanced (CBT-E) may have great advantages for patients if its efficacy can be established. Objective: The aim of this study was to examine the efficacy of guided self-help CBT-E compared with that of a delayed-treatment control condition. Methods: A single-blind 2-arm randomized controlled trial was designed to evaluate guided self-help CBT-E according to an intention-to-treat analysis. A total of 180 patients were randomly assigned to guided self-help CBT-E (n=90, 50%) or the delayed-treatment control condition (n=90, 50%) for which guided self-help CBT-E was provided after the initial 12-week delay. The primary outcome was reduction in binges. The secondary outcome was full recovery at the end of treatment, as measured using the Eating Disorder Examination during the last 4 weeks of treatment. A linear mixed model analysis was performed to compare treatment outcomes at the end of treatment. A second linear mixed model analysis was performed to measure between- and within-group effects for up to 24 weeks of follow-up. The Eating Disorder Examination–Questionnaire and clinical impairment assessment were conducted before and after treatment and during follow-up. In addition, dropout rates were assessed in both conditions. Results: During the last 4 weeks of treatment, objective binges reduced from an average of 19 (SD 16) to 3 (SD 5) binges, and 40% (36/90) showed full recovery in the guided self-help CBT-E group. Between-group effect size (Cohen d) was 1.0 for objective binges. At follow-up, after both groups received treatment, there was no longer a difference between the groups. Of the 180 participants, 142 (78.9%) completed treatment. The overall treatment dropout appeared to be associated with gender, level of education, and number of objective binges at baseline but not with treatment condition. Conclusions: This is the first study to investigate the efficacy of guided self-help CBT-E. Guided self-help CBT-E appeared to be an efficacious treatment. This study’s findings underscore the international guidelines recommending this type of treatment for binge eating disorder. Trial Registration: Netherlands Trial Registry (NTR) NL7994; https://trialsearch.who.int/Trial2.aspx?TrialID=NL7994 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-020-02604-1 %M 37126386 %R 10.2196/40472 %U https://www.jmir.org/2023/1/e40472 %U https://doi.org/10.2196/40472 %U http://www.ncbi.nlm.nih.gov/pubmed/37126386 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43862 %T Conversational Agent Interventions for Mental Health Problems: Systematic Review and Meta-analysis of Randomized Controlled Trials %A He,Yuhao %A Yang,Li %A Qian,Chunlian %A Li,Tong %A Su,Zhengyuan %A Zhang,Qiang %A Hou,Xiangqing %+ Institute of Applied Psychology, College of Education, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin, 300354, China, 86 15034071215, 2020212056@tju.edu.cn %K chatbot and conversational agent %K mental health %K meta-analysis %K depression %K anxiety %K quality of life %K stress %K mobile health %K mHealth %K digital medicine %K meta-regression %K mobile phone %D 2023 %7 28.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Mental health problems are a crucial global public health concern. Owing to their cost-effectiveness and accessibility, conversational agent interventions (CAIs) are promising in the field of mental health care. Objective: This study aims to present a thorough summary of the traits of CAIs available for a range of mental health problems, find evidence of efficacy, and analyze the statistically significant moderators of efficacy via a meta-analysis of randomized controlled trial. Methods: Web-based databases (Embase, MEDLINE, PsycINFO, CINAHL, Web of Science, and Cochrane) were systematically searched dated from the establishment of the database to October 30, 2021, and updated to May 1, 2022. Randomized controlled trials comparing CAIs with any other type of control condition in improving depressive symptoms, generalized anxiety symptoms, specific anxiety symptoms, quality of life or well-being, general distress, stress, mental disorder symptoms, psychosomatic disease symptoms, and positive and negative affect were considered eligible. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Data were extracted by 2 independent reviewers, checked by a third reviewer, and pooled using both random effect models and fixed effects models. Hedges g was chosen as the effect size. Results: Of the 6900 identified records, a total of 32 studies were included, involving 6089 participants. CAIs showed statistically significant short-term effects compared with control conditions in improving depressive symptoms (g=0.29, 95% CI 0.20-0.38), generalized anxiety symptoms (g=0.29, 95% CI 0.21-0.36), specific anxiety symptoms (g=0.47, 95% CI 0.07-0.86), quality of life or well-being (g=0.27, 95% CI 0.16-0.39), general distress (g=0.33, 95% CI 0.20-0.45), stress (g=0.24, 95% CI 0.08-0.41), mental disorder symptoms (g=0.36, 95% CI 0.17-0.54), psychosomatic disease symptoms (g=0.62, 95% CI 0.14-1.11), and negative affect (g=0.28, 95% CI 0.05-0.51). However, the long-term effects of CAIs for the most mental health outcomes were not statistically significant (g=−0.04 to 0.39). Personalization and empathic response were 2 critical facilitators of efficacy. The longer duration of interaction with conversational agents was associated with the larger pooled effect sizes. Conclusions: The findings show that CAIs are research-proven interventions that ought to be implemented more widely in mental health care. CAIs are effective and easily acceptable for those with mental health problems. The clinical application of this novel digital technology will conserve human health resources and optimize the allocation of mental health services. Trial Registration: PROSPERO CRD42022350130; https://tinyurl.com/mvhk6w9p %M 37115595 %R 10.2196/43862 %U https://www.jmir.org/2023/1/e43862 %U https://doi.org/10.2196/43862 %U http://www.ncbi.nlm.nih.gov/pubmed/37115595 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42024 %T Intervening on Social Comparisons on Social Media: Electronic Daily Diary Pilot Study %A Andrade,Fernanda C %A Erwin,Savannah %A Burnell,Kaitlyn %A Jackson,Jalisa %A Storch,Marley %A Nicholas,Julia %A Zucker,Nancy %+ Department of Psychology & Neuroscience, Duke University, 417 Chapel Drive, Campus Box 90086, Durham, NC, 27708, United States, 1 (919) 660 5640, fernanda.andrade@duke.edu %K social media %K social comparison %K young adults %K social savoring %K intervention %K self-esteem %K depression %D 2023 %7 28.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Literature has underscored the dark aspects of social media use, including associations with depressive symptoms, feelings of social isolation, and diminished self-esteem. Social comparison, the process of evaluating oneself relative to another person, is thought to contribute to these negative experiences such that people with a stronger tendency to compare themselves with others are particularly susceptible to the detrimental effects of social media. Social media as a form of social connection and communication is nevertheless an inevitable—and arguably integral—part of life, particularly for young adults. Therefore, there is a need to investigate strategies that could alter the manner in which people interact with social media to minimize its detrimental effects and maximize the feelings of affiliation and connection. Objective: This pilot study examined the feasibility, acceptability, and effectiveness of a brief web-based intervention designed to alter engagement with social media and promote psychological well-being by encouraging social savoring as an alternative to social comparison. Social savoring was operationalized as experiencing joyful emotions related to the happiness of someone else’s experiences (ie, feeling happy for someone else). Methods: Following an intensive longitudinal design, 55 college students (mean age 19.29, SD 0.93 years; n=43, 78% women and n=23, 42% White) completed baseline measures (individual differences, psychological well-being, connectedness, and social media use) and then 14 days of daily surveys on their social media activity and well-being. On day 8, the group that was randomized to receive the intervention watched a video instructing them on the skill of social savoring and was asked to practice this skill during days 8 to 14. Results: Overall, participants reported positive perceptions of the intervention. Participants who watched the intervention video reported significantly higher performance self-esteem (P=.02) at posttest than those in the control condition, after controlling for baseline levels. Participants also reported significantly higher state self-esteem (P=.01) on days in which they engaged in more social savoring while using social media, and the use of social savoring increased significantly (P=.01) over time, suggesting that participants found it helpful. Participants in both conditions reported significantly lower levels of social comparison (control: P=.01; intervention: P=.002) and higher levels of connectedness (control: P<.001; intervention: P=.001) at posttest than at baseline. Conclusions: Initial evidence from this pilot study suggests that a web-based social savoring intervention may help minimize the potentially harmful consequences of social media use, at least in some domains. Future work is needed to examine the effectiveness and acceptance of this intervention in different age groups and in clinical samples that are in part characterized by higher levels of comparison with others (eg, people with eating disorders). %M 37115607 %R 10.2196/42024 %U https://mental.jmir.org/2023/1/e42024 %U https://doi.org/10.2196/42024 %U http://www.ncbi.nlm.nih.gov/pubmed/37115607 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45040 %T Evaluation of Various Support Intensities of Digital Mental Health Treatment for Reducing Anxiety and Depression in Adults: Protocol for a Mixed Methods, Adaptive, Randomized Clinical Trial %A Andrews,Brooke %A Klein,Britt %A McLaren,Suzanne %A Watson,Shaun %A Corboy,Denise %+ Health Innovation & Transformation Centre, Federation University Australia, PO BOX 663, Ballarat, 3353, Australia, 61 53279623 ext 9623, b.andrews@federation.edu.au %K video chat therapy %K therapist assistance %K self-help %K transdiagnostic %K digital intervention %K anxiety %K depression %K comorbidity %D 2023 %7 28.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anxiety and depression are leading causes of disease worldwide, requiring timely access to evidence-based treatment. Digital mental health (dMH) interventions increase accessibility to evidence-based psychological services delivered in a variety of web-based formats (eg, self-help and therapist-assisted interventions). Robust and rigorous studies of adaptive web-based intervention designs are scarce. No identified randomized clinical trial has investigated the efficacy of a 2-stage adaptive design, whereby the program-only condition or no support dMH treatment program is augmented by either low or high therapist assistance, if a participant does not improve or engage in the program-only condition. Objective: The primary objective is to assess whether low or high therapist-assisted support delivered via video chat is more effective in reducing anxiety and depressive symptoms compared with a dMH program–only condition. The secondary objective is to evaluate the role of motivation; self-efficacy; and preferences in participant engagement, adherence, and clinical outcomes (anxiety and depression symptoms) among the 3 treatment conditions (program only, low-intensity therapist assistance, and high-intensity therapist assistance). A mixed methods analysis of factors affecting participant attrition, participant reasons for nonengagement and withdrawal, and therapist training and implementation of dMH interventions will be completed. Qualitative data regarding participant and therapist experiences and satisfaction with video chat assessment and treatment will also be analyzed. Methods: Australian adults (N=137) with symptoms or a diagnosis of anxiety or depression will be screened for eligibility and given access to the 8-module Life Flex dMH treatment program. On day 15, participants who meet the augmentation criteria will be stepped up via block randomization to receive therapist assistance delivered via video chat for either 10 minutes (low intensity) or 50 minutes (high intensity) per week. This adaptive trial will implement a mixed methods design, with outcomes assessed before the intervention (week 0), during the intervention (weeks 3 and 6), after the intervention (week 9), and at the 3-month follow-up (week 21). Results: The primary outcome measures are for anxiety (Generalized Anxiety Disorder–7) and depression severity (Patient Health Questionnaire–9). Measures of working alliance, health status, health resources, preferences, self-efficacy, and motivation will be used for secondary outcomes. Qualitative methods will be used to explore participant and therapist experiences of video chat assessment and treatment, participant reasons for withdrawal and nonengagement, and therapist training and implementation experiences. Data collection commenced in November 2020 and was completed at the end of March 2022. Conclusions: This is the first mixed methods adaptive trial to explore the comparative efficacy of different intensity levels of self-help and a therapist-assisted dMH intervention program delivered via video chat for adults with anxiety or depression. Anticipated results may have implications for the implementation of dMH interventions. Trial Registration: Australian and New Zealand Clinical Trials Registry 12620000422921; https://tinyurl.com/t9cyu372 International Registered Report Identifier (IRRID): RR1-10.2196/45040 %M 37115623 %R 10.2196/45040 %U https://www.researchprotocols.org/2023/1/e45040 %U https://doi.org/10.2196/45040 %U http://www.ncbi.nlm.nih.gov/pubmed/37115623 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43929 %T Validation of the Attitudes Towards Psychological Online Interventions Questionnaire Among Black Americans: Cross-cultural Confirmatory Factor Analysis %A Ellis,Donovan Michael %A Anderson,Page Lyn %+ Department of Psychology, Georgia State University, Urban Life Bldg, 11th Floor, 140 Decatur Street, Atlanta, GA, 30303, United States, 1 404 413 6258, panderson@gsu.edu %K acceptability %K Black American %K iCBT %K internet-based cognitive behavioral therapy %K digital treatment %K confirmatory factor analysis %K bifactor model %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Acceptability of digital mental health interventions is a significant predictor of treatment-seeking behavior and engagement. However, acceptability has been conceptualized and operationalized in various ways, which decreases measurement precision and leads to heterogeneous conclusions about acceptability. Standardized self-report measures of acceptability have been developed, which have the potential to ameliorate these problems, but none have demonstrated evidence for validation among Black communities, which limits our understanding of attitudes toward these interventions among racially minoritized groups with well-documented barriers to mental health treatment. Objective: This study aims to examine the psychometric validity and reliability of one of the first and most widely used measures of acceptability, the Attitudes Towards Psychological Online Interventions Questionnaire, among a Black American sample. Methods: Participants (N=254) were recruited from a large southeastern university and the surrounding metropolitan area and completed the self-report measure via a web-based survey. A confirmatory factor analysis using mean and variance adjusted weighted least squares estimation was conducted to examine the validity of the underlying hierarchical 4-factor structure proposed by the original authors of the scale. An alternative, hierarchical 2-factor structure model and bifactor model were examined for comparative fit. Results: The findings indicated that the bifactor model demonstrated a superior fit (comparative fit index=0.96, Tucker-Lewis index=0.94, standardized root mean squared residual=0.03, and root mean square error of approximation=0.09) compared with both 2- and 4-factor hierarchical structure models. Conclusions: The findings suggest that, within a Black American sample, there may be greater utility in interpreting the Attitudes Towards Psychological Online Interventions Questionnaire subscales as attitudinal constructs that are distinct from the global acceptability factor. The theoretical and practical implications for culturally responsive measurements were explored. %M 37103983 %R 10.2196/43929 %U https://mental.jmir.org/2023/1/e43929 %U https://doi.org/10.2196/43929 %U http://www.ncbi.nlm.nih.gov/pubmed/37103983 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46136 %T Promoting Social Participation and Recovery Using Virtual Reality–Based Interventions Among People With Mental Health and Substance Use Disorders: Qualitative Study %A Aasen,Jan %A Galaaen,Kari %A Nilsson,Fredrik %A Sørensen,Torgeir %A Lien,Lars %A Leonhardt,Marja %+ Norwegian National Advisory Unit on Concurrent Substance Use and Mental Health Disorders, Innlandet Hospital Trust, Post Box 104, Brummundal, 2381, Norway, 47 99428096, jan.aasen@sykehuset-innlandet.no %K mental health disorders and substance use disorders %K MHD %K SUD %K recovery %K social participation %K social functioning impairments %K virtual reality–based interventions %K VRI %K reflexive thematic analysis %K qualitative study %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: People with mental health disorders (MHDs) and substance use disorders (SUDs) are a highly vulnerable group, particularly affected by social exclusion, marginalization, and disconnectedness. Virtual reality technology holds a potential for simulating social environments and interactions to mitigate the social barriers and marginalization faced by people recovering from MHDs and SUDs. However, it is still unclear how we can harness the greater ecological validity of virtual reality–based interventions targeting social and functional impairments in individuals with MHDs and SUDs. Objective: The aim of this paper was to explore how service providers in community-based MHD and SUD health care services perceive the barriers to social participation among adults recovering from MHDs and SUDs to provide a broader understanding of how learning experiences can be modeled to promote social participation in virtual reality environments. Methods: Two semistructured, open-ended, and dual-moderator focus group interviews were conducted with participants representing different community-based MHD and SUD health care services. Service providers were recruited from their MHD and SUD services in our collaborating municipality in Eastern Norway. We recruited the first participant group at a municipal MHD and SUD assisted living facility for service users with ongoing excessive substance use and severe social dysfunctionality. We recruited the second participant group at a community-based follow-up care service aimed at clients with a broad range of MHDs and SUDs and various levels of social functioning. The qualitative data extracted in the interviews were analyzed, using reflexive thematic analysis. Results: The analysis of the service providers’ perceptions of the barriers to social participation among clients with MHDs and SUDs revealed the following five main themes: challenging or lacking social connections, impaired cognitive functions, negative self-perception, impaired personal functioning, and insufficient social security. The barriers identified are interrelated in a cluster of cognitive, socioemotional, and functional impairments, leading to a severe and diverse complex of barriers to social participation. Conclusions: Social participation relies on people’s capability to use their present social opportunities. Promoting basic human functioning is key to promoting social participation among people with MHDs and SUDs. The findings in this study indicate a need to address cognitive functioning, socioemotional learning, instrumental skills, and complex social functions to meet the complexity and diversity of the identified barriers to social functioning in our target group. Virtual reality–based interventions for promoting social participation should be sequenced into distinct scenarios dedicated to specific learning goals to build complex learning in a step-by-step process based on successively more complex levels of human and social functioning. %M 37104000 %R 10.2196/46136 %U https://formative.jmir.org/2023/1/e46136 %U https://doi.org/10.2196/46136 %U http://www.ncbi.nlm.nih.gov/pubmed/37104000 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46281 %T Telehealth-Based Music Therapy Versus Cognitive Behavioral Therapy for Anxiety in Cancer Survivors: Rationale and Protocol for a Comparative Effectiveness Trial %A Liou,Kevin T %A McConnell,Kelly M %A Currier,M Beatriz %A Baser,Raymond E %A MacLeod,Jodi %A Walker,Desiree %A Casaw,Camila %A Wong,Greta %A Piulson,Lauren %A Popkin,Karen %A Lopez,Ana Maria %A Panageas,Katherine %A Bradt,Joke %A Mao,Jun J %+ Memorial Sloan Kettering Cancer Center, 321 East 61st Street, New York, NY, 10065, United States, 1 646 608 8558, liouk@mskcc.org %K oncology %K anxiety %K cognitive behavioral therapy %K music therapy %K telehealth %K cancer survivorship %K mental health %K digital health %K mobile phone %D 2023 %7 27.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer survivors represent one of the fastest growing populations in the United States. Unfortunately, nearly 1 in 3 survivors experience anxiety symptoms as a long-term consequence of cancer and its treatment. Characterized by restlessness, muscle tension, and worry, anxiety worsens the quality of life; impairs daily functioning; and is associated with poor sleep, depressed mood, and fatigue. Although pharmacological treatment options are available, polypharmacy has become a growing concern for cancer survivors. Music therapy (MT) and cognitive behavioral therapy (CBT) are evidence-based, nonpharmacological treatments that have demonstrated effectiveness in treating anxiety symptoms in cancer populations and can be adapted for remote delivery to increase access to mental health treatments. However, the comparative effectiveness of these 2 interventions delivered via telehealth is unknown. Objective: The aims of the Music Therapy Versus Cognitive Behavioral Therapy for Cancer-related Anxiety (MELODY) study are to determine the comparative effectiveness of telehealth-based MT versus telehealth-based CBT for anxiety and comorbid symptoms in cancer survivors and to identify patient-level factors associated with greater anxiety symptom reduction for MT and CBT. Methods: The MELODY study is a 2-arm, parallel-group randomized clinical trial that aims to compare the effectiveness of MT versus CBT for anxiety and comorbid symptoms. The trial will enroll 300 English- or Spanish-speaking survivors of any cancer type or stage who have experienced anxiety symptoms for at least 1 month. Participants will receive 7 weekly sessions of MT or CBT delivered remotely via Zoom (Zoom Video Communications, Inc) over 7 weeks. Validated instruments to assess anxiety (primary outcome), comorbid symptoms (fatigue, depression, insomnia, pain, and cognitive dysfunction), and health-related quality of life will be administered at baseline and at weeks 4, 8 (end of treatment), 16, and 26. Semistructured interviews will be conducted at week 8 with a subsample of 60 participants (30 per treatment arm) to understand individual experiences with the treatment sessions and their impact. Results: The first study participant was enrolled in February 2022. As of January 2023, 151 participants have been enrolled. The trial is expected to be completed by September 2024. Conclusions: This study is the first and largest randomized clinical trial to compare the short- and long-term effectiveness of remotely delivered MT and CBT for anxiety in cancer survivors. Limitations include the lack of usual care or placebo control groups and the lack of formal diagnostic assessments for psychiatric disorders among trial participants. The study findings will help guide treatment decisions for 2 evidence-based, scalable, and accessible interventions to promote mental well-being during cancer survivorship. International Registered Report Identifier (IRRID): DERR1-10.2196/46281 %M 37103999 %R 10.2196/46281 %U https://www.researchprotocols.org/2023/1/e46281 %U https://doi.org/10.2196/46281 %U http://www.ncbi.nlm.nih.gov/pubmed/37103999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46578 %T Using Digital Measurement–Based Care to Address Symptoms of Inattention, Hyperactivity, and Opposition in Youth: Retrospective Analysis of Bend Health %A Lawrence-Sidebottom,Darian %A Huffman,Landry Goodgame %A Huberty,Jennifer %A Beatty,Clare %A Roots,Monika %A Roots,Kurt %A Parikh,Amit %A Guerra,Rachael %A Weiser,Jaclyn %+ Bend Health, Inc., 2801 Marshall Ct, Madison, WI, 53705, United States, 1 8005160975, darian.lawrence@bendhealth.com %K digital mental health intervention %K attention-deficit/hyperactivity disorder %K opposition defiance disorder %K attention deficit %K collaborative care %K behavioral care %K mental health %K adolescent %K child %K hyperactivity %K hyperactive %K inattention %K ADHD %K use %K caregiver %K behavioral problem %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Attention-deficit/hyperactivity disorder (ADHD) and associated behavioral disorders are highly prevalent in children and adolescents, yet many of them do not receive the care they need. Digital mental health interventions (DMHIs) may address this need by providing accessible and high-quality care. Given the necessity for high levels of caregiver and primary care practitioner involvement in addressing ADHD symptoms and behavioral problems, collaborative care interventions that adopt a whole-family approach may be particularly well suited to reduce symptoms of inattention, hyperactivity, and opposition in children and adolescents. Objective: The purpose of this study is to use member (ie, child and adolescent) data from Bend Health, Inc, a collaborative care DMHI that uses a whole-family approach to address child and adolescent mental health concerns, to (1) determine the effects of a collaborative care DMHI on inattention, hyperactivity, and oppositional symptoms in children and adolescents and (2) assess whether the effects of a collaborative care DMHI vary across ADHD subtypes and demographic factors. Methods: Caregivers of children and adolescents with elevated symptoms of inattention, hyperactivity, or opposition assessed their children’s symptom severity approximately every 30 days while participating in Bend Health, Inc. Data from 107 children and adolescents aged 6-17 years who exhibited clinically elevated symptoms at baseline were used to assess symptom severity across monthly assessments (inattention symptom group: n=91, 85.0%; hyperactivity symptom group: n=48, 44.9%; oppositional symptom group: n=70, 65.4%). The majority of the sample exhibited elevated symptoms of at least 2 symptom types at baseline (n=67, 62.6%). Results: Members received care for up to 5.52 months and attended between 0 and 10 coaching, therapy, or psychiatry sessions through Bend Health, Inc. For those with at least 2 assessments, 71.0% (n=22) showed improvements in inattention symptoms, 60.0% (n=9) showed improvements in hyperactivity symptoms, and 60.0% (n=12) showed improvements in oppositional symptoms. When considering group-level change over time, symptom severity decreased over the course of treatment with Bend Health, Inc, for inattention (average decrease=3.51 points, P=.001) and hyperactivity (average decrease=3.07 points, P=.049) but not for oppositional symptoms (average decrease=0.70 points, P=.26). There was a main effect of the duration of care on symptom severity (P<.001) such that each additional month of care was associated with lower symptom scores. Conclusions: This study offers promising early evidence that collaborative care DHMIs may facilitate improvements in ADHD symptoms among children and adolescents, addressing the growing need for accessible and high-quality care for behavioral health problems in the United States. However, additional follow-up studies bolstered by larger samples and control groups are necessary to further establish the robustness of these findings. %M 37099379 %R 10.2196/46578 %U https://formative.jmir.org/2023/1/e46578 %U https://doi.org/10.2196/46578 %U http://www.ncbi.nlm.nih.gov/pubmed/37099379 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42523 %T Development of an Alcohol Refusal Training in Immersive Virtual Reality for Patients With Mild to Borderline Intellectual Disability and Alcohol Use Disorder: Cocreation With Experts in Addiction Care %A Langener,Simon %A Kolkmeier,Jan %A VanDerNagel,Joanne %A Klaassen,Randy %A van Manen,Jeannette %A Heylen,Dirk %+ Department of Human Media Interaction, University of Twente, Hallenweg 15, Enschede, 7522NH, Netherlands, 31 534898771, s.langener@utwente.nl %K virtual reality %K conversational agent %K embodied agent %K persuasion %K peer pressure %K addiction %K alcohol %K intellectual disability %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: People with mild to borderline intellectual disability (MBID; IQ=50-85) are at risk for developing an alcohol use disorder (AUD). One factor contributing to this risk is sensitivity to peer pressure. Hence, tailored trainings are needed to practice alcohol refusal in impacted patients. Immersive virtual reality (IVR) appears promising to engage patients in dialogs with virtual humans, allowing to practice alcohol refusal realistically. However, requirements for such an IVR have not been studied for MBID/AUD. Objective: This study aims to develop an IVR alcohol refusal training for patients with MBID and AUD. In this work, we cocreated our peer pressure simulation with experienced experts in addiction care. Methods: We followed the Persuasive System Design (PSD) model to develop our IVR alcohol refusal training. With 5 experts from a Dutch addiction clinic for patients with MBID, we held 3 focus groups to design the virtual environment, persuasive virtual human(s), and persuasive dialog. Subsequently, we developed our initial IVR prototype and conducted another focus group to evaluate IVR and procedures for clinical usage, resulting in our final peer pressure simulation. Results: Our experts described visiting a friend at home with multiple friends as the most relevant peer pressure situation in the clinical setting. Based on the identified requirements, we developed a social-housing apartment with multiple virtual friends present. Moreover, we embedded a virtual man with generic appearance to exert peer pressure using a persuasive dialog. Patients can respond to persuasive attempts by selecting (refusal) responses with varying degrees of risk for relapse in alcohol use. Our evaluation showed that experts value a realistic and interactable IVR. However, experts identified lacking persuasive design elements, such as paralanguage, for our virtual human. For clinical usage, a user-centered customization is needed to prevent adverse effects. Further, interventions should be therapist delivered to avoid try-and-error in patients with MBID. Lastly, we identified factors for immersion, as well as facilitators and barriers for IVR accessibility. Conclusions: Our work establishes an initial PSD for IVR for alcohol refusal trainings in patients with MBID and AUD. With this, scholars can create comparable simulations by performing an analogous cocreation, replicate findings, and identify active PSD elements. For peer pressure, conveying emotional information in a virtual human’s voice (eg, paralanguage) seems vital. However, previous rapport building may be needed to ensure that virtual humans are perceived as cognitively capable entities. Future work should validate our PSD with patients and start developing IVR treatment protocols using interdisciplinary teams. %M 37099362 %R 10.2196/42523 %U https://formative.jmir.org/2023/1/e42523 %U https://doi.org/10.2196/42523 %U http://www.ncbi.nlm.nih.gov/pubmed/37099362 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e34446 %T Work-Focused Versus Generic Internet-Based Interventions for Employees With Stress-Related Disorders: Randomized Controlled Trial %A Persson Asplund,Robert %A Asplund,Sofia %A von Buxhoeveden,Helene %A Delby,Hanna %A Eriksson,Karin %A Svenning Gerhardsson,Maurits %A Palm,Joachim %A Skyttberg,Thea %A Torstensson,Julia %A Ljótsson,Brjánn %A Carlbring,Per %A Andersson,Gerhard %+ Department of Behavioural Sciences and Learning, Linköping University, Campus Valla, I-huset, 3, Linköping, 58183, Sweden, 46 0707870231, robert.persson.asplund@liu.se %K stress %K burnout %K exhaustion %K work-focused %K internet-based %K intervention %K sickness absence %D 2023 %7 25.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent decades, stress-related disorders have received more attention, with an increasing prevalence, especially within the working population. The internet provides new options for broad dissemination, and a growing body of evidence suggests that web-based interventions for stress might be effective. However, few studies have examined the efficacy of interventions in clinical samples and work-related outcomes. Objective: The aim of this study was to evaluate the efficacy of an internet-based cognitive behavioral intervention for stress-related disorders integrating work-related aspects (work-focused and internet-based cognitive behavioral therapy [W-iCBT]), compared with a generic internet-based cognitive behavioral therapy (iCBT) group and a waitlist control (WLC) group. Methods: In this trial, 182 employees, mainly employed in the health care, IT, or educational sector, who fulfilled the criteria for a stress-related disorder, were randomized to a 10-week W-iCBT (n=61, 33.5%), generic iCBT (n=61, 33.5%), or WLC (n=60, 33%). Self-rated questionnaires on perceived stress, burnout, exhaustion, and other mental health– and work-related outcomes were administered before and after the treatment and at 6- and 12-month follow-ups. Results: Compared with the WLC group, participants of the W-iCBT and iCBT groups showed an equal and significant reduction in the primary outcome (Shirom-Melamed Burnout Questionnaire [SMBQ]) from pretreatment to posttreatment assessment (Cohen d=1.00 and 0.83, respectively) and at the 6-month follow-up (Cohen d=0.74 and 0.74, respectively). Significant moderate-to-large effect sizes were also found in the secondary health- and work-related outcomes. The W-iCBT was the only group that exhibited significant effects on work ability and short-term sickness absence. Short-term sickness absence was 445 days lower than the WLC group and 324 days lower than the iCBT intervention group. However, no significant differences were found in terms of work experience or long-term sick leave. Conclusions: The work-focused and generic iCBT interventions proved to be superior compared with the control condition in reducing chronic stress and several other mental health–related symptoms. Interestingly, effects on work ability and short-term sickness absence were only seen between the W-iCBT intervention and the WLC groups. These preliminary results are promising, indicating that treatments that include work aspects may have the potential to accelerate recovery and reduce short-term sickness absence because of stress-related disorders. Trial Registration: ClinicalTrials.gov NCT05240495; https://clinicaltrials.gov/ct2/show/NCT05240495 (retrospectively registered) %M 37097739 %R 10.2196/34446 %U https://www.jmir.org/2023/1/e34446 %U https://doi.org/10.2196/34446 %U http://www.ncbi.nlm.nih.gov/pubmed/37097739 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45796 %T Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment %A Berry,Katie R %A Gliske,Kate %A Schmidt,Clare %A Cray,Ley David Elliette %A Killian,Michael %A Fenkel,Caroline %+ Charlie Health, Inc, 233 E Main St, Ste. 401, Bozeman, MT, 59715, United States, 1 9545527671, krberry@fsu.edu %K lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities %K LGBTQIA+ %K youth %K mental health %K affirming health care %K suicidal ideation %K depression %K nonsuicidal self-harm %K NSSI %D 2023 %7 21.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Lesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population. Objective: This program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming. Methods: Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum. Results: LGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge. Conclusions: This program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically. %M 37083637 %R 10.2196/45796 %U https://formative.jmir.org/2023/1/e45796 %U https://doi.org/10.2196/45796 %U http://www.ncbi.nlm.nih.gov/pubmed/37083637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46254 %T Association Between Internet Searches Related to Suicide/Self-harm and Adolescent Suicide Death in South Korea in 2016-2020: Secondary Data Analysis %A Choi,Won-Seok %A Han,Junhee %A Hong,Hyun Ju %+ Department of Psychiatry, Hallym University Sacred Heart Hospital, College of Medicine, Hallym Univerisity, 22, Gwanpyeong-ro 170beon-gil, Dongan-gu, Gyeonggi-do, Anyang, 14068, Republic of Korea, 82 010 8880 8769, honghj88@gmail.com %K adolescent %K suicide %K self-mutilation %K internet %K search engine %K Korea %K suicide death %K surveillance %K monitoring %K internet search %D 2023 %7 20.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have investigated the association between suicide and internet search volumes of terms related to suicide or self-harm. However, the results varied by people’s age, period, and country, and no study has exclusively investigated suicide or self-harm rates among adolescents. Objective: This study aims to determine the association between the internet search volumes of terms related to suicide/self-harm and the number of suicides among South Korean adolescents. We investigated gender differences in this association and the time lag between the internet search volumes of the terms and the connected suicide deaths. Methods: We selected 26 search terms related to suicide and self-harm among South Korean adolescents, and the search volumes of these terms for adolescents aged 13-18 years were obtained from the leading internet search engine in South Korea (Naver Datalab). A data set was constructed by combining data from Naver Datalab and the number of suicide deaths of adolescents on a daily basis from January 1, 2016, to December 31, 2020. Spearman rank correlation and multivariate Poisson regression analyses were performed to identify the association between the search volumes of the terms and the suicide deaths during that period. The time lag between suicide death and the increasing trend in the search volumes of the related terms was estimated from the cross-correlation coefficients. Results: Significant correlations were observed within the search volumes of the 26 terms related to suicide/self-harm. The internet search volumes of several terms were associated with the number of suicide deaths among South Korean adolescents, and this association differed by gender. The search volume for “dropout” showed a statistically significant correlation with the number of suicides in all adolescent population groups. The correlation between the internet search volume for “dropout” and the connected suicide deaths was the strongest for a time lag of 0 days. In females, self-harm and academic score showed significant associations with suicide deaths, but academic score showed a negative correlation, and the time lags with the strongest correlations were 0 and –11 days, respectively. In the total population, self-harm and suicide method were associated with the number of suicides, and the time lags with the strongest correlations were +7 and 0 days, respectively. Conclusions: This study identifies a correlation between suicides and internet search volumes related to suicide/self-harm among South Korean adolescents, but the relatively weak correlation (incidence rate ratio 0.990-1.068) should be interpreted with caution. %M 37079349 %R 10.2196/46254 %U https://www.jmir.org/2023/1/e46254 %U https://doi.org/10.2196/46254 %U http://www.ncbi.nlm.nih.gov/pubmed/37079349 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41712 %T Examination of the Feasibility, Acceptability, and Efficacy of the Online Personalised Training in Memory Strategies for Everyday Program for Older Adults: Single-Arm Pre-Post Trial %A Pike,Kerryn %A Moller,Carl I %A Bryant,Christina %A Farrow,Maree %A Dao,Duy P %A Ellis,Kathryn A %+ School of Applied Psychology, Griffith Centre for Mental Health & Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast, 4222, Australia, 61 756788606, k.pike@griffith.edu.au %K cognition %K learning %K internet-based intervention %K social support %K subjective cognitive decline %K mobile phone %D 2023 %7 20.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Memory strategy training for older adults helps maintain and improve cognitive health but is traditionally offered face-to-face, which is resource intensive, limits accessibility, and is challenging during a pandemic. Web-based interventions, such as the Online Personalised Training in Memory Strategies for Everyday (OPTIMiSE) program, may overcome such barriers. Objective: We report on OPTIMiSE’s feasibility, acceptability, and efficacy. Methods: Australians aged ≥60 years reporting subjective cognitive decline participated in this single-arm pre-post web-based intervention. OPTIMiSE is a 6-module web-based program offered over 8-weeks with a 3-month booster. It has a problem-solving approach to memory issues, focusing on psychoeducation about memory and aging, knowledge and practice of compensatory memory strategies, and personalized content related to individual priorities. We examined the feasibility (recruitment, attrition, and data collection), acceptability (recommendation to others, suggestions for improvement, and withdrawal reasons), and efficacy (change in goal satisfaction, strategy knowledge and use, self-reported memory, memory satisfaction and knowledge, and mood; thematic content analysis of the most significant change; and the application of knowledge and strategies in daily life) of OPTIMiSE. Results: OPTIMiSE was feasible, demonstrated by strong interest (633 individuals screened), a satisfactory level of attrition (158/312, 50.6%), and minimal missing data from those completing the intervention. It was acceptable, with 97.4% (150/154) of participants agreeing they would recommend OPTIMiSE, the main suggestion for improvement being more time to complete modules, and withdrawal reasons similar to those in in-person interventions. OPTIMiSE was also efficacious, with linear mixed-effects analyses revealing improvements, of moderate to large effect sizes, across all primary outcomes (all P<.001): memory goal satisfaction (Cohen d after course=1.24; Cohen d at 3-month booster=1.64), strategy knowledge (Cohen d after course=0.67; Cohen d at 3-month booster=0.72) and use (Cohen d after course=0.79; Cohen d at 3-month booster=0.90), self-reported memory (Cohen d after course=0.80; Cohen d at 3-month booster=0.83), memory satisfaction (Cohen d after course=1.25; Cohen d at 3-month booster=1.29) and knowledge (Cohen d after course=0.96; Cohen d at 3-month booster=0.26), and mood (Cohen d after course=−0.35; nonsignificant Cohen d at booster). Furthermore, the most significant changes reported by participants (strategy use, improvements in daily life, reduced concern about memory, confidence and self-efficacy, and sharing and shame busting with others) reflected the course objectives and were consistent with themes arising from previous in-person interventions. At the 3-month booster, many participants reported continued implementation of knowledge and strategies in their daily lives. Conclusions: This feasible, acceptable, and efficacious web-based program has the potential to enable access to evidence-based memory interventions for older adults worldwide. Notably, the changes in knowledge, beliefs, and strategy use continued beyond the initial program. This is particularly important for supporting the growing number of older adults living with cognitive concerns. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000979954; https://tinyurl.com/34cdantv International Registered Report Identifier (IRRID): RR2-10.3233/ADR-200251 %M 37079356 %R 10.2196/41712 %U https://www.jmir.org/2023/1/e41712 %U https://doi.org/10.2196/41712 %U http://www.ncbi.nlm.nih.gov/pubmed/37079356 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43164 %T Mobile Acceptance and Commitment Therapy in Bipolar Disorder: Microrandomized Trial %A Cochran,Amy %A Maronge,Jacob M %A Victory,Amanda %A Hoel,Sydney %A McInnis,Melvin G %A Thomas,Emily BK %+ Department of Population Health Sciences, University of Wisconsin Madison, 610 Walnut Street, Madison, WI, 53726, United States, 1 608 262 0772, cochran4@wisc.edu %K acceptance and commitment therapy %K bipolar disorder %K mobile applications %K randomized controlled trials %K micro-randomized trial %K precision medicine %K mindfulness %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mobile interventions promise to fill in gaps in care with their broad reach and flexible delivery. Objective: Our goal was to investigate delivery of a mobile version of acceptance and commitment therapy (ACT) for individuals with bipolar disorder (BP). Methods: Individuals with BP (n=30) participated in a 6-week microrandomized trial. Twice daily, participants logged symptoms in the app and were repeatedly randomized (or not) to receive an ACT intervention. Self-reported behavior and mood were measured as the energy devoted to moving toward valued domains or away from difficult emotions and with depressive d and manic m scores from the digital survey of mood in BP survey (digiBP). Results: Participants completed an average of 66% of in-app assessments. Interventions did not significantly impact the average toward energy or away energy but did significantly increase the average manic score m (P=.008) and depressive score d (P=.02). This was driven by increased fidgeting and irritability and interventions focused on increasing awareness of internal experiences. Conclusions: The findings of the study do not support a larger study on the mobile ACT in BP but have significant implications for future studies seeking mobile therapy for individuals with BP. Trial Registration: ClinicalTrials.gov NCT04098497; https://clinicaltrials.gov/ct2/show/NCT04098497 %M 37079363 %R 10.2196/43164 %U https://mental.jmir.org/2023/1/e43164 %U https://doi.org/10.2196/43164 %U http://www.ncbi.nlm.nih.gov/pubmed/37079363 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42316 %T Suicide Prevention Using Google Ads: Randomized Controlled Trial Measuring Engagement %A Onie,Sandersan %A Berlinquette,Patrick %A Holland,Sarah %A Livingstone,Nicola %A Finemore,Coco %A Gale,Nyree %A Elder,Emma %A Laggis,George %A Heffernan,Cassandra %A Armstrong,Susanne Oliver %A Theobald,Adam %A Josifovski,Natasha %A Torok,Michelle %A Shand,Fiona %A Larsen,Mark %+ Black Dog Institute, 1 Hospital Rd, Randwick, 2031, Australia, 61 (02) 9382 4530, s.onie@blackdog.org.au %K suicide prevention %K suicide %K suicidal %K self harm %K digital advertising %K Google Ads %K search %K suicide hotline %K advertise %K advertising %K campaign %K mental health %K prevention %K digital intervention %K online intervention %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Studies have shown that individuals may search for suicide-related terms on the internet prior to an attempt. Objective: Thus, across 2 studies, we investigated engagement with an advertisement campaign designed to reach individuals contemplating suicide. Methods: First, we designed the campaign to focus on crisis, running a campaign for 16 days in which crisis-related keywords would trigger an ad and landing page to help individuals find the national suicide hotline number. Second, we expanded the campaign to also help individuals contemplating suicide, running the campaign for 19 days with a wider range of keywords through a co-designed website with a wider range of offerings (eg, lived experience stories). Results: In the first study, the ad was shown 16,505 times and was clicked 664 times (4.02% click rate). There were 101 calls to the hotline. In the second study, the ad was shown 120,881 times and clicked 6227 times (5.15% click rate); of these 6227 clicks, there were 1419 (22.79%) engagements with the site, a substantially higher rate than the industry average of 3%. The number of clicks on the ad was high despite a suicide hotline banner likely being present. Conclusions: Search advertisements are a quick, far-reaching, and cost-efficient way of reaching those contemplating suicide and are needed despite suicide hotline banners being present. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623000084684; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385209 %M 37079348 %R 10.2196/42316 %U https://mental.jmir.org/2023/1/e42316 %U https://doi.org/10.2196/42316 %U http://www.ncbi.nlm.nih.gov/pubmed/37079348 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e46154 %T Using Digital Measurement–Based Care for the Treatment of Anxiety and Depression in Children and Adolescents: Observational Retrospective Analysis of Bend Health Data %A Huffman,Landry Goodgame %A Lawrence-Sidebottom,Darian %A Huberty,Jennifer %A Roots,Monika %A Roots,Kurt %A Parikh,Amit %A Guerra,Rachael %A Weiser,Jaclyn %+ Bend Health Inc, 9450 SW Gemini Drive, Beaverton, OR, 97008, United States, 1 800 516 0975, landry.huffman@bendhealth.com %K digital mental health intervention %K anxiety %K depression %K child %K adolescent %K collaborative care %K mental health %K caregiver %K pediatric %K youth %K demographic %K health outcome %K retrospective %K treatment %K e-mental health %K symptoms %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: A growing body of evidence supports the efficacy of measurement-based care (MBC) for children and adolescents experiencing mental health concerns, particularly anxiety and depression. In recent years, MBC has increasingly transitioned to web-based spaces in the form of digital mental health interventions (DMHIs), which render high-quality mental health care more accessible nationwide. Although extant research is promising, the emergence of MBC DMHIs means that much is unknown regarding their effectiveness as a treatment for anxiety and depression, particularly among children and adolescents. Objective: This study uses preliminary data from children and adolescents participating in an MBC DMHI administered by Bend Health Inc, a mental health care provider that uses a collaborative care model to assess changes in anxiety and depressive symptoms during participation in the MBC DMHI. Methods: Caregivers of children and adolescents participating in Bend Health Inc for anxiety or depressive symptoms reported measures of their children’s symptoms every 30 days throughout the duration of participation in Bend Health Inc. Data from 114 children (age 6-12 years) and adolescents (age 13-17 years) were used for the analyses (anxiety symptom group: n=98, depressive symptom group: n=61). Results: Among children and adolescents participating in care with Bend Health Inc, 73% (72/98) exhibited improvements in anxiety symptoms and 73% (44/61) exhibited improvement in depressive symptoms, as indicated by either a decrease in symptom severity or screening out of completing the complete assessment. Among those with complete assessment data, group-level anxiety symptom T-scores exhibited a moderate decrease of 4.69 points (P=.002) from the first to the last assessment. However, members’ depressive symptom T-scores remained largely stable throughout their involvement. Conclusions: As increasing numbers of young people and families seek DMHIs over traditional mental health treatments due to their accessibility and affordability, this study offers promising early evidence that youth anxiety symptoms decrease during involvement in an MBC DMHI such as Bend Health Inc. However, further analyses with enhanced longitudinal symptom measures are necessary to determine whether depressive symptoms show similar improvements among those involved in Bend Health Inc. %M 37079366 %R 10.2196/46154 %U https://pediatrics.jmir.org/2023/1/e46154 %U https://doi.org/10.2196/46154 %U http://www.ncbi.nlm.nih.gov/pubmed/37079366 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45305 %T The Impact of Family Therapy Participation on Youths and Young Adult Engagement and Retention in a Telehealth Intensive Outpatient Program: Quality Improvement Analysis %A Berry,Katie R %A Gliske,Kate %A Schmidt,Clare %A Ballard,Jaime %A Killian,Michael %A Fenkel,Caroline %+ Charlie Health, Inc, 233 E Main St Suite 401, Bozeman, MT, 59715, United States, 1 9545527671, krberry@fsu.edu %K adolescents %K family therapy %K intensive outpatient %K mental health %K treatment engagement %K young adults %D 2023 %7 20.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background:  Early treatment dropout among youths and young adults (28%-75%) puts them at risk for poorer outcomes. Family engagement in treatment is linked to lower dropout and better attendance in outpatient, in-person treatment. However, this has not been studied in intensive or telehealth settings. Objective:  We aimed to examine whether family members’ participation in telehealth intensive outpatient (IOP) therapy for mental health disorders in youths and young adults is associated with patient’s treatment engagement. A secondary aim was to assess demographic factors associated with family engagement in treatment. Methods:  Data were collected from intake surveys, discharge outcome surveys, and administrative data for patients who attended a remote IOP for youths and young adults, nationwide. Data included 1487 patients who completed both intake and discharge surveys and either completed or disengaged from treatment between December 2020 and September 2022. Descriptive statistics were used to characterize the sample’s baseline differences in demographics, engagement, and participation in family therapy. Mann-Whitney U and chi-square tests were used to explore differences in engagement and treatment completion between patients with and those without family therapy. Binomial regression was used to explore significant demographic predictors of family therapy participation and treatment completion. Results:  Patients with family therapy had significantly better engagement and treatment completion outcomes than clients with no family therapy. Youths and young adults with ≥1 family therapy session were significantly more likely to stay in treatment an average of 2 weeks longer (median 11 weeks vs 9 weeks) and to attend a higher percentage of IOP sessions (median 84.38% vs 75.00%). Patients with family therapy were more likely to complete treatment than clients with no family therapy (608/731, 83.2% vs 445/752, 59.2%; P<.001). Different demographic variables were associated with an increased likelihood of participating in family therapy, including younger age (odds ratio 1.3) and identifying as heterosexual (odds ratio 1.4). After controlling for demographic factors, family therapy remained a significant predictor of treatment completion, such that each family therapy session attended was associated with a 1.4-fold increase in the odds of completing treatment (95% CI 1.3-1.4). Conclusions:  Youths and young adults whose families participate in any family therapy have lower dropout, greater length of stay, and higher treatment completion than those whose families do not participate in services in a remote IOP program. The findings of this quality improvement analysis are the first to establish a relationship between participation in family therapy and an increased engagement and retention in remote treatment for youths and young patients in IOP programing. Given the established importance of obtaining an adequate dosage of treatment, bolstering family therapy offerings is another tool that could contribute to the provision of care that better meets the needs of youths, young adults, and their families. %M 37079372 %R 10.2196/45305 %U https://formative.jmir.org/2023/1/e45305 %U https://doi.org/10.2196/45305 %U http://www.ncbi.nlm.nih.gov/pubmed/37079372 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43956 %T A Digital Peer Support Platform to Translate Online Peer Support for Emerging Adult Mental Well-being: Randomized Controlled Trial %A Yeo,GeckHong %A Loo,Gladys %A Oon,Matt %A Pang,Rachel %A Ho,Dean %+ N.1 Institute for Health, National University of Singapore, 28 Medical Drive, Singapore, 117456, Singapore, 65 6601 7766, geckhongyeo@gmail.com %K mental health %K digital health %K peer support intervention %K peer emotional disclosure %K randomized controlled trial %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Emerging adulthood (ages 19 to 25 years) is a developmental phase that is marked by increased mental health conditions, especially depression and anxiety. A growing body of work indicates that digital peer emotional support has positive implications for the psychological functioning of emerging adults. There is burgeoning interest among health care professionals, educational stakeholders, and policy makers in understanding the implementation and clinical effectiveness, as well as the associated mechanism of change, of digital peer support as an intervention. Objective: This randomized controlled trial (RCT) examined the effectiveness of a digital peer support intervention over a digital platform—Acceset—for emerging adult psychological well-being with 3 primary aims. First, we evaluated the implementation effectiveness of digital peer support training for individuals providing support (befrienders) and of the digital platform for peer support. Second, we assessed the clinical outcomes of digital peer support in terms of the intervening effect on emerging adult psychological well-being. Third, we investigated the mechanism of change linking the digital peer support intervention to emerging adult psychological well-being. Methods: This RCT involving 100 emerging adults from the National University of Singapore follows the published protocol for this trial. Results: This RCT found effectiveness in digital peer support training—specifically, befrienders’ peer support responses demonstrating significantly higher post- than pretraining scores in selfhood (posttraining score: mean 62.83, SD 10.18, and SE 1.72; pretraining score: mean 54.86, SD 7.32, and SE 1.24; t34=3.88; P<.001). The digital peer support intervention demonstrated clinical effectiveness in enhancing selfhood, compassion, and mindfulness and lowering depressive and anxiety symptoms among seekers in the intervention group after the intervention (mean 7.15, SD 5.14; SE 0.88) than among seekers in the waitlist control group before the intervention (mean 11.75, SD 6.72; SE 0.89; t89=3.44; P<.001). The effect of the intervention on seekers’ psychological well-being was sustained beyond the period of the intervention. The mechanism of change revealed that seekers’ engagement with the intervention had both immediate and prospective implications for their psychological well-being. Conclusions: This RCT of a digital peer support intervention for emerging adult psychological well-being harnesses the interventional potential of 4 components of psychological well-being and elucidated a mechanism of change. By incorporating and validating the digital features and process of a peer support platform, our RCT provides the parameters and conditions for deploying an effective and novel digital peer support intervention for emerging adult psychological well-being in real-world settings. Trial Registration: ClinicalTrials.gov NCT05083676; https://clinicaltrials.gov/ct2/show/NCT05083676 %M 36756843 %R 10.2196/43956 %U https://mental.jmir.org/2023/1/e43956 %U https://doi.org/10.2196/43956 %U http://www.ncbi.nlm.nih.gov/pubmed/36756843 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44722 %T The Impacts of a Psychoeducational Alcohol Resource During Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety: Observational Study %A Peynenburg,Vanessa %A Sapkota,Ram P %A Lozinski,Tristen %A Sundström,Christopher %A Wilhelms,Andrew %A Titov,Nickolai %A Dear,Blake %A Hadjistavropoulos,Heather %+ University of Regina, 3737 Wascana Parkway, Regina, SK, Canada, 1 306 585 5133, hadjista@uregina.ca %K internet-delivered cognitive behavioral therapy %K transdiagnostic %K depression %K anxiety %K alcohol %K drinking %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Problematic alcohol use is common among clients seeking transdiagnostic internet-delivered cognitive behavioral therapy (ICBT) for depression or anxiety but is not often addressed in these treatment programs. The benefits of offering clients a psychoeducational resource focused on alcohol use during ICBT for depression or anxiety are unknown. Objective: This observational study aimed to elucidate the impacts of addressing comorbid alcohol use in ICBT for depression and anxiety. Methods: All patients (N=1333) who started an 8-week transdiagnostic ICBT course for depression and anxiety received access to a resource containing information, worksheets, and strategies for reducing alcohol use, including psychoeducation, reasons for change, identifying risk situations, goal setting, replacing drinking with positive activities, and information on relapse prevention. We assessed clients’ use and perceptions of the resource; client characteristics associated with reviewing the resource; and whether reviewing the resource was associated with decreases in clients’ alcohol use, depression, and anxiety at posttreatment and 3-month follow-up among clients dichotomized into low-risk and hazardous drinking categories based on pretreatment Alcohol Use Disorders Identification Test (AUDIT) scores. Results: During the 8-week course, 10.8% (144/1333) of clients reviewed the resource, and those who reviewed the resource provided positive feedback (eg, 127/144, 88.2% of resource reviewers found it worth their time). Furthermore, 18.15% (242/1333) of clients exhibited hazardous drinking, with 14.9% (36/242) of these clients reviewing the resources. Compared with nonreviewers, resource reviewers were typically older (P=.004) and separated, divorced, or widowed (P<.001). Reviewers also consumed more weekly drinks (P<.001), scored higher on the AUDIT (P<.001), and were more likely to exhibit hazardous drinking (P<.001). Regardless of their drinking level (ie, low risk vs hazardous), all clients showed a reduction in AUDIT-Consumption scores (P=.004), depression (P<.001), and anxiety (P<.001) over time; in contrast, there was no change in clients’ drinks per week over time (P=.81). Reviewing alcohol resources did not predict changes in AUDIT-Consumption scores or drinks per week. Conclusions: Overall, ICBT appeared to be associated with a reduction in alcohol consumption scores, but this reduction was not greater among alcohol resource reviewers. Although there was some evidence that the resource was more likely to be used by clients with greater alcohol-related difficulties, the results suggest that further attention should be given to ensuring that those who could benefit from the resource review it to adequately assess the benefits of the resource. %M 37071454 %R 10.2196/44722 %U https://mental.jmir.org/2023/1/e44722 %U https://doi.org/10.2196/44722 %U http://www.ncbi.nlm.nih.gov/pubmed/37071454 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45309 %T Geolocation Patterns, Wi-Fi Connectivity Rates, and Psychiatric Symptoms Among Urban Homeless Youth: Mixed Methods Study Using Self-report and Smartphone Data %A Ilyas,Yousaf %A Hassanbeigi Daryani,Shahrzad %A Kiriella,Dona %A Pachwicewicz,Paul %A Boley,Randy A %A Reyes,Karen M %A Smith,Dale L %A Zalta,Alyson K %A Schueller,Stephen M %A Karnik,Niranjan S %A Stiles-Shields,Colleen %+ Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, United States, 1 3122730185, ecss@uic.edu %K mHealth %K mobile health %K smartphones %K geolocation %K Wi-Fi %K youth experiencing homelessness %K mobile phone %K homelessness %K youth %D 2023 %7 18.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite significant research done on youth experiencing homelessness, few studies have examined movement patterns and digital habits in this population. Examining these digital behaviors may provide useful data to design new digital health intervention models for youth experiencing homelessness. Specifically, passive data collection (data collected without extra steps for a user) may provide insights into lived experience and user needs without putting an additional burden on youth experiencing homelessness to inform digital health intervention design. Objective: The objective of this study was to explore patterns of mobile phone Wi-Fi usage and GPS location movement among youth experiencing homelessness. Additionally, we further examined the relationship between usage and location as correlated with depression and posttraumatic stress disorder (PTSD) symptoms. Methods: A total of 35 adolescent and young adult participants were recruited from the general community of youth experiencing homelessness for a mobile intervention study that included installing a sensor data acquisition app (Purple Robot) for up to 6 months. Of these participants, 19 had sufficient passive data to conduct analyses. At baseline, participants completed self-reported measures for depression (Patient Health Questionnaire-9 [PHQ-9]) and PTSD (PTSD Checklist for DSM-5 [PCL-5]). Behavioral features were developed and extracted from phone location and usage data. Results: Almost all participants (18/19, 95%) used private networks for most of their noncellular connectivity. Greater Wi-Fi usage was associated with a higher PCL-5 score (P=.006). Greater location entropy, representing the amount of variability in time spent across identified clusters, was also associated with higher severity in both PCL-5 (P=.007) and PHQ-9 (P=.045) scores. Conclusions: Location and Wi-Fi usage both demonstrated associations with PTSD symptoms, while only location was associated with depression symptom severity. While further research needs to be conducted to establish the consistency of these findings, they suggest that the digital patterns of youth experiencing homelessness offer insights that could be used to tailor digital interventions. %M 37071457 %R 10.2196/45309 %U https://formative.jmir.org/2023/1/e45309 %U https://doi.org/10.2196/45309 %U http://www.ncbi.nlm.nih.gov/pubmed/37071457 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44064 %T Digital Technology Use and Mental Health Consultations: Survey of the Views and Experiences of Clinicians and Young People %A Rifkin-Zybutz,Raphael %A Turner,Nicholas %A Derges,Jane %A Bould,Helen %A Sedgewick,Felicity %A Gooberman-Hill,Rachael %A Linton,Myles-Jay %A Moran,Paul %A Biddle,Lucy %+ Population Health Sciences, Bristol University Medical School, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom, 44 (0)117 928 9000, lucy.biddle@bristol.ac.uk %K internet %K adolescent %K child %K mental health %K anxiety %K patient-physician relationship %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital technologies play an increasingly important role in the lives of young people and have important effects on their mental health. Objective: We aimed to explore 3 key areas of the intersection between digital technology and mental health: the views and experiences of young people and clinicians about digital technology and mental health; implementation and barriers to the UK national guidance recommendation—that the discussion of digital technology use should form a core part of mental health assessment; and how digital technology might be used to support existing consultations. Methods: Two cross-sectional web-based surveys were conducted in 2020 between June and December, with mental health clinicians (n=99) and young people (n=320). Descriptive statistics were used to summarize the proportions. Multilinear regression was used to explore how the answers varied by gender, sexuality, and age. Thematic analysis was used to explore the contents of the extended free-text answers. Anxiety was measured using the Generalized Anxiety Disorder Questionnaire-7 (GAD-7). Results: Digital technology use was ubiquitous among young people, with positive and negative aspects acknowledged by both clinicians and young people. Negative experiences were common (131/284, 46.1%) and were associated with increased anxiety levels among young people (GAD-7 3.29; 95% CI 1.97-4.61; P<.001). Although the discussion of digital technology use was regarded as important by clinicians and acceptable by young people, less than half of clinicians (42/85, 49.4%) routinely asked about the use of digital technology and over a third of young people (48/121, 39.6%) who had received mental health care had never been asked about their digital technology use. The conversations were often experienced as unhelpful. Helpful conversations were characterized by greater depth and exploration of how an individual’s digital technology use related to mental health. Despite most clinicians (59/83, 71.1%) wanting training, very few (21/86, 24.4%) reported receiving training. Clinicians were open to viewing mental health data from apps or social media to help with consultations. Although young people were generally, in theory, comfortable sharing such data with health professionals, when presented with a binary choice, most reported not wanting to share social media (84/117, 71.8%) or app data (67/118, 56.8%) during consultations. Conclusions: Digital technology use was common, and negative experiences were frequent and associated with anxiety. Over a third of young people were not asked about their digital technology use during mental health consultations, and potentially valuable information about relevant negative experiences on the web was not being captured during consultations. Clinicians would benefit from having access to training to support these discussions with young people. Although young people recognized that app data could be helpful to clinicians, they appeared hesitant to share their own data. This finding suggests that data sharing has barriers that need to be further explored. %M 37067869 %R 10.2196/44064 %U https://mental.jmir.org/2023/1/e44064 %U https://doi.org/10.2196/44064 %U http://www.ncbi.nlm.nih.gov/pubmed/37067869 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44183 %T Personalized, Naturalistic Virtual Reality Scenarios Coupled With Web-Based Progressive Muscle Relaxation Training for the General Population: Protocol for a Proof-of-Principle Randomized Controlled Trial %A Pardini,Susanna %A Gabrielli,Silvia %A Olivetto,Silvia %A Fusina,Francesca %A Dianti,Marco %A Forti,Stefano %A Lancini,Cristina %A Novara,Caterina %+ Department of General Psychology, University of Padova, via Venezia 14, Padova, 35131, Italy, 39 3335944315, susanna.pardini@phd.unipd.it %K digital health %K progressive muscular relaxation technique %K mental well-being %K virtual reality therapy %K anxiety %K relaxation %K e-therapy %K e-Health %K virtual reality %K tool %K symptoms %K depression %K quality of life %K coping %D 2023 %7 17.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Virtual reality (VR) is an innovative tool that can facilitate exposure to either stressful or relaxing stimuli and enables individuals who have difficulties visualizing scenes to be involved in a more realistic sensorimotor experience. It also facilitates multisensory stimulation, a sense of presence, and achievement of relaxation. VR scenarios representing visual and auditory elements of natural relaxing environments can facilitate the learning of relaxation techniques such as the progressive muscle relaxation technique (PMRT). A complementary standardized technique deployed to reduce anxiety symptoms is the integration of PMRT and guided imagery (GI). Exposure to a pleasant imaginary environment helps the establishment of an association between a relaxing scenario and the relaxation technique, consequently promoting relaxation. Empirical evidence has shown that VR scenarios can increase the effects of relaxation techniques by enabling people to experience emotional conditions in more vivid settings. Objective: The main aim of this pilot study protocol is to investigate the impact on state anxiety of PMRT, associated with a personalized relaxing scenario in VR, and the role of VR scenarios in facilitating the recall of relaxing images and a sense of presence. A secondary aim is to understand if relaxing sessions administered via Zoom are more effective for managing anxiety and stress than a procedural setting based on audio-track guidance. Methods: Based on a longitudinal, between-subject design, 108 university students will be randomly exposed to one of three experimental conditions: (1) PMRT via Zoom and GI exposure, (2) PMRT via Zoom and personalized VR exposure, and (3) PMRT based on audio-track guidance and personalized VR exposure. Individuals are assessed before and after 7 training sessions based on self-report questionnaires investigating anxiety, depression, quality of life, coping strategies, sense of presence, engagement, and side effects related to VR exposure. Heart rate data are also detected by an Mi Band 2 sensor. Results: The experimental procedure is ongoing. In this paper, preliminary data from a sample of 40 participants will be illustrated. The experimental phase is expected to conclude in May 2023, and the final results of the research will be presented in June 2023. Conclusions: The results of this study will help shape the experimental design to apply it on a subsequent randomized controlled trial, also considering clinical samples. This work is expected to measure whether VR is a more engaging and helpful technique in promoting relaxation and decreasing anxiety levels than GI, by making the visualization process easier and by helping people to face more realistic sensory experiences. Assessing the efficacy of the PMRT in alternative delivery modes may extend its applications, especially in situations where the standard procedure is more challenging to be administered. To our knowledge, no equivalent study has been published so far on this matter. Trial Registration: ClinicalTrials.gov NCT05478941; https://clinicaltrials.gov/ct2/show/NCT05478941 International Registered Report Identifier (IRRID): DERR1-10.2196/44183 %M 37067881 %R 10.2196/44183 %U https://www.researchprotocols.org/2023/1/e44183 %U https://doi.org/10.2196/44183 %U http://www.ncbi.nlm.nih.gov/pubmed/37067881 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37847 %T Sensory Overresponsivity and Symptoms Across the Obsessive-Compulsive Spectrum: Web-Based Longitudinal Observational Study %A Moreno-Amador,Beatriz %A Cervin,Matti %A Martínez-González,Agustin Ernesto %A Piqueras,Jose A %A , %+ Area of Personality, Assessment and Psychological Treatment, Department of Health Psychology, Universidad Miguel Hernández de Elche, Edificio Altamira, Avda. de la Universidad, s/n, Elche, 03202, Spain, 34 966658343, jpiqueras@umh.es %K sensory symptoms %K sensory overresponsivity %K obsessive-compulsive %K hair-pulling %K skin-picking %K hoarding %K body dysmorphic %K adolescents %K adults %D 2023 %7 13.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sensory overresponsivity (SOR) has emerged as a potential endophenotype in obsessive-compulsive disorder (OCD), but few studies have examined SOR in relation to the major symptom dimensions of OCD and to symptoms across the full obsessive-compulsive (OC) symptom spectrum. Objective: This study had 2 main objectives. First, we examined the psychometric properties of the SOR Scales in a community-based sample of Spanish adolescents and adults. Second, we identified how SOR difficulties are related to symptoms across the full OC spectrum (eg, OC, body dysmorphic, hoarding, skin-picking, and hair-pulling symptoms), including the heterogeneity of OC symptoms. Methods: We translated the SOR Scales into Spanish—a measure that assesses SOR across the 5 sensory modalities—and created a web-based version of the measure. A sample of 1454 adolescents and adults (mean age 23.84, SD 8.46 years) participated in the study, and 388 (26.69%) participants completed the survey twice (approximately 8 months apart). The survey also contained a web-based measure that assesses symptoms across the full OC spectrum: harm and checking, taboo obsessions, contamination or cleaning, symmetry and ordering, body dysmorphic, hoarding, hair-pulling, and skin-picking symptoms. Results: The psychometric properties of the SOR Scales were excellent, and the test-retest reliability was adequate. All types of SOR were related to all major symptom dimensions of OCD and to all OC spectrum symptoms. Conclusions: SOR across the sensory modalities can be validly assessed using a web-based measure. SOR emerged as a pure transdiagnostic phenomenon in relation to symptoms across the OC spectrum, with no specific sensory modality being more strongly related to OC symptoms. SOR can shed much needed light on basic mechanisms that are important for the onset and maintenance of OC spectrum symptoms, and this study shows that large-scale web-based studies can aid in this endeavor. Future studies should examine whether SOR precedes or emerges alongside OC symptoms. %M 37052983 %R 10.2196/37847 %U https://www.jmir.org/2023/1/e37847 %U https://doi.org/10.2196/37847 %U http://www.ncbi.nlm.nih.gov/pubmed/37052983 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e45616 %T A Family-Based Collaborative Care Model for Treatment of Depressive and Anxiety Symptoms in Perinatal Women: Results From a Pilot Study %A Cluxton-Keller,Fallon %A Olson,Ardis %+ Department of Psychiatry, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 4726, Fallon.P.Cluxton-Keller@dartmouth.edu %K anxiety %K depression %K family treatment %K infant care %K maternal health %K parenting %K pediatric primary care %K perinatal anxiety %K perinatal care %K perinatal depression %K video therapy %K women's health %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Untreated perinatal depression and anxiety can have detrimental consequences on family function. Logistical barriers prevent many perinatal women from accessing treatment, and these barriers are compounded for women residing in rural areas. This paper describes a Family-Based Collaborative Care Model (FBCCM) that is designed to bypass barriers to increase access to care for depressed and anxious perinatal women in rural regions of the United States. The FBCCM includes the following two components: (1) a 10-session video-delivered family therapy treatment for perinatal depression and anxiety and (2) a video-delivered infant care provider training on addressing the parenting needs of depressed and anxious mothers. Objective: This paper describes the feasibility of implementing the FBCCM with families and infant care providers. Findings are presented on the preliminary effectiveness of the video-delivered family therapy treatment in reducing maternal depressive and anxiety symptoms, and family conflict. Methods: This pilot study was carried out using an implementation-effectiveness hybrid trial design without a comparison group. Changes in maternal depressive symptoms, maternal anxiety symptoms, and family conflict were measured at posttreatment, 3 months, and 6 months later. Results: On average, mothers (n=24) attended 9.79 (SD 1.02) sessions. On average, their family members (n=24) attended 9.42 (SD 1.28) sessions. A total of 31 infant care providers attended the training on addressing the parenting needs of depressed and anxious mothers. Mothers reported a significant reduction in depressive symptoms (P<.001) and anxiety symptoms (P<.001) from baseline to the 6-month follow-up. Mothers reported a significant reduction in conflict (P<.001), and their family members also reported a significant reduction in conflict (P=.007) from baseline to the 6-month follow-up. Conclusions: The findings from this study provide support for the feasibility and preliminary effectiveness of the FBCCM. The findings will be used to inform a larger study of the FBCCM. %M 37052997 %R 10.2196/45616 %U https://pediatrics.jmir.org/2023/1/e45616 %U https://doi.org/10.2196/45616 %U http://www.ncbi.nlm.nih.gov/pubmed/37052997 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40671 %T Sensa Mobile App for Managing Stress, Anxiety, and Depression Symptoms: Pilot Cohort Study %A Valinskas,Sarunas %A Nakrys,Marius %A Aleknavicius,Kasparas %A Jonusas,Justinas %+ KiloHealth, Antakalnio st. 17, Vilnius, LT 10312, Lithuania, 370 61456067, justinas.jonusas@kilo.health %K depression %K anxiety %K stress %K depressive %K DASS-21 %K mobile application %K CBT %K cognitive behavioral therapy %K psychotherapy %K mHealth %K mobile health %K Sensa %K app %K application %K health care %K intervention %K effectiveness %K assessment %K symptoms %K treatment %K mental health %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: An increase in depression, anxiety, and stress symptoms worldwide, attributed to the COVID-19 pandemic, has been reported. If not treated, it may negatively affect a person's everyday life by altering physical and social well-being and productivity and increasing expenditure on health care. Cognitive behavioral therapy (CBT)–based interventions are gaining popularity as a means to reduce stress and alleviate anxiety and depression symptoms. Moreover, CBT delivered through a mobile app has the same elements as traditional CBT training (eg, guided discovery). However, unlike conventional training, users of mobile apps are allowed to tailor their own experience at their own speed and schedule. Objective: This study aims to analyze Sensa users’ retrospective data and explore the dose-duration effect to find the optimal usage time when the user showed results. Methods: The study cohort comprised 381 consecutive community-based nonclinical users who started using Sensa between October 2021 and March 2022. All users included in the study took the Depression Anxiety Stress Scale-21 (DASS-21) assessment at least 2 times. Other parameters from the database containing all self-reported data were gender, number of active days, total time of use, and age. The primary outcome of the study was a change in the DASS-21 score. Statistical analyses were performed using GraphPad Prism (version 9, GraphPad Software). In addition, a logistic regression model was created to predict how the obtained independent parameters influenced the DASS-21 score. Results: The main finding of our study was that the majority of participants who started using Sensa were experiencing depression, anxiety, and stress symptoms (92.13%, 80.05%, and 87.93%, respectively). There was a statistically significant decrease of the DASS-21 subdomain scores after the use of the application (anxiety: mean 7.25, SD 4.03 vs mean 6.12, SD 4.00; P=.001; depression: mean 11.05, SD 4.26 vs mean 9.01, SD 4.77; P=.001; stress: mean 11.42, SD 3.44 vs mean 9.96, SD 3.65; P<.001). Finally, the logistic regression model showed that users who were using the app for more than 24 days and had at least 12 active days during that time had 3.463 (95% CI 1.142-11.93) and 2.644 (95% CI 1.024-7.127) times higher chances to reduce their DASS-21 subdomain scores of depression and anxiety, respectively. Conclusions: Using the Sensa mobile app was related to decreased depression, anxiety, and stress symptoms. %M 37052990 %R 10.2196/40671 %U https://formative.jmir.org/2023/1/e40671 %U https://doi.org/10.2196/40671 %U http://www.ncbi.nlm.nih.gov/pubmed/37052990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39029 %T Time-Dependent Changes in Depressive Symptoms Among Control Participants in Digital-Based Psychological Intervention Studies: Meta-analysis of Randomized Controlled Trials %A Tong,Alan CY %A Ho,Florence SY %A Chu,Owen HH %A Mak,Winnie WS %+ Department of Psychology, The Chinese University of Hong Kong, Rm 354, Sino Building, New Territories, Hong Kong, 852 39436577, wwsmak@cuhk.edu.hk %K digital-based psychological intervention %K control groups %K meta-analysis %K depression %K depressive symptoms %K mobile phone %D 2023 %7 12.4.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital-based psychological interventions (DPIs) have been shown to be efficacious in many randomized controlled trials (RCTs) in dealing with depression in adults. However, the effects of control comparators in these DPI studies have been largely overlooked, and they may vary in their effects on depression management. Objective: This meta-analytical study aimed to provide a quantitative estimate of the within-subject effects of control groups across different time intervals and explore the moderating effects of control types and symptom severity at baseline. Methods: A systematic literature search was conducted in late September 2021 on selected electronic databases: PubMed; ProQuest; Web of Science; and the Ovid system with MEDLINE, PsycINFO, and Embase. The control conditions in 107 RCTs with a total of 11,803 adults with depressive symptoms were included in the meta-analysis, and effect sizes (Hedges g) were calculated using the standardized mean difference approach. Study quality was assessed using the Cochrane risk-of-bias tool for randomized trials version 2. Results: The control conditions collectively yielded small to moderate effects in reducing depressive symptoms within 8 weeks since the baseline assessment (g=−0.358, 95% CI −0.434 to −0.281). The effects grew to moderate within 9 to 24 weeks (g=−0.549, 95% CI −0.638 to −0.460) and peaked at g=−0.810 (95% CI −0.950 to −0.670) between 25 and 48 weeks. The effects were maintained at moderate to large ranges (g=−0.769, 95% CI −1.041 to −0.498) beyond 48 weeks. The magnitude of the reduction differed across the types of control and severity of symptoms. Care as usual was the most powerful condition of all and produced a large effect (g=−0.950, 95% CI −1.161 to −0.739) in the medium term. The findings showed that waitlist controls also produced a significant symptomatic reduction in the short term (g=−0.291, 95% CI −0.478 to −0.104), refuting the previous suspicion of a nocebo effect. In addition, a large effect on depressive symptom reduction in the long term (g=−1.091, 95% CI −1.210 to −0.972) was noted among participants with severe levels of depressive symptoms at baseline. Conclusions: This study provided evidence that depressive symptoms generally reduced over time among control conditions in research trials of DPIs. Given that different control conditions produce variable and significant levels of symptomatic reduction, future intervention trials must adopt an RCT design and should consider the contents of control treatments when investigating the efficacy of DPIs. The results of waitlist controls confirmed previous findings of spontaneous recovery among people with mild to moderate depressive symptoms in face-to-face studies. Researchers may adopt watchful waiting as participants wait for the availability of digital-based psychological services. %M 37043276 %R 10.2196/39029 %U https://www.jmir.org/2023/1/e39029 %U https://doi.org/10.2196/39029 %U http://www.ncbi.nlm.nih.gov/pubmed/37043276 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45970 %T Barriers to and Facilitators of a Blended Cognitive Behavioral Therapy Program for Depression and Anxiety Based on Experiences of University Students: Qualitative Interview Study %A Braun,Pia %A Atik,Ece %A Guthardt,Lisa %A Apolinário-Hagen,Jennifer %A Schückes,Magnus %+ Institute of Occupational, Social and Environmental Medicine, Faculty of Medicine, Centre for Health and Society, Heinrich Heine University Düsseldorf, Moorenstr. 5, Düsseldorf, 40225, Germany, 49 211 8106477, jennifer.apolinario.hagen@hhu.de %K digital therapeutics %K blended cognitive behavioral therapy %K bCBT %K depression %K anxiety %K acceptance %K user experiences %K university students %K mobile phone %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Blended cognitive behavioral therapy (bCBT) programs have been proposed to increase the acceptance and adoption of digital therapeutics (DTx) such as digital health apps. These programs allow for more personalized care by combining regular face-to-face therapy sessions with DTx. However, facilitators of and barriers to the use of DTx in bCBT programs have rarely been examined among students, who are particularly at risk for developing symptoms of depression and anxiety disorders. Objective: This study aimed to evaluate the facilitators of and barriers to the use of a bCBT program with the elona therapy app among university students with mild to moderate depression or anxiety symptoms. Methods: Semistructured interviews were conducted via videoconference between January 2022 and April 2022 with 102 students (mean age 23.93, SD 3.63 years; 89/102, 87.2% female) from universities in North Rhine-Westphalia, Germany, after they had completed weekly individual cognitive behavioral therapy sessions (25 minutes each) via videoconference for 6 weeks and regularly used the depression (n=67, 65.7%) or anxiety (n=35, 34.3%) module of the app. The interviews were coded based on grounded theory. Results: Many participants highlighted the intuitive handling of the app and indicated that they perceived it as a supportive tool between face-to-face sessions. Participants listed other benefits, such as increased self-reflection and disorder-specific knowledge as well as the transfer of the content of therapy sessions into their daily lives. Some stated that they would have benefited from more personalized and interactive tasks. In general, participants mentioned the time requirement, increased use of the smartphone, and the feeling of being left alone with potentially arising emotions while working on tasks for the next therapy session as possible barriers to the use of the app. Data security was not considered a major concern. Conclusions: Students mostly had positive attitudes toward elona therapy as part of the bCBT program. Our study shows that DTx complementing face-to-face therapy sessions can be perceived as a helpful tool for university students with mild to moderate anxiety or depression symptoms in their daily lives. Future research could elaborate on whether bCBT programs might also be suitable for students with more severe symptoms of mental disorders. In addition, the methods by which such bCBT programs could be incorporated into the university context to reach students in need of psychological support should be explored. %M 37043272 %R 10.2196/45970 %U https://formative.jmir.org/2023/1/e45970 %U https://doi.org/10.2196/45970 %U http://www.ncbi.nlm.nih.gov/pubmed/37043272 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44756 %T Treating Depression in Adolescents and Young Adults Using Remote Intensive Outpatient Programs: Quality Improvement Assessment %A Evans-Chase,Michelle %A Solomon,Phyllis %A Peralta,Bethany %A Kornmann,Rachel %A Fenkel,Caroline %+ School of Social Policy & Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104, United States, 1 6096023792, meva@upenn.edu %K depression %K IOP %K LGBTQ+ %K mental health %K telehealth %K youth %K young adult %D 2023 %7 11.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Youth and young adults face barriers to mental health care, including a shortage of programs that accept youth and a lack of developmentally sensitive programming among those that do. This shortage, along with the associated geographically limited options, has contributed to the health disparities experienced by youth in general and by those with higher acuity mental health needs in particular. Although intensive outpatient programs can be an effective option for youth with more complex mental health needs, place-based intensive outpatient programming locations are still limited to clients who have the ability to travel to the clinical setting several days per week. Objective: The objective of the analysis reported here was to assess changes in depression between intake and discharge among youth and young adults diagnosed with depression attending remote intensive outpatient programming treatment. Analysis of outcomes and the application of findings to programmatic decisions are regular parts of ongoing quality improvement efforts of the program whose results are reported here. Methods: Outcomes data are collected for all clients at intake and discharge. The Patient Health Questionnaire (PHQ) adapted for adolescents is used to measure depression, with changes between intake and discharge regularly assessed for quality improvement purposes using repeated measures t tests. Changes in clinical symptoms are assessed using McNamar chi-square analyses. One-way ANOVA is used to test for differences among age, gender, and sexual orientation groups. For this analysis, 1062 cases were selected using criteria that included a diagnosis of depression and a minimum of 18 hours of treatment over a minimum of 2 weeks of care. Results: Clients ranged in age from 11 to 25 years, with an average of 16 years. Almost one-quarter (23%) identified as nongender binary and 60% identified as members of the lesbian, gay, bisexual, transgender, queer (LGBTQ+) community. Significant decreases (mean difference –6.06) were seen in depression between intake and discharge (t967=–24.68; P<.001), with the symptoms of a significant number of clients (P<.001) crossing below the clinical cutoff for major depressive disorder between intake and discharge (388/732, 53%). No significant differences were found across subgroups defined by age (F2,958=0.47; P=.63), gender identity (F7,886=1.20; P=.30), or sexual orientation (F7,872=0.47; P=.86). Conclusions: Findings support the use of remote intensive outpatient programming to treat depression among youth and young adults, suggesting that it may be a modality that is an effective alternative to place-based mental health treatment. Additionally, findings suggest that the remote intensive outpatient program model may be an effective treatment approach for youth from marginalized groups defined by gender and sexual orientation. This is important given that youth from these groups tend to have poorer outcomes and greater barriers to treatment compared to cisgender, heterosexual youth. %M 37040155 %R 10.2196/44756 %U https://formative.jmir.org/2023/1/e44756 %U https://doi.org/10.2196/44756 %U http://www.ncbi.nlm.nih.gov/pubmed/37040155 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e43904 %T Co-design of a Virtual Reality Cognitive Remediation Program for Depression (bWell-D) With Patient End Users and Clinicians: Qualitative Interview Study Among Patients and Clinicians %A Hernandez Hernandez,Maria Elena %A Michalak,Erin %A Choudhury,Nusrat %A Hewko,Mark %A Torres,Ivan %A Menon,Mahesh %A Lam,Raymond W %A Chakrabarty,Trisha %+ University of British Columbia, Faculty of Medicine, Department of Psychiatry, 2255 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 822 7314, elena.hernandez@ntnu.no %K depression %K cognitive remediation %K cognitive dysfunction %K thematic analysis %K virtual reality %K VR %K qualitative study %K user-centered design %K immersive %K co-design %K depressive %K mental health %K mental illness %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Major depressive disorder (MDD) is the leading cause of global disability; however, the existing treatments do not always address cognitive dysfunction—a core feature of MDD. Immersive virtual reality (VR) has emerged as a promising modality to enhance the real-world effectiveness of cognitive remediation. Objective: This study aimed to develop the first prototype VR cognitive remediation program for MDD (“bWell-D”). This study gathered qualitative data from end users early in the design process to enhance its efficacy and feasibility in clinical settings. Methods: Semistructured end-user interviews were conducted remotely (n=15 patients and n=12 clinicians), assessing the participants’ perceptions and goals for a VR cognitive remediation program. Video samples of bWell-D were also shared to obtain feedback regarding the program. The interviews were transcribed, coded, and analyzed via thematic analysis. Results: End users showed an optimistic outlook toward VR as a treatment modality, and perceived it as a novel approach with the potential of having multiple applications. The participants expressed a need for an engaging VR treatment that included realistic and multisensorial settings and activities, as well as customizable features. Some skepticism regarding its effectiveness was also reported, especially when the real-world applications of the practiced skills were not made explicit, as well as some concerns regarding equipment accessibility. A home-based or hybrid (ie, home and clinic) treatment modality was preferred. Conclusions: Patients and clinicians considered bWell-D interesting, acceptable, and potentially feasible, and provided suggestions to enhance its real-world applicability. The inclusion of end-user feedback is encouraged when developing future VR programs for clinical purposes. %M 37027183 %R 10.2196/43904 %U https://games.jmir.org/2023/1/e43904 %U https://doi.org/10.2196/43904 %U http://www.ncbi.nlm.nih.gov/pubmed/37027183 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42403 %T The Role of Compassionate Technology in Blended and Digital Mental Health Interventions: Systematic Scoping Review %A van Lotringen,Charlotte %A Lusi,Benedetta %A Westerhof,Gerben J %A Ludden,Geke D S %A Kip,Hanneke %A Kelders,Saskia M %A Noordzij,Matthijs L %+ Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, Netherlands, 31 534892100, c.m.vanlotringen@utwente.nl %K compassionate technology %K digital mental health interventions %K eHealth %K e–mental health %K compassion %K mental health care %D 2023 %7 7.4.2023 %9 Review %J JMIR Ment Health %G English %X Background: An essential value in mental health care is compassion: awareness of suffering, tolerating difficult feelings in the face of suffering, and acting or being motivated to alleviate suffering. Currently, technologies for mental health care are on the rise and could offer several advantages, such as more options for self-management by clients and more accessible and economically viable care. However, digital mental health interventions (DMHIs) have not been widely implemented in daily practice. Developing and evaluating DMHIs around important mental health care values, such as compassion, could be key for a better integration of technology in the mental health care context. Objective: This systematic scoping review explored the literature for previous instances where technology for mental health care has been linked to compassion or empathy to investigate how DMHIs can support compassion in mental health care. Methods: Searches were conducted in the PsycINFO, PubMed, Scopus, and Web of Science databases, and screening by 2 reviewers resulted in 33 included articles. From these articles, we extracted the following data: technology types, goals, target groups, and roles of the technologies in the intervention; study designs; outcome measures; and the extent to which the technologies met a 5-step proposed definition of compassion. Results: We found 3 main ways in which technology can contribute to compassion in mental health care: by showing compassion to people, by enhancing self-compassion in people, or by facilitating compassion between people. However, none of the included technologies met all 5 elements of compassion nor were they evaluated in terms of compassion. Conclusions: We discuss the potential of compassionate technology, its challenges, and the need to evaluate technology for mental health care on compassion. Our findings could contribute to the development of compassionate technology, in which elements of compassion are explicitly embedded in its design, use, and evaluation. %M 37027207 %R 10.2196/42403 %U https://mental.jmir.org/2023/1/e42403 %U https://doi.org/10.2196/42403 %U http://www.ncbi.nlm.nih.gov/pubmed/37027207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43115 %T Mental Health Practitioners’ and Young People’s Experiences of Talking About Social Media During Mental Health Consultations: Qualitative Focus Group and Interview Study %A Derges,Jane %A Bould,Helen %A Gooberman-Hill,Rachael %A Moran,Paul %A Linton,Myles-Jay %A Rifkin-Zybutz,Raphael %A Biddle,Lucy %+ Population Health Sciences, Bristol University Medical School, Canynge Hall, Whatley Road, Bristol, BS8 2PS, United Kingdom, 44 0117 455 6004, jd13527@bristol.ac.uk %K young people %K digital technology and social media %K mental health consultations %K clinician and young people’s experiences %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing concerns among mental health care professionals have focused on the impact of young people’s use of digital technology and social media on their mental well-being. It has been recommended that the use of digital technology and social media be routinely explored during mental health clinical consultations with young people. Whether these conversations occur and how they are experienced by both clinicians and young people are currently unknown. Objective: This study aimed to explore mental health practitioners’ and young people’s experiences of talking about young people’s web-based activities related to their mental health during clinical consultations. Web-based activities include use of social media, websites, and messaging. Our aim was to identify barriers to effective communication and examples of good practice. In particular, we wanted to obtain the views of young people, who are underrepresented in studies, on their social media and digital technology use related to mental health. Methods: A qualitative study was conducted using focus groups (11 participants across 3 groups) with young people aged 16 to 24 years and interviews (n=8) and focus groups (7 participants across 2 groups) with mental health practitioners in the United Kingdom. Young people had experience of mental health problems and support provided by statutory mental health services or third-sector organizations. Practitioners worked in children and young people’s mental health services, statutory services, or third-sector organizations such as a university counseling service. Thematic analysis was used to analyze the data. Results: Practitioners and young people agreed that talking about young people’s web-based activities and their impact on mental health is important. Mental health practitioners varied in their confidence in doing this and were keen to have more guidance. Young people said that practitioners seldom asked about their web-based activities, but when asked, they often felt judged or misunderstood. This stopped them from disclosing difficult web-based experiences and precluded useful conversations about web-based safety and how to access appropriate web-based support. Young people supported the idea of guidance or training for practitioners and were enthusiastic about sharing their experiences and being involved in the training or guidance provided to practitioners. Conclusions: Practitioners would benefit from structured guidance and professional development to enable them to support young people in feeling more willing to disclose and talk about their web-based experiences and their impact on their mental health. This is reflected in practitioners’ desire for guidance to improve their confidence and skills to safely support young people in navigating the challenges of the web-based world. Young people want to feel comfortable discussing their web-based activities during their consultations with mental health practitioners, both in tackling the challenges and using the opportunity to discuss their experiences, gain support, and develop coping strategies related to web-based safety. %M 37027182 %R 10.2196/43115 %U https://formative.jmir.org/2023/1/e43115 %U https://doi.org/10.2196/43115 %U http://www.ncbi.nlm.nih.gov/pubmed/37027182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43839 %T The Efficacy and Usability of an Unguided Web-Based Grief Intervention for Adults Who Lost a Loved One During the COVID-19 Pandemic: Randomized Controlled Trial %A Dominguez-Rodriguez,Alejandro %A Sanz-Gomez,Sergio %A González Ramírez,Leivy Patricia %A Herdoiza-Arroyo,Paulina Erika %A Trevino Garcia,Lorena Edith %A de la Rosa-Gómez,Anabel %A González-Cantero,Joel Omar %A Macias-Aguinaga,Valeria %A Miaja,Melina %+ School of Psychology, Universidad Internacional del Ecuador, Av. Simón Bolívar and Av. Jorge Fernández, Quito, 170102, Ecuador, 593 22985 600, pherdoiza@uide.edu.ec %K web-based intervention %K usability %K complicated grief %K hopelessness %K suicidal risk %K depression %K anxiety %K posttraumatic stress %K mobile phone %D 2023 %7 6.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The death of a loved one was a challenge many people faced during the COVID-19 pandemic within the context of extraordinary circumstances and great uncertainty. Grief is an unavoidable part of life, and for most people, feelings of grief decrease naturally over time. However, for some people, grieving can become a particularly painful process with clinical symptoms that may require professional help to resolve. To provide psychological support to people who had lost a loved one during the COVID-19 pandemic, an unguided web-based psychological intervention was developed. Objective: The main objective of this study was to evaluate the efficacy of the web-based treatment, Grief COVID (Duelo COVID in Spanish; ITLAB), in reducing clinical symptoms of complicated grief, depression, posttraumatic stress, hopelessness, anxiety, and suicidal risk in adults. The secondary aim was to validate the usability of the self-applied intervention system. Methods: We used a randomized controlled trial with an intervention group (IG) and a waitlist control group (CG). The groups were assessed 3 times (before beginning the intervention, upon completing the intervention, and 3 months after the intervention). The intervention was delivered on the web in an asynchronous format through the Duelo COVID web page. Participants created an account that could be used on their computers, smartphones, or tablets. The evaluation process was automated as part of the intervention. Results: A total of 114 participants were randomly assigned to the IG or CG and met criteria for inclusion in the study (n=45, 39.5% completed the intervention and n=69, 60.5% completed the waitlist period). Most participants (103/114, 90.4%) were women. The results indicated that the treatment significantly reduced baseline clinical symptoms in the IG for all variables (P<.001 to P=.006), with larger effect sizes for depression, hopelessness, grief, anxiety, and risk of suicide (all effect sizes ≥0.5). The follow-up evaluation showed that symptom reduction was maintained at 3 months after the intervention. The results from the CG showed that participants experienced significantly decreased levels of hopelessness after completing the time on the waitlist (P<.001), but their suicidal risk scores increased. Regarding the usability of the self-applied intervention system, the results indicated a high level of satisfaction with the Grief COVID. Conclusions: The self-applied web-based intervention Grief COVID was effective in reducing symptoms of anxiety, depression, hopelessness, risk of suicide risk, posttraumatic stress disorder, and complicated grief disorder. Grief COVID was evaluated by the participants, who reported that the system was easy to use. These results affirm the importance of developing additional web-based psychological tools to help reduce clinical symptoms in people experiencing grief because of the loss of a loved one during a pandemic. Trial Registration: ClinicalTrials.gov NCT04638842; https://clinicaltrials.gov/ct2/show/NCT04638842 %M 36877800 %R 10.2196/43839 %U https://www.jmir.org/2023/1/e43839 %U https://doi.org/10.2196/43839 %U http://www.ncbi.nlm.nih.gov/pubmed/36877800 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e40429 %T Technology Implementation for Mental Health End Users: A Model to Guide Digital Transformation for Inpatient Mental Health Professionals %A Westheimer,Jessa Lin %A Moukaddam,Nidal %A Lindsay,Jan A %A Sabharwal,Ashutosh %A Najafi,Bijan %A Iacobelli,Peter A %A Boland,Robert J %A Patriquin,Michelle A %+ Research Department, The Menninger Clinic, 12301 S Main St, Houston, TX, 77035, United States, 1 832 738 8300, jwestheimer@menninger.edu %K digital transformation %K user-centered design %K innovation %K implementation science %K user acceptability %K wearables %K mental health %K implementation %K technology implementation %D 2023 %7 6.4.2023 %9 Viewpoint %J JMIR Ment Health %G English %X Digital transformation is the adoption of digital technologies by an entity in an effort to increase operational efficiency. In mental health care, digital transformation entails technology implementation to improve the quality of care and mental health outcomes. Most psychiatric hospitals rely heavily on “high-touch” interventions or those that require in-person, face-to-face interaction with the patient. Those that are exploring digital mental health care interventions, particularly for outpatient care, often copiously commit to the “high-tech” model, losing the crucial human element. The process of digital transformation, especially within acute psychiatric treatment settings, is in its infancy. Existing implementation models outline the development of patient-facing treatment interventions within the primary care system; however, to our knowledge, there is no proposed or established model for implementing a new provider-facing ministration tool within an acute inpatient psychiatric setting. Solving the complex challenges within mental health care demands that new mental health technology is developed in concert with a use protocol by and for the inpatient mental health professional (IMHP; the end user), allowing the “high-touch” to inform the “high-tech” and vice versa. Therefore, in this viewpoint article, we propose the Technology Implementation for Mental-Health End-Users framework, which outlines the process for developing a prototype of an IMHP-facing digital intervention tool in parallel with a protocol for the IMHP end user to deliver the intervention. By balancing the design of the digital mental health care intervention tool with IMHP end user resource development, we can significantly improve mental health outcomes and pioneer digital transformation nationwide. %M 37023415 %R 10.2196/40429 %U https://mental.jmir.org/2023/1/e40429 %U https://doi.org/10.2196/40429 %U http://www.ncbi.nlm.nih.gov/pubmed/37023415 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41751 %T A Probiotic Intervention With Bifidobacterium longum NCC3001 on Perinatal Mood Outcomes (PROMOTE Study): Protocol for a Decentralized Randomized Controlled Trial %A Toh,Melissa P S %A Yang,Chui Yuen %A Lim,Phei Cze %A Loh,Hui Li J %A Bergonzelli,Gabriela %A Lavalle,Luca %A Mardhy,Elias %A Samuel,Tinu Mary %A Suniega-Tolentino,Elvira %A Silva Zolezzi,Irma %A Fries,Lisa R %A Chan,Shiao Yng %+ Nestle Research, Beijing, 3rd floor, Building 5, Courtyard 6 Jiuxianqiao Road, Chaoyang District, Beijing, 100016, China, 86 139 1034 2174, lisa.fries@rd.nestle.com %K perinatal mood disturbances %K pregnancy %K randomized clinical trial %K low mood %K stress %K anxiety %K depression %K probiotics %K mobile phone %D 2023 %7 5.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Perinatal mood disorders such as depression and anxiety are common, with subclinical symptomology manifesting as perinatal mood disturbances being even more prevalent. These could potentially affect breastfeeding practices and infant development. Pregnant and lactating women usually limit their exposure to medications, including those for psychological symptoms. Interestingly, the naturally occurring probiotic Bifidobacterium longum (BL) NCC3001 has been shown to reduce anxious behavior in preclinical models and feelings of low mood in nonpregnant human adults. During the COVID-19 pandemic, mental health issues increased, and conventionally conducted clinical trials were restricted by social distancing regulations. Objective: This study, Probiotics on Mothers’ Mood and Stress (PROMOTE), aimed to use a decentralized clinical trial design to test whether BL NCC3001 can reduce symptoms of depression, anxiety, and stress over the perinatal period. Methods: This double-blind, placebo-controlled, randomized, and 3-parallel-arm study aimed to recruit 180 women to evaluate the efficacy of the probiotic taken either during pregnancy and post partum (from 28-32 weeks’ gestation until 12 weeks after delivery; n=60, 33.3%) or post partum only (from birth until 12 weeks after delivery; n=60, 33.3%) in comparison with a placebo control group (n=60, 33.3%). Participants consumed the probiotic or matched placebo in a drink once daily. Mood outcomes were measured using the State-Trait Anxiety Inventory and Edinburgh Postnatal Depression Scale questionnaires, captured electronically at baseline (28-32 weeks’ gestation) and during e-study sessions over 5 further time points (36 weeks’ gestation; 9 days post partum; and 4, 8, and 12 weeks post partum). Saliva and stool samples were collected longitudinally at home to provide mechanistic insights. Results: In total, 520 women registered their interest on our website, of whom 184 (35.4%) were eligible and randomized. Of these 184 participants, 5 (2.7%) withdrew after randomization, leaving 179 (97.3%) who completed the study. Recruitment occurred between November 7, 2020, and August 20, 2021. Advertising on social media brought in 46.9% (244/520) of the prospective participants, followed by parenting-specific websites (116/520, 22.3%). Nationwide recruitment was achieved. Data processing is ongoing, and there are no outcomes to report yet. Conclusions: Multiple converging factors contributed to speedy recruitment and retention of participants despite COVID-19–related restrictions. This decentralized trial design sets a precedent for similar studies, in addition to potentially providing novel evidence on the impact of BL NCC3001 on symptoms of perinatal mood disturbances. This study was ideal for remote conduct: because of the high digital literacy and public trust in digital security in Singapore, the intervention could be self-administered without regular clinical monitoring, and the eligibility criteria and outcomes were measured using electronic questionnaires and self-collected biological samples. This design was particularly suited for a group considered vulnerable—pregnant women—during the challenging times of COVID-19–related social restrictions. Trial Registration: ClinicalTrials.gov NCT04685252; https://clinicaltrials.gov/ct2/show/NCT04685252 International Registered Report Identifier (IRRID): DERR1-10.2196/41751 %M 37018024 %R 10.2196/41751 %U https://www.researchprotocols.org/2023/1/e41751 %U https://doi.org/10.2196/41751 %U http://www.ncbi.nlm.nih.gov/pubmed/37018024 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45777 %T Public Attitudes Toward Anxiety Disorder on Sina Weibo: Content Analysis %A Zhu,Jianghong %A Li,Zepeng %A Zhang,Xiu %A Zhang,Zhenwen %A Hu,Bin %+ Gansu Provincial Key Laboratory of Wearable Computing, School of Information Science and Engineering, Lanzhou University, No 222 South Tianshui Road, Lanzhou, 730000, China, 86 17352120733, bh@lzu.edu.cn %K anxiety disorder %K linguistic feature %K topic model %K public attitude %K social media %D 2023 %7 4.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Anxiety disorder has become a major clinical and public health problem, causing a significant economic burden worldwide. Public attitudes toward anxiety can impact the psychological state, help-seeking behavior, and social activities of people with anxiety disorder. Objective: The purpose of this study was to explore public attitudes toward anxiety disorders and the changing trends of these attitudes by analyzing the posts related to anxiety disorders on Sina Weibo, a Chinese social media platform that has about 582 million users, as well as the psycholinguistic and topical features in the text content of the posts. Methods: From April 2018 to March 2022, 325,807 Sina Weibo posts with the keyword “anxiety disorder” were collected and analyzed. First, we analyzed the changing trends in the number and total length of posts every month. Second, a Chinese Linguistic Psychological Text Analysis System (TextMind) was used to analyze the changing trends in the language features of the posts, in which 20 linguistic features were selected and presented. Third, a topic model (biterm topic model) was used for semantic content analysis to identify specific themes in Weibo users’ attitudes toward anxiety. Results: The changing trends in the number and the total length of posts indicated that anxiety-related posts significantly increased from April 2018 to March 2022 (R2=0.6512; P<.001 to R2=0.8133; P<.001, respectively) and were greatly impacted by the beginning of a new semester (spring/fall). The analysis of linguistic features showed that the frequency of the cognitive process (R2=0.1782; P=.003), perceptual process (R2=0.1435; P=.008), biological process (R2=0.3225; P<.001), and assent words (R2=0.4412; P<.001) increased significantly over time, while the frequency of the social process words (R2=0.2889; P<.001) decreased significantly, and public anxiety was greatly impacted by the COVID-19 pandemic. Feature correlation analysis showed that the frequencies of words related to work and family are almost negatively correlated with those of other psychological words. Semantic content analysis identified 5 common topical areas: discrimination and stigma, symptoms and physical health, treatment and support, work and social, and family and life. Our results showed that the occurrence probability of the topical area “discrimination and stigma” reached the highest value and averagely accounted for 26.66% in the 4-year period. The occurrence probability of the topical area “family and life” (R2=0.1888; P=.09) decreased over time, while that of the other 4 topical areas increased. Conclusions: The findings of our study indicate that public discrimination and stigma against anxiety disorder remain high, particularly in the aspects of self-denial and negative emotions. People with anxiety disorders should receive more social support to reduce the impact of discrimination and stigma. %M 37014691 %R 10.2196/45777 %U https://www.jmir.org/2023/1/e45777 %U https://doi.org/10.2196/45777 %U http://www.ncbi.nlm.nih.gov/pubmed/37014691 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43293 %T Vickybot, a Chatbot for Anxiety-Depressive Symptoms and Work-Related Burnout in Primary Care and Health Care Professionals: Development, Feasibility, and Potential Effectiveness Studies %A Anmella,Gerard %A Sanabra,Miriam %A Primé-Tous,Mireia %A Segú,Xavier %A Cavero,Myriam %A Morilla,Ivette %A Grande,Iria %A Ruiz,Victoria %A Mas,Ariadna %A Martín-Villalba,Inés %A Caballo,Alejandro %A Esteva,Julia-Parisad %A Rodríguez-Rey,Arturo %A Piazza,Flavia %A Valdesoiro,Francisco José %A Rodriguez-Torrella,Claudia %A Espinosa,Marta %A Virgili,Giulia %A Sorroche,Carlota %A Ruiz,Alicia %A Solanes,Aleix %A Radua,Joaquim %A Also,María Antonieta %A Sant,Elisenda %A Murgui,Sandra %A Sans-Corrales,Mireia %A H Young,Allan %A Vicens,Victor %A Blanch,Jordi %A Caballeria,Elsa %A López-Pelayo,Hugo %A López,Clara %A Olivé,Victoria %A Pujol,Laura %A Quesada,Sebastiana %A Solé,Brisa %A Torrent,Carla %A Martínez-Aran,Anabel %A Guarch,Joana %A Navinés,Ricard %A Murru,Andrea %A Fico,Giovanna %A de Prisco,Michele %A Oliva,Vicenzo %A Amoretti,Silvia %A Pio-Carrino,Casimiro %A Fernández-Canseco,María %A Villegas,Marta %A Vieta,Eduard %A Hidalgo-Mazzei,Diego %+ Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, 170 Villarroel St, Barcelona, 08036, Spain, 34 606699877, dahidalg@clinic.cat %K primary care %K health care workers %K depression %K anxiety %K symptom %K burnout %K digital %K smartphone %K chatbot %K primary care digital support tool in mental health %K PRESTO %D 2023 %7 3.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Many people attending primary care (PC) have anxiety-depressive symptoms and work-related burnout compounded by a lack of resources to meet their needs. The COVID-19 pandemic has exacerbated this problem, and digital tools have been proposed as a solution. Objective: We aimed to present the development, feasibility, and potential effectiveness of Vickybot, a chatbot aimed at screening, monitoring, and reducing anxiety-depressive symptoms and work-related burnout, and detecting suicide risk in patients from PC and health care workers. Methods: Healthy controls (HCs) tested Vickybot for reliability. For the simulation study, HCs used Vickybot for 2 weeks to simulate different clinical situations. For feasibility and effectiveness study, people consulting PC or health care workers with mental health problems used Vickybot for 1 month. Self-assessments for anxiety (Generalized Anxiety Disorder 7-item) and depression (Patient Health Questionnaire-9) symptoms and work-related burnout (based on the Maslach Burnout Inventory) were administered at baseline and every 2 weeks. Feasibility was determined from both subjective and objective user-engagement indicators (UEIs). Potential effectiveness was measured using paired 2-tailed t tests or Wilcoxon signed-rank test for changes in self-assessment scores. Results: Overall, 40 HCs tested Vickybot simultaneously, and the data were reliably transmitted and registered. For simulation, 17 HCs (n=13, 76% female; mean age 36.5, SD 9.7 years) received 98.8% of the expected modules. Suicidal alerts were received correctly. For the feasibility and potential effectiveness study, 34 patients (15 from PC and 19 health care workers; 76% [26/34] female; mean age 35.3, SD 10.1 years) completed the first self-assessments, with 100% (34/34) presenting anxiety symptoms, 94% (32/34) depressive symptoms, and 65% (22/34) work-related burnout. In addition, 27% (9/34) of patients completed the second self-assessment after 2 weeks of use. No significant differences were found between the first and second self-assessments for anxiety (t8=1.000; P=.34) or depressive (t8=0.40; P=.70) symptoms. However, work-related burnout scores were moderately reduced (z=−2.07, P=.04, r=0.32). There was a nonsignificant trend toward a greater reduction in anxiety-depressive symptoms and work-related burnout with greater use of the chatbot. Furthermore, 9% (3/34) of patients activated the suicide alert, and the research team promptly intervened with successful outcomes. Vickybot showed high subjective UEI (acceptability, usability, and satisfaction), but low objective UEI (completion, adherence, compliance, and engagement). Vickybot was moderately feasible. Conclusions: The chatbot was useful in screening for the presence and severity of anxiety and depressive symptoms, and for detecting suicidal risk. Potential effectiveness was shown to reduce work-related burnout but not anxiety or depressive symptoms. Subjective perceptions of use contrasted with low objective-use metrics. Our results are promising but suggest the need to adapt and enhance the smartphone-based solution to improve engagement. A consensus on how to report UEIs and validate digital solutions, particularly for chatbots, is required. %M 36719325 %R 10.2196/43293 %U https://www.jmir.org/2023/1/e43293 %U https://doi.org/10.2196/43293 %U http://www.ncbi.nlm.nih.gov/pubmed/36719325 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42499 %T Evaluating the Efficacy of a Social Media–Based Intervention (Warna-Warni Waktu) to Improve Body Image Among Young Indonesian Women: Parallel Randomized Controlled Trial %A Garbett,Kirsty M %A Haywood,Sharon %A Craddock,Nadia %A Gentili,Caterina %A Nasution,Kholisah %A Saraswati,L Ayu %A Medise,Bernie Endyarni %A White,Paul %A Diedrichs,Phillippa C %A Williamson,Heidi %+ Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 11732 82911, kirsty.garbett@uwe.ac.uk %K body image %K body dissatisfaction %K Indonesia %K adolescent mental health %K randomized controlled trial %K eHealth intervention %K Southeast Asia %K social media %K lower- and middle-income countries %K LMICs %D 2023 %7 3.4.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Body dissatisfaction is a global issue, particularly among adolescent girls and young women. Effective body image interventions exist but face barriers to scaling up, particularly in lower- and middle-income countries, such as Indonesia, where a need exists. Objective: We aimed to evaluate the acceptability and efficacy of Warna-Warni Waktu, a social media–based, fictional 6-episode video series with self-guided web-based activities for improving body image among young Indonesian adolescent girls and young women. We hypothesized that Warna-Warni Waktu would increase trait body satisfaction and mood and decrease internalization of appearance ideals and skin shade dissatisfaction relative to the waitlist control condition. We also anticipated improvements in state body satisfaction and mood immediately following each video. Methods: We conducted a web-based, 2-arm randomized controlled trial among 2000 adolescent girls and young women, aged 15 to 19 years, recruited via telephone by an Indonesian research agency. Block randomization (1:1 allocation) was performed. Participants and researchers were not concealed from the randomized arm. Participants completed self-report assessments of trait body satisfaction (primary outcome) and the internalization of appearance ideals, mood, and skin shade dissatisfaction at baseline (before randomization), time 2 (1 day after the intervention [T2]), and time 3 (1 month after the intervention [T3]). Participants also completed state body satisfaction and mood measures immediately before and after each video. Data were evaluated using linear mixed models with an intent-to-treat analysis. Intervention adherence was tracked. Acceptability data were collected. Results: There were 1847 participants. Relative to the control condition (n=923), the intervention group (n=924) showed reduced internalization of appearance ideals at T2 (F1,1758=40.56, P<.001, partial η2=0.022) and T3 (F1,1782=54.03, P<.001, partial η2=0.03) and reduced skin shade dissatisfaction at T2 (F1,1744=8.05, P=.005, partial η2=0.005). Trait body satisfaction improvements occurred in the intervention group at T3 (F1, 1781=9.02, P=.005, partial η2=0.005), which was completely mediated by the internalization change scores between baseline and T2 (indirect effect: β=.03, 95% CI 0.017-0.041; direct effect: β=.03, P=.13), consistent with the Tripartite Influence Model of body dissatisfaction. Trait mood showed no significant effects. Dependent sample t tests (2-tailed) found each video improved state body satisfaction and mood. Cumulative analyses found significant and progressive improvements in pre- and poststate body satisfaction and mood. Intervention adherence was good; participants watched an average of 5.2 (SD 1.66) videos. Acceptability scores were high for understandability, enjoyment, age appropriateness, usefulness, and likelihood to recommend. Conclusions: Warna-Warni Waktu is an effective eHealth intervention to reduce body dissatisfaction among Indonesian adolescent girls and young women. Although the effects were small, Warna-Warni Waktu is a scalable, cost-effective alternative to more intense interventions. Initially, dissemination through paid social media advertising will reach thousands of young Indonesian women. Trial Registration: ClinicalTrials.gov NCT05383807, https://clinicaltrials.gov/ct2/show/NCT05383807 ; ISRCTN Registry ISRCTN35483207, https://www.isrctn.com/ISRCTN35483207 International Registered Report Identifier (IRRID): RR2-10.2196/33596 %M 37010911 %R 10.2196/42499 %U https://www.jmir.org/2023/1/e42499 %U https://doi.org/10.2196/42499 %U http://www.ncbi.nlm.nih.gov/pubmed/37010911 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e44862 %T The Effectiveness of a Smartphone Intervention Targeting Suicidal Ideation in Young Adults: Randomized Controlled Trial Examining the Influence of Loneliness %A McGillivray,Lauren %A Keng-Meng Hui,Nicholas %A Wong,Quincy J J %A Han,Jin %A Qian,Jiahui %A Torok,Michelle %+ Black Dog Institute, University of New South Wales, Hospital Rd, Sydney, 2031, Australia, 61 2 9065 9133, m.torok@unsw.edu.au %K loneliness %K suicidal ideation %K suicide prevention %K digital therapeutics %K smartphone intervention %K apps %D 2023 %7 30.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is commonly reported by young people and has been shown to contribute to the rapid onset and escalation of depression and suicidal ideation during adolescence. Lonely people may also be particularly susceptible to disengaging from treatment early given the likelihood of their more complex clinical profiles leading to cognitive fatigue. While a smartphone intervention (LifeBuoy) has been shown to effectively reduce suicidal ideation in young adults, poor engagement is a well-documented issue for this therapeutic modality and has been shown to result in poorer treatment outcomes. Objective: This study aims to determine whether loneliness affects how young people experiencing suicidal ideation engage with and benefit from a therapeutic smartphone intervention (LifeBuoy). Methods: A total of 455 community-based Australian young adults (aged 18-25 years) experiencing recent suicidal ideation were randomized to use a dialectical behavioral therapy–based smartphone intervention (LifeBuoy) or an attention-matched control app (LifeBuoy-C) for 6 weeks. Participants completed measures of suicidal ideation, depression, anxiety, and loneliness at baseline (T0), post intervention (T1), and 3 months post intervention (T2). Piecewise linear mixed models were used to examine whether loneliness levels moderated the effect of LifeBuoy and LifeBuoy-C on suicidal ideation and depression across time (T0 to T1; T1 to T2). This statistical method was then used to examine whether app engagement (number of modules completed) influenced the relationship between baseline loneliness and suicidal ideation and depression across time. Results: Loneliness was positively associated with higher levels of overall suicidal ideation (B=0.75, 95% CI 0.08-1.42; P=.03) and depression (B=0.88, 95% CI 0.45-1.32; P<.001), regardless of time point or allocated condition. However, loneliness did not affect suicidal ideation scores across time (time 1: B=1.10, 95% CI –0.25 to 2.46; P=.11; time 2: B=0.43, 95% CI –1.25 to 2.12; P=.61) and depression scores across time (time 1: B=0.00, 95% CI –0.67 to 0.66; P=.99; time 2: B=0.41, 95% CI –0.37 to 1.18; P=.30) in either condition. Similarly, engagement with the LifeBuoy app was not found to moderate the impact of loneliness on suicidal ideation (B=0.00, 95% CI –0.17 to 0.18; P=.98) or depression (B=–0.08, 95% CI –0.19 to 0.03; P=.14). Conclusions: Loneliness was not found to affect young adults’ engagement with a smartphone intervention (LifeBuoy) nor any clinical benefits derived from the intervention. LifeBuoy, in its current form, can effectively engage and treat individuals regardless of how lonely they may be. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001671156; https://tinyurl.com/yvpvn5n8 International Registered Report Identifier (IRRID): RR2-10.2196/23655 %M 36995752 %R 10.2196/44862 %U https://mental.jmir.org/2023/1/e44862 %U https://doi.org/10.2196/44862 %U http://www.ncbi.nlm.nih.gov/pubmed/36995752 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42167 %T Perceptions of a Digital Mental Health Platform Among Participants With Depressive Disorder, Anxiety Disorder, and Other Clinically Diagnosed Mental Disorders in Singapore: Usability and Acceptability Study %A Phang,Ye Sheng %A Heaukulani,Creighton %A Martanto,Wijaya %A Morris,Robert %A Tong,Mian Mian %A Ho,Roger %+ MOH Office for Healthcare Transformation, 1 Maritime Square, #12-10 Harborfront Centre, Singapore, 099253, Singapore, 65 6679 3147, yesheng.phang@moht.com.sg %K mHealth %K mobile health %K CBT %K cognitive behavioral therapy %K cognitive behavioural therapy %K iCBT %K internet-based cognitive behavioral therapy %K usability %K Post-Study System Usability Questionnaire %K PSSUQ %K acceptability %K mental health %K Singapore %K depression disorder %K anxiety disorder %K mental illness %K anxiety %K depression %K depressive %D 2023 %7 29.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The website mindline.sg is a stress management and coping website that can be accessed anonymously in Singapore for free. Although designed to serve individuals who are well or have mild depression and anxiety symptoms, mindline.sg may potentially be used by clinicians as an adjunct therapeutic aid for patients with clinically diagnosed mental disorders. Objective: This study aims to determine the perceived usability, acceptability, and usefulness of mindline.sg among individuals with diagnosed mental disorders in a clinical setting. Methods: A cross-sectional study with 173 participants was conducted in the waiting room of a psychiatrist’s office at the National University Hospital in Singapore. Participants waiting for an appointment were given 30 minutes and a simple set of instructions to use three features of mindline.sg. They subsequently answered a set of web-based survey questions via their smartphones, including a 16-item subset of the Post-Study System Usability Questionnaire (PSSUQ) for usability measurement and 5 questions designed to understand the perceived usefulness and acceptability of mindline.sg. Multiple linear regression is used to determine the associated demographic factors with overall PSSUQ score. A chi-square test is performed to investigate associations of psychiatric condition with users’ responses on acceptability and perceived usefulness of mindline.sg. For this study, P<.05 is considered significant. Results: We observed that the overall (mean 2.86, SD 1.46), system usefulness (mean 2.74, SD 1.46), and information quality (mean 2.98, SD 1.33) subscores of the PSSUQ survey are within a 99% CI of a literature-derived norm, which all have the interpretation of having high perceived usability. However, interface quality (mean 2.98, SD 1.33) scored lower than the literature-derived norm, although it is still better than the neutral score of 4. We find participants with lower than a General Certificate of Education O-Level or N-Level education tend to give a lower usability score as compared to others (β=.49; P=.02). Participants who have not been hospitalized previously due to their condition are also more likely to give a lower PSSUQ score as compared to individuals who have been hospitalized (β=.18; P=.03). The platform mindline.sg is also deemed to be generally useful and acceptable with all the survey questions receiving more than a 60% positive response. We found no association between the type(s) of self-reported psychiatric disorder(s) and the perceived usefulness and acceptability of mindline.sg. Conclusions: Our results show that mindline.sg is generally perceived as usable and acceptable by individuals with a diagnosed mental disorder in Singapore. The study suggests improving usability among individuals with lower education levels. Particularly promising is the finding that previously hospitalized individuals have significantly higher perceived usability and satisfaction of the website, suggesting potential impact could be found among a moderately to severely at-risk clinical population. The effectiveness of mindline.sg as an adjunct therapy for individuals with diagnosed mental disorders should therefore be explored in future studies. %M 36989020 %R 10.2196/42167 %U https://humanfactors.jmir.org/2023/1/e42167 %U https://doi.org/10.2196/42167 %U http://www.ncbi.nlm.nih.gov/pubmed/36989020 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43222 %T Optimizing an Adolescent Hybrid Telemedical Mental Health Service Through Staff Scheduling Using Mathematical Programming: Model Development Study %A Palmer,Abigail %A Johns,Gemma %A Ahuja,Alka %A Gartner,Daniel %+ School of Mathematics, Cardiff University, Senghennydd road, Cardiff, CF24 4AG, United Kingdom, 44 7843747862, gartnerd@cardiff.ac.uk %K linear Programming %K telemedicine %K remote consultation %K mental health %K teen %K adolescent %K mental disorder %K disorder %K disease %K youth %K decision %K support %K tool %K model %D 2023 %7 28.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: According to the World Health Organization, globally, one in seven 10- to 19-year-olds experiences a mental disorder, accounting for 13% of the global burden of disease in this age group. Half of all mental illnesses begin by the age of 14 years and some teenagers with severe presentations must be admitted to the hospital and assessed by highly skilled mental health care practitioners. Digital telehealth solutions can be useful for the assessment of young individuals remotely. Ultimately, this technology can save travel costs for the health service rather than assessing adolescents in person at the corresponding hospital. Especially in rural regions, where travel times can be high, this innovative approach can make a difference to patients by providing quicker assessments. Objective: The aim of this study is to share insights on how we developed a decision support tool to assign staff to days and locations where adolescent mental health patients are assessed face to face. Where possible, patients are seen through video consultation. The model not only seeks to reduce travel times and consequently carbon emissions but also can be used to find a minimum number of staff to run the service. Methods: To model the problem, we used integer linear programming, a technique that is used in mathematical modeling. The model features 2 objectives: first, we aim to find a minimum coverage of staff to provide the service and second, to reduce travel time. The constraints that are formulated algebraically are used to ensure the feasibility of the schedule. The model is implemented using an open-source solver backend. Results: In our case study, we focus on real-world demand coming from different hospital sites in the UK National Health Service (NHS). We incorporate our model into a decision support tool and solve a realistic test instance. Our results reveal that the tool is not only capable of solving this problem efficiently but also shows the benefits of using mathematical modeling in health services. Conclusions: Our approach can be used by NHS managers to better match capacity and location-dependent demands within an increasing need for hybrid telemedical services, and the aims to reduce traveling and the carbon footprint within health care organizations. %M 36976622 %R 10.2196/43222 %U https://formative.jmir.org/2023/1/e43222 %U https://doi.org/10.2196/43222 %U http://www.ncbi.nlm.nih.gov/pubmed/36976622 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43623 %T The Association of a Geographically Wide Social Media Network on Depression: County-Level Ecological Analysis %A Beauchamp,Alaina M %A Lehmann,Christoph U %A Medford,Richard J %A Hughes,Amy E %+ Peter O'Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, United States, 1 2146483232, alaina.beauchamp@utsouthwestern.edu %K Facebook %K social connectedness %K depression %K county-level analysis %K social media %K mental health %K research %K ecological %K geography %K GIS %D 2023 %7 27.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Social connectedness decreases human mortality, improves cancer survival, cardiovascular health, and body mass, results in better-controlled glucose levels, and strengthens mental health. However, few public health studies have leveraged large social media data sets to classify user network structure and geographic reach rather than the sole use of social media platforms. Objective: The objective of this study was to determine the association between population-level digital social connectedness and reach and depression in the population across geographies of the United States. Methods: Our study used an ecological assessment of aggregated, cross-sectional population measures of social connectedness, and self-reported depression across all counties in the United States. This study included all 3142 counties in the contiguous United States. We used measures obtained between 2018 and 2020 for adult residents in the study area. The study’s main exposure of interest is the Social Connectedness Index (SCI), a pair-wise composite index describing the “strength of connectedness between 2 geographic areas as represented by Facebook friendship ties.” This measure describes the density and geographical reach of average county residents’ social network using Facebook friendships and can differentiate between local and long-distance Facebook connections. The study’s outcome of interest is self-reported depressive disorder as published by the Centers for Disease Control and Prevention. Results: On average, 21% (21/100) of all adult residents in the United States reported a depressive disorder. Depression frequency was the lowest for counties in the Northeast (18.6%) and was highest for southern counties (22.4%). Social networks in northeastern counties involved moderately local connections (SCI 5-10 the 20th percentile for n=70, 36% of counties), whereas social networks in Midwest, southern, and western counties contained mostly local connections (SCI 1-2 the 20th percentile for n=598, 56.7%, n=401, 28.2%, and n=159, 38.4%, respectively). As the quantity and distance that social connections span (ie, SCI) increased, the prevalence of depressive disorders decreased by 0.3% (SE 0.1%) per rank. Conclusions: Social connectedness and depression showed, after adjusting for confounding factors such as income, education, cohabitation, natural resources, employment categories, accessibility, and urbanicity, that a greater social connectedness score is associated with a decreased prevalence of depression. %M 36972109 %R 10.2196/43623 %U https://www.jmir.org/2023/1/e43623 %U https://doi.org/10.2196/43623 %U http://www.ncbi.nlm.nih.gov/pubmed/36972109 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 9 %N %P e44246 %T A Web-Based Therapist Training Tutorial on Prolonged Grief Disorder Therapy: Pre-Post Assessment Study %A Kobak,Kenneth %A Shear,M Katherine %A Skritskaya,Natalia A %A Bloom,Colleen %A Bottex,Gaelle %+ Center for Telepsychology, 22 North Harwood Circle, Madison, WI, 53717, United States, 1 608 406 2621, kobak@charter.net %K grief %K prolonged grief disorder %K evidence-based practice %K mental health training %K therapist training %K new technology %K web-based training %K dissemination %K e-learning %D 2023 %7 27.3.2023 %9 Original Paper %J JMIR Med Educ %G English %X Background: Prolonged grief disorder (PGD) is a newly recognized mental disorder characterized by pervasive intense grief that persists longer than cultural or social expectations and interferes with functioning. The COVID-19 epidemic has resulted in increased rates of PGD, and few clinicians feel confident in treating this condition. PGD therapy (PGDT) is a simple, short-term, and evidence-based treatment developed in tandem with the validation of the PGD diagnosis. To facilitate the dissemination of PGDT training, we developed a web-based therapist tutorial that includes didactic training on PGDT concepts and principles as well as web-based multimedia patient scenarios and examples of clinical implementation of PGDT. Objective: We aimed to evaluate user satisfaction with the tutorial and whether the tutorial increased trainees’ knowledge of PGDT principles and procedures. Moreover, we included a small number of pilot questions to evaluate the PGDT-related clinical skills. Methods: This study evaluated tutorial learning using a pre- and poststudy design. Participants were recruited from professional organization mailing lists, announcements to graduates of the Columbia School of Social Work, and through word of mouth. After signing consent, participants completed a brief demographic survey, a 55-item multiple-choice prestudy test on the concepts and principles of PGD and PGDT covered in the tutorial, and a 4-item pilot web-based prestudy test to gauge PGD clinical implementation skills. The link to the course content was then activated, and participants were given 8 weeks to complete the 11-module tutorial containing information, web-based exercises, simulated patient and video examples, and self-tests. Results: Overall, 406 clinicians signed consent, and 236 (58.1%) started the tutorial. Of these, 83.1% (196/236) completed all 11 modules. Trainee scores on our PDGT assessment improved substantially from pretraining to the postmodule assessment, with the total number of correct answers increasing from a mean of 29 (SD 5.5; 52.7% correct) to 36.7 (SD 5.2; 66.7% correct; t195=18.93; P<.001). In addition, the trainee’s implementation scores on 4 clinical vignettes increased from 2.6 (SD 0.7) correct out of 4 to 3.1 (SD 0.4) out of 4 (t188=7.02; P<.001). Effect sizes (Cohen d) were 1.44 (95% CI 1.23-1.65) for PDGT assessment and 1.06 (95% CI 0.84-1.29) for implementation. Trainees found the tutorial interesting, enjoyable, clearly presented, and useful for professional development. They endorsed a mean score of 3.7 (SD 0.47) on a 1 to 4 scale of agreement with recommending the course to others and feeling satisfied with the tutorial, and a mean of 3.3 (SD 0.57) with feeling able to apply the skills with clients. Conclusions: This pilot study provides support for the usefulness of this web-based training for teaching clinicians how to administer PGDT. The addition of patient scenarios for clinical implementation strategies holds promise for increasing the effectiveness of PGDT training and other evidence-based treatments. Trial Registration: ClinicalTrials.gov NCT05121792; https://www.clinicaltrials.gov/ct2/show/NCT05121792 %M 36972105 %R 10.2196/44246 %U https://mededu.jmir.org/2023/1/e44246 %U https://doi.org/10.2196/44246 %U http://www.ncbi.nlm.nih.gov/pubmed/36972105 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43213 %T The Longitudinal Impact of Social Media Use on UK Adolescents' Mental Health: Longitudinal Observational Study %A Plackett,Ruth %A Sheringham,Jessica %A Dykxhoorn,Jennifer %+ Research Department of Primary Care & Population Health, University College London, Rowland Hill Street, London, NW3 2PF, United Kingdom, 44 20 3108 3096, ruth.plackett.15@ucl.ac.uk %K social media %K mental health %K depression %K depressive %K anxiety %K adolescent %K adolescence %K mediation analysis %K cohort study %K youth %K young people %K self-esteem %K national survey %K household survey %K computer use %K technology use %K screen time %D 2023 %7 24.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Cross-sectional studies have found a relationship between social media use and depression and anxiety in young people. However, few longitudinal studies using representative data and mediation analysis have been conducted to understand the causal pathways of this relationship. Objective: This study aims to examine the longitudinal relationship between social media use and young people’s mental health and the role of self-esteem and social connectedness as potential mediators. Methods: The sample included 3228 participants who were 10- to 15-year-olds from Understanding Society (2009-2019), a UK longitudinal household survey. The number of hours spent on social media was measured on a 5-point scale from “none” to “7 or more hours” at the ages of 12-13 years. Self-esteem and social connectedness (number of friends and happiness with friendships) were measured at the ages of 13-14 years. Mental health problems measured by the Strengths and Difficulties Questionnaire were assessed at the ages of 14-15 years. Covariates included demographic and household variables. Unadjusted and adjusted multilevel linear regression models were used to estimate the association between social media use and mental health. We used path analysis with structural equation modeling to investigate the mediation pathways. Results: In adjusted analysis, there was a nonsignificant linear trend showing that more time spent on social media was related to poorer mental health 2 years later (n=2603, β=.21, 95% CI −0.43 to 0.84; P=.52). In an unadjusted path analysis, 68% of the effect of social media use on mental health was mediated by self-esteem (indirect effect, n=2569, β=.70, 95% CI 0.15-1.30; P=.02). This effect was attenuated in the adjusted analysis, and it was found that self-esteem was no longer a significant mediator (indirect effect, n=2316, β=.24, 95% CI −0.12 to 0.66; P=.22). We did not find evidence that the association between social media and mental health was mediated by social connectedness. Similar results were found in imputed data. Conclusions: There was little evidence to suggest that more time spent on social media was associated with later mental health problems in UK adolescents. This study shows the importance of longitudinal studies to examine this relationship and suggests that prevention strategies and interventions to improve mental health associated with social media use could consider the role of factors like self-esteem. %M 36961482 %R 10.2196/43213 %U https://www.jmir.org/2023/1/e43213 %U https://doi.org/10.2196/43213 %U http://www.ncbi.nlm.nih.gov/pubmed/36961482 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38504 %T A Web-Based Stratified Stepped Care Platform for Mental Well-being (TourHeart+): User-Centered Research and Design %A Mak,Winnie W S %A Ng,Sin Man %A Leung,Florence H T %+ Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong, 852 39436577, wwsmak@cuhk.edu.hk %K user-centered design %K qualitative research %K usability testing %K mental health %K self-care %K stratified stepped care %K internet-based psychological interventions %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based mental health interventions have been demonstrated to be effective in alleviating psychological distress and promoting mental well-being. However, real-world uptake and engagement of such interventions have been low. Rather than being stand-alone interventions, situating internet-based interventions under a stratified stepped care system can support users to continue with mental health practice and monitor their mental health status for timely services that are commensurate with their needs. A user-centered approach should be used in the development of such web-based platforms to understand the facilitators and barriers in user engagement to enhance platform uptake, usability, and adherence so it can support the users’ continued adoption and practice of self-care for their mental health. Objective: The aim of this study was to describe the design process taken to develop a web-based stratified stepped care mental health platform, TourHeart+, using a user-centered approach that gathers target users’ perceptions on mental self-care and feedback on the platform design and incorporates them into the design. Methods: The process involved a design workshop with the interdisciplinary development team, user interviews, and 2 usability testing sessions on the flow of registration and mental health assessment and the web-based self-help interventions of the platform. The data collected were summarized as descriptive statistics if appropriate and insights are extracted inductively. Qualitative data were extracted using a thematic coding approach. Results: In the design workshop, the team generated empathy maps and point-of-view statements related to the possible mental health needs of target users. Four user personas and related processes in the mental health self-care journey were developed based on user interviews. Design considerations were derived based on the insights drawn from the personas and mental health self-care journey. Survey results from 104 users during usability testing showed that the overall experience during registration and mental health assessment was friendly, and they felt cared for, although no statistically significant differences on preference ratings were found between using a web-based questionnaire tool and through an interactive chatbot, except that chatbot format was deemed more interesting. Facilitators of and barriers to registering the platform and completing the mental health assessment were identified through user feedback during simulation with mock-ups. In the usability testing for guided self-help interventions, users expressed pain points in course adherence, and corresponding amendments were made in the flow and design of the web-based courses. Conclusions: The design process and findings presented in the study are important in developing a user-centric platform to optimize users’ acceptance and usability of a web-based stratified stepped care platform with guided self-help interventions for mental well-being. Accounting for users’ perceptions and needs toward mental health self-care and their experiences in the design process can enhance the usability of an evidence-based mental health platform on the web. %M 36947112 %R 10.2196/38504 %U https://formative.jmir.org/2023/1/e38504 %U https://doi.org/10.2196/38504 %U http://www.ncbi.nlm.nih.gov/pubmed/36947112 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44055 %T Tracking Population-Level Anxiety Using Search Engine Data: Ecological Study %A Gilbert,Barnabas James %A Lu,Chunling %A Yom-Tov,Elad %+ Department of Brain Sciences, Imperial College London, The Commonwealth Building, Hammersmith Hospital, Du Cane Road, London, W12 0NN, United Kingdom, 44 2075943278, bgilbert@ic.ac.uk %K anxiety disorders %K anxiety themes %K Bing search %K country-level %K epidemiology %K Google trends %K internet search data %K mental disorder %K search engine %K socioeconomic %D 2023 %7 22.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety disorders are the most prevalent mental disorders globally, with a substantial impact on quality of life. The prevalence of anxiety disorders has increased substantially following the COVID-19 pandemic, and it is likely to be further affected by a global economic recession. Understanding anxiety themes and how they change over time and across countries is crucial for preventive and treatment strategies. Objective: The aim of this study was to track the trends in anxiety themes between 2004 and 2020 in the 50 most populous countries with high volumes of internet search data. This study extends previous research by using a novel search-based methodology and including a longer time span and more countries at different income levels. Methods: We used a crowdsourced questionnaire, alongside Bing search query data and Google Trends search volume data, to identify themes associated with anxiety disorders across 50 countries from 2004 to 2020. We analyzed themes and their mutual interactions and investigated the associations between countries’ socioeconomic attributes and anxiety themes using time-series linear models. This study was approved by the Microsoft Research Institutional Review Board. Results: Query volume for anxiety themes was highly stable in countries from 2004 to 2019 (Spearman r=0.89) and moderately correlated with geography (r=0.49 in 2019). Anxiety themes were predominantly long-term and personal, with “having kids,” “pregnancy,” and “job” the most voluminous themes in most countries and years. In 2020, “COVID-19” became a dominant theme in 27 countries. Countries with a constant volume of anxiety themes over time had lower fragile state indexes (P=.007) and higher individualism (P=.003). An increase in the volume of the most searched anxiety themes was associated with a reduction in the volume of the remaining themes in 13 countries and an increase in 17 countries, and these 30 countries had a lower prevalence of mental disorders (P<.001) than the countries where no correlations were found. Conclusions: Internet search data could be a potential source for predicting the country-level prevalence of anxiety disorders, especially in understudied populations or when an in-person survey is not viable. %M 36947130 %R 10.2196/44055 %U https://formative.jmir.org/2023/1/e44055 %U https://doi.org/10.2196/44055 %U http://www.ncbi.nlm.nih.gov/pubmed/36947130 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44542 %T Exploring the Perceptions of mHealth Interventions for the Prevention of Common Mental Disorders in University Students in Singapore: Qualitative Study %A Salamanca-Sanabria,Alicia %A Jabir,Ahmad Ishqi %A Lin,Xiaowen %A Alattas,Aishah %A Kocaballi,A Baki %A Lee,Jimmy %A Kowatsch,Tobias %A Tudor Car,Lorainne %+ Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Level 18, Singapore, 308232, Singapore, 65 69041258, lorainne.tudor.car@ntu.edu.sg %K interventions %K students %K mobile health %K mHealth %K mental health %K mental disorders %K university %K common mental disorders %K anxiety %K depression %D 2023 %7 20.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health interventions delivered through mobile health (mHealth) technologies can increase the access to mental health services, especially among university students. The development of mHealth intervention is complex and needs to be context sensitive. There is currently limited evidence on the perceptions, needs, and barriers related to these interventions in the Southeast Asian context. Objective: This qualitative study aimed to explore the perception of university students and mental health supporters in Singapore about mental health services, campaigns, and mHealth interventions with a focus on conversational agent interventions for the prevention of common mental disorders such as anxiety and depression. Methods: We conducted 6 web-based focus group discussions with 30 university students and one-to-one web-based interviews with 11 mental health supporters consisting of faculty members tasked with student pastoral care, a mental health first aider, counselors, psychologists, a clinical psychologist, and a psychiatrist. The qualitative analysis followed a reflexive thematic analysis framework. Results: The following 6 main themes were identified: a healthy lifestyle as students, access to mental health services, the role of mental health promotion campaigns, preferred mHealth engagement features, factors that influence the adoption of mHealth interventions, and cultural relevance of mHealth interventions. The interpretation of our findings shows that students were reluctant to use mental health services because of the fear of stigma and a possible lack of confidentiality. Conclusions: Study participants viewed mHealth interventions for mental health as part of a blended intervention. They also felt that future mental health mHealth interventions should be more personalized and capable of managing adverse events such as suicidal ideation. %M 36939808 %R 10.2196/44542 %U https://www.jmir.org/2023/1/e44542 %U https://doi.org/10.2196/44542 %U http://www.ncbi.nlm.nih.gov/pubmed/36939808 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43066 %T Effectiveness of Digital Mental Health Tools to Reduce Depressive and Anxiety Symptoms in Low- and Middle-Income Countries: Systematic Review and Meta-analysis %A Kim,Jiyeong %A Aryee,Lois M D %A Bang,Heejung %A Prajogo,Steffi %A Choi,Yong K %A Hoch,Jeffrey S %A Prado,Elizabeth L %+ Department of Public Health Sciences, School of Medicine, University of California, Davis, 1 Shields Avenue, Davis, CA, 95616, United States, 1 5307522793, jiykim@ucdavis.edu %K digital mental health %K mHealth %K mobile health %K digital health %K low- and middle-income country %K depression %K anxiety %K mobile phone %D 2023 %7 20.3.2023 %9 Review %J JMIR Ment Health %G English %X Background: Depression and anxiety contribute to an estimated 74.6 million years of life with disability, and 80% of this burden occurs in low- and middle-income countries (LMICs), where there is a large gap in care. Objective: We aimed to systematically synthesize available evidence and quantify the effectiveness of digital mental health interventions in reducing depression and anxiety in LMICs. Methods: In this systematic review and meta-analysis, we searched PubMed, Embase, and Cochrane databases from the inception date to February 2022. We included randomized controlled trials conducted in LMICs that compared groups that received digital health interventions with controls (active control, treatment as usual, or no intervention) on depression or anxiety symptoms. Two reviewers independently extracted summary data reported in the papers and performed study quality assessments. The outcomes were postintervention measures of depression or anxiety symptoms (Hedges g). We calculated the pooled effect size weighted by inverse variance. Results: Among 11,196 retrieved records, we included 80 studies in the meta-analysis (12,070 participants n=6052, 50.14% in the intervention group and n=6018, 49.85% in the control group) and 96 studies in the systematic review. The pooled effect sizes were −0.61 (95% CI −0.78 to −0.44; n=67 comparisons) for depression and −0.73 (95% CI −0.93 to −0.53; n=65 comparisons) for anxiety, indicating that digital health intervention groups had lower postintervention depression and anxiety symptoms compared with controls. Although heterogeneity was considerable (I2=0.94 for depression and 0.95 for anxiety), we found notable sources of variability between the studies, including intervention content, depression or anxiety symptom severity, control type, and age. Grading of Recommendations, Assessments, Development, and Evaluation showed that the evidence quality was overall high. Conclusions: Digital mental health tools are moderately to highly effective in reducing depression and anxiety symptoms in LMICs. Thus, they could be effective options to close the gap in depression and anxiety care in LMICs, where the usual mental health care is minimal. Trial Registration: PROSPERO CRD42021289709; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=289709 %M 36939820 %R 10.2196/43066 %U https://mental.jmir.org/2023/1/e43066 %U https://doi.org/10.2196/43066 %U http://www.ncbi.nlm.nih.gov/pubmed/36939820 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42610 %T Virtual Partnership Addressing Mental Health Crises: Mixed Methods Study of a Coresponder Program in Rural Law Enforcement %A Nataliansyah,M Muska %A Merchant,Kimberly A S %A Vakkalanka,J Priyanka %A Mack,Luke %A Parsons,Seth %A Ward,Marcia M %+ Department of Surgery, Collaborative for Healthcare Delivery Science, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53005, United States, 1 4149551402, mnataliansyah@mcw.edu %K mental health %K telehealth %K rural health %K coresponder model %K implementation %K mixed methods %K community %K technology %K virtual care %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: A mental health crisis can create challenges for individuals, families, and communities. This multifaceted issue often involves different professionals from law enforcement and health care systems, which may lead to siloed and suboptimal care. The virtual crisis care (VCC) program was developed to provide rural law enforcement with access to behavioral health professionals and facilitated collaborative care via telehealth technology. Objective: This study was designed to evaluate the implementation and use of a VCC program from a telehealth hub for law enforcement in rural areas. Methods: This study used a mixed methods approach. The quantitative data came from the telehealth hub’s electronic record system. The qualitative data came from in-depth interviews with law enforcement in the 18 counties that adopted the VCC program. Results: Across the 181 VCC encounters, the telehealth hub's recommended disposition and the actual disposition were similar for remaining in place (n=141, 77.9%, and n=137, 75.7%, respectively), voluntary admission (n=9, 5.0%, and n=10, 5.5%, respectively), and involuntary committal (IVC; n=27, 14.9%, and n=19, 10.5%, respectively). Qualitative insights related to the VCC program's implementation, use, benefits, and challenges were identified, providing a comprehensive view of the virtual partnership between rural law enforcement and behavioral health professionals. Conclusions: Use of a VCC program likely averts unnecessary IVCs. Law enforcement interviews affirmed the positive impact of VCC due to its ease of use and the benefits it provides to the individuals in need, the first responders involved, law enforcement resources, and the community. %M 36939827 %R 10.2196/42610 %U https://mental.jmir.org/2023/1/e42610 %U https://doi.org/10.2196/42610 %U http://www.ncbi.nlm.nih.gov/pubmed/36939827 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42646 %T Capturing the Dynamics of the Social Environment Through Experience Sampling Methods, Passive Sensing, and Egocentric Networks: Scoping Review %A Langener,Anna M %A Stulp,Gert %A Kas,Martien J %A Bringmann,Laura F %+ Groningen Institute for Evolutionary Life Sciences, Nijenborgh 7, Groningen, 9747 AG, Netherlands, 31 050 363 8, langener95@gmail.com %K social context %K experience sampling method %K egocentric network %K digital phenotyping %K passive measures %K ambulatory assessment %K mobile phone %D 2023 %7 17.3.2023 %9 Review %J JMIR Ment Health %G English %X Background: Social interactions are important for well-being, and therefore, researchers are increasingly attempting to capture people’s social environment. Many different disciplines have developed tools to measure the social environment, which can be highly variable over time. The experience sampling method (ESM) is often used in psychology to study the dynamics within a person and the social environment. In addition, passive sensing is often used to capture social behavior via sensors from smartphones or other wearable devices. Furthermore, sociologists use egocentric networks to track how social relationships are changing. Each of these methods is likely to tap into different but important parts of people’s social environment. Thus far, the development and implementation of these methods have occurred mostly separately from each other. Objective: Our aim was to synthesize the literature on how these methods are currently used to capture the changing social environment in relation to well-being and assess how to best combine these methods to study well-being. Methods: We conducted a scoping review according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: We included 275 studies. In total, 3 important points follow from our review. First, each method captures a different but important part of the social environment at a different temporal resolution. Second, measures are rarely validated (>70% of ESM studies and 50% of passive sensing studies were not validated), which undermines the robustness of the conclusions drawn. Third, a combination of methods is currently lacking (only 15/275, 5.5% of the studies combined ESM and passive sensing, and no studies combined all 3 methods) but is essential in understanding well-being. Conclusions: We highlight that the practice of using poorly validated measures hampers progress in understanding the relationship between the changing social environment and well-being. We conclude that different methods should be combined more often to reduce the participants’ burden and form a holistic perspective on the social environment. %M 36930210 %R 10.2196/42646 %U https://mental.jmir.org/2023/1/e42646 %U https://doi.org/10.2196/42646 %U http://www.ncbi.nlm.nih.gov/pubmed/36930210 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40542 %T Enhancing Therapeutic Processes in Videoconferencing Psychotherapy: Interview Study of Psychologists’ Technological Perspective %A Cataldo,Francesco %A Mendoza,Antonette %A Chang,Shanton %A Buchanan,George %A Van Dam,Nicholas T %+ School of Computing and Information Systems, Faculty of Engineering and Information Technology, University of Melbourne, Carlton VIC, 700 Swanston St, Melbourne, 3053, Australia, 61 444574920, fcataldo@student.unimelb.edu.au %K videoconference psychotherapy %K therapeutic relationship %K therapeutic alliance %K telehealth %K technology %K therapeutic processes %D 2023 %7 16.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic caused a surge in the use of telehealth platforms. Psychologists have shifted from face-to-face sessions to videoconference sessions. Therefore, essential information that is easily obtainable via in-person sessions may be missing. Consequently, therapeutic work could be compromised. Objective: This study aimed to explore the videoconference psychotherapy (VCP) experiences of psychologists around the world. Furthermore, we aimed to identify technological features that may enhance psychologists’ therapeutic work through augmented VCP. Methods: In total, 17 psychologists across the world (n=7, 41% from Australia; n=1, 6% from England; n=5, 29% from Italy; n=1, 6% from Mexico; n=1, 6% from Spain; and n=2, 12% from the United States) were interviewed. We used thematic analysis to examine the data collected from a sample of 17 psychologists. We applied the Chaos Theory to interpret the system dynamics and collected details about the challenges posed by VCP. For collecting further information about the technology and processes involved, we relied on the Input-Process-Output (IPO) model. Results: The analysis resulted in the generation of 9 themes (input themes: psychologists’ attitude, trust-reinforcing features, reducing cognitive load, enhancing emotional communication, and engaging features between psychologists and patients; process themes: building and reinforcing trust, decreasing cognitive load, enhancing emotional communication, and increasing psychologist-patient engagement) and 19 subthemes. Psychologists found new strategies to deal with VCP limitations but also reported the need for more technical control to facilitate therapeutic processes. The suggested technologies (eye contact functionality, emergency call functionality, screen control functionality, interactive interface with other apps and software, and zooming in and out functionality) could enhance the presence and dynamic nature of the therapeutic relationship. Conclusions: Psychologists expressed a desire for enhanced control of VCP sessions. Psychologists reported a decreased sense of control within the therapeutic relationship owing to the influence of the VCP system. Great control of the VCP system could better approximate the critical elements of in-person psychotherapy (eg, observation of body language). To facilitate improved control, psychologists would like technology to implement features such as improved eye contact, better screen control, emergency call functionality, ability to zoom in and out, and an interactive interface to communicate with other apps. These results contribute to the general perception of the computer as an actual part of the VCP process. Thus, the computer plays a key role in the communication, rather than remaining as a technical medium. By adopting the IPO model in the VCP environment (VCP-IPO model), the relationship experience may help psychologists have more control in their VCP sessions. %M 36927506 %R 10.2196/40542 %U https://formative.jmir.org/2023/1/e40542 %U https://doi.org/10.2196/40542 %U http://www.ncbi.nlm.nih.gov/pubmed/36927506 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41793 %T Association Between Social Networking Site Use Intensity and Depression Among Chinese Pregnant Women: Cross-sectional Study %A Wang,Rui %A Cong,Shengnan %A Sha,Lijuan %A Sun,Xiaoqing %A Zhu,Rong %A Feng,Jingyi %A Wang,Jianfang %A Tang,Xiaomei %A Zhao,Dan %A Zhu,Qing %A Fan,Xuemei %A Ren,Ziqi %A Zhang,Aixia %+ Department of Nursing, Women’s Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, 123 Tianfei Alley, Qinhuai District, Nanjing, 210004, China, 86 13401920998, zhangaixia@njmu.edu.cn %K antenatal depression %K social network site %K social media %K WeChat %K upward social comparison %K rumination %D 2023 %7 15.3.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite extensive debates about the mental health impacts of the use of social networking sites (SNSs), including WeChat, the association and mechanisms between social interaction of WeChat use intensity and antenatal depression are unclear. Objective: We aimed to test the mediating roles of upward social comparison on social interaction of WeChat and rumination in the association between social interaction of WeChat use intensity and antenatal depression. Methods: A cross-sectional survey was conducted in four hospitals with the self-reported measures of social interaction of WeChat use intensity, upward social comparison on social interaction of WeChat, rumination, antenatal depression, and control variables. The mediation analysis was performed through Model 6 from the PROCESS macro 4.0 in SPSS 26. Results: Results from 2661 participants showed that antenatal depression was unrelated to social interaction of WeChat use intensity (P=.54), but was significantly positively related to the attitude toward social interaction of WeChat (P=.01). The direct effect of attitude toward social interaction of WeChat use on antenatal depression was not statistically significant (β=–.03, P=.05). The results supported an indirect relationship between attitude toward social interaction of WeChat use and antenatal depression via (1) upward social comparison on social interaction of WeChat (indirect effect value=0.04, 95% CI 0.03 to 0.06); (2) rumination (indirect effect value=–0.02, 95% CI –0.04 to –0.01); and (3) upward social comparison on social interaction of WeChat and rumination in sequence (indirect effect value=0.07, 95% CI 0.06 to 0.08). Conclusions: Our findings highlight the necessity of focusing on attitudes toward SNS use, and the importance of upward social comparison and rumination in understanding the effect of SNS use on antenatal depression. %M 36920458 %R 10.2196/41793 %U https://www.jmir.org/2023/1/e41793 %U https://doi.org/10.2196/41793 %U http://www.ncbi.nlm.nih.gov/pubmed/36920458 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39425 %T Objective Prediction of Next-Day’s Affect Using Multimodal Physiological and Behavioral Data: Algorithm Development and Validation Study %A Jafarlou,Salar %A Lai,Jocelyn %A Azimi,Iman %A Mousavi,Zahra %A Labbaf,Sina %A Jain,Ramesh C %A Dutt,Nikil %A Borelli,Jessica L %A Rahmani,Amir %+ Donald Bren School of Information and Computer Sciences, University of California, Irvine, Donald Bren Hall, 6210, Irvine, CA, 92697, United States, 1 (949) 824 7427, jafarlos@uci.edu %K wearable devices %K mental health %K affective computing %D 2023 %7 15.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Affective states are important aspects of healthy functioning; as such, monitoring and understanding affect is necessary for the assessment and treatment of mood-based disorders. Recent advancements in wearable technologies have increased the use of such tools in detecting and accurately estimating mental states (eg, affect, mood, and stress), offering comprehensive and continuous monitoring of individuals over time. Objective: Previous attempts to model an individual’s mental state relied on subjective measurements or the inclusion of only a few objective monitoring modalities (eg, smartphones). This study aims to investigate the capacity of monitoring affect using fully objective measurements. We conducted a comparatively long-term (12-month) study with a holistic sampling of participants’ moods, including 20 affective states. Methods: Longitudinal physiological data (eg, sleep and heart rate), as well as daily assessments of affect, were collected using 3 modalities (ie, smartphone, watch, and ring) from 20 college students over a year. We examined the difference between the distributions of data collected from each modality along with the differences between their rates of missingness. Out of the 20 participants, 7 provided us with 200 or more days’ worth of data, and we used this for our predictive modeling setup. Distributions of positive affect (PA) and negative affect (NA) among the 7 selected participants were observed. For predictive modeling, we assessed the performance of different machine learning models, including random forests (RFs), support vector machines (SVMs), multilayer perceptron (MLP), and K-nearest neighbor (KNN). We also investigated the capability of each modality in predicting mood and the most important features of PA and NA RF models. Results: RF was the best-performing model in our analysis and performed mood and stress (nervousness) prediction with ~81% and ~72% accuracy, respectively. PA models resulted in better performance compared to NA. The order of the most important modalities in predicting PA and NA was the smart ring, phone, and watch, respectively. SHAP (Shapley Additive Explanations) analysis showed that sleep and activity-related features were the most impactful in predicting PA and NA. Conclusions: Generic machine learning–based affect prediction models, trained with population data, outperform existing methods, which use the individual’s historical information. Our findings indicated that our mood prediction method outperformed the existing methods. Additionally, we found that sleep and activity level were the most important features for predicting next-day PA and NA, respectively. %M 36920456 %R 10.2196/39425 %U https://formative.jmir.org/2023/1/e39425 %U https://doi.org/10.2196/39425 %U http://www.ncbi.nlm.nih.gov/pubmed/36920456 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41413 %T Evaluation of Two Web-Based Interventions (Res-Up! and REMOTION) in Routine Outpatient Psychotherapy (Therapy Online Plus—TOP): Protocol for a Randomized Controlled Trial %A Trimpop,Leonie Franziska %A Bielinski,Laura Luisa %A Berger,Thomas %A Willutzki,Ulrike %+ Department of Clinical Psychology and Psychotherapy, University of Witten/Herdecke, Alfred-Herrhausen-Strasse 44, Witten, 58455, Germany, 49 2302 926 9704, leonie.trimpop@uni-wh.de %K online therapy %K randomized controlled trial %K transdiagnostic %K resilience %K emotion regulation %K capitalization %K compensation %K intervention %K psychotherapy %K Germany %K treatment %K mental disorder %K effectiveness %D 2023 %7 15.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Only 11%-40% of those with a mental disorder in Germany receive treatment. In many cases, face-to-face psychotherapy is not available because of limited resources, such as an insufficient number of therapists in the area. New approaches to improve the German health care system are needed to counter chronification. Web-based interventions have been shown to be effective as stand-alone and add-on treatments to routine practice. Interventions designed for a wide range of mental disorders such as transdiagnostic interventions are needed to make treatment for mental disorders more accessible and thus shorten waiting times and mitigate the chronification of mental health problems. In general, interventions can be differentiated as having either a capitalization (CAP) focus—thus drawing on already existing strengths—or a compensation (COMP) focus—trying to compensate for deficits. Up to now, the effectiveness of transdiagnostic web-based interventions with either a CAP or a COMP focus has not yet been evaluated. Objective: This study is the first to examine the effectiveness of two transdiagnostic web-based interventions: (1) the activation of resilience and drawing on existing strengths (CAP: Res-Up!) and (2) the improvement of emotion regulation (COMP: REMOTION), compared with care as usual (CAU) in routine outpatient psychotherapy. Methods: Adults with at least 1 mental health disorder will be recruited at 4 outpatient centers in Germany. Participants will then be randomized equally into 1 of the 2 intervention groups Res-Up! (CAP) and REMOTION (COMP) or into the control group (CAU). Assessments will be made at baseline (T0), at 6 weeks after treatment start (T1), and at 12 weeks after treatment start (T2). A primary outcome will be symptom severity (Brief Symptom Inventory-18). Secondary outcomes will focus on emotion regulation and resilience. Results: Participant recruitment and data collection started in April 2020 and were ongoing as of July 2022. We expect participants to benefit more from the interventions than from the CAU control on the dimensions of symptom severity, resilience, and emotion regulation. Furthermore, we expect to find possible differences between CAP and COMP. The results of the study are expected in 2023. Conclusions: This randomized controlled trial will compare CAU with the transdiagnostic web-based interventions Res-Up! and REMOTION, and will thus inform future studies concerning the effectiveness of transdiagnostic web-based interventions in routine outpatient psychotherapy. Trial Registration: ClinicalTrials.gov NCT04352010; https://clinicaltrials.gov/ct2/show/NCT04352010 International Registered Report Identifier (IRRID): DERR1-10.2196/41413 %M 36920449 %R 10.2196/41413 %U https://www.researchprotocols.org/2023/1/e41413 %U https://doi.org/10.2196/41413 %U http://www.ncbi.nlm.nih.gov/pubmed/36920449 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41273 %T Acceptability and Feasibility of “Village,” a Digital Communication App for Young People Experiencing Low Mood, Thoughts of Self-harm, and Suicidal Ideation to Obtain Support From Family and Friends: Mixed Methods Pilot Open Trial %A Thabrew,Hiran %A Kumar,Harshali %A Steadman,Evandah %+ Department of Psychological Medicine, The University go Auckland, 20-22 Park Road, Grafton, Auckland, 1142, New Zealand, 64 021402055, h.thabrew@auckland.ac.nz %K youth %K suicide %K self-harm %K depression %K support %K application %K mobile phone %D 2023 %7 13.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people experiencing low mood, thoughts related to self-harm, and suicidal ideation often struggle to communicate their emotions and receive timely support from family and friends. Technologically delivered support interventions may be useful in addressing this need. Objective: This paper aimed to evaluate the acceptability and feasibility of “Village,” a communication app co-designed with young people and their family and friends from New Zealand. Methods: A mixed methods pilot open trial design was adopted. Participants were primarily recruited via social media advertisements and clinicians in specialist mental health services over an 8-month period. The primary outcomes were acceptability of the app (via thematically analyzed qualitative feedback and retention rates) and feasibility of conducting a larger randomized controlled trial gauged via effectiveness of recruitment methods, completion of chosen outcome measures, and occurrence of unanticipated operational issues. Secondary outcomes were app usability, safety, and changes in symptoms of depression (via the Patient Health Questionnaire–9 modified for adolescents), suicidal ideation (on the Suicidal Ideation Questionnaire), and functioning (using the World Health Organization Disability Assessment Schedule 2.0 or Child and Youth version). Results: A total of 26 young people (“users”) were enrolled in the trial, of which 21 recruited friends and family members (“buddies”) and completed quantitative outcome measures at baseline, 4 weeks, and 3 months. Furthermore, 13 users and 12 buddies also provided qualitative feedback about the app, identifying the key themes of appeal of app features and layout, usefulness of its content, and technological challenges (primarily with onboarding and notifications). Users gave Village a mean rating of 3.8 (range 2.7-4.6) out of 5 on a 5-point scale for app quality and an overall star rating of 3.4 out of 5 for subjective quality. Within this limited sample, users reported a clinically significant reduction in depressive symptoms (P=.007), but nonsignificant changes in suicidal ideation and functioning. The embedded risk detection software was activated on 3 occasions, and no additional support was required for users. Conclusions: During this open trial, Village was found to be acceptable, usable, and safe. The feasibility of a larger randomized controlled trial was also confirmed after some modifications to the recruitment strategy and app. Trial Registration: Australian New Zealand Clinical Trials Network Registry ACTRN12620000241932p; https://tinyurl.com/ya6t4fx2 %M 36912882 %R 10.2196/41273 %U https://formative.jmir.org/2023/1/e41273 %U https://doi.org/10.2196/41273 %U http://www.ncbi.nlm.nih.gov/pubmed/36912882 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e38493 %T Evaluating the Utility of a Psychoeducational Serious Game (SPARX) in Protecting Inuit Youth From Depression: Pilot Randomized Controlled Trial %A Bohr,Yvonne %A Litwin,Leah %A Hankey,Jeffrey Ryan %A McCague,Hugh %A Singoorie,Chelsea %A Lucassen,Mathijs F G %A Shepherd,Matthew %A Barnhardt,Jenna %+ LaMarsh Centre for Child and Youth Research, York University, 4700 Keele Street, Toronto, ON, M3J1P3, Canada, 1 6475616464, jrhankey@yorku.ca %K psychoeducation %K cognitive behavioral therapy %K Inuit youth %K Nunavut %K depression %K suicide %K resilience %K serious game %K youth %K mental health %K teen %K adolescent %K pilot study %K community %D 2023 %7 9.3.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: Inuit youth in Northern Canada show considerable resilience in the face of extreme adversities. However, they also experience significant mental health needs and some of the highest adolescent suicide rates in the world. Disproportionate rates of truancy, depression, and suicide among Inuit adolescents have captured the attention of all levels of government and the country. Inuit communities have expressed an urgent imperative to create, or adapt, and then evaluate prevention and intervention tools for mental health. These tools should build upon existing strengths, be culturally appropriate for Inuit communities, and be accessible and sustainable in Northern contexts, where mental health resources are often scarce. Objective: This pilot study assesses the utility, for Inuit youth in Canada, of a psychoeducational e-intervention designed to teach cognitive behavioral therapy strategies and techniques. This serious game, SPARX, had previously demonstrated effectiveness in addressing depression with Māori youth in New Zealand. Methods: The Nunavut Territorial Department of Health sponsored this study, and a team of Nunavut-based community mental health staff facilitated youth’s participation in an entirely remotely administered pilot trial using a modified randomized control approach with 24 youths aged 13-18 across 11 communities in Nunavut. These youth had been identified by the community facilitators as exhibiting low mood, negative affect, depressive presentations, or significant levels of stress. Entire communities, instead of individual youth, were randomly assigned to an intervention group or a waitlist control group. Results: Mixed models (multilevel regression) revealed that participating youth felt less hopeless (P=.02) and engaged in less self-blame (P=.03), rumination (P=.04), and catastrophizing (P=.03) following the SPARX intervention. However, participants did not show a decrease in depressive symptoms or an increase in formal resilience indicators. Conclusions: Preliminary results suggest that SPARX may be a good first step for supporting Inuit youth with skill development to regulate their emotions, challenge maladaptive thoughts, and provide behavioral management techniques such as deep breathing. However, it will be imperative to work with youth and communities to design, develop, and test an Inuit version of the SPARX program, tailored to fit the interests of Inuit youth and Elders in Canada and to increase engagement and effectiveness of the program. Trial Registration: ClinicalTrials.gov NCT05702086; https://www.clinicaltrials.gov/ct2/show/NCT05702086 %M 36892940 %R 10.2196/38493 %U https://games.jmir.org/2023/1/e38493 %U https://doi.org/10.2196/38493 %U http://www.ncbi.nlm.nih.gov/pubmed/36892940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40104 %T The Use of Evaluation Panels During the Development of a Digital Intervention for Veterans Based on Cognitive Behavioral Therapy for Insomnia: Qualitative Evaluation Study %A Ryan,Arthur Thomas %A Brenner,Lisa Anne %A Ulmer,Christi S %A Mackintosh,Margaret-Anne %A Greene,Carolyn J %+ Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention, Department of Veterans Affairs, Rocky Mountain Regional Veterans Affairs Medical Center, 1700 N Wheeling St, G-3-116M, Aurora, CO, 80045, United States, 1 720 723 7493, arthur.ryan@va.gov %K cognitive behavioral therapy for insomnia %K CBT-I %K insomnia %K digital mental health intervention %K digital MH intervention %K internet-delivered %K veterans %K Path to Better Sleep %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals enrolling in the Veterans Health Administration frequently report symptoms consistent with insomnia disorder. Cognitive behavioral therapy for insomnia (CBT-I) is a gold standard treatment for insomnia disorder. While the Veterans Health Administration has successfully implemented a large dissemination effort to train providers in CBT-I, the limited number of trained CBT-I providers continues to restrict the number of individuals who can receive CBT-I. Digital mental health intervention adaptations of CBT-I have been found to have similar efficacy as traditional CBT-I. To help address the unmet need for insomnia disorder treatment, the VA commissioned the creation of a freely available, internet-delivered digital mental health intervention adaptation of CBT-I known as Path to Better Sleep (PTBS). Objective: We aimed to describe the use of evaluation panels composed of veterans and spouses of veterans during the development of PTBS. Specifically, we report on the methods used to conduct the panels, the feedback they provided on elements of the course relevant to user engagement, and how their feedback influenced the design and content of PTBS. Methods: A communications firm was contracted to recruit 3 veteran (n=27) and 2 spouse of veteran (n=18) panels and convene them for three 1-hour meetings. Members of the VA team identified key questions for the panels, and the communications firm prepared facilitator guides to elicit feedback on these key questions. The guides provided a script for facilitators to follow while convening the panels. The panels were telephonically conducted, with visual content displayed via remote presentation software. The communications firm prepared reports summarizing the panelists’ feedback during each panel meeting. The qualitative feedback described in these reports served as the raw material for this study. Results: The panel members provided markedly consistent feedback on several elements of PTBS, including recommendations to emphasize the efficacy of CBT-I techniques; clarify and simplify written content as much as possible; and ensure that content is consistent with the lived experiences of veterans. Their feedback was congruent with previous studies on the factors influencing user engagement with digital mental health interventions. Panelist feedback influenced multiple course design decisions, including reducing the effort required to use the course’s sleep diary function, making written content more concise, and selecting veteran testimonial videos that emphasized the benefits of treating chronic insomnia symptoms. Conclusions: The veteran and spouse evaluation panels provided useful feedback during the design of PTBS. This feedback was used to make concrete revisions and design decisions consistent with existing research on improving user engagement with digital mental health interventions. We believe that many of the key feedback messages provided by these evaluation panels could prove useful to other digital mental health intervention designers. %M 36877553 %R 10.2196/40104 %U https://formative.jmir.org/2023/1/e40104 %U https://doi.org/10.2196/40104 %U http://www.ncbi.nlm.nih.gov/pubmed/36877553 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44370 %T Improving Mental Health Literacy and Reducing Psychological Problems Among Teachers in Zambia: Protocol for Implementation and Evaluation of a Wellness4Teachers Email Messaging Program %A Agyapong,Belinda %A Chishimba,Charles %A Wei,Yifeng %A da Luz Dias,Raquel %A Eboreime,Ejemai %A Msidi,Eleanor %A Abidi,Syed Sibte Raza %A Mutaka-Loongo,Maryn %A Mwansa,James %A Orji,Rita %A Zulu,John Mathias %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J. Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, agyapong@ualberta.ca %K burnout %K stress %K Zambia %K Africa %K teacher %K educator %K school %K anxiety %K wellness %K depression %K e-mental health %K intervention %K health literacy %K mental health %K depressive %K psychological issue %K psychological problem %K text message %K messaging %K decision-making %D 2023 %7 6.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Primary, basic, secondary, and high school teachers are constantly faced with increased work stressors that can result in psychological health challenges such as burnout, anxiety, and depression, and in some cases, physical health problems. It is presently unknown what the mental health literacy levels are or the prevalence and correlates of psychological issues among teachers in Zambia. It is also unknown if an email mental messaging program (Wellness4Teachers) would effectively reduce burnout and associated psychological problems and improve mental health literacy among teachers. Objective: The primary objectives of this study are to determine if daily supportive email messages plus weekly mental health literacy information delivered via email can help improve mental health literacy and reduce the prevalence of moderate to high stress symptoms, burnout, moderate to high anxiety symptoms, moderate to high depression symptoms, and low resilience among school teachers in Zambia. The secondary objectives of this study are to evaluate the baseline prevalence and correlates of moderate to high stress, burnout, moderate to high anxiety, moderate to high depression, and low resilience among school teachers in Zambia. Methods: This is a quantitative longitudinal and cross-sessional study. Data will be collected at the baseline (the onset of the program), 6 weeks, 3 months, 6 months (the program midpoint), and 12 months (the end point) using web-based surveys. Individual teachers will subscribe by accepting an invitation to do so from the Lusaka Apex Medical University organizational account on the ResilienceNHope web-based application. Data will be analyzed using SPSS version 25 with descriptive and inferential statistics. Outcome measures will be evaluated using standardized rating scales. Results: The Wellness4Teachers email program is expected to improve the participating teachers’ mental health literacy and well-being. It is anticipated that the prevalence of stress, burnout, anxiety, depression, and low resilience among teachers in Zambia will be similar to those reported in other jurisdictions. In addition, it is expected that demographic, socioeconomic, and organizational factors, class size, and grade teaching will be associated with burnout and other psychological disorders among teachers, as indicated in the literature. Results are expected 2 years after the program’s launch. Conclusions: The Wellness4Teachers email program will provide essential insight into the prevalence and correlates of psychological problems among teachers in Zambia and the program’s impact on subscribers’ mental health literacy and well-being. The outcome of this study will help inform policy and decision-making regarding psychological interventions for teachers in Zambia. International Registered Report Identifier (IRRID): PRR1-10.2196/44370 %M 36877571 %R 10.2196/44370 %U https://www.researchprotocols.org/2023/1/e44370 %U https://doi.org/10.2196/44370 %U http://www.ncbi.nlm.nih.gov/pubmed/36877571 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44940 %T A Relational Agent Intervention for Adolescents Seeking Mental Health Treatment: Protocol for a Randomized Controlled Trial %A Chiauzzi,Emil %A Robinson,Athena %A Martin,Kate %A Petersen,Carl %A Wells,Nicole %A Williams,Andre %A Gleason,Mary Margaret %+ Woebot Health, 535 Mission Street, 14th Floor, San Francisco, CA, 94105, United States, 1 6502242216, athena@woebothealth.com %K adolescent %K digital health %K cognitive behavioral therapy %K CBT %K chatbot %K feasibility %K therapeutic alliance %K depression %K anxiety %K relational agent %K mental health care %K intervention %K agent %K youth %K teenager %K mental health %K treatment %K protocol %K feasibility %K randomized controlled trial %K acceptability %K telehealth %K outcome %K utility %D 2023 %7 3.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Unmet pediatric mental health (MH) needs are growing as rates of pediatric depression and anxiety dramatically increase. Access to care is limited by multiple factors, including a shortage of clinicians trained in developmentally specific, evidence-based services. Novel approaches to MH care delivery, including technology-leveraged and readily accessible options, need to be evaluated in service of expanding evidence-based services to youths and their families. Preliminary evidence supports the use of Woebot, a relational agent that digitally delivers guided cognitive behavioral therapy (CBT) through a mobile app, for adults with MH concerns. However, no studies have evaluated the feasibility and acceptability of such app-delivered relational agents specifically for adolescents with depression and/or anxiety within an outpatient MH clinic, nor compared them to other MH support services. Objective: This paper describes the protocol for a randomized controlled trial evaluating the feasibility and acceptability of an investigational device, Woebot for Adolescents (W-GenZD), within an outpatient MH clinic for youths presenting with depression and/or anxiety. The study’s secondary aim will compare the clinical outcomes of self-reported depressive symptoms with W-GenZD and a telehealth-delivered CBT-based skills group (CBT-group). Tertiary aims will evaluate additional clinical outcomes and therapeutic alliance between adolescents in W-GenZD and the CBT-group. Methods: Participants include youths aged 13-17 years with depression and/or anxiety seeking care from an outpatient MH clinic at a children’s hospital. Eligible youths will have no recent safety concerns or complex comorbid clinical diagnoses; have no concurrent individual therapy; and, if on medications, are on stable doses, based on clinical screening and as well as study-specific criteria. Results: Recruitment began in May 2022. As of December 8, 2022, we have randomized 133 participants. Conclusions: Establishing the feasibility and acceptability of W-GenZD within an outpatient MH clinical setting will add to the field’s current understanding of the utility and implementation considerations of this MH care service modality. The study will also evaluate the noninferiority of W-GenZD against the CBT-group. Findings may also have implications for patients, families, and providers looking for additional MH support options for adolescents seeking help for their depression and/or anxiety. Such options expand the menu of supports for youths with lower-intensity needs as well as possibly reduce waitlists and optimize clinician deployment toward more severe cases. Trial Registration: ClinicalTrials.gov NCT05372913; https://clinicaltrials.gov/ct2/show/NCT05372913 International Registered Report Identifier (IRRID): DERR1-10.2196/44940 %M 36867455 %R 10.2196/44940 %U https://www.researchprotocols.org/2023/1/e44940 %U https://doi.org/10.2196/44940 %U http://www.ncbi.nlm.nih.gov/pubmed/36867455 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40440 %T Effects of Text4Hope-Addiction Support Program on Cravings and Mental Health Symptoms: Results of a Longitudinal Cross-sectional Study %A Obuobi-Donkor,Gloria %A Shalaby,Reham %A Vuong,Wesley %A Agyapong,Belinda %A Hrabok,Marianne %A Gusnowski,April %A Surood,Shireen %A Greenshaw,Andrew J %A Agyapong,Vincent IO %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor, Abbie J Lane Memorial Building, QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 780 215 7771, vn602367@dal.ca %K addiction %K substance craving %K depression %K anxiety %K Text4Hope %K satisfaction %D 2023 %7 1.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Drug misuse is complex, and various treatment modalities are emerging. Providing supportive text messages to individuals with substance use disorder offers the prospect of managing and improving symptoms of drug misuse and associated comorbidities. Objective: This study evaluated the impact of the daily supportive text message program (Text4Hope-Addiction Support) in mitigating cravings and mental health symptoms in subscribers and quantify user satisfaction with the Text4Hope-Addiction Support program. Methods: Subscribers to the Text4Hope-Addiction Support program received daily supportive text messages for 3 months; the messages were crafted based on addiction counseling and cognitive behavioral therapy principles. Participants completed an anonymous web-based questionnaire to assess cravings, anxiety, and depressive symptoms using the Brief Substance Craving Scale (BSCS), Generalized Anxiety Disorder-7 (GAD-7) scale, and Patient Health Questionnaire-9 (PHQ-9) scale at enrollment (baseline), after 6 weeks, and after 3 months. Likert scale satisfaction responses were used to assess various aspects of the Text4Hope-Addiction program. Results: In total, 408 people subscribed to the program, and 110 of 408 (26.9%) subscribers completed the surveys at least at one time point. There were significant differences between the mean baseline and 3-month BSCS scores P=.01 (−2.17, 95% CI –0.62 to 3.72), PHQ-9 scores, P=.004 (−5.08, 95% CI −1.65 to −8.51), and GAD-7 scores, P=.02 (−3.02, 95% CI −0.48 to −5.56). Participants who received the supportive text messages reported a reduced desire to use drugs and a longer time interval between substance use, which are reflected in 41.1% and 32.5% decrease, respectively, from baseline score. Approximately 89% (23/26) of the participants agreed that Text4Hope-Addiction program helped them cope with addiction-related stress, and 81% (21/25) of the participants reported that the messages assisted them in dealing with anxiety. Overall, 69% (18/26) of the participants agreed that it helped them cope with depression related to addiction; 85% (22/26) of the participants felt connected to a support system; 77% (20/26) of the participants were hopeful of their ability to manage addiction issues; and 73% (19/26) of the participants felt that their overall mental well-being was improved. Most of the participants agreed that the interventions were always positive and affirmative (19/26, 73%), and succinct (17/26, 65%). Furthermore, 88% (21/24) of the participants always read the messages; 83% (20/24) of the participants took positive or beneficial actions after reading; and no participant took a negative action after reading the messages. In addition, most participants agreed to recommend other diverse technology-based services as an adjunctive treatment for their mental and physical health disorders. Conclusions: Subscribers of Text4Hope-Addiction Support program experienced improved mental health and addiction symptoms. Addiction care practitioners and policy makers can implement supportive text-based strategies to complement conventional treatments for addiction, given that mobile devices are widely used. %M 36857114 %R 10.2196/40440 %U https://formative.jmir.org/2023/1/e40440 %U https://doi.org/10.2196/40440 %U http://www.ncbi.nlm.nih.gov/pubmed/36857114 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e41855 %T From Social Network to Peer Support Network: Opportunities to Explore Mechanisms of Online Peer Support for Mental Health %A Rayland,Amy %A Andrews,Jacob %+ National Institute for Health and Care Research Mindtech Medtech Co-operative, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 1157484 218, jacob.andrews@nottingham.ac.uk %K peer-to-peer support %K Facebook %K social networking sites %K mental health %K moderation %D 2023 %7 28.2.2023 %9 Viewpoint %J JMIR Ment Health %G English %X An increasing number of psychological interventions are shifting to online modes of delivery. One such intervention is peer-to-peer support, which in this context may provide internet users living with mental health disorders an opportunity to connect with and support others living with similar conditions. This paper presents a call for further research into how platforms such as Facebook could be used as channels for peer support and the mechanisms that may underlie their effectiveness. We discuss the background of peer support, how it has transitioned online, and consider theories and models that may have relevance. We also consider the importance of moderation within online peer support and the development of specific social network–based online interventions. We conclude that for social network sites to be used as peer-to-peer support interventions, more research is needed to understand their effectiveness, the role of moderation in these communities, and the mechanisms that produce the benefits experienced by users. %M 36853738 %R 10.2196/41855 %U https://mental.jmir.org/2023/1/e41855 %U https://doi.org/10.2196/41855 %U http://www.ncbi.nlm.nih.gov/pubmed/36853738 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40937 %T Digital Behavioral Activation Interventions During the Perinatal Period: Scoping Review %A Mancinelli,Elisa %A Dell'Arciprete,Gaia %A Pattarozzi,Davide %A Gabrielli,Silvia %A Salcuni,Silvia %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35121, Italy, 39 3342799698, elisa.mancinelli@phd.unipd.it %K behavioral activation %K eHealth %K perinatal care %K depression symptoms %K scoping review %K mobile phone %D 2023 %7 28.2.2023 %9 Review %J JMIR Pediatr Parent %G English %X Background: Pregnancy is a complex period that implies many biopsychosocial changes, and the way women adapt to these changes impacts their well-being and the chances of developing mental health problems. During the perinatal period, women have expressed a preference for support delivered on the web. In this regard, interventions such as behavioral activation (BA), which are brief and structured psychosocial interventions, seem particularly suited to be delivered through digital solutions. Objective: This study aimed to map the literature investigating digital BA interventions deployed during the perinatal period. We paid particular attention to the methodological underpinnings of the studies, the potential impact of BA interventions on symptoms other than depression, and the existence of differences occurring when these interventions were administered during pregnancy versus the postpartum period. Methods: A systematic search compliant with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines was conducted considering 5 bibliographic databases; reference lists and key journals were also screened by 2 independent authors following a double-blind approach. Results: A total of 7 studies published between 2013 and 2022 were included. In total, 2 studies were protocols for randomized controlled trials, 5 were empirical studies, and 1 was a qualitative study. All studies focused on the postpartum period, except for 1 that focused on the broader perinatal period. Promising effects on depression symptoms were reported but not on other psychosocial symptoms. Low intervention adherence has emerged, whereas the usability associated with the digital means used to deploy interventions was scarcely addressed; moreover, information on the digital platforms used was poorly reported overall. Conclusions: Our findings highlight the scarcity and preliminary nature of digital BA interventions deployed during the perinatal period, where the focus seems more on treatment rather than prevention. Moreover, future studies should also consider and address usability and user engagement, given their relevance to intervention efficacy. %M 36853756 %R 10.2196/40937 %U https://pediatrics.jmir.org/2023/1/e40937 %U https://doi.org/10.2196/40937 %U http://www.ncbi.nlm.nih.gov/pubmed/36853756 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42501 %T Identifying and Categorizing Adverse Events in Trials of Digital Mental Health Interventions: Narrative Scoping Review of Trials in the International Standard Randomized Controlled Trial Number Registry %A Gómez Bergin,Aislinn D %A Valentine,Althea Z %A Rennick-Egglestone,Stefan %A Slade,Mike %A Hollis,Chris %A Hall,Charlotte L %+ National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, University Park, Nottingham, NG7 2TU, United Kingdom, 44 0115 823 2438, charlotte.hall@nottingham.ac.uk %K adverse events %K harm %K psychological interventions %K clinical trials %K review %K digital %K mobile phone %D 2023 %7 22.2.2023 %9 Review %J JMIR Ment Health %G English %X Background: To contextualize the benefits of an intervention, it is important that adverse events (AEs) are reported. This is potentially difficult in trials of digital mental health interventions, where delivery may be remote and the mechanisms of actions less understood. Objective: We aimed to explore the reporting of AEs in randomized controlled trials of digital mental health interventions. Methods: The International Standard Randomized Controlled Trial Number database was searched for trials registered before May 2022. Using advanced search filters, we identified 2546 trials in the category of mental and behavioral disorders. These trials were independently reviewed by 2 researchers against the eligibility criteria. Trials were included where digital mental health interventions for participants with a mental health disorder were evaluated through a completed randomized controlled trial (protocol and primary results publication published). Published protocols and primary results publications were then retrieved. Data were extracted independently by 3 researchers, with discussion to reach consensus when required. Results: Twenty-three trials met the eligibility criteria, of which 16 (69%) included a statement on AEs within a publication, but only 6 (26%) reported AEs within their primary results publication. Seriousness was referred to by 6 trials, relatedness by 4, and expectedness by 2. More interventions delivered with human support (9/11, 82%) than those with only remote or no support (6/12, 50%) included a statement on AEs, but they did not report more AEs. Several reasons for participant dropout were identified by trials that did not report AEs, of which some were identifiable or related to AEs, including serious AEs. Conclusions: There is significant variation in the reporting of AEs in trials of digital mental health interventions. This variation may reflect limited reporting processes and difficulty recognizing AEs related to digital mental health interventions. There is a need to develop guidelines specifically for these trials to improve future reporting. %M 36811940 %R 10.2196/42501 %U https://mental.jmir.org/2023/1/e42501 %U https://doi.org/10.2196/42501 %U http://www.ncbi.nlm.nih.gov/pubmed/36811940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42935 %T Association Between the Severity of Depressive Symptoms and Human-Smartphone Interactions: Longitudinal Study %A Yang,Xiao %A Knights,Jonathan %A Bangieva,Victoria %A Kambhampati,Vinayak %+ Mindstrong Health, 101 Jefferson Dr. Suite 228, Menlo Park, CA, 94025, United States, 1 8889952230, vwendy@gmail.com %K depression %K human-smartphone interaction %K longitudinal data analysis %K within-person effect %K between-person effect %K nonergodicity %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Various behavioral sensing research studies have found that depressive symptoms are associated with human-smartphone interaction behaviors, including lack of diversity in unique physical locations, entropy of time spent in each location, sleep disruption, session duration, and typing speed. These behavioral measures are often tested against the total score of depressive symptoms, and the recommended practice to disaggregate within- and between-person effects in longitudinal data is often neglected. Objective: We aimed to understand depression as a multidimensional process and explore the association between specific dimensions and behavioral measures computed from passively sensed human-smartphone interactions. We also aimed to highlight the nonergodicity in psychological processes and the importance of disaggregating within- and between-person effects in the analysis. Methods: Data used in this study were collected by Mindstrong Health, a telehealth provider that focuses on individuals with serious mental illness. Depressive symptoms were measured by the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) Self-Rated Level 1 Cross-Cutting Symptom Measure-Adult Survey every 60 days for a year. Participants’ interactions with their smartphones were passively recorded, and 5 behavioral measures were developed and were expected to be associated with depressive symptoms according to either theoretical proposition or previous empirical evidence. Multilevel modeling was used to explore the longitudinal relations between the severity of depressive symptoms and these behavioral measures. Furthermore, within- and between-person effects were disaggregated to accommodate the nonergodicity commonly found in psychological processes. Results: This study included 982 records of DSM Level 1 depressive symptom measurements and corresponding human-smartphone interaction data from 142 participants (age range 29-77 years; mean age 55.1 years, SD 10.8 years; 96 female participants). Loss of interest in pleasurable activities was associated with app count (γ10=−0.14; P=.01; within-person effect). Depressed mood was associated with typing time interval (γ05=0.88; P=.047; within-person effect) and session duration (γ05=−0.37; P=.03; between-person effect). Conclusions: This study contributes new evidence for associations between human-smartphone interaction behaviors and the severity of depressive symptoms from a dimensional perspective, and it highlights the importance of considering the nonergodicity of psychological processes and analyzing the within- and between-person effects separately. %M 36811951 %R 10.2196/42935 %U https://formative.jmir.org/2023/1/e42935 %U https://doi.org/10.2196/42935 %U http://www.ncbi.nlm.nih.gov/pubmed/36811951 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42861 %T Effects of a Social Media–Based Mind-Body Intervention Embedded With Acupressure and Mindfulness for Stress Reduction Among Family Caregivers of Frail Older Adults: Pilot Randomized Controlled Trial %A Sui,Yufang %A Kor,Patrick Pui Kin %A Li,Mengli %A Wang,Jingjing %+ School of Nursing, The Hong Kong Polytechnic University, FG421, 11 Yuk Choi Road, Hung Hom, Kowloon, Hong Kong, Hong Kong, 852 2766 5622, patrick.kor@polyu.edu.hk %K mind-body intervention %K acupressure %K mindfulness meditation %K social media %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Family caregivers of frail older adults experience high levels of stress. Mind-body interventions (MBIs) focused on caregiver stress are often limited in teaching approaches, difficult to practice, and costly. A social media–based MBI embedded with mindfulness meditation (MM) and self-administered acupressure (SA) may be effective for family caregivers, offer greater usability, and lead to greater adherence. Objective: The aim of this study was to test the feasibility and preliminary effects of a social media–based MBI embedded with MM and SA on family caregivers of frail older adults and to investigate the preliminary effects of the intervention using a pilot randomized controlled trial. Methods: A 2-arm randomized controlled trial design was adopted. Family caregivers of frail older adults (n=64) were randomized into either the intervention group (n=32), receiving 8 weeks of social media–based MM and SA, or the control group (n=32), receiving brief education on caregiving for people with frailty. The primary outcome (caregiver stress) and secondary outcomes (caregiver burden, sleep quality, and mindfulness awareness and attention) were measured using a web-based survey at baseline (T0), immediately after the intervention (T1), and at the 3-month follow-up (T2). Results: The feasibility of the intervention was established with a high attendance rate (87.5%), high usability score (79), and low attrition rate (1.6%). The generalized estimating equation results showed that participants in the intervention group at T1 and T2 experienced a significant improvement in stress reduction (P=.02 and P=.04, respectively), sleep quality (P=.004 and P=.01, respectively), and mindful awareness and attention (P=.006 and P=.02, respectively) compared with the control group. There were no substantial improvements in caregiver burden at T1 and T2 (P=.59 and P=.47, respectively). A focus group session conducted after the intervention had 5 themes: impact on the family caregivers, difficulty in practicing the intervention, the strength of the program, the limitations of the program, and perception of the intervention. Conclusions: The findings support the feasibility and preliminary effects of social media–based MBI embedded with acupressure and MM on reducing stress among family caregivers of frail older people and enhancing sleep quality and mindfulness levels. A future study with a larger and more diverse sample is proposed to evaluate the longer-term effects and generalizability of the intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100049507; http://www.chictr.org.cn/showproj.aspx?proj=128031 %M 36804167 %R 10.2196/42861 %U https://formative.jmir.org/2023/1/e42861 %U https://doi.org/10.2196/42861 %U http://www.ncbi.nlm.nih.gov/pubmed/36804167 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35659 %T Personalized Help-Seeking Web Application for Chinese-Speaking International University Students: Development and Usability Study %A Choi,Isabella %A Mestroni,Gemma %A Hunt,Caroline %A Glozier,Nick %+ Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Office 4, Level 5, Professor Marie Bashir Centre, Missenden Road, Camperdown, 2050, Australia, 61 0286277240, isabella.choi@sydney.edu.au %K help seeking %K mental health %K international students %K Chinese international students %K mental health awareness %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The mental health of international students is a growing concern for education providers, students, and their families. Chinese international students have low rates of help seeking owing to language, stigma, and mental health literacy barriers. Web-based help-seeking interventions may improve the rate of help seeking among Chinese international students. Objective: This study aimed to describe the development of a mental well-being web app providing personalized feedback and tailored psychoeducation and resources to support help seeking among international university students whose first language is Chinese and test the web application’s uptake and engagement. Methods: The bilingual MindYourHead web application contains 6 in-app assessments for various areas of mental health, and users are provided with personalized feedback on symptom severity, psychoeducation tailored to the person’s symptoms and information about relevant interventions, and tailored links to external resources and mental health services. A feasibility study was conducted within a school at the University of Sydney to examine the uptake and engagement of the web application among Chinese international students and any demographic characteristics or help-seeking attitudes or intentions that were associated with its engagement. Results: A total of 130 Chinese international students signed up on the web application. There was an uptake of 13.4% (122/908) in the schools’ Chinese student enrollment. Most participants (76/130, 58.5%) preferred to use the web application in Chinese and used informal but not formal help for their mental health. There was considerable attrition owing to a design issue, and only 46 students gained access to the full content of the web application. Of these, 67% (31/46) of participants completed 1 or more of the in-app mental well-being assessments. The most commonly engaged in-app assessments were distress (23/31, 74%), stress (17/31, 55%), and sleep (15/31, 48%), with the majority scoring within the moderate- or high-risk level of the score range. In total, 10% (9/81) of the completed in-app assessments led to clicks to external resources or services. No demographic or help-seeking intentions or attitudes were associated with web-application engagement. Conclusions: There were promising levels of demand, uptake, and engagement with the MindYourHead web application. The web application appears to attract students who wished to access mental health information in their native language, those who had poor mental health in the past but relied on informal support, and those who were at moderate or high risk of poor mental well-being. Further research is required to explore ways to improve uptake and engagement and to test the efficacy of the web application on Chinese international students’ mental health literacy, stigma, and help seeking. %M 36800231 %R 10.2196/35659 %U https://formative.jmir.org/2023/1/e35659 %U https://doi.org/10.2196/35659 %U http://www.ncbi.nlm.nih.gov/pubmed/36800231 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44300 %T Testing the Impact of the #chatsafe Intervention on Young People’s Ability to Communicate Safely About Suicide on Social Media: Protocol for a Randomized Controlled Trial %A Robinson,Jo %A La Sala,Louise %A Cooper,Charlie %A Spittal,Matthew %A Rice,Simon %A Lamblin,Michelle %A Brown,Ellie %A Nolan,Hayley %A Battersby-Coulter,Rikki %A Rajaram,Gowri %A Thorn,Pinar %A Pirkis,Jane %A May-Finlay,Summer %A Silenzio,Vincent %A Skehan,Jaelea %A Krysinska,Karolina %A Bellairs-Walsh,India %+ Orygen, 35 Poplar Road, Parkville, 3052, Australia, 61 412999140, jo.robinson@orygen.org.au %K suicide %K young people %K social media %K intervention, sexual health, randomized-controlled trial %D 2023 %7 17.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is the leading cause of death among Australians. One commonly cited explanation is the impact of social media, in particular, the ways in which young people use social media to communicate about their own experiences and their exposure to suicide-related content posted by others. Guidelines designed to assist mainstream media to safely report about suicide are widespread. Until recently, no guidelines existed that targeted social media or young people. In response, we developed the #chatsafe guidelines and a supporting social media campaign, which together make up the #chatsafe intervention. The intervention was tested in a pilot study with positive results. However, the study was limited by the lack of a control group. Objective: The aim of this study is to assess the impact of the #chatsafe social media intervention on young people’s safety and confidence when communicating on the web about suicide. Methods: The study employs a pragmatic, parallel, superiority randomized controlled design. It will be conducted in accordance with the Consolidated Standards of Reporting Trials statement over 18 months. Participants will be 400 young people aged 16-25 years (200 per arm). Participants will be recruited via social media advertising and assessed at 3 time points: time 1—baseline; time 2—8-week postintervention commencement; and time 3—4-week postintervention. They will be asked to complete a weekly survey to monitor safety and evaluate each piece of social media content. The intervention comprises an 8-week social media campaign including social media posts shared on public Instagram profiles. The intervention group will receive the #chatsafe suicide prevention content and the control group will receive sexual health content. Both groups will receive 24 pieces of content delivered to their mobile phones via text message. The primary outcome is safety when communicating on the web about suicide, as measured via the purpose-designed #chatsafe online safety questionnaire. Additional outcomes include willingness to intervene against suicide, internet self-efficacy, safety, and acceptability. Results: The study was funded in November 2020, approved by the University of Melbourne Human Research Ethics Committee on October 7, 2022, and prospectively registered with the Australian New Zealand Clinical Trials registry. Trial recruitment began in November 2022 and study completion is anticipated by June 2024. Conclusions: This will be the first randomized controlled trial internationally to test the impact of a social media intervention designed to equip young people to communicate safely on the web about suicide. Given the rising rates of youth suicide in Australia and the acceptability of social media among young people, incorporating social media–based interventions into the suicide prevention landscape is an obvious next step. This intervention, if effective, could also be extended internationally, thereby improving web-based safety for young people not just in Australia but globally. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622001397707; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384318 International Registered Report Identifier (IRRID): DERR1-10.2196/44300 %M 36800220 %R 10.2196/44300 %U https://www.researchprotocols.org/2023/1/e44300 %U https://doi.org/10.2196/44300 %U http://www.ncbi.nlm.nih.gov/pubmed/36800220 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43771 %T Implementation of a Web-Based Resilience Enhancement Training for Nurses: Pilot Randomized Controlled Trial %A Henshall,Catherine %A Davey,Zoe %A Srikesavan,Cynthia %A Hart,Liam %A Butcher,Dan %A Cipriani,Andrea %+ Oxford Institute for Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Headington Campus, Marston Road Site, Oxford, OX3 0FL, United Kingdom, 44 7778 428994, chenshall@brookes.ac.uk %K burnout %K COVID-19 %K health care setting %K health care staff %K health care provider %K mental health %K mental well-being %K nurses %K nursing %K pilot trial %K psychological health %K resilience training %K resilience %K web-based health %K web-based training %D 2023 %7 14.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Global workforce challenges faced by health care providers are linked to low levels of job satisfaction, recruitment, retention, and well-being, with detrimental impacts on patient care outcomes. Resilience-building programs can provide support for staff who endure highly stressful environments, enhance resilience, and support recruitment and retention, with web-based formats being key to increasing accessibility. Objective: We aimed to examine participants’ engagement with a newly developed Resilience Enhancement Online Training for Nurses (REsOluTioN), explore its acceptability, and compare levels of resilience and psychological well-being in nurses who completed REsOluTioN with those who did not. Methods: We carried out a pilot randomized trial (1:1), conducted at a single site (mental health and community trust in South England) between August 2021 and May 2022. Local research ethics approvals were obtained. Nurses were invited to participate and were randomly assigned to a waitlist group or REsOluTioN group. Training lasted for 4 weeks, consisting of prereading, web-based facilitated sessions, and mentorship support. We evaluated trial engagement, acceptability of training, and pre-post changes in resilience, measured by the Brief Resilience Scale, and psychological well-being, measured by the Warwick Edinburgh Mental Wellbeing Scale. Qualitative participant feedback was collected. Consolidated Standards of Reporting Trials 2010 extension guidelines for reporting pilot and feasibility trials were used. Results: Of 108 participants recruited, 93 completed the study. Participants’ mean age was 44 (SD 10.85) years. Most participants were female (n=95, 88.8%), White (n=95, 88.8%), and worked in community settings (n=91, 85.0%). Sixteen facilitated and 150 mentoring sessions took place. Most REsOluTioN program participants reported the sessions helped improve their resilience (n=24, 72.8%), self-confidence (n=24, 72.7%), ability to provide good patient care (n=25, 75.8%), relationships with colleagues (n=24, 72.7%), and communication skills (n=25, 75.8%). No statistically significant differences between training and control groups and time on well-being (F1,91=1.44, P=.23, partial η2=0.02) and resilience scores (F1,91=0.33, P=.57, partial η2=0.004) were revealed; however, there were positive trends toward improvement in both. Nurse participants engaged with the REsOluTioN program and found it acceptable. Most found web-based training and mentoring useful and enjoyed learning, reflection, networking, and participatory sessions. Conclusions: The REsOluTioN program was acceptable, engaging, perceived as useful, and nurses were keen for it to be implemented to optimize resilience, psychological health, communication, and workplace environments. The study has evidenced that it is acceptable to implement web-based resilience programs with similar design features within busy health care settings, indicating a need for similar programs to be carefully evaluated. Mentorship support may also be a key in optimizing resilience. Trial limitations include small sample size and reduced statistical power; a multicenter randomized controlled trial could test effectiveness of the training on a larger scale. Trial Registration: ClinicalTrials.gov NCT05074563; https://clinicaltrials.gov/ct2/show/NCT05074563 International Registered Report Identifier (IRRID): RR2-10.2196/37015 %M 36787181 %R 10.2196/43771 %U https://www.jmir.org/2023/1/e43771 %U https://doi.org/10.2196/43771 %U http://www.ncbi.nlm.nih.gov/pubmed/36787181 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43062 %T A Digital Single-Session Intervention Platform for Youth Mental Health: Cultural Adaptation, Evaluation, and Dissemination %A Shroff,Akash %A Roulston,Chantelle %A Fassler,Julia %A Dierschke,Nicole A %A Todd,Jennifer San Pedro %A Ríos-Herrera,Ámbar %A Plastino,Kristen A %A Schleider,Jessica Lee %+ Department of Psychology, Stony Brook University, Psychology B-340, Stony Brook, NY, 17794, United States, 1 9174391872, jessica.schleider@stonybrook.edu %K single-session intervention %K cultural adaptation %K web-based intervention %K adolescents %K mobile phone %D 2023 %7 14.2.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the proliferation of evidence-based digital mental health programs for young people, their low uptake and inconsistent implementation preclude them from benefiting youths at scale. Identifying effective implementation strategies for evidence-based supports is especially critical in regions where treatment access is lowest owing to mental health provider shortages. Objective: The goal of this academic-community partnership, funded by the City of San Antonio Metropolitan Health District, was to culturally adapt, disseminate, and gauge the acceptability and utility of an evidence-based digital mental health platform—Project Youth Empowerment and Support (YES)—among English- and Spanish-speaking youths living in south Texas. Methods: Project YES is an open-access, anonymous platform containing 3 evidence-based, self-guided interventions for youth mental health. Project YES was culturally adapted via focus groups and co-design sessions with San Antonio youths with lived experience of depression and anxiety; translated into Spanish; and disseminated throughout San Antonio, Texas, via community and school partnerships. Results: During the project period (April 2021 to December 2021), 1801 San Antonio youths began and 894 (49.64%) of them completed a 30-minute, single-session intervention within Project YES (aged 11-17 years; n=718, 39.87% male; n=961, 53.36% female; and n=3, 0.17% intersex; n=1477, 82.01% Hispanic; n=77, 4.28% non-Hispanic White; n=113, 6.27% Black; n=28, 1.55% Asian; and n=93, 5.16% other). This completion rate (49.64%) surpassed those previously observed for Project YES (eg, 34% when disseminated via social media). San Antonio youths rated Project YES as highly acceptable across all metrics, both in English and Spanish. In addition, the youths who completed Project YES—ENGLISH reported significant improvements in hopelessness (Cohen d=0.33; P<001), self-hate (Cohen d=0.27; P<001), and perceived agency (Cohen d=0.25; P<001) from before to after the intervention, and the youths who completed Project YES—SPANISH reported significant improvements in self-hate (Cohen d=0.37; P=.049) from before to after the intervention. Conclusions: The results indicate that Project YES—an open-access, free, and anonymous web-based single-session intervention platform—is an acceptable, accessible, and applicable mental health support for English- and Spanish-speaking San Antonio youths. %M 36787180 %R 10.2196/43062 %U https://mental.jmir.org/2023/1/e43062 %U https://doi.org/10.2196/43062 %U http://www.ncbi.nlm.nih.gov/pubmed/36787180 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41298 %T Effectiveness of Digital Guided Self-help Mindfulness Training During Pregnancy on Maternal Psychological Distress and Infant Neuropsychological Development: Randomized Controlled Trial %A Zhang,Xuan %A Li,Yang %A Wang,Juan %A Mao,Fangxiang %A Wu,Liuliu %A Huang,Yongqi %A Sun,Jiwei %A Cao,Fenglin %+ School of Nursing and Rehabilitation, Shandong University, No.44 Wenhua Xi Road, Jinan, 250012, China, 86 53188382291, caofenglin2008@126.com %K digital %K mobile health %K mHealth %K guided self-help %K psychological distress %K pregnancy %K psychosocial intervention %K mindfulness %K infant %K neuropsychological performance %D 2023 %7 10.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Maternal psychological distress during pregnancy is associated with unfavorable outcomes in infants. Mindfulness-based interventions (MBIs) can effectively alleviate psychological distress, but there are often barriers to the access of face-to-face interventions. Objective: This study aimed to investigate the effectiveness of a digital guided self-help (GSH) MBI (GSH-MBI) in reducing maternal psychological distress and improving infant neuropsychological performance. Methods: This was a randomized controlled trial. We recruited 160 women who were 12 to 20 weeks pregnant and exhibited psychological distress. We randomized them into a digital GSH-MBI group and a control group (usual perinatal care). The digital GSH-MBI consisted of a 6-week intervention through a WeChat mini program, with a daily reminder sent to the participants by a research assistant via WeChat. The primary outcomes consisted of maternal psychological distress, including depression, anxiety, and pregnancy-related anxiety symptoms, which were assessed at 6 time points from baseline to 6 months post partum (only pregnancy-related anxiety symptoms were assessed 3 times during pregnancy). The secondary outcomes were infant neuropsychological outcomes, including temperament and developmental behaviors, which were assessed at 6 weeks and 6 months post partum. Results: Compared with the control group, the digital GSH-MBI group showed a significant reduction in depression, anxiety, and pregnancy-related anxiety symptoms. In addition, the scores of the digital GSH-MBI group were lower than those of the control group for the 3 types of infant temperament at 6 weeks post partum, including quality of mood, distractibility, and adaptability. Conclusions: Digital GSH-MBIs are effective in alleviating psychological distress among pregnant women and protecting infant outcomes. Trial Registration: Chinese Clinical Trial Register ChiCTR2000040717; https://www.chictr.org.cn/showproj.aspx?proj=65376 %M 36763452 %R 10.2196/41298 %U https://www.jmir.org/2023/1/e41298 %U https://doi.org/10.2196/41298 %U http://www.ncbi.nlm.nih.gov/pubmed/36763452 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39258 %T Digital Phenotyping Data to Predict Symptom Improvement and Mental Health App Personalization in College Students: Prospective Validation of a Predictive Model %A Currey,Danielle %A Torous,John %+ Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA, 02446, United States, 1 6176676700, jtorous@gmail.com %K mHealth %K mental health %K smartphones %K phenotype %K symptom %K college %K students %K young adults %K responsive %K personalized %K app %K application %K intervention %K effectiveness %K protocol %K model %K digital %K engagement %K algorithm %K usage %D 2023 %7 9.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health apps offer a transformative means to increase access to scalable evidence-based care for college students. Yet low rates of engagement currently preclude the effectiveness of these apps. One promising solution is to make these apps more responsive and personalized through digital phenotyping methods able to predict symptoms and offer tailored interventions. Objective: Following our protocol and using the exact model shared in that paper, our primary aim in this study is to assess the prospective validity of mental health symptom prediction using the mindLAMP app through a replication study. We also explored secondary aims around app intervention personalization and correlations of engagement with the Technology Acceptance Model (TAM) and Digital Working Alliance Inventory scale in the context of automating the study. Methods: The study was 28 days in duration and followed the published protocol, with participants collecting digital phenotyping data and being offered optional scheduled and algorithm-recommended app interventions. Study compensation was tied to the completion of weekly surveys and was not otherwise tied to engagement or use of the app. Results: The data from 67 participants were used in this analysis. The area under the curve values for the symptom prediction model ranged from 0.58 for the UCLA Loneliness Scale to 0.71 for the Patient Health Questionnaire-9. Engagement with the scheduled app interventions was high, with a study mean of 73%, but few participants engaged with the optional recommended interventions. The perceived utility of the app in the TAM was higher (P=.01) among those completing at least one recommended intervention. Conclusions: Our results suggest how digital phenotyping methods can be used to create generalizable models that may help create more personalized and engaging mental health apps. Automating studies is feasible, and our results suggest targets to increase engagement in future studies. International Registered Report Identifier (IRRID): RR2-10.2196/37954 %M 36757759 %R 10.2196/39258 %U https://www.jmir.org/2023/1/e39258 %U https://doi.org/10.2196/39258 %U http://www.ncbi.nlm.nih.gov/pubmed/36757759 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43401 %T Effectiveness of a Patient-Centered Assessment With a Solution-Focused Approach (DIALOG-A) in the Routine Care of Colombian Adolescents With Depression and Anxiety: Protocol for a Multicenter Cluster Randomized Controlled Trial %A Gómez-Restrepo,Carlos %A Romero,Jose Alejandro Rumbo %A Rodriguez,Martha %A Ospina-Pinillos,Laura %A Stanislaus Sureshkumar,Diliniya %A Priebe,Stefan %A Bird,Victoria %+ Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, Newham Centre for Mental Health, Cherry Tree Way, London, E13 8SP, United Kingdom, 44 20754043802340, v.j.bird@qmul.ac.uk %K randomised controlled trial %K adolescent %K mental health %K depression %K anxiety %K telemedicine %K primary health care %K Colombia %D 2023 %7 8.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Colombia is a middle-income country in South America, which has historically had high rates of mental health problems, coupled with a scarcity of mental health care. There is growing concern for the mental health of the adolescent population within this region. There is a significant treatment gap for young people, especially those living in the most vulnerable areas. DIALOG+ is a low-cost patient-centered intervention that can potentially improve the delivery of care and quality of life for adolescents with mental health problems. Objective: This exploratory randomized controlled trial aims to evaluate the effectiveness, acceptability, and feasibility of an adapted version of the DIALOG+ intervention (DIALOG-A) in the community treatment of Colombian adolescents with depression and anxiety. Methods: In total, 18 clinicians and 108 adolescents will be recruited from primary health care services in Bogota and Duitama, Colombia. Clinicians will be randomized 2:1 to either the intervention (12 clinicians:72 adolescents) or control group (6 clinicians:36 adolescents). In the intervention arm, clinicians will use DIALOG-A with adolescents once per month over 6 months. The control arm will continue to receive routine care. Outcomes will be measured at baseline, 6 months, and 9 months following randomization. Semistructured interviews with all clinicians and a subset of adolescents in the intervention arm will be conducted at the end of the intervention period. Quantitative and qualitative analysis of the data will be conducted. Results: Trial recruitment was completed toward the end of October 2022, and follow-up is anticipated to last through to October 2023. Conclusions: This is the first study to test an adapted resource-orientated intervention (DIALOG-A) in the treatment of adolescents with depression and anxiety attending primary care services. If the results are positive, DIALOG-A can be implemented in the routine care of adolescents with these mental health problems and provide valuable insight to other middle-income countries. Trial Registration: ISRCTN Registry ISRCTN13980767; https://www.isrctn.com/ISRCTN13980767?q=ISRCTN13980767 International Registered Report Identifier (IRRID): DERR1-10.2196/43401 %M 36753329 %R 10.2196/43401 %U https://www.researchprotocols.org/2023/1/e43401 %U https://doi.org/10.2196/43401 %U http://www.ncbi.nlm.nih.gov/pubmed/36753329 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e42919 %T Mobile Mental Health in Women’s Community-Based Organizations: Protocol for a Pilot Randomized Controlled Trial %A Bhat,Amritha %A Goud,B Ramakrishna %A Kalidindi,Bharat %A Ruben,Johnson Pradeep %A Devadass,Dhinagaran %A Waghmare,Abijeet %A Collins,Pamela Y %A Raj,Tony %A Srinivasan,Krishnamachari %+ Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195, United States, 1 2065433117, amritha@uw.edu %K mobile mental health %K women %K community-based %K depression %K rural %K stepped care %D 2023 %7 8.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Of every 10 women in rural India, 1 suffers from a common mental disorder such as depression, and untreated depression is associated with significant morbidity and mortality. Several factors lead to a large treatment gap, specifically for women in rural India, including stigma, lack of provider mental health workforce, and travel times. There is an urgent need to improve the rates of detection and treatment of depression among women in rural India without overburdening the scarce mental health resources. Objective: We propose to develop, test, and deploy a mental health app, MITHRA (Multiuser Interactive Health Response Application), for depression screening and brief intervention, designed for use in women’s self-help groups (SHGs) in rural India. Methods: We will use focus groups with SHG members and community health workers to guide the initial development of the app, followed by iterative modification based on input from a participatory design group consisting of proposed end users of the app (SHG members). The final version of the app will then be deployed for testing in a pilot cluster randomized trial, with 3 SHGs randomized to receive the app and 3 to receive enhanced care as usual. Results: This study was funded in June 2021. As of September 2022, we have completed both focus groups, 1 participatory design group, and app development. Conclusions: Delivering app-based depression screening and treatment in community settings such as SHGs can address stigma and transportation-related barriers to access to depression care and overcome cultural and contextual barriers to mobile health use. It can also address the mental health workforce shortage. If we find that the MITHRA approach is feasible, we will test the implementation and effectiveness of MITHRA in multiple SHGs across India in a larger randomized controlled trial. This approach of leveraging community-based organizations to improve the reach of depression screening and treatment is applicable in rural and underserved areas across the globe. International Registered Report Identifier (IRRID): DERR1-10.2196/42919 %M 36753310 %R 10.2196/42919 %U https://www.researchprotocols.org/2023/1/e42919 %U https://doi.org/10.2196/42919 %U http://www.ncbi.nlm.nih.gov/pubmed/36753310 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42864 %T Providing Human Support for the Use of Digital Mental Health Interventions: Systematic Meta-review %A Werntz,Alexandra %A Amado,Selen %A Jasman,Megyn %A Ervin,Ariel %A Rhodes,Jean E %+ Center for Evidence-Based Mentoring, University of Massachusetts Boston, 100 Morrissey Boulevard, Boston, MA, 02125, United States, 1 6172876368, jean.rhodes@umb.edu %K digital mental health interventions %K human support %K supportive accountability %K systematic meta-review %D 2023 %7 6.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Digital mental health interventions (DMHIs) have been increasingly deployed to bridge gaps in mental health care, particularly given their promising efficacy. Nevertheless, attrition among DMHI users remains high. In response, human support has been studied as a means of improving retention to and outcomes of DMHIs. Although a growing number of studies and meta-analyses have investigated the effects of human support for DMHIs on mental health outcomes, systematic empirical evidence of its effectiveness across mental health domains remains scant. Objective: We aimed to summarize the results of meta-analyses of human support versus no support for DMHI use across various outcome domains, participant samples, and support providers. Methods: We conducted a systematic meta-review of meta-analyses, comparing the effects of human support with those of no support for DMHI use, with the goal of qualitatively summarizing data across various outcome domains, participant samples, and support providers. We used MEDLINE, PubMed, and PsycINFO electronic databases. Articles were included if the study had a quantitative meta-analysis study design; the intervention targeted mental health symptoms and was delivered via a technology platform (excluding person-delivered interventions mediated through telehealth, text messages, or social media); the outcome variables included mental health symptoms such as anxiety, depression, stress, posttraumatic stress disorder symptoms, or a number of these symptoms together; and the study included quantitative comparisons of outcomes in which human support versus those when no or minimal human support was provided. Results: The results of 31 meta-analyses (505 unique primary studies) were analyzed. The meta-analyses reported 45 effect sizes; almost half (n=22, 48%) of them showed that human-supported DMHIs were significantly more effective than unsupported DMHIs. A total of 9% (4/45) of effect sizes showed that unsupported DMHIs were significantly more effective. No clear patterns of results emerged regarding the efficacy of human support for the outcomes assessed (including anxiety, depression, posttraumatic stress disorder, stress, and multiple outcomes). Human-supported DMHIs may be more effective than unsupported DMHIs for individuals with elevated mental health symptoms. There were no clear results regarding the type of training for those providing support. Conclusions: Our findings highlight the potential of human support in improving the effects of DMHIs. Specifically, evidence emerged for stronger effects of human support for individuals with greater symptom severity. There was considerable heterogeneity across meta-analyses in the level of detail regarding the nature of the interventions, population served, and support delivered, making it difficult to draw strong conclusions regarding the circumstances under which human support is most effective. Future research should emphasize reporting detailed descriptions of sample and intervention characteristics and describe the mechanism through which they believe the coach will be most useful for the DMHI. %M 36745497 %R 10.2196/42864 %U https://www.jmir.org/2023/1/e42864 %U https://doi.org/10.2196/42864 %U http://www.ncbi.nlm.nih.gov/pubmed/36745497 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39334 %T Implementation of a Knowledge Management System in Mental Health and Addictions: Mixed Methods Case Study %A Chorney,Jill %A Johnson Emberly,Debbie %A Jeffrey,Jennifer %A Hundert,Amos %A Pakkanlilar,Onur %A Abidi,Sabina %A Bagnell,Alexa %A Brennan,Maureen %A Campbell,Leslie Anne %A Clark,Sharon %A Bradley,Kristina %A Ross,Olivia %+ Mental Health and Addictions Program, IWK Health, 5850 University Ave, Halifax, NS, B3K 6R8, Canada, 1 902 470 7707, jill.chorney@iwk.nshealth.ca %K mental health %K knowledge management %K information %K technology %K capacity building %D 2023 %7 6.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health and addictions (MHA) care is complex and individualized and requires coordination across providers and areas of care. Knowledge management is an essential facilitator and common challenge in MHA services. Objective: This paper aimed to describe the development of a knowledge management system (KMS) and the associated processes in 1 MHA program. We also aimed to examine the uptake and use, satisfaction, and feedback on implementation among a group of pilot testers. Methods: This project was conducted as a continuous quality-improvement initiative. Integrated stakeholder engagement was used to scope the content and design the information architecture to be implemented using a commercially available knowledge management platform. A group of 30 clinical and administrative staff were trained and tested with the KMS over a period of 10 weeks. Feedback was collected via surveys and focus groups. System analytics were used to characterize engagement. The content, design, and full-scale implementation planning of the KMS were refined based on the results. Results: Satisfaction with accessing the content increased from baseline to after the pilot. Most testers indicated that they would recommend the KMS to a colleague, and satisfaction with KMS functionalities was high. A median of 7 testers was active each week, and testers were active for a median of 4 days over the course of the pilot. Focus group themes included the following: the KMS was a solution to problems for staff members, functionality of the KMS was important, quality content matters, training was helpful and could be improved, and KMS access was required to be easy and barrier free. Conclusions: Knowledge management is an ongoing need in MHA services, and KMSs hold promise in addressing this need. Testers in 1 MHA program found a KMS that is easy to use and would recommend it to colleagues. Opportunities to improve implementation and increase uptake were identified. Future research is needed to understand the impact of KMSs on quality of care and organizational efficiency. %M 36745489 %R 10.2196/39334 %U https://formative.jmir.org/2023/1/e39334 %U https://doi.org/10.2196/39334 %U http://www.ncbi.nlm.nih.gov/pubmed/36745489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41532 %T Effectiveness of Self-guided Tailored Implementation Strategies in Integrating and Embedding Internet-Based Cognitive Behavioral Therapy in Routine Mental Health Care: Results of a Multicenter Stepped-Wedge Cluster Randomized Trial %A Vis,Christiaan %A Schuurmans,Josien %A Aouizerate,Bruno %A Atipei Craggs,Mette %A Batterham,Philip %A Bührmann,Leah %A Calear,Alison %A Cerga Pashoja,Arlinda %A Christensen,Helen %A Dozeman,Els %A Duedal Pedersen,Claus %A Ebert,David Daniel %A Etzelmueller,Anne %A Fanaj,Naim %A Finch,Tracy L %A Hanssen,Denise %A Hegerl,Ulrich %A Hoogendoorn,Adriaan %A Mathiasen,Kim %A May,Carl %A Meksi,Andia %A Mustafa,Sevim %A O'Dea,Bridianne %A Oehler,Caroline %A Piera-Jiménez,Jordi %A Potthoff,Sebastian %A Qirjako,Gentiana %A Rapley,Tim %A Rosmalen,Judith %A Sacco,Ylenia %A Samalin,Ludovic %A Skjoth,Mette Maria %A Tarp,Kristine %A Titzler,Ingrid %A Van der Eycken,Erik %A van Genugten,Claire Rosalie %A Whitton,Alexis %A Zanalda,Enrico %A Smit,Jan H %A Riper,Heleen %+ Clinical, Neuro-, & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, Amsterdam, 1081 BT, Netherlands, 31 646098094, p.d.c.vis@vu.nl %K common mental health disorders %K internet-based cognitive behavioral therapy %K iCBT %K implementation strategies %K tailored implementation %K mobile phone %D 2023 %7 3.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) services for common mental health disorders have been found to be effective. There is a need for strategies that improve implementation in routine practice. One-size-fits-all strategies are likely to be ineffective. Tailored implementation is considered as a promising approach. The self-guided integrated theory-based Framework for intervention tailoring strategies toolkit (ItFits-toolkit) supports local implementers in developing tailored implementation strategies. Tailoring involves identifying local barriers; matching selected barriers to implementation strategies; developing an actionable work plan; and applying, monitoring, and adapting where necessary. Objective: This study aimed to compare the effectiveness of the ItFits-toolkit with implementation-as-usual (IAU) in implementing iCBT services in 12 routine mental health care organizations in 9 countries in Europe and Australia. Methods: A stepped-wedge cluster randomized trial design with repeated measures was applied. The trial period lasted 30 months. The primary outcome was the normalization of iCBT delivery by service providers (therapists, referrers, IT developers, and administrators), which was measured with the Normalization Measure Development as a proxy for implementation success. A 3-level linear mixed-effects modeling was applied to estimate the effects. iCBT service uptake (referral and treatment completion rates) and implementation effort (hours) were used as secondary outcomes. The perceived satisfaction (Client Satisfaction Questionnaire), usability (System Usability Scale), and impact of the ItFits-toolkit by implementers were used to assess the acceptability of the ItFits-toolkit. Results: In total, 456 mental health service providers were included in this study. Compared with IAU, the ItFits-toolkit had a small positive statistically significant effect on normalization levels in service providers (mean 0.09, SD 0.04; P=.02; Cohen d=0.12). The uptake of iCBT by patients was similar to that of IAU. Implementers did not spend more time on implementation work when using the ItFits-toolkit and generally regarded the ItFits-toolkit as usable and were satisfied with it. Conclusions: The ItFits-toolkit performed better than the usual implementation activities in implementing iCBT services in routine practice. There is practical utility in the ItFits-toolkit for supporting implementers in developing and applying effective tailored implementation strategies. However, the effect on normalization levels among mental health service providers was small. These findings warrant modesty regarding the effectiveness of self-guided tailored implementation of iCBT services in routine practice. Trial Registration: ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04686-4 %M 36735287 %R 10.2196/41532 %U https://www.jmir.org/2023/1/e41532 %U https://doi.org/10.2196/41532 %U http://www.ncbi.nlm.nih.gov/pubmed/36735287 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41663 %T Factors Influencing Community Participation in Internet Interventions Compared With Research Trials: Observational Study in a Nationally Representative Adult Cohort %A Batterham,Philip %A Gulliver,Amelia %A Sunderland,Matthew %A Farrer,Louise %A Kay-Lambkin,Frances %A Trias,Angelica %A Calear,Alison %+ Centre for Mental Health Research, College of Health and Medicine, The Australian National University, 63 Eggleston Road, Acton ACT, 2601, Australia, 61 2 61251031, philip.batterham@anu.edu.au %K mental health %K uptake %K engagement %K internet %K research participation %K implementation %D 2023 %7 2.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital mental health (DMH) programs can be effective in treating and preventing mental health problems. However, community engagement with these programs can be poor. Understanding the barriers and enablers of DMH program use may assist in identifying ways to increase the uptake of these programs, which have the potential to provide broad-scale prevention and treatment in the community. Objective: In this study, we aimed to identify and compare factors that may influence participation in DMH programs in practice and research trials, identify any respondent characteristics that are associated with these factors, and assess the relationship between intentions to use DMH programs and actual uptake. Methods: Australian adults aged ≥18 years were recruited from market research panels to participate in the study. The sample was representative of the Australian adult population based on age, gender, and location. Participants completed a cross-sectional web-based survey assessing demographic characteristics, mental health symptom measures, attitudes and use of DMH programs in practice and in research studies, and the factors influencing their use in both settings. Results: Across both research and practice, trust in the organization delivering the service or trial was the top-ranked factor influencing participation, followed by anonymity or privacy and adequate information. There was little variation in rankings across demographic groups, including intentions to use DMH programs or mental health status. Intentions to use DMH programs were a strong predictor of both current (odds ratio 2.50, 99% CI 1.41-4.43; P<.001) and past (odds ratio 2.98, 99% CI 1.71-5.19; P<.001) use behaviors. Conclusions: Efforts to increase the uptake of DMH programs or participation in research trials should focus on clearly communicating the following to users: the legitimacy of the organization delivering the program, security and use of participant data, and effectiveness of DMH programs. %M 36729613 %R 10.2196/41663 %U https://www.jmir.org/2023/1/e41663 %U https://doi.org/10.2196/41663 %U http://www.ncbi.nlm.nih.gov/pubmed/36729613 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e36964 %T The Empowering Role of Web-Based Help Seeking on Depressive Symptoms: Systematic Review and Meta-analysis %A Bizzotto,Nicole %A Marciano,Laura %A de Bruijn,Gert-Jan %A Schulz,Peter Johannes %+ Università della Svizzera italiana, Via Buffi 13, Lugano, 6900, Switzerland, 41 58 666 4724, peter.schulz@usi.ch %K web-based help-seeking %K support groups %K depressive symptoms %K internet %K mental health %K empowerment %D 2023 %7 2.2.2023 %9 Review %J J Med Internet Res %G English %X Background: Most research on web-based help seeking for mental health problems has focused on the antecedents of this behavior. Therefore, little is known about the outcomes of web-based help seeking in general or in specific mental health issues. Objective: This study was a systematic review and meta-analysis of the literature on the antecedents and consequences of web-based help-seeking behaviors for depressive symptoms. Methods: A systematic literature search was carried out in 6 scientific databases, leading to 48 studies (for a total of 314,921 participants) included in the qualitative synthesis and 19 included in the meta-analysis. Results: The results indicated a positive relationship between depressive symptoms and web-based help-seeking behaviors through online support groups (r=0.089; P=.009), and Generation Z (r=0.102; P=.008) tended to participate in support groups more than previous generations. In addition, web-based help seeking was positively related to empowerment (r=0.245; P=.004). Other forms of support reported included the internet and specific self-help tools, but no significant relationships were found with depressive symptoms. Conclusions: More studies examining the outcomes are needed, together with a more rigorous assessment of web-based help-seeking behaviors. Ultimately, we propose a summary framework for the literature on this topic, including the antecedents, patterns of use, and outcomes of web-based help seeking in the context of depressive symptoms. %M 36729571 %R 10.2196/36964 %U https://www.jmir.org/2023/1/e36964 %U https://doi.org/10.2196/36964 %U http://www.ncbi.nlm.nih.gov/pubmed/36729571 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44138 %T Outcomes of a Live Messaging, Blended Care Coaching Program Among Adults With Symptoms of Anxiety: Pragmatic Retrospective Cohort Study %A Owusu,Jocelynn T %A Wang,Pam %A Wickham,Robert E %A Smith,Sarah F %A Lee,Jennifer L %A Chen,Connie %A Lungu,Anita %+ Lyra Health, 287 Lorton Avenue, Burlingame, CA, 94010, United States, 1 877 505 7147, jowusu@lyrahealth.com %K text-based coaching %K anxiety %K blended care %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety disorders are common and can be debilitating. In addition, various barriers exist that can hinder access to adequate care. Coaching that is grounded in evidence-based interventions and delivered via synchronous (ie, live) text-based messaging could potentially increase the reach of mental health services among populations who select this modality instead of other services (eg, face-to-face coaching and psychotherapy). In addition, the delivery of live messaging coaching within a blended care model has the potential to combine the benefits of coaching with those of evidence-based digital mental health tools. Objective: This real-world study evaluates the anxiety and satisfaction outcomes of live messaging coaching blended with digital tools (ie, digital exercises and activities). Methods: This was a retrospective cohort study of 121 adults with moderate levels of anxiety symptoms at the beginning of coaching (Generalized Anxiety Disorder-7 [GAD-7] scores: range 8-14). Participants received an employer-offered blended messaging coaching (BMC) program, and those who opted to receive all live coaching sessions via text-based messaging were included. Anxiety symptom severity was regularly measured by using the GAD-7 scale. Using growth curve models, the change in GAD-7 scores over the course of BMC was evaluated, as were the effects of text-based coaching sessions on GAD-7 scores. The proportion of participants that had a reliable improvement in anxiety symptom severity (GAD-7 score reduction of ≥4) or subclinical symptom severity (GAD-7 score of <8) at the end of care was also estimated. Participants also self-reported their likelihood of recommending their live messaging coach to someone with similar needs. Results: At baseline, the average GAD-7 score was 9.88 (SD 1.80). Anxiety symptom severity significantly decreased with each week in the BMC program (week: b=−1.04; P<.001), and the rate of decline in anxiety symptom severity decreased over time (week2: b=0.06; P<.001). Each live messaging coaching session was associated with significantly lower anxiety symptom severity during the week of the coaching session (b=−1.56; P<.001) and the week immediately following the session (b=−1.03; P<.001). Overall, 86% (104/121) of participants had subclinical symptom severity or a reliable reduction in anxiety symptom severity by the end of care. Further, 33.1% (40/121) of participants reported coaching satisfaction levels; of the 40 participants in this subset, 37 (92.5%) were likely or extremely likely to recommend their live messaging coach. Conclusions: BMC that provides coaching sessions via live messaging can be beneficial for adults with moderate symptoms of anxiety who qualify for and self-select this care modality. Large-scale studies with longer follow-ups are needed. %M 36724014 %R 10.2196/44138 %U https://formative.jmir.org/2023/1/e44138 %U https://doi.org/10.2196/44138 %U http://www.ncbi.nlm.nih.gov/pubmed/36724014 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40145 %T Web-Based Mind-Body Tactical Resilience Training Program for First Responders: Pre-Post Study Assessing Feasibility, Acceptability, and Usability %A Tan,Leona %A Deady,Mark %A Mead,Olivia %A Foright,Rebecca M %A Brenneman,Eric M %A Yeager,Jamie R %A Bryant,Richard A %A Harvey,Samuel B %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 290659135, leona.tan@unsw.edu.au %K resilience training %K first responders %K web-based intervention %K mental health %K mind-body %K posttraumatic stress disorder %K PTSD %K prevention %D 2023 %7 1.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: First responders report elevated rates of mental disorders, including posttraumatic stress disorder (PTSD), yet many are reluctant to seek care. Preventative resilience training programs attempt to proactively address this issue, and there is evidence showing promise for programs targeting cognitive processes. However, these programs rarely address the physical health conditions associated with PTSD. There is emerging evidence of mind-body exercise training improving PTSD symptoms as well as its associated physical health symptoms. However, the feasibility and acceptability of delivering a web-based mind-body resilience training among first responders are not yet known. Objective: This study aimed to evaluate the feasibility, usability, and acceptability of a web-based mind-body tactical resilience training program designed for first responders. In addition, we explored the preliminary effectiveness of the training program on mental health outcomes, adaptive cognitive strategies, and work productivity. Methods: A total of 42 first responders based in the United States enrolled in the web-based training program. Participants were administered web-based surveys before enrolling in the 6-week web-based program and at the end of the program. The primary outcomes of feasibility were measured using the number of training hours, program adherence rates, and self-reported data on frequency of practice. Acceptability and usability were measured using self-reported data. Secondary outcomes were symptoms of PTSD, psychological distress, emotion regulation, stress mindset, psychological preparedness, and work performance. Results: Overall, the training program was feasible based on the median number of training hours spent on the web-based program (7.57 hours out of an expected total of 6 to 9 hours), and 55% (23/42) of the enrolled participants completed more than half of the program. Although acceptability, usability, and frequency of practice were rated as high, this was based on only 29% (12/42) of the respondents who provided follow-up data. Secondary outcomes showed a significant improvement in the adaptive cognitive strategy of the stress mindset, with a mean difference of –5.42 (SD 4.81; 95% CI −8.475 to −2.358; t11=−3.898; P=.002). All other secondary outcomes were not significant. However, the secondary outcomes were exploratory only, and this study was neither designed nor powered to adequately assess efficacy. Conclusions: These findings suggest that a mind-body tactical resilience training program delivered in a web-based format is feasible and acceptable among first responders; however, further refinements may be required to improve adherence rates. Further research using a larger, more rigorous trial design is warranted to examine the effectiveness of this type of training as a possible prevention or treatment strategy for this population. %M 36724011 %R 10.2196/40145 %U https://formative.jmir.org/2023/1/e40145 %U https://doi.org/10.2196/40145 %U http://www.ncbi.nlm.nih.gov/pubmed/36724011 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41823 %T Sensing Psychological Well-being Using Social Media Language: Prediction Model Development Study %A Han,Nuo %A Li,Sijia %A Huang,Feng %A Wen,Yeye %A Wang,Xiaoyang %A Liu,Xiaoqian %A Li,Linyan %A Zhu,Tingshao %+ Chinese Academy Sciences Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, No 16 Lincui Road, Chaoyang District, Beijing, 100101, China, 86 13810990002, liuxiaoqian@psych.ac.cn %K mental health %K psychological well-being %K social media %K machine learning %K domain knowledge %K mental well being %K mental wellbeing %K linguistic %K predict %K model %K ground truth %K lexicon %D 2023 %7 31.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Positive mental health is arguably increasingly important and can be revealed, to some extent, in terms of psychological well-being (PWB). However, PWB is difficult to assess in real time on a large scale. The popularity and proliferation of social media make it possible to sense and monitor online users’ PWB in a nonintrusive way, and the objective of this study is to test the effectiveness of using social media language expression as a predictor of PWB. Objective: This study aims to investigate the predictive power of social media corresponding to ground truth well-being data in a psychological way. Methods: We recruited 1427 participants. Their well-being was evaluated using 6 dimensions of PWB. Their posts on social media were collected, and 6 psychological lexicons were used to extract linguistic features. A multiobjective prediction model was then built with the extracted linguistic features as input and PWB as the output. Further, the validity of the prediction model was confirmed by evaluating the model's discriminant validity, convergent validity, and criterion validity. The reliability of the model was also confirmed by evaluating the split-half reliability. Results: The correlation coefficients between the predicted PWB scores of social media users and the actual scores obtained using the linguistic prediction model of this study were between 0.49 and 0.54 (P<.001), which means that the model had good criterion validity. In terms of the model’s structural validity, it exhibited excellent convergent validity but less than satisfactory discriminant validity. The results also suggested that our model had good split-half reliability levels for every dimension (ranging from 0.65 to 0.85; P<.001). Conclusions: By confirming the availability and stability of the linguistic prediction model, this study verified the predictability of social media corresponding to ground truth well-being data from the perspective of PWB. Our study has positive implications for the use of social media to predict mental health in nonprofessional settings such as self-testing or a large-scale user study. %M 36719723 %R 10.2196/41823 %U https://www.jmir.org/2023/1/e41823 %U https://doi.org/10.2196/41823 %U http://www.ncbi.nlm.nih.gov/pubmed/36719723 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43840 %T Investigating How People Who Self-harm Evaluate Web-Based Lived Experience Stories: Focus Group Study %A Winstone,Lizzy %A Mars,Becky %A Ferrar,Jennifer %A Moran,Paul %A Penton-Voak,Ian %A Grace,Lydia %A Biddle,Lucy %+ Population Health Sciences, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, United Kingdom, 44 07843301453, lizzy.winstone@bristol.ac.uk %K self-harm %K lived experience stories %K web-based support %K self-help %K recovery %K focus groups %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The positive and negative effects of interacting with web-based content on mental health, and especially self-harm, are well documented. Lived experience stories are one such type of static web-based content, frequently published on health care or third-sector organization websites, as well as social media and blogs, as a form of support for those seeking help via the web. Objective: This study aimed to increase understanding about how people who self-harm engage with and evaluate web-based lived experience stories. Methods: Overall, 4 web-based focus groups were conducted with 13 people with recent self-harm experience (aged 16-40 years). In total, 3 example lived experience stories were read aloud to participants, who were then asked to share their reactions to the stories. Participants were also encouraged to reflect on stories previously encountered on the web. Data were analyzed thematically. Results: Overall, 5 themes were generated: stories of recovery from self-harm and their emotional impact, impact on self-help and help-seeking behaviors, identifying with the narrator, authenticity, and language and stereotyping. Conclusions: Lived experience stories published on the web can provide a valuable form of support for those experiencing self-harm. They can be motivating and empowering for the reader, and they have the potential to distract readers from urges to self-harm. However, these effects may be moderated by age, and narratives of recovery may demoralize older readers. Our findings have implications for organizations publishing lived experience content and for community guidelines and moderators of web-based forums in which users share their stories. These include the need to consider the narrator’s age and the relatability and authenticity of their journey and the need to avoid using stigmatizing language. %M 36719729 %R 10.2196/43840 %U https://mental.jmir.org/2023/1/e43840 %U https://doi.org/10.2196/43840 %U http://www.ncbi.nlm.nih.gov/pubmed/36719729 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43253 %T Leveraging Symptom Search Data to Understand Disparities in US Mental Health Care: Demographic Analysis of Search Engine Trace Data %A Rochford,Ben %A Pendse,Sachin %A Kumar,Neha %A De Choudhury,Munmun %+ School of Interactive Computing, College of Computing, Georgia Institute of Technology, 756 W Peachtree St NW, Atlanta, GA, 30308, United States, 1 404 385 8603, brochford3@gatech.edu %K mental health %K search engine algorithms %K digital mental health %K health equity %D 2023 %7 30.1.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: In the United States, 1 out of every 3 people lives in a mental health professional shortage area. Shortage areas tend to be rural, have higher levels of poverty, and have poor mental health outcomes. Previous work has demonstrated that these poor outcomes may arise from interactions between a lack of resources and lack of recognition of mental illness by medical professionals. Objective: We aimed to understand the differences in how people in shortage and nonshortage areas search for information about mental health on the web. Methods: We analyzed search engine log data related to health from 2017-2021 and examined the differences in mental health search behavior between shortage and nonshortage areas. We analyzed several axes of difference, including shortage versus nonshortage comparisons, urban versus rural comparisons, and temporal comparisons. Results: We found specific differences in search behavior between shortage and nonshortage areas. In shortage areas, broader and more general mental health symptom categories, namely anxiety (mean 2.03%, SD 0.44%), depression (mean 1.15%, SD 0.27%), fatigue (mean 1.21%, SD 0.28%), and headache (mean 1.03%, SD 0.23%), were searched significantly more often (Q<.0003). In contrast, specific symptom categories and mental health disorders such as binge eating (mean 0.02%, SD 0.02%), psychosis (mean 0.37%, SD 0.06%), and attention-deficit/hyperactivity disorder (mean 0.77%, SD 0.10%) were searched significantly more often (Q<.0009) in nonshortage areas. Although suicide rates are consistently known to be higher in shortage and rural areas, we see that the rates of suicide-related searching are lower in shortage areas (mean 0.05%, SD 0.04%) than in nonshortage areas (mean 0.10%, SD 0.03%; Q<.0003), more so when a shortage area is rural (mean 0.024%, SD 0.029%; Q<2 × 10–12). Conclusions: This study demonstrates differences in how people from geographically marginalized groups search on the web for mental health. One main implication of this work is the influence that search engine ranking algorithms and interface design might have on the kinds of resources that individuals use when in distress. Our results support the idea that search engine algorithm designers should be conscientious of the role that structural factors play in expressions of distress and they should attempt to design search engine algorithms and interfaces to close gaps in care. %M 36716082 %R 10.2196/43253 %U https://mental.jmir.org/2023/1/e43253 %U https://doi.org/10.2196/43253 %U http://www.ncbi.nlm.nih.gov/pubmed/36716082 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43174 %T Social Media is Addictive and Influences Behavior: Should it Be Regulated as a Digital Therapeutic? %A Perakslis,Eric %A Quintana,Yuri %+ Beth Israel Deaconess Medical Center, 133 Brookline Avenue, HVMA Annex, Suite 2200, Boston, MA, 02215, United States, 1 901 568 1964, yquintan@bidmc.harvard.edu %K social media %K mental health %K suicide %K health policy %K addictions %K youth mental health %K FDA %K Food and Drug Administration %K Canada %K United Kingdom %K United States %K European Union %K privacy %K security %K adverse event %D 2023 %7 26.1.2023 %9 Viewpoint %J J Med Internet Res %G English %X Recently, we were deeply saddened by the findings of the coroner investigating the death of 14-year-old Molly Russell. Deeply saddened and angry but not surprised. This case should be seen as a sentinel event, given that this is the first time social media was directly implicated as a cause of death. We should use this opportunity to advance proposals for the regulations of the health effects of social media. %M 36701180 %R 10.2196/43174 %U https://www.jmir.org/2023/1/e43174 %U https://doi.org/10.2196/43174 %U http://www.ncbi.nlm.nih.gov/pubmed/36701180 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e39479 %T Understanding the Subjective Experience of Long-term Remote Measurement Technology Use for Symptom Tracking in People With Depression: Multisite Longitudinal Qualitative Analysis %A White,Katie M %A Dawe-Lane,Erin %A Siddi,Sara %A Lamers,Femke %A Simblett,Sara %A Riquelme Alacid,Gemma %A Ivan,Alina %A Myin-Germeys,Inez %A Haro,Josep Maria %A Oetzmann,Carolin %A Popat,Priya %A Rintala,Aki %A Rubio-Abadal,Elena %A Wykes,Til %A Henderson,Claire %A Hotopf,Matthew %A Matcham,Faith %+ Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, 16 de Crespigny Park, London, SE5 8AB, United Kingdom, 44 7850684847, katie.white@kcl.ac.uk %K remote measurement %K technology %K qualitative %K engagement %K telehealth %K depression %K mental health %K mobile phone %D 2023 %7 26.1.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Remote measurement technologies (RMTs) have the potential to revolutionize major depressive disorder (MDD) disease management by offering the ability to assess, monitor, and predict symptom changes. However, the promise of RMT data depends heavily on sustained user engagement over extended periods. In this paper, we report a longitudinal qualitative study of the subjective experience of people with MDD engaging with RMTs to provide insight into system usability and user experience and to provide the basis for future promotion of RMT use in research and clinical practice. Objective: We aimed to understand the subjective experience of long-term engagement with RMTs using qualitative data collected in a longitudinal study of RMTs for monitoring MDD. The objectives were to explore the key themes associated with long-term RMT use and to identify recommendations for future system engagement. Methods: In this multisite, longitudinal qualitative research study, 124 semistructured interviews were conducted with 99 participants across the United Kingdom, Spain, and the Netherlands at 3-month, 12-month, and 24-month time points during a study exploring RMT use (the Remote Assessment of Disease and Relapse-Major Depressive Disorder study). Data were analyzed using thematic analysis, and interviews were audio recorded, transcribed, and coded in the native language, with the resulting quotes translated into English. Results: There were 5 main themes regarding the subjective experience of long-term RMT use: research-related factors, the utility of RMTs for self-management, technology-related factors, clinical factors, and system amendments and additions. Conclusions: The subjective experience of long-term RMT use can be considered from 2 main perspectives: experiential factors (how participants construct their experience of engaging with RMTs) and system-related factors (direct engagement with the technologies). A set of recommendations based on these strands are proposed for both future research and the real-world implementation of RMTs into clinical practice. Future exploration of experiential engagement with RMTs will be key to the successful use of RMTs in clinical care. %M 36701179 %R 10.2196/39479 %U https://humanfactors.jmir.org/2023/1/e39479 %U https://doi.org/10.2196/39479 %U http://www.ncbi.nlm.nih.gov/pubmed/36701179 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41913 %T Understanding Digital Mental Health Needs and Usage With an Artificial Intelligence–Led Mental Health App (Wysa) During the COVID-19 Pandemic: Retrospective Analysis %A Sinha,Chaitali %A Meheli,Saha %A Kadaba,Madhura %+ Wysa, 131 Dartmouth St, Boston, MA, 02116, United States, 1 6177129979, chaitali@wysa.io %K digital mental health %K COVID-19 %K engagement %K retention %K perceived needs %K pandemic waves %K chatbot %K conversational agent %K mental health app %K mobile health %K digital health intervention %D 2023 %7 26.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: There has been a surge in mental health concerns during the COVID-19 pandemic, which has prompted the increased use of digital platforms. However, there is little known about the mental health needs and behaviors of the global population during the pandemic. This study aims to fill this knowledge gap through the analysis of real-world data collected from users of a digital mental health app (Wysa) regarding their engagement patterns and behaviors, as shown by their usage of the service. Objective: This study aims to (1) examine the relationship between mental health distress, digital health uptake, and COVID-19 case numbers; (2) evaluate engagement patterns with the app during the study period; and (3) examine the efficacy of the app in improving mental health outcomes for its users during the pandemic. Methods: This study used a retrospective observational design. During the COVID-19 pandemic, the app’s installations and emotional utterances were measured from March 2020 to October 2021 for the United Kingdom, the United States of America, and India and were mapped against COVID-19 case numbers and their peaks. The engagement of the users from this period (N=4541) with the Wysa app was compared to that of equivalent samples of users from a pre–COVID-19 period (1000 iterations). The efficacy was assessed for users who completed pre-post assessments for symptoms of depression (n=2061) and anxiety (n=1995) on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) test measures, respectively. Results: Our findings demonstrate a significant positive correlation between the increase in the number of installs of the Wysa mental health app and the peaks of COVID-19 case numbers in the United Kingdom (P=.02) and India (P<.001). Findings indicate that users (N=4541) during the COVID period had a significantly higher engagement than the samples from the pre-COVID period, with a medium to large effect size for 80% of these 1000 iterative samples, as observed on the Mann-Whitney test. The PHQ-9 and GAD-7 pre-post assessments indicated statistically significant improvement with a medium effect size (PHQ-9: P=.57; GAD-7: P=.56). Conclusions: This study demonstrates that emotional distress increased substantially during the pandemic, prompting the increased uptake of an artificial intelligence–led mental health app (Wysa), and also offers evidence that the Wysa app could support its users and its usage could result in a significant reduction in symptoms of anxiety and depression. This study also highlights the importance of contextualizing interventions and suggests that digital health interventions can provide large populations with scalable and evidence-based support for mental health care. %M 36540052 %R 10.2196/41913 %U https://formative.jmir.org/2023/1/e41913 %U https://doi.org/10.2196/41913 %U http://www.ncbi.nlm.nih.gov/pubmed/36540052 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44694 %T Developing and Implementing a Web-Based Relapse Prevention Psychotherapy Program for Patients With Alcohol Use Disorder: Protocol for a Randomized Controlled Trial %A Eadie,Jazmin %A Gutierrez,Gilmar %A Moghimi,Elnaz %A Stephenson,Callum %A Khalafi,Payam %A Nikjoo,Niloofar %A Jagayat,Jasleen %A Gizzarelli,Tessa %A Reshetukha,Taras %A Omrani,Mohsen %A Yang,Megan %A Alavi,Nazanin %+ Department of Psychiatry, Queen's University, 166 Brock street, Kingston, ON, K7L 5G2, Canada, 1 613 544 3310, nazanin.alavitabari@kingstonhsc.ca %K mental health %K alcohol use disorder %K psychotherapy %K eHealth %K cognitive behavioral therapy %K online %K internet %K treatment %K electronic care %D 2023 %7 25.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background:  Alcohol use disorder (AUD) is characterized by problematic alcohol use accompanied by clinically substantial distress. Patients with AUD frequently experience high relapse rates, and only 1 in 5 remain abstinent 12 months post treatment. Traditional face-to-face relapse prevention therapy (RPT) is a form of cognitive behavioral therapy (CBT) that examines one's situational triggers, maladaptive thought processes, self-efficacy, and motivation. However, access to this treatment is frequently limited due to its high cost, long waitlists, and inaccessibility. A web-based adaptation of RPT (e-RPT) could address these limitations by providing a more cost-effective and accessible delivery method for mental health care in this population. Objective:  This study protocol aims to establish the first academic e-RPT program to address AUD in the general population. The primary objective of this study is to compare the efficacy of e-RPT to face-to-face RPT in decreasing relapse rates. The secondary objective is to assess the effects of e-RPT on quality of life, self-efficacy, resilience, and depressive symptomatology. The tertiary objective is to evaluate the cost-effectiveness of e-RPT compared to face-to-face RPT. Methods:  Adult participants (n=60) with a confirmed diagnosis of AUD will be randomly assigned to receive 10 sessions of e-RPT or face-to-face RPT. e-RPT will consist of 10 predesigned modules and homework with asynchronous, personalized feedback from a therapist. Face-to-face RPT will comprise 10 one-hour face-to-face sessions with a therapist. The predesigned modules and the face-to-face sessions will present the same content and structure. Self-efficacy, resilience, depressive symptomatology, and alcohol consumption will be measured through various questionnaires at baseline, amid treatment, and at the end of treatment. Results:  Participant recruitment is expected to begin in October 2022 through targeted advertisements and physician referrals. Completed data collection and analysis are expected to conclude by October 2023. Outcome data will be assessed using linear and binomial regression (for continuous and categorical outcomes, respectively). Qualitative data will be analyzed using thematic analysis methods. Conclusions:  This study will be the first to examine the effectiveness of e-RPT compared to face-to-face RPT. It is posited that web-based care can present benefits in terms of accessibility and affordability compared to traditional face-to-face psychotherapy. Trial Registration: ClinicalTrials.gov NCT05579210; https://clinicaltrials.gov/ct2/show/NCT05579210 International Registered Report Identifier (IRRID): PRR1-10.2196/44694 %M 36567076 %R 10.2196/44694 %U https://www.researchprotocols.org/2023/1/e44694 %U https://doi.org/10.2196/44694 %U http://www.ncbi.nlm.nih.gov/pubmed/36567076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e37289 %T Analyzing User-Generated Web-Based Posts of Adolescents’ Emotional, Behavioral, and Symptom Responses to Beliefs About Depression: Qualitative Thematic Analysis %A Dysthe,Kim Kristoffer %A Røssberg,Jan Ivar %A Brandtzaeg,Petter Bae %A Skjuve,Marita %A Haavet,Ole Rikard %A Følstad,Asbjørn %A Klovning,Atle %+ Department of General Practice/Family Medicine, University of Oslo, Kirkeveien 166, Oslo, 0450, Norway, 47 47 22 85 05 50, k.k.dysthe@medisin.uio.no %K adolescent %K depression %K internet %K education %K preventive psychiatry %K early medical intervention %K health literacy %K cognitive behavioral therapy %D 2023 %7 24.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is common during adolescence. Early intervention can prevent it from developing into more progressive mental disorders. Combining information technology and clinical psychoeducation is a promising way to intervene at an earlier stage. However, data-driven research on the cognitive response to health information targeting adolescents with symptoms of depression is lacking. Objective: This study aimed to fill this knowledge gap through a new understanding of adolescents’ cognitive response to health information about depression. This knowledge can help to develop population-specific information technology, such as chatbots, in addition to clinical therapeutic tools for use in general practice. Methods: The data set consists of 1870 depression-related questions posted by adolescents on a public web-based information service. Most of the posts contain descriptions of events that lead to depression. On a sample of 100 posts, we conducted a qualitative thematic analysis based on cognitive behavioral theory investigating behavioral, emotional, and symptom responses to beliefs associated with depression. Results: Results were organized into four themes. (1) Hopelessness, appearing as a set of negative beliefs about the future, possibly results from erroneous beliefs about the causal link between risk factors and the course of depression. We found beliefs about establishing a sturdy therapy alliance as a responsibility resting on the patient. (2) Therapy hesitancy seemed to be associated with negative beliefs about therapy prognosis and doubts about confidentiality. (3) Social shame appeared as a consequence of impaired daily function when the cause is not acknowledged. (4) Failing to attain social interaction appeared to be associated with a negative symptom response. In contrast, actively obtaining social support reduces symptoms and suicidal thoughts. Conclusions: These results could be used to meet the clinical aims stated by earlier psychoeducation development, such as instilling hope through direct reattribution of beliefs about the future; challenging causal attributions, thereby lowering therapy hesitancy; reducing shame through the mechanisms of externalization by providing a tentative diagnosis despite the risk of stigmatizing; and providing initial symptom relief by giving advice on how to open up and reveal themselves to friends and family and balance the message of self-management to fit coping capabilities. An active counseling style advises the patient to approach the social environment, demonstrating an attitude toward self-action. %M 36692944 %R 10.2196/37289 %U https://www.jmir.org/2023/1/e37289 %U https://doi.org/10.2196/37289 %U http://www.ncbi.nlm.nih.gov/pubmed/36692944 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e42866 %T The Feasibility of Implementing Remote Measurement Technologies in Psychological Treatment for Depression: Mixed Methods Study on Engagement %A de Angel,Valeria %A Adeleye,Fadekemi %A Zhang,Yuezhou %A Cummins,Nicholas %A Munir,Sara %A Lewis,Serena %A Laporta Puyal,Estela %A Matcham,Faith %A Sun,Shaoxiong %A Folarin,Amos A %A Ranjan,Yatharth %A Conde,Pauline %A Rashid,Zulqarnain %A Dobson,Richard %A Hotopf,Matthew %+ Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, E3.08, 3rd Floor East Wing, de Crespigny park, London, SE5 8AF, United Kingdom, 44 20 7848 0002, valeria.de_angel@kcl.ac.uk %K depression %K anxiety %K digital health %K wearable devices %K smartphone %K passive sensing %K mobile health %K mHealth %K digital phenotyping %K mobile phone %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Remote measurement technologies (RMTs) such as smartphones and wearables can help improve treatment for depression by providing objective, continuous, and ecologically valid insights into mood and behavior. Engagement with RMTs is varied and highly context dependent; however, few studies have investigated their feasibility in the context of treatment. Objective: A mixed methods design was used to evaluate engagement with active and passive data collection via RMT in people with depression undergoing psychotherapy. We evaluated the effects of treatment on 2 different types of engagement: study attrition (engagement with study protocol) and patterns of missing data (engagement with digital devices), which we termed data availability. Qualitative interviews were conducted to help interpret the differences in engagement. Methods: A total of 66 people undergoing psychological therapy for depression were followed up for 7 months. Active data were gathered from weekly questionnaires and speech and cognitive tasks, and passive data were gathered from smartphone sensors and a Fitbit (Fitbit Inc) wearable device. Results: The overall retention rate was 60%. Higher-intensity treatment (χ21=4.6; P=.03) and higher baseline anxiety (t56.28=−2.80, 2-tailed; P=.007) were associated with attrition, but depression severity was not (t50.4=−0.18; P=.86). A trend toward significance was found for the association between longer treatments and increased attrition (U=339.5; P=.05). Data availability was higher for active data than for passive data initially but declined at a sharper rate (90%-30% drop in 7 months). As for passive data, wearable data availability fell from a maximum of 80% to 45% at 7 months but showed higher overall data availability than smartphone-based data, which remained stable at the range of 20%-40% throughout. Missing data were more prevalent among GPS location data, followed by among Bluetooth data, then among accelerometry data. As for active data, speech and cognitive tasks had lower completion rates than clinical questionnaires. The participants in treatment provided less Fitbit data but more active data than those on the waiting list. Conclusions: Different data streams showed varied patterns of missing data, despite being gathered from the same device. Longer and more complex treatments and clinical characteristics such as higher baseline anxiety may reduce long-term engagement with RMTs, and different devices may show opposite patterns of missingness during treatment. This has implications for the scalability and uptake of RMTs in health care settings, the generalizability and accuracy of the data collected by these methods, feature construction, and the appropriateness of RMT use in the long term. %M 36692937 %R 10.2196/42866 %U https://mental.jmir.org/2023/1/e42866 %U https://doi.org/10.2196/42866 %U http://www.ncbi.nlm.nih.gov/pubmed/36692937 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43627 %T The Influence of Social Media Interactions and Behaviors on Depressive Symptoms Among Sexual and Gender Minority Young Adults in the United States: Protocol for a Mixed Methods Longitudinal Study %A Escobar-Viera,César %A Coulter,Robert W S %A Friedman,M Reuel %A Thoma,Brian %A Switzer,Galen E %A Martina,Jamie %A Egan,James Erin %A Primack,Brian %+ Department of Psychiatry, School of Medicine, University of Pittsburgh, 505 Bellefield Towers, 3811 O'Hara St., Pittsburgh, PA, 15213, United States, 1 (412) 246 5864, Escobar-Viera@pitt.edu %K mixed methods %K longitudinal %K depression %K sexual and gender minorities %K social media %D 2023 %7 24.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual and gender minority (SGM; ie, lesbian, gay, bisexual, transgender, and otherwise queer) young adults experience disparities in depression and other internalizing psychopathology. Although social media use is widespread and SGM people have more social media accounts and are more socially active on them than non-SGM individuals, few studies have examined the impact of social media on depression in this group. Objective: The PRIDE iM study will be the first longitudinal, mixed methods research conducted to determine the impact of social media interactions and behaviors as pathways to depressive symptoms among SGM young adults living in the United States. Methods: PRIDE iM uses a bookends variation of the longitudinal sequential mixed methods design. Participants will be recruited nationally from social media. First, between July 2019 and February 2020, we conducted a qualitative phase (T1) comprising web-based individual interviews (N=58) to inform the building and content of the quantitative survey. Second, from February 2022 to September 2022, we will conduct a series of web-based surveys (N=1000 at baseline) with 4 data points (T2-T5), each one collected every 6 to 8 weeks. Third, from October 2022 to December 2022, we will conduct a second qualitative phase (T6) of web-based interviews using outcome trajectories found in the longitudinal survey analyses to purposively sample survey participants and conduct web-based interviews to contextualize and explain survey findings. Qualitative data from T1 and T6 will be analyzed using a reflexive thematic analysis approach. As we sought to capture change over time in the association between the main predictors (ie, social media interactions and behaviors) and depressive symptoms, we propose analyzing T2 to T5 data using latent growth models with a structural equation modeling framework. Data integration at the method, interpretation, and reporting levels will be achieved through building and connecting and the use of a staged approach and joint displays, respectively. At all stages, we will assess the fit of data integration as recommended by the principles of best practice for mixed methods research in psychology. Results: Data collection will be completed by December 2022. Qualitative data analyses will be completed by March 2023, and quantitative analyses of the primary outcome of interest will be completed by June 2023. Conclusions: PRIDE iM will confirm, reject, or uncover the presence of potential relationships between social media interactions and behaviors and depressive symptoms among SGM people. This study represents fundamental groundwork to develop social media–based interventions that target modifiable interactions and behaviors that are most likely to influence mental health outcomes, thus seizing the opportunity to merge the popularity of this medium among SGM people with evidence-based approaches. International Registered Report Identifier (IRRID): DERR1-10.2196/43627 %M 36692929 %R 10.2196/43627 %U https://www.researchprotocols.org/2023/1/e43627 %U https://doi.org/10.2196/43627 %U http://www.ncbi.nlm.nih.gov/pubmed/36692929 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41523 %T Virtual Reality Therapy for People With Epilepsy and Related Anxiety: Protocol for a 3-Phase Pilot Clinical Trial %A Gray,Hannah Gabrielle %A Tchao,Danielle %A Lewis-Fung,Samantha %A Pardini,Susanna %A Harris,Laurence R %A Appel,Lora %+ School of Health Policy & Management, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 6475046537, lappel16@yorku.ca %K epilepsy %K anxiety %K virtual reality %K exposure therapy %K eHealth %K digital health %K virtual reality exposure therapy %K cognitive behavioral therapy %K CBT %K nonpharmacological intervention %K biomedical technology %D 2023 %7 24.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anxiety is one of the most common psychiatric comorbidities in people with epilepsy and often involves fears specifically related to the condition, such as anxiety related to the fear of having another seizure. These epilepsy- or seizure-related fears have been reported as being more disabling than the seizures themselves and significantly impact quality of life. Although research has suggested that exposure therapy (ET) is helpful in decreasing anxiety in people with epilepsy, no research to our knowledge has been conducted on ET in people with epilepsy using virtual reality (VR). The use of novel technologies such as an immersive VR head-mounted display for ET in this population offers several benefits. Indeed, using VR can increase accessibility for people with epilepsy with transportation barriers (eg, those who live outside urban centers or who have a suspended driver’s license owing to their condition), among other advantages. In the present research protocol, we describe the design of an innovative VR-ET program administered in the home that focuses on decreasing anxiety in people with epilepsy, specifically anxiety related to their epilepsy or seizures. Objective: Our primary objective is to examine the feasibility of the study protocol and proposed treatment as well as identify suggestions for improvement when designing subsequent larger clinical trials. Our secondary objective is to evaluate whether VR-ET is effective in decreasing anxiety in a pilot study. We hypothesize that levels of anxiety in people with epilepsy will decrease from using VR-ET. Methods: This mixed methods study comprises 3 phases. Phase 1 involves engaging with those with lived experience through a web-based questionnaire to validate assumptions about anxiety in people with epilepsy. Phase 2 involves filming videos using a 360° camera for the VR-ET intervention (likely consisting of 3 sets of scenes, each with 3 intensity levels) based on the epilepsy- and seizure-related fears most commonly reported in the phase 1 questionnaire. Finally, phase 3 involves evaluating the at-home VR-ET intervention and study methods using a series of validated scales, as well as semistructured interviews. Results: This pilot study was funded in November 2021. Data collection for phase 1 was completed as of August 7, 2022, and had a final sample of 18 participants. Conclusions: Our findings will add to the limited body of knowledge on anxiety in people with epilepsy and the use of VR in this population. We anticipate that the insights gained from this study will lay the foundation for a novel and accessible VR intervention for this underrecognized and undertreated comorbidity in people with epilepsy. Trial Registration: ClinicalTrials.gov NCT05296057; https://clinicaltrials.gov/ct2/show/NCT05296057 International Registered Report Identifier (IRRID): DERR1-10.2196/41523 %M 36692939 %R 10.2196/41523 %U https://www.researchprotocols.org/2023/1/e41523 %U https://doi.org/10.2196/41523 %U http://www.ncbi.nlm.nih.gov/pubmed/36692939 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e37225 %T Digital Phenotyping for Differential Diagnosis of Major Depressive Episode: Narrative Review %A Ettore,Eric %A Müller,Philipp %A Hinze,Jonas %A Riemenschneider,Matthias %A Benoit,Michel %A Giordana,Bruno %A Postin,Danilo %A Hurlemann,Rene %A Lecomte,Amandine %A Musiol,Michel %A Lindsay,Hali %A Robert,Philippe %A König,Alexandra %+ Department of Psychiatry and Memory Clinic, University Hospital of Nice, 30 Voie Romaine, Nice, 06000, France, 33 633306394, ettore.e@chu-nice.fr %K depression %K bipolar disorder %K posttraumatic stress disorder %K differential diagnosis %K digital phenotyping %K speech analysis %K nonverbal behavior %K physiological measures %K posttraumatic stress disorder %K mental health %K clinical interview %K diagnosis %K mental disorder %K interview %K digital health %K psychotrauma %K digital %K information %D 2023 %7 23.1.2023 %9 Review %J JMIR Ment Health %G English %X Background: Major depressive episode (MDE) is a common clinical syndrome. It can be found in different pathologies such as major depressive disorder (MDD), bipolar disorder (BD), posttraumatic stress disorder (PTSD), or even occur in the context of psychological trauma. However, only 1 syndrome is described in international classifications (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition [DSM-5]/International Classification of Diseases 11th Revision [ICD-11]), which do not take into account the underlying pathology at the origin of the MDE. Clinical interviews are currently the best source of information to obtain the etiological diagnosis of MDE. Nevertheless, it does not allow an early diagnosis and there are no objective measures of extracted clinical information. To remedy this, the use of digital tools and their correlation with clinical symptomatology could be useful. Objective: We aimed to review the current application of digital tools for MDE diagnosis while highlighting shortcomings for further research. In addition, our work was focused on digital devices easy to use during clinical interview and mental health issues where depression is common. Methods: We conducted a narrative review of the use of digital tools during clinical interviews for MDE by searching papers published in PubMed/MEDLINE, Web of Science, and Google Scholar databases since February 2010. The search was conducted from June to September 2021. Potentially relevant papers were then compared against a checklist for relevance and reviewed independently for inclusion, with focus on 4 allocated topics of (1) automated voice analysis, behavior analysis by (2) video and physiological measures, (3) heart rate variability (HRV), and (4) electrodermal activity (EDA). For this purpose, we were interested in 4 frequently found clinical conditions in which MDE can occur: (1) MDD, (2) BD, (3) PTSD, and (4) psychological trauma. Results: A total of 74 relevant papers on the subject were qualitatively analyzed and the information was synthesized. Thus, a digital phenotype of MDE seems to emerge consisting of modifications in speech features (namely, temporal, prosodic, spectral, source, and formants) and in speech content, modifications in nonverbal behavior (head, hand, body and eyes movement, facial expressivity, and gaze), and a decrease in physiological measurements (HRV and EDA). We not only found similarities but also differences when MDE occurs in MDD, BD, PTSD, or psychological trauma. However, comparative studies were rare in BD or PTSD conditions, which does not allow us to identify clear and distinct digital phenotypes. Conclusions: Our search identified markers from several modalities that hold promise for helping with a more objective diagnosis of MDE. To validate their potential, further longitudinal and prospective studies are needed. %M 36689265 %R 10.2196/37225 %U https://mental.jmir.org/2023/1/e37225 %U https://doi.org/10.2196/37225 %U http://www.ncbi.nlm.nih.gov/pubmed/36689265 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42672 %T Wearable Artificial Intelligence for Anxiety and Depression: Scoping Review %A Abd-alrazaq,Alaa %A AlSaad,Rawan %A Aziz,Sarah %A Ahmed,Arfan %A Denecke,Kerstin %A Househ,Mowafa %A Farooq,Faisal %A Sheikh,Javaid %+ AI Center for Precision Health, Weill Cornell Medicine-Qatar, P.O. Box 5825, Doha Al Luqta St, Ar-Rayyan, Doha, Qatar, 974 55708549, alaa_alzoubi88@yahoo.com %K wearable artificial intelligence %K artificial intelligence %K wearable devices %K anxiety %K depression %K scoping review %K mobile phone %D 2023 %7 19.1.2023 %9 Review %J J Med Internet Res %G English %X Background: Anxiety and depression are the most common mental disorders worldwide. Owing to the lack of psychiatrists around the world, the incorporation of artificial intelligence (AI) into wearable devices (wearable AI) has been exploited to provide mental health services. Objective: This review aimed to explore the features of wearable AI used for anxiety and depression to identify application areas and open research issues. Methods: We searched 8 electronic databases (MEDLINE, PsycINFO, Embase, CINAHL, IEEE Xplore, ACM Digital Library, Scopus, and Google Scholar) and included studies that met the inclusion criteria. Then, we checked the studies that cited the included studies and screened studies that were cited by the included studies. The study selection and data extraction were carried out by 2 reviewers independently. The extracted data were aggregated and summarized using narrative synthesis. Results: Of the 1203 studies identified, 69 (5.74%) were included in this review. Approximately, two-thirds of the studies used wearable AI for depression, whereas the remaining studies used it for anxiety. The most frequent application of wearable AI was in diagnosing anxiety and depression; however, none of the studies used it for treatment purposes. Most studies targeted individuals aged between 18 and 65 years. The most common wearable device used in the studies was Actiwatch AW4 (Cambridge Neurotechnology Ltd). Wrist-worn devices were the most common type of wearable device in the studies. The most commonly used category of data for model development was physical activity data, followed by sleep data and heart rate data. The most frequently used data set from open sources was Depresjon. The most commonly used algorithm was random forest, followed by support vector machine. Conclusions: Wearable AI can offer great promise in providing mental health services related to anxiety and depression. Wearable AI can be used by individuals for the prescreening assessment of anxiety and depression. Further reviews are needed to statistically synthesize the studies’ results related to the performance and effectiveness of wearable AI. Given its potential, technology companies should invest more in wearable AI for the treatment of anxiety and depression. %M 36656625 %R 10.2196/42672 %U https://www.jmir.org/2023/1/e42672 %U https://doi.org/10.2196/42672 %U http://www.ncbi.nlm.nih.gov/pubmed/36656625 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40135 %T Effects of a Neuroscience-Based Mindfulness Meditation Program on Psychological Health: Pilot Randomized Controlled Trial %A Lynn,Sarah %A Basso,Julia C %+ Department of Human Nutrition, Foods and Exercise, Virginia Tech, Integrated Life Sciences Building, 1981 Kraft Drive, Blacksburg, VA, 24060, United States, 1 8567456363, jbasso@vt.edu %K meditation %K mindfulness %K mental health %K compassion %K self-compassion %K digital %K medical education %K neuroscience education %K depression %K psychological health %K mental illness %K anxiety %D 2023 %7 19.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mindfulness and meditation have a rich historical tradition, and a growing scientific base of evidence supports their use in creating positive psychological and neuroplastic changes for practitioners. Although meditation can be taught in various ways, the scientific community has yet to systematically study the impact of different types of meditation on neuropsychological outcomes, especially as it pertains to digital implementation. Therefore, it is critical that the instruction of mindfulness be evidence based because meditation is being used in both scientific and clinical settings. Objective: This study investigated the use of teacher cueing and the integration of neuroscience education into a meditation program. Compassion cueing was chosen as the element of experimental manipulation because traditional lineages of Buddhist meditation teach compassion for self and others as one of the primary outcomes of meditation. We hypothesized that participants receiving compassion cueing would have enhanced neuropsychological outcomes compared with those receiving functional cueing and that gains in neuroscience knowledge would relate to positive neuropsychological outcomes. Methods: Participants (n=89) were randomized to receive either functional cueing (control group) or compassion cueing (experimental group) and engaged with five 10-minute meditation sessions a week for 4 weeks. All intervention sessions were administered through digital presentation. All participants completed ecological momentary assessments before and after the daily intervention, as well as pre- and postintervention questionnaires. Results: Participants demonstrated significant benefits over time, including increased mindfulness and self-compassion, decreased depression, and gains in neuroscience content (all P<.001); however, no significant between-group differences were found. Daily scores from each day of the intervention showed a statistically significant shift from active toward settled. Importantly, long-term increases in mindfulness were positively correlated to changes in compassion (r=0.326; P=.009) and self-compassion (r=0.424; P<.001) and negatively correlated to changes in anxiety (r=–0.266; P=.03) and depression (r=–0.271; P=.03). Finally, the acute effects of meditation were significantly correlated to the longitudinal outcomes (with a small-to-medium effect size), especially those relevant to mindfulness. Conclusions: We developed a novel neuroscience-based education–meditation program that enhanced self-regulation as evidenced by improved mindfulness, self-compassion, and mood state. Our findings demonstrate the behavioral importance of engaging with mindfulness meditation and reinforce the idea that the benefits of meditation are independent of teacher cueing behavior. Future studies will need to investigate the brain-based changes underlying these meditation-induced outcomes. %M 36656631 %R 10.2196/40135 %U https://formative.jmir.org/2023/1/e40135 %U https://doi.org/10.2196/40135 %U http://www.ncbi.nlm.nih.gov/pubmed/36656631 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e38831 %T Content Recommendation Systems in Web-Based Mental Health Care: Real-world Application and Formative Evaluation %A Chaturvedi,Akhil %A Aylward,Brandon %A Shah,Setu %A Graziani,Grant %A Zhang,Joan %A Manuel,Bobby %A Telewa,Emmanuel %A Froelich,Stefan %A Baruwa,Olalekan %A Kulkarni,Prathamesh Param %A Ξ,Watson %A Kunkle,Sarah %+ Headspace Health, 595 Market St, 7th floor, San Francisco, CA, 94105, United States, 1 720 243 4668, akhilchatur@gmail.com %K behavioral coaching %K recommender systems %K mental health %K machine learning %K natural language processing %K telemental health %K mobile health %K mHealth %K digital health %K digital coaching %K health platform %D 2023 %7 19.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Recommender systems have great potential in mental health care to personalize self-guided content for patients, allowing them to supplement their mental health treatment in a scalable way. Objective: In this paper, we describe and evaluate 2 knowledge-based content recommendation systems as parts of Ginger, an on-demand mental health platform, to bolster engagement in self-guided mental health content. Methods: We developed two algorithms to provide content recommendations in the Ginger mental health smartphone app: (1) one that uses users' responses to app onboarding questions to recommend content cards and (2) one that uses the semantic similarity between the transcript of a coaching conversation and the description of content cards to make recommendations after every session. As a measure of success for these recommendation algorithms, we examined the relevance of content cards to users’ conversations with their coach and completion rates of selected content within the app measured over 14,018 users. Results: In a real-world setting, content consumed in the recommendations section (or “Explore” in the app) had the highest completion rates (3353/7871, 42.6%) compared to other sections of the app, which had an average completion rate of 37.35% (21,982/58,614; P<.001). Within the app’s recommendations section, conversation-based content recommendations had 11.4% (1108/2364) higher completion rates per card than onboarding response-based recommendations (1712/4067; P=.003) and 26.1% higher than random recommendations (534/1440; P=.005). Studied via subject matter experts’ annotations, conversation-based recommendations had a 16.1% higher relevance rate for the top 5 recommended cards, averaged across sessions of varying lengths, compared to a random control (110 conversational sessions). Finally, it was observed that both age and gender variables were sensitive to different recommendation methods, with responsiveness to personalized recommendations being higher if the users were older than 35 years or identified as male. Conclusions: Recommender systems can help scale and supplement digital mental health care with personalized content and self-care recommendations. Onboarding-based recommendations are ideal for “cold starting” the process of recommending content for new users and users that tend to use the app just for content but not for therapy or coaching. The conversation-based recommendation algorithm allows for dynamic recommendations based on information gathered during coaching sessions, which is a critical capability, given the changing nature of mental health needs during treatment. The proposed algorithms are just one step toward the direction of outcome-driven personalization in mental health. Our future work will involve a robust causal evaluation of these algorithms using randomized controlled trials, along with consumer feedback–driven improvement of these algorithms, to drive better clinical outcomes. %M 36656628 %R 10.2196/38831 %U https://formative.jmir.org/2023/1/e38831 %U https://doi.org/10.2196/38831 %U http://www.ncbi.nlm.nih.gov/pubmed/36656628 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e38597 %T The Effectiveness of Internet-Based Cognitive Behavioral Therapy as a Preventive Intervention in the Workplace to Improve Work Engagement and Psychological Outcomes: Protocol for a Systematic Review and Meta-analysis %A Luangphituck,Wasana %A Boonyamalik,Plernpit %A Klainin-Yobas,Piyanee %+ Department of Public Health Nursing, Faculty of Public Health, Mahidol University, 420/1 Rajvithi Road, Rajthavi, Bangkok, 10400, Thailand, 66 2 354 8542 ext 3403, plernpit.suw@mahidol.ac.th %K systematic review %K internet-based %K cognitive behavioral therapy %K work engagement %K psychological outcomes %K employees %K workplace %K web-based %K occupational health %K mental health %K stress %K depression %K anxiety %K eHealth %K digital health %D 2023 %7 19.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health has become an increasingly significant issue in the workplace. Non–health care workers are experiencing increased levels of psychological symptoms in their workplaces, especially during the COVID-19 pandemic, which limited social interactions and health service access. These conditions have a negative effect on employees’ mental health and may also be associated with work-related outcomes, such as reduced levels of work engagement. Cognitive behavioral therapy (CBT) is one of the most effective methods used for treating workers with mental illness and preventing work-related psychological outcomes. The delivery of internet-based CBT (iCBT) has been established as a result of both technological improvements that have influenced health promotion and prevention components, and limited social contact and health service access. Objective: The purpose of this systematic review is to synthesize the best available evidence concerning the preventive effect of iCBT on employees. Methods: A systematic search will be conducted across 12 electronic databases, including a hand search for main journals and reference lists. Randomized controlled trials testing the effects of iCBT on psychological outcomes and work engagement among employees will be eligible. Initial keywords will cover the concepts of employees, workers, non–health care personnel, internet-based, web-based, eHealth cognitive behavioral interventions, stress, depression, anxiety, and work engagement, and then a full search strategy will be developed. Following titles, abstracts and the full text will be screened for assessment against the inclusion criteria for the review. Search results will be fully reported and presented per Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Two independent reviewers will screen and extract data, appraise methodological quality using the Cochrane risk-of-bias assessment tool, and assess overall quality of evidence with the Grading of Recommendations Assessment, Development, and Evaluation approach. A random effects meta-analysis and standardized mean differences using review manager software will be applied to synthesize the effect of iCBT based on similar outcomes. Results: This protocol was registered in the International Prospective Register of Systematic Reviews in March 2022 and is now an ongoing process. The data will be analyzed in August 2022, and the review process should be completed by December 2022. All included studies will be synthesized and presented to demonstrate the effectiveness of iCBT in decreasing psychological distress and optimizing work engagement outcomes among employees. Conclusions: According to the findings of this study, iCBT therapies will be used to promote mental health concerns such as depressive symptoms, anxiety, psychological distress, stress, insomnia, and resilience among non–health care professionals. In addition, the results will be used to ensure the policy related to reducing psychological distress and optimizing work engagement in the workplace. International Registered Report Identifier (IRRID): PRR1-10.2196/38597 %M 36656635 %R 10.2196/38597 %U https://www.researchprotocols.org/2023/1/e38597 %U https://doi.org/10.2196/38597 %U http://www.ncbi.nlm.nih.gov/pubmed/36656635 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e35669 %T Predictors of Adolescents’ Response to a Web-Based Intervention to Improve Psychosocial Adjustment to Having an Appearance-Affecting Condition (Young Person’s Face IT): Prospective Study %A Zelihić,Deniz %A Feragen,Kristin J Billaud %A Pripp,Are Hugo %A Nordgreen,Tine %A Williamson,Heidi %A Kling,Johanna %+ Centre for Rare Disorders, Rikshospitalet, Oslo University Hospital, Børrestuveien 3, Oslo, 0373, Norway, 47 23075340, denizz@student.sv.uio.no %K visible difference %K web-based interventions %K eHealth %K body esteem %K social anxiety %K adolescents %D 2023 %7 18.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents with a condition affecting their appearance that results in a visible difference can be at risk of psychosocial distress and impaired adjustment. Evidence for the effectiveness of existing interventions in improving psychosocial outcomes is limited, and relevant treatment can be difficult to access. Young Person’s Face IT (YPF), a self-guided web-based intervention, has demonstrated potential in reducing social anxiety in adolescents with a visible difference. However, more knowledge is needed about the variables that contribute to variations in intervention effects to identify those who may benefit most from YPF. Objective: This study aimed to investigate demographic, psychosocial, and intervention-related variables as predictors of overall intervention effects after adolescents’ use of YPF. Methods: We used longitudinal data collected as part of a larger, ongoing mixed methods project and randomized controlled trial (ClinicalTrials.gov NCT03165331) investigating the effectiveness of the Norwegian version of YPF. Participants were 71 adolescents (mean age 13.98, SD 1.74 years; range 11-18 years; 43/71, 61% girls) with a wide range of visible differences. The adolescents completed primary (body esteem and social anxiety symptoms) and secondary (perceived stigmatization, life disengagement, and self-rated health satisfaction) outcome measures at baseline and postintervention measurement. The predictor variables were demographic (age and gender), psychosocial (frequency of teasing experiences related to aspects of the body and appearance as well as depressive and anxiety symptoms), and intervention-related (time spent on YPF) variables. Results: Two-thirds (47/71, 66%) of the adolescents completed all YPF sessions and spent an average of 265 (SD 125) minutes on the intervention. Backward multiple regression analyses with a 2-tailed P-value threshold of .20 revealed that several variables were retained in the final models and predicted postintervention outcome changes. Body esteem was predicted by age (P=.14) and frequency of teasing experiences (P=.09). Social anxiety symptoms were predicted by gender (P=.12), frequency of teasing experiences (P=.03), depressive and anxiety symptoms (P=.08), and time spent on YPF (P=.06). Perceived stigmatization was predicted by age (P=.09), gender (P=.09), frequency of teasing experiences (P=.19), and depressive and anxiety symptoms (P=.06). Life disengagement was predicted by gender (P=.03), depressive and anxiety symptoms (P=.001), and time spent on YPF (P=.14). Self-rated health satisfaction was predicted by age (P=.008). However, the results were limited by relatively low explained postintervention variance, ranging from 1.6% to 24.1%. Conclusions: This study suggests that adolescent boys, adolescents who experience higher levels of psychosocial distress related to their visible difference, and adolescents who spend sufficient time on YPF may obtain better overall intervention effects. %M 36652281 %R 10.2196/35669 %U https://formative.jmir.org/2023/1/e35669 %U https://doi.org/10.2196/35669 %U http://www.ncbi.nlm.nih.gov/pubmed/36652281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43532 %T The Associations Between Loneliness, Hopelessness, and Self-control and Internet Gaming Disorder Among University Students Who Were Men Who Have Sex With Men: Cross-sectional Mediation Study %A Yu,Yanqiu %A Fong,Vivian W I %A Ng,Joyce Hoi-Yuk %A Wang,Zixin %A Tian,Xiaobing %A Lau,Joseph T F %+ Zhejiang Provincial Clinical Research Center for Mental Disorders, The Affiliated Wenzhou Kangning Hospital, Wenzhou Medical University, Shengjin Road, Huanglong Residential Area, Wenzhou, 325005, China, 86 13143882252, jlau@cuhk.edu.hk %K men who have sex with men %K internet gaming disorder %K self-control %K loneliness %K hopelessness %K structural equation modeling %D 2023 %7 17.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The minority stress model postulates that men who have sex with men (MSM) often encounter multiple stressors because of their sexual minority status, which may lead to psychological problems and maladaptive coping such as addictive behaviors (eg, internet gaming disorder [IGD]). It was hypothesized that hopelessness and loneliness would be associated with IGD via self-control among MSM. Objective: This study investigated the prevalence of IGD and its associations with variables related to minority stress (loneliness and hopelessness) among MSM who were university students. Mediation involving such associations via self-control was also explored. Methods: With informed consent, 305 MSM attending universities in Sichuan, China participated in the study. The validated Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) checklist was used to assess IGD. Multivariable logistic regression adjusted for background factors and structural equation modeling were conducted. Results: The prevalence of IGD was 12.8% (n=39). Logistic regression found that IGD was positively associated with hopelessness and loneliness, and negatively associated with self-control. The structural equation modeling identified three significant paths between hopelessness/loneliness and IGD: (1) hopelessness → lower self-control → higher IGD (full mediation), (2) loneliness → lower self-control → higher IGD (partial mediation: effect size of 28%), and (3) a direct effect from loneliness to IGD. Conclusions: IGD was prevalent among young MSM and warrants interventions that may try to reduce the level of psychosocial problems such as loneliness and hopelessness and improve self-control. According to the socioecological model, the promotion of social acceptance and reduction in stigma toward MSM are important in reducing loneliness and hopefulness among MSM. Self-control links up the relationships between psychosocial problems and IGD and should be given special attention. Longitudinal studies are warranted to confirm the findings and test new mediations between loneliness/hopelessness and MSM with IGD. %M 36649059 %R 10.2196/43532 %U https://www.jmir.org/2023/1/e43532 %U https://doi.org/10.2196/43532 %U http://www.ncbi.nlm.nih.gov/pubmed/36649059 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e41939 %T The Use of Technology to Provide Mental Health Services to Youth Experiencing Homelessness: Scoping Review %A Lal,Shalini %A Elias,Sarah %A Sieu,Vida %A Peredo,Rossana %+ School of Rehabilitation, Faculty of Medicine, University of Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada, 1 5148908000 ext 31581, shalini.lal@umontreal.ca %K digital equity %K homelessness %K telemedicine %K telehealth %K cellular phone %K internet %K e-mental health %K digital health %K mobile health %K mHealth %K literature review %K mobile phone %D 2023 %7 16.1.2023 %9 Review %J J Med Internet Res %G English %X Background: There is growing interest in using information and communication technologies (ICTs) to improve access to mental health services for youth experiencing homelessness (YEH); however, limited efforts have been made to synthesize this literature. Objective: This study aimed to review the research on the use of ICTs to provide mental health services and interventions for YEH. Methods: We used a scoping review methodology following the Arksey and O’Malley framework and guidelines from the Joanna Briggs Institute Manual for Evidence Synthesis. The results are reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). A systematic search was conducted from 2005 to 2021 in MEDLINE, Embase, CINAHL, PsycInfo, Cochrane, Web of Science, and Maestro and in ProQuest Thesis and Dissertations, Papyrus, Homeless Hub, and Google Scholar for gray literature. Studies were included if participants’ mean age was between 13 and 29 years, youth with mental health issues were experiencing homelessness or living in a shelter, ICTs were used as a means of intervention, and the study provided a description of the technology. The exclusion criteria were technology that did not allow for interaction (eg, television) and languages other than French or English. The data were analyzed using descriptive statistics and qualitative approaches. Two reviewers were involved in the screening and data extraction process in consultation with a third reviewer. The data were summarized in tables and by narrative synthesis. Results: From the 2153 abstracts and titles screened, 12 were included in the analysis. The most common types of ICTs used were communication technologies (eg, phone, video, and SMS text messages) and mobile apps. The intervention goals varied widely across studies; the most common goal was reducing risky behaviors, followed by addressing cognitive functioning, providing emotional support, providing vital resources, and reducing anxiety. Most studies (9/11, 82%) focused on the feasibility of interventions. Almost all studies reported high levels of acceptability (8/9, 89%) and moderate to high frequency of use (5/6, 83%). The principal challenges were related to technical problems such as the need to replace phones, issues with data services, and phone charging. Conclusions: Our results indicate the emerging role of ICTs in the delivery of mental health services to YEH and that there is a high level of acceptability based on early feasibility studies. However, our results should be interpreted cautiously, considering the limited number of studies included in the analysis and the elevated levels of dropout. There is a need to advance efficacy and effectiveness research in this area with larger and longer studies. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-061313 %M 36645703 %R 10.2196/41939 %U https://www.jmir.org/2023/1/e41939 %U https://doi.org/10.2196/41939 %U http://www.ncbi.nlm.nih.gov/pubmed/36645703 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39206 %T “I Haven’t Been Diagnosed, but I Should Be”—Insight Into Self-diagnoses of Common Mental Health Disorders: Cross-sectional Study %A Rutter,Lauren A %A Howard,Jacqueline %A Lakhan,Prabhvir %A Valdez,Danny %A Bollen,Johan %A Lorenzo-Luaces,Lorenzo %+ Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E Tenth Street, Bloomington, IN, 47405, United States, 1 8128569953, larutter@iu.edu %K assessment %K depression %K anxiety %K self-report %K social media %D 2023 %7 13.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, social media has become a rich source of mental health data. However, there is a lack of web-based research on the accuracy and validity of self-reported diagnostic information available on the web. Objective: An analysis of the degree of correspondence between self-reported diagnoses and clinical indicators will afford researchers and clinicians higher levels of trust in social media analyses. We hypothesized that self-reported diagnoses would correspond to validated disorder-specific severity questionnaires across 2 large web-based samples. Methods: The participants of study 1 were 1123 adults from a national Qualtrics panel (mean age 34.65, SD 12.56 years; n=635, 56.65% female participants,). The participants of study 2 were 2237 college students from a large university in the Midwest (mean age 19.08, SD 2.75 years; n=1761, 75.35% female participants). All participants completed a web-based survey on their mental health, social media use, and demographic information. Additionally, the participants reported whether they had ever been diagnosed with a series of disorders, with the option of selecting “Yes”; “No, but I should be”; “I don’t know”; or “No” for each condition. We conducted a series of ANOVA tests to determine whether there were differences among the 4 diagnostic groups and used post hoc Tukey tests to examine the nature of the differences. Results: In study 1, for self-reported mania (F3,1097=2.75; P=.04), somatic symptom disorder (F3,1060=26.75; P<.001), and alcohol use disorder (F3,1097=77.73; P<.001), the pattern of mean differences did not suggest that the individuals were accurate in their self-diagnoses. In study 2, for all disorders but bipolar disorder (F3,659=1.43; P=.23), ANOVA results were consistent with our expectations. Across both studies and for most conditions assessed, the individuals who said that they had been diagnosed with a disorder had the highest severity scores on self-report questionnaires, but this was closely followed by individuals who had not been diagnosed but believed that they should be diagnosed. This was especially true for depression, generalized anxiety, and insomnia. For mania and bipolar disorder, the questionnaire scores did not differentiate individuals who had been diagnosed from those who had not. Conclusions: In general, if an individual believes that they should be diagnosed with an internalizing disorder, they are experiencing a degree of psychopathology similar to those who have already been diagnosed. Self-reported diagnoses correspond well with symptom severity on a continuum and can be trusted as clinical indicators, especially in common internalizing disorders such as depression and generalized anxiety disorder. Researchers can put more faith into patient self-reports, including those in web-based experiments such as social media posts, when individuals report diagnoses of depression and anxiety disorders. However, replication and further study are recommended. %M 36637885 %R 10.2196/39206 %U https://formative.jmir.org/2023/1/e39206 %U https://doi.org/10.2196/39206 %U http://www.ncbi.nlm.nih.gov/pubmed/36637885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e40121 %T Internet-Based Self-Assessment for Symptoms of Internet Use Disorder—Impact of Gender, Social Aspects, and Symptom Severity: German Cross-sectional Study %A Dieris-Hirche,Jan %A Bottel,Laura %A Herpertz,Stephan %A Timmesfeld,Nina %A te Wildt,Bert Theodor %A Wölfling,Klaus %A Henningsen,Peter %A Neumann,Anja %A Beckers,Rainer %A Pape,Magdalena %+ Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstr. 1-3, Bochum, 44791, Germany, 49 234 5077 3135, jan.dieris-hirche@rub.de %K internet use disorder %K eHealth %K telemedicine %K internet addiction %K gaming disorder %K OMPRIS %K internet use %K online self-assessment %K self-assessment %K eHealth services %D 2023 %7 12.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet use disorder (IUD) is a new type of behavioral addiction in the digital age. At the same time, internet applications and eHealth can also provide useful support in medical treatment. Objective: The purpose of this study is to examine if an internet-based eHealth service can reach individuals with IUD. In particular, it should be investigated whether both male and female individuals with more severe IUDs can be reached. Methods: Data were retrieved from the OMPRIS (online-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and internet use disorder) project (DRKS00019925), an internet-based motivational intervention to reduce problematic internet use and promote treatment motivation in internet gaming disorder and IUD. During the recruitment process (August 2020-March 2022), a total of 3007 individuals filled out the standardized scale for the assessment of internet and computer game addiction (AICA-S). The assessment was accessible via the project homepage. There was no preselection of participants at this stage of the study; however, the offer was addressed to people with hazardous internet use and IUDs. The web-based assessment was free and could be found via search engines, but attention was also drawn to the service via newspaper articles, radio reports, and podcasts. Results: Out of 3007 who participated in the web-based self-assessment, 1033 (34.4%) are female, 1740 (57.9%) are male, 67 (2.2%) are diverse individuals, and 167 (5.5%) did not disclose their gender. The IUD symptom severity score showed a wide range between the AICA-S extreme values of 0 and 27 points. On average, the total sample (mean 8.19, SD 5.47) was in the range of hazardous IUD behavior (AICA-S cutoff>7.0). Furthermore, 561 individuals (18.7% of the total sample; mean 17.42, SD 3.38) presented severe IUD (AICA-S cutoff>13.5). Focusing on female and male participants, 20.9% (363/1740) of the men and 14.9% (151/1033) of the women scored above 13.5 points, which can be considered pathological IUD behavior (χ22,2773=16.73, P<.001, effect size: Cramér V=0.078). Unemployment, being in vocational training or studying at a university, and being male were significantly associated with high IUD symptoms. Conclusions: Using a large sample, the study showed that both mildly and severely IUD-affected individuals can be reached via the internet. An internet-based eHealth offer can thus be a good way to reach patients with IUD where they are addicted—on the internet. In addition, eHealth services increase the likelihood of reaching female patients, who hardly ever come to specialized outpatient clinics and hospitals. Since social problems, especially unemployment, have a strong association with disease severity, the integration of social counseling into treatment seems advisable in terms of a multidisciplinary approach. Trial Registration: German Clinical Trials Register (DRKS) DRKS00019925; https://drks.de/search/de/trial/DRKS00019925 %M 36633897 %R 10.2196/40121 %U https://www.jmir.org/2023/1/e40121 %U https://doi.org/10.2196/40121 %U http://www.ncbi.nlm.nih.gov/pubmed/36633897 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e41773 %T Training Staff Across the Veterans Affairs Health Care System to Use Mobile Mental Health Apps: A National Quality Improvement Project %A McGee-Vincent,Pearl %A Mackintosh,Margaret-Anne %A Jamison,Andrea L %A Juhasz,Katherine %A Becket-Davenport,Colleen %A Bosch,Jeane %A Avery,Timothy J %A Glamb,Lauren %A Hampole,Shilpa %+ Office of Mental Health and Suicide Prevention, Veterans Health Administration, 795 Willow Rd (334-NCPTSD), Menlo Park, CA, 94025, United States, 1 650 353 8847, pearl.mcgee-vincent@va.gov %K mental health %K mobile apps %K digital health %K technology %K veterans %K training %D 2023 %7 12.1.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The National Center for PTSD, within the Department of Veterans Affairs (VA), has developed a suite of free, publicly available, evidence-informed apps that can reach an increasing number of veterans and bridge gaps in care by providing resources to those who are not engaged in mental health treatment. To expand the reach of these apps, staff across VA service lines learned about these apps, their features and limitations, and how to introduce them to veterans. Objective: This study aimed to develop, disseminate, and evaluate a training for multidisciplinary staff as part of a national quality improvement project to increase the reach of mobile mental health apps as a resource for veterans. Methods: Sites from all of VA’s 18 geographic regions enrolled in this project. At each site, a minimum of 25 VA staff members who had direct contact with veterans, including staff from the mental health service line and all other service lines, were recruited to participate. Training included a 3-hour multidisciplinary core module, and a 1-hour clinical integration module designed specifically for mental health clinicians. Owing to the COVID-19 pandemic, the trainings were adapted to a live, web-based format. Pre- and posttraining surveys assessed program reach (ie, participants enrolled per site), satisfaction, and effectiveness of the training as measured by changes in knowledge, basic skills, and behavioral intentions to use apps with veterans. Results: A total of 1110 participants representing 34 disciplines at 19 VA sites completed the training. Overall, 67% (743/1109) of participants were mental health staff members. Sites averaged 58.4 participants (SD 36.49, median [IQR] 51). Most (961/1024, 93.85%) participants were satisfied with the training and reported that they (941/1018, 92.44%) would recommend it to others. App knowledge scores significantly increased from pretraining (mean 80.8% correct, SD 15.77%) to posttraining (mean 91.1% correct, SD 9.57%; P<.001). At posttraining, participants also reported greater confidence in their ability to show veterans how to download (z=−13.86; P<.001) and use VA mental health apps (z=−15.13; P<.001). There was near universal endorsement by staff for their intentions to recommend apps to veterans as well as their ability to think of at least one specific veteran to whom they could recommend an app. Staff also reported a strong motivation to encourage other VA staff to share apps with veterans. Conclusions: The training far exceeded the initial goals for staff recruitment and training for all three metrics. Overall, 33% (366/1109) of participants came from service lines outside of mental health, indicating the feasibility of introducing these mental health resources during medical appointments and in other contexts. %M 36633895 %R 10.2196/41773 %U https://mental.jmir.org/2023/1/e41773 %U https://doi.org/10.2196/41773 %U http://www.ncbi.nlm.nih.gov/pubmed/36633895 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e38955 %T Efficacy of Virtual Care for Depressive Disorders: Systematic Review and Meta-analysis %A Schiller,Crystal Edler %A Prim,Julianna %A Bauer,Anna E %A Lux,Linda %A Lundegard,Laura Claire %A Kang,Michelle %A Hellberg,Samantha %A Thompson,Katherine %A Webber,Theresa %A Teklezghi,Adonay %A Pettee,Noah %A Gaffney,Katherine %A Hodgins,Gabrielle %A Rahman,Fariha %A Steinsiek,J Nikki %A Modi,Anita %A Gaynes,Bradley N %+ Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, 304 MacNider Hall, Chapel Hill, NC, 27599-7160, United States, 1 919 966 4810, crystal_schiller@med.unc.edu %K depression %K virtual %K treatment %K therapy %K efficacy %K virtual care %K meta-analysis %K review %K mental health %K depressive disorder %K virtual intervention %K digital intervention %K digital health %K eHealth %K health outcome %K digital mental health %K health intervention %D 2023 %7 9.1.2023 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has created an epidemic of distress-related mental disorders such as depression, while simultaneously necessitating a shift to virtual domains of mental health care; yet, the evidence to support the use of virtual interventions is unclear. Objective: The purpose of this study was to evaluate the efficacy of virtual interventions for depressive disorders by addressing three key questions: (1) Does virtual intervention provide better outcomes than no treatment or other control conditions (ie, waitlist, treatment as usual [TAU], or attention control)? (2) Does in-person intervention provide better outcomes than virtual intervention? (3) Does one type of virtual intervention provide better outcomes than another? Methods: We searched the PubMed, EMBASE, and PsycINFO databases for trials published from January 1, 2010, to October 30, 2021. We included randomized controlled trials of adults with depressive disorders that tested a virtual intervention and used a validated depression measure. Primary outcomes were defined as remission (ie, no longer meeting the clinical cutoff for depression), response (ie, a clinically significant reduction in depressive symptoms), and depression severity at posttreatment. Two researchers independently selected studies and extracted data using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was evaluated based on Agency for Healthcare and Research Quality guidelines. We calculated odds ratios (ORs) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes. Results: We identified 3797 references, 24 of which were eligible. Compared with waitlist, virtual intervention had higher odds of remission (OR 10.30, 95% CI 5.70-18.60; N=619 patients) and lower posttreatment symptom severity (SMD 0.81, 95% CI 0.52-1.10; N=1071). Compared with TAU and virtual attention control conditions, virtual intervention had higher odds of remission (OR 2.27, 95% CI 1.10-3.35; N=512) and lower posttreatment symptom severity (SMD 0.25, 95% CI 0.09-0.42; N=573). In-person intervention outcomes were not significantly different from virtual intervention outcomes (eg, remission OR 0.84, CI 0.51-1.37; N=789). No eligible studies directly compared one active virtual intervention to another. Conclusions: Virtual interventions were efficacious compared with control conditions, including waitlist control, TAU, and attention control. Although the number of studies was relatively small, the strength of evidence was moderate that in-person interventions did not yield significantly better outcomes than virtual interventions for depressive disorders. %M 36622747 %R 10.2196/38955 %U https://mental.jmir.org/2023/1/e38955 %U https://doi.org/10.2196/38955 %U http://www.ncbi.nlm.nih.gov/pubmed/36622747 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e38346 %T Young People’s Trust in Cocreated Web-Based Resources to Promote Mental Health Literacy: Focus Group Study %A Ito-Jaeger,Sachiyo %A Perez Vallejos,Elvira %A Logathasan,Saruka %A Curran,Thomas %A Crawford,Paul %+ Faculty of Medicine and Health Sciences, University of Nottingham, Institute of Mental Health, Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 1158231294, sachiyo.ito-jaeger@nottingham.ac.uk %K trust %K mental health %K web %K young people %K cocreation %K mental health literacy %K qualitative study %K thematic analysis %K trustworthy %K digital mental health %K internet %K digital health %K mobile phone %D 2023 %7 9.1.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is a pressing need to create resources to promote mental health literacy among young people. Digital media is one of the methods that can be used to successfully promote mental health literacy. Although digital mental health resources are generally favorably perceived by young people, one of the essential factors in whether they choose to use these interventions is trust. Objective: The objective of this study was to explore young people’s trust-related concerns about and recommendations for the cocreated mental health website “What’s Up With Everyone” by using TrustScapes. Our aim was to use the findings to improve the trustworthiness of the website and to inform future creators of web-based mental health resources. Methods: In total, 30 young people (mean age 19, SD 1.509; range 17-21 years) participated in TrustScapes focus groups. Thematic analysis was carried out to analyze both the TrustScapes worksheets and audio transcripts. Results: Qualitative analysis revealed that the mental health website contains elements perceived to be both trustworthy and untrustworthy by young people. The relatable and high-quality design, which was achieved by cocreating the website with a team of design professionals and young people, was considered to increase trust. Creators’ credibility also positively affected trust, but the logos and other information about the creators were recommended to be more salient for users. Suggestions were made to update the privacy policy and cookie settings and include communication functions on the platform to improve the trustworthiness of the website. Conclusions: Factors perceived to be trustworthy included the website's relatable, high-quality design and creators’ credibility, whereas those perceived to be untrustworthy included the privacy policy and cookie settings. The findings highlighted the significance of collaborating with end users and industrial partners and the importance of making the trust-enabling factors salient for users. We hope that these findings will inform future creators of web-based mental health resources to make these resources as trustworthy and effective as possible. %M 36622752 %R 10.2196/38346 %U https://mental.jmir.org/2023/1/e38346 %U https://doi.org/10.2196/38346 %U http://www.ncbi.nlm.nih.gov/pubmed/36622752 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e38204 %T Cost-effectiveness of Internet Interventions Compared With Treatment as Usual for People With Mental Disorders: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Rohrbach,Pieter J %A Dingemans,Alexandra E %A Evers,Catharine %A Van Furth,Eric F %A Spinhoven,Philip %A Aardoom,Jiska J %A Lähde,Irene %A Clemens,Fleur C %A Van den Akker-Van Marle,M Elske %+ GGZ Rivierduinen Eating Disorders Ursula, Sandifortdreef 19, PO Box 405, Leiden, 2300 AK, Netherlands, 31 634642298, p.j.rohrbach@lumc.nl %K economic evaluation %K cost-benefit analysis %K methods of economic evaluation %K meta-analysis %K eHealth %K internet-based interventions %K mental disorders %K mental health %K systematic review %K randomized controlled trial %K mobile phone %D 2023 %7 5.1.2023 %9 Review %J J Med Internet Res %G English %X Background: The economic costs of mental disorders for society are huge. Internet-based interventions are often coined as cost-effective alternatives to usual care, but the evidence is mixed. Objective: The aim was to review the literature on the cost-effectiveness of internet interventions for mental disorders compared with usual care and to provide an estimate of the monetary benefits of such interventions compared with usual care. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted, which included participants with symptoms of mental disorders; investigated a telephone- or internet-based intervention; included a control condition in the form of treatment as usual, psychological placebo, waiting list control, or bibliotherapy; reported outcomes on both quality of life and costs; and included articles published in English. Electronic databases such as PubMed (including MEDLINE), Embase, Emcare, PsycINFO, Web of Science, and the Cochrane Library were used. Data on risk of bias, quality of the economic evaluation, quality-adjusted life years, and costs were extracted from the included studies, and the incremental net benefit was calculated and pooled. Results: The search yielded 6226 abstracts, and 37 studies with 14,946 participants were included. The quality of economic evaluations of the included studies was rated as moderate, and the risk of bias was high. A random-effects approach was maintained. Analyses suggested internet interventions were slightly more effective than usual care in terms of quality-adjusted life years gain (Hedges g=0.052, 95% CI 0.010-0.094; P=.02) and equally expensive (Hedges g=0.002, 95% CI −0.080 to 0.84; P=.96). The pooled incremental net benefit was US $255 (95% CI US $91 to US $419; P=.002), favoring internet interventions over usual care. The perspective of the economic evaluation and targeted mental disorder moderated the results. Conclusions: The findings indicate that the cost-effectiveness of internet interventions for mental disorders compared with a care-as-usual approach is likely, but generalizability to new studies is poor given the substantial heterogeneity. This is the first study in the field of mental health to pool cost-effectiveness outcomes in an aggregate data meta-analysis. Trial Registration: PROSPERO CRD42019141659; https://tinyurl.com/3cu99b34 %M 36602854 %R 10.2196/38204 %U https://www.jmir.org/2023/1/e38204 %U https://doi.org/10.2196/38204 %U http://www.ncbi.nlm.nih.gov/pubmed/36602854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37270 %T Assessment and Disruption of Ruminative Episodes to Enhance Mobile Cognitive Behavioral Therapy Just-in-Time Adaptive Interventions in Clinical Depression: Pilot Randomized Controlled Trial %A Wang,Liyuan %A Miller,Lynn %+ Children's Hospital, Los Angeles, Department of Adolescent and Young Adult, 3250 Wilshire Blvd, Suite 1202, Los Angeles, CA, 90027-0000, United States, 1 7654911022, liwang@chla.usc.edu %K depressive rumination %K mobile health %K mHealth %K just-in-time adaptive intervention %K depression %K mental health %K mobile phone %D 2023 %7 5.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A just-in-time adaptive intervention (JITAI) is “designed to address the dynamically changing needs of individuals via the provision of the type or amount of support needed, at the right time when needed.” If and how rumination-focused cognitive behavioral therapy (RFCBT), the gold standard, blocks emotional cascades underlying rumination is unclear. Furthermore, cognitive behavioral therapy has been successfully used as a mobile variant, but RFCBT has not been adapted for a mobile variant (mobile RFCBT [MRFCBT]) or for a JITAI variant. Objective: This study aimed to pilot-test a fully automated JITAI leveraging RFCBT and ways to identify and block cascading depressive rumination. Methods: Patients in therapy for clinical depression were recruited for a randomized controlled trial (RCT). After consenting to be part of the RCT, they were randomly assigned to either of the 2 mobile versions of the RFCBT conditions personalized to the individual’s rumination timing patterns (JITAI-MRFCBT) or a no-treatment control condition through a double-blind procedure. Although the initial design was to have a 3-armed trial with 2 JITAI conditions (a JITAI and a narrative JITAI condition), we later opted to collapse those 2 conditions into 1 JITAI condition because of the low number of participants. All participants were recruited and participated through their smartphones, receiving 5 SMS text message reminders on each of the 35 days to self-report their rumination-related symptoms (eg, rumination episodes and duration). In the JITAI-MRFCBT condition, they also received treatment materials. The first 7 days provided a rumination baseline, and the last 7 days provided a postintervention rumination value. In total, 42% (25/59) of volunteers were eligible and provided their phone numbers, 20% (5/25) of whom never replied to the SMS text message reminding them to start the RCT. A total of 90% (18/20) of volunteers completed it (ie, finishing, as prespecified, 80% of the questionnaires and training tasks) and, therefore, were included in the analysis. Results: Using independent 2-tailed t tests with bootstrapping, results showed that participants in the JITAI-MRFCBT condition, compared with those in the control condition, reported a greater reduction in counts of rumination episodes (mean −25.28, SD 14.50 vs mean 1.44, SD 4.12, P<.001) and greater reduced average time (minutes) spent in rumination (mean −21.53, SD 17.6 vs mean 1.47, SD 1.5; P=.04). Results also suggest that, compared with those in the control group, those in treatment reduced ruminative carryover from one episode to the next. Conclusions: The results suggest that JITAI-MRFCBT may reduce negative rumination by providing RFCBT just in time following rumination, thereby blocking the next rumination episode using the same trigger. This study supports a subsequent, full-scale JITAI and the importance of leveraging mobile smartphone technology with MRFCBT to curb depressive symptoms. Trial Registration: ClinicalTrials.gov NCT04554706; https://clinicaltrials.gov/ct2/show/NCT04554706 %M 36602841 %R 10.2196/37270 %U https://formative.jmir.org/2023/1/e37270 %U https://doi.org/10.2196/37270 %U http://www.ncbi.nlm.nih.gov/pubmed/36602841 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44318 %T Relapse Prevention Therapy for Problem Gaming or Internet Gaming Disorder in Swedish Child and Youth Psychiatric Clinics: Protocol for a Randomized Controlled Trial %A Kapetanovic,Sabina %A Gurdal,Sevtap %A Einarsson,Isak %A Werner,Marie %A André,Frida %A Håkansson,Anders %A Claesdotter-Knutsson,Emma %+ Department of Social and Behavioral Sciences, University West, Gustava Melinsgata 2, Trollhättan, 46132, Sweden, 46 704851666, sabina.kapetanovic@hv.se %K problem gaming %K internet gaming disorder %K parent-child relationship %K randomized controlled trial %K relapse prevention %K psychiatry %K psychology %K treatment %D 2023 %7 5.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although gaming is a common arena where children socialize, an increasing number of children are exhibiting signs of problem gaming or internet gaming disorder. An important factor to the development of problem gaming is parent-child relationships. A cognitive behavioral therapy–based form of treatment, labeled relapse prevention, has been developed as a treatment for child and adolescent problem gaming or internet gaming disorder. However, no study has evaluated the effect of this treatment among Swedish children and youth nor the role of the parent-child relationships in this treatment. Objective: This study aims (1) to evaluate a relapse prevention treatment for patients showing signs of problem gaming or internet gaming disorder recruited from child and youth psychiatric clinics and (2) to test whether the quality of parent-child relationships plays a role in the effect of relapse prevention treatment and vice versa—whether the relapse prevention treatment has a spillover effect on the quality of parent-child relationships. Moreover, we explore the carer’s attitudes about parent-child relationships and child gaming, as well as experiences of the treatment among the children, their carers, and the clinicians who carried out the treatment. Methods: This study is a 2-arm, parallel-group, early-stage randomized controlled trial with embedded qualitative components. Children aged 12-18 years who meet the criteria for problem gaming or internet gaming disorder will be randomized in a 1:1 ratio to either intervention (relapse prevention treatment) or control (treatment as usual), with a total of 160 (80 + 80) participants. The primary outcomes are measures of gaming and gambling behavior before and after intervention, and the secondary outcomes include child ratings of parent-child communication and family functioning. The study is supplemented with a qualitative component with semistructured interviews to capture participants’ and clinicians’ experiences of the relapse prevention, as well as attitudes about parent-child relationships and parenting needs in carers whose children completed the treatment. Results: The trial started in January 2022 and is expected to end in December 2023. The first results are expected in March 2023. Conclusions: This study will be the first randomized controlled trial evaluating relapse prevention as a treatment for child and adolescent problem gaming and internet gaming disorder in Sweden. Since problem behaviors in children interact with the family context, investigating parent-child relationships adjacent to the treatment of child problem gaming and internet gaming disorder is an important strength of the study. Further, different parties, ie, children, carers, and clinicians, will be directly or indirectly involved in the evaluation of the treatment, providing more knowledge of the treatment and its effect. Limitations include comorbidity in children with problem gaming and internet gaming disorder and challenges with the recruitment of participants. Trial Registration: ClinicalTrials.gov NCT05506384 (retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT05506384 International Registered Report Identifier (IRRID): DERR1-10.2196/44318 %M 36602846 %R 10.2196/44318 %U https://www.researchprotocols.org/2023/1/e44318 %U https://doi.org/10.2196/44318 %U http://www.ncbi.nlm.nih.gov/pubmed/36602846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39128 %T Effects of Mobile Mindfulness Meditation on the Mental Health of University Students: Systematic Review and Meta-analysis %A Chen,Bin %A Yang,Ting %A Xiao,Lei %A Xu,Changxia %A Zhu,Chunqin %+ Department of Nursing, Affiliated Hospital of Nanjing University of Chinese Medicine, Number 155, Hanzhong Road, Nanjing, 210001, China, 86 13951086486, zhu504123@163.com %K digital health %K mobile mindfulness meditation %K mental health %K university students %K meta-analysis %D 2023 %7 3.1.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile mindfulness meditation (MMM) is a mindfulness meditation intervention implemented using mobile devices such as smartphones and apps. MMM has been used to help manage the mental health of university students. Objective: This study aims to evaluate the effectiveness of MMM on the mental health of university students in the areas of stress, anxiety, depression, mindfulness, well-being, and resilience. Methods: We conducted a systematic review and meta-analysis of the effectiveness of MMM on the mental health of university students. This study followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic literature search was performed on PubMed, Web of Science, EBSCO, Cochrane Library, and Embase databases, from inception to July 16, 2021. This study was conducted to identify studies that reported the effects of MMM on the primary outcomes including stress, anxiety, and depression, and on the secondary outcomes including mindfulness, well-being, and resilience. Two reviewers retrieved articles, evaluated quality, and extracted data independently. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment. Standardized mean differences (SMDs) for continuous outcomes and risk ratios for dichotomous outcomes were calculated. Sensitivity analyses and subgroup analyses were performed for results with high heterogeneity. The RevMan version 5.3 was used to perform meta-analysis. Results: A total of 10 studies, including 958 university students, were selected for this meta-analysis. Results of the primary outcome showed that the MMM groups were more effective than the control groups in decreasing stress (SMD –0.41, 95% CI –0.59 to –0.23; P<.001) and alleviating anxiety (SMD –0.29, 95% CI –0.50 to –0.09; P=.004). However, there was no difference between the MMM groups and the control groups in depression (SMD –0.14, 95% CI –0.30 to 0.03; P=.11). The use of either waitlist control or traditional face-to-face intervention in the control group was identified as the source of heterogeneity. Specifically, the waitlist control subgroup (SMD –0.33, 95% CI –0.53 to –0.13; P=.002) was superior when compared with the face-to-face subgroup (SMD 0.29, 95% CI –0.01 to 0.59; P=.06). Results of the secondary outcome showed that the MMM groups were more effective than the control groups in enhancing well-being (SMD 0.30, 95% CI 0.11-0.50; P=.003) and improving mindfulness (SMD 2.66, 95% CI 0.77-4.55; P=.006). Whether commercial sponsorship was obtained was considered as the source of heterogeneity. The “without company support” group (SMD 17.60, 95% CI 11.32-23.87; P<.001) was superior to the “with company support” group (SMD 1.17, 95% CI –0.82 to 3.15; P=.25) in raising the level of mindfulness. However, there was no difference between the MMM and control groups in resilience (SMD –0.06, 95% CI –0.26 to 0.15; P=.59). The evidence level of the results from the 10 studies was determined to be moderate to low. Conclusions: MMM was an effective method to reduce stress and anxiety, and to increase the well-being and mindfulness of university students. However, further studies are needed to confirm our findings. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022303585; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=303585 %M 36596239 %R 10.2196/39128 %U https://www.jmir.org/2023/1/e39128 %U https://doi.org/10.2196/39128 %U http://www.ncbi.nlm.nih.gov/pubmed/36596239 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e36806 %T Patient and Therapist Expectations for a Blended Cognitive Behavioral Therapy Program for Depression: Qualitative Exploratory Study %A Atik,Ece %A Schückes,Magnus %A Apolinário-Hagen,Jennifer %+ Institute for SME Research and Entrepreneurship, University of Mannheim, L 9, 1–2, Mannheim, 68161, Germany, 49 621 181 2273, schueckes@bwl.uni-mannheim.de %K blended cognitive behavioral therapy %K bCBT %K cognitive behavioral therapy %K digital health %K mental health %K internet %K mobile app %K blended psychotherapy %K depression %K user perspectives %K mobile phone %D 2022 %7 30.12.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Blended cognitive behavioral therapy (bCBT)—the combination of digital elements and face-to-face psychotherapy—has been proposed to alleviate challenges that patients and therapists face in conventional cognitive behavioral therapy. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings, and knowledge on how to improve digital apps using a bCBT protocol is limited. Objective: This study aimed to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. Methods: We used a qualitative exploratory study design and conducted 3 focus group interviews (n=6 in each) and 5 semistructured in-depth interviews with therapists as well as 11 individual interviews with patients with a primary diagnosis of depression and currently undergoing cognitive behavioral therapy treatment in Germany. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. Results: Both therapists and patients expected a digital app to provide patients with the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments, and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital apps as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. Conclusions: Both patients and therapists had substantially positive attitudes toward the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists. %M 36583934 %R 10.2196/36806 %U https://mental.jmir.org/2022/12/e36806 %U https://doi.org/10.2196/36806 %U http://www.ncbi.nlm.nih.gov/pubmed/36583934 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37533 %T IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England %A Konteh,Frederick Hassan %A Mannion,Russell %A Jacobs,Rowena %+ Health Services Management Centre, School of Social Policy, University of Birmingham, 40 Edgbaston Park Road, Park House, Birmingham, B15 2RT, United Kingdom, 44 7401415960, f.konteh@sky.com %K COVID-19 %K mental health care %K information technology %K digital %K inequalities %K sociotechnical systems %D 2022 %7 29.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In England, COVID-19 has significantly affected mental health care and tested the resilience of health care providers. In many areas, the increased use of IT has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision. Objective: This study aimed to assess the use and impact of IT, in remote service provision, on the quality and efficiency of mental health care during the pandemic. We drew on sociotechnical systems theory as a conceptual framework to help structure the gathering, analysis, and interpretation of data. Methods: We conducted a national scoping survey that involved documentary analysis and semistructured interviews with 6 national stakeholders and case studies of 4 purposefully selected mental health providers in England involving interviews with 53 staff members. Results: Following the outbreak of COVID-19, mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. The informants provided nuanced perspectives on the impact on the quality and efficiency of remote service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Among its negative effects are concerns about the unsuitability of remote consultation for some people with mental health conditions and the potential to widen the digital divide and exacerbate existing inequalities. Sociotechnical systems theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors that influence the use of technology in mental health care delivery in times of crisis and normalcy. Conclusions: Although the use of IT has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. In contrast, patient choice was often compromised, and patient experience and outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. However, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires more sustained and longitudinal research. %M 36423321 %R 10.2196/37533 %U https://formative.jmir.org/2022/12/e37533 %U https://doi.org/10.2196/37533 %U http://www.ncbi.nlm.nih.gov/pubmed/36423321 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e32705 %T The Role of Dysfunctional Sleep Beliefs in Mediating the Outcomes of Web-Based Cognitive Behavioral Therapy for Insomnia in Community-Dwelling Older Adults: Protocol for a Single-Group, Nonrandomized Trial %A Kutzer,Yvonne %A Whitehead,Lisa %A Quigley,Eimear %A Stanley,Mandy %+ School of Medical and Health Sciences, Edith Cowan University, 270 Joondalup Drive, Joondalup, 6027, Australia, 61 8 6304 5656, yvonnek@our.ecu.edu.au %K older adults %K insomnia %K cognitive therapy %K digital literacy %K cognitive behavioral therapy for insomnia (CBT-I) %K online psychological intervention %D 2022 %7 27.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sleeping well is an essential part of good health. Older adult populations report a high rate of sleep problems, with recent studies suggesting that cognitive processes as well as behavioral and hyperarousal-related mechanisms could be important factors in the development and maintenance of insomnia. Individuals who have an asynchronous or uncoupled sleep pattern and sleep appraisal—those who complain about their sleep but do not have poor sleep quality, and vice versa—might show differences in subjective sleep and sleep perceptions and other characteristics that could impact their treatment outcomes following cognitive behavioral therapy for insomnia (CBT-I). Objective: The purpose of this protocol is to describe the rationale and methods for a nonrandomized, single-arm trial assessing objective and subjective sleep quality in community-dwelling older adults aged 60-80 years with synchronous sleep patterns and sleep appraisal compared to those in older adults with asynchronous sleep patterns and sleep appraisal. The trial will further examine the role of cognitive, behavioral, and hyperarousal processes in mediating the treatment outcomes of web-based CBT-I. Methods: This trial aims to recruit a sample of 60 participants, who will be assigned to 1 of 4 sleep groups based on their sleep pattern and sleep appraisal status: complaining good sleepers, complaining poor sleepers, noncomplaining good sleepers, and noncomplaining poor sleepers, respectively. The trial will be completed in 2 phases: phase 1 will assess objective sleep (measured via wrist actigraphy) and subjective (self-reported) sleep. Phase 2 will investigate the impact of a web-based CBT-I program on the sleep outcomes of individuals with uncoupled sleep compared to that of individuals without uncoupled sleep, as well as the mediators of CBT-I. Results: Recruitment began in March 2020, and the last participants were recruited by March 2021. A total of 65 participants completed phases 1 and 2. Data analysis for phase 1 was finished in December 2021, and data analysis for phase 2 was finalized in July 2022. The results for phase 1 were submitted for publication in March 2022, and those for phase 2 will be submitted by the end of December 2022. Conclusions: This trial will provide guidance on factors that contribute to the variability of sleep in older adults and their sleep outcomes following CBT-I. The outcomes of this study could be valuable for future research attempting to tailor CBT-I to individual needs. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001509156; https://tinyurl.com/69hhdu2w International Registered Report Identifier (IRRID): DERR1-10.2196/32705 %M 36574272 %R 10.2196/32705 %U https://www.researchprotocols.org/2022/12/e32705 %U https://doi.org/10.2196/32705 %U http://www.ncbi.nlm.nih.gov/pubmed/36574272 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e40933 %T Preferences for a Mental Health Support Technology Among Chinese Employees: Mixed Methods Approach %A Sun,Sijin %A Zhang,Zheyuan %A Tian,Mu %A Mougenot,Celine %A Glozier,Nick %A Calvo,Rafael A %+ Dyson School of Design Engineering, Imperial College London, Imperial College Rd, South Kensington, London, SW7 9EG, United Kingdom, 44 779967397, s.sun20@imperial.ac.uk %K mental health %K digital health %K workplace %K China %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Workplace mental health is under-studied in China, making it difficult to design effective interventions. To encourage the engagement with interventions, it is crucial to understand employees’ motivation toward seeking help through technologies. Objective: This study aimed to understanding how Chinese employees view digital mental health support technology and how mental health support technology could be designed to boost the motivation of Chinese employees to use it. Methods: A mixed methods approach was used. In total, 458 Chinese employees (248/458, 54% female) in 5 industries (manufacturing, software, medical, government, and education) responded to a survey, and 14 employees and 5 managers were interviewed. Results: Government data and employee responses showed that mental health support in China is limited. In the workplace, Chinese employees experience a lower sense of autonomy satisfaction compared with competence and relatedness. Although managers and employees try to empathize with those who have mental health issues, discrimination and the stigma of mental illness are rife in Chinese workplaces. Digital technologies are perceived as a potential medium for mental health interventions; however, privacy is a major concern. Conclusions: The results of this study demonstrated the potential of self-help digital mental health support for Chinese employees. Interdisciplinary cooperation between design engineers and mental health researchers can contribute toward understanding the issues that engage or disengage users with digital mental health interventions. %M 36548027 %R 10.2196/40933 %U https://humanfactors.jmir.org/2022/4/e40933 %U https://doi.org/10.2196/40933 %U http://www.ncbi.nlm.nih.gov/pubmed/36548027 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e40892 %T Challenges in Recruiting University Students for Web-Based Indicated Prevention of Depression and Anxiety: Results From a Randomized Controlled Trial (ICare Prevent) %A Bolinski,Felix %A Kleiboer,Annet %A Neijenhuijs,Koen %A Karyotaki,Eirini %A Wiers,Reinout %A de Koning,Lisa %A Jacobi,Corinna %A Zarski,Anna-Carlotta %A Weisel,Kiona K %A Cuijpers,Pim %A Riper,Heleen %+ Department of Clinical, Neuro, and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, De Boelelaan 1105, Amsterdam, 1081HV, Netherlands, 31 0205985204, f.bolinski@vu.nl %K digital mental health %K students %K indicated prevention %K recruitment %K randomized trial %K mobile phone %D 2022 %7 14.12.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression and anxiety are common mental health conditions in college and university student populations. Offering transdiagnostic, web-based prevention programs such as ICare Prevent to those with subclinical complaints has the potential to reduce some barriers to receiving help (eg, availability of services, privacy considerations, and students’ desire for autonomy). However, uptake of these interventions is often low, and accounts of recruitment challenges are needed to complement available effectiveness research in student populations. Objective: The aims of this study were to describe recruitment challenges together with effective recruitment strategies for ICare Prevent and provide basic information on the intervention’s effectiveness. Methods: A 3-arm randomized controlled trial was conducted in a student sample with subclinical symptoms of depression and anxiety on the effectiveness of an individually guided (human support and feedback on exercises provided after each session, tailored to each participant) and automatically guided (computer-generated messages provided after each session, geared toward motivation) version of ICare Prevent, a web-based intervention with transdiagnostic components for the indicated prevention of depression and anxiety. The intervention was compared with care as usual. Descriptive statistics were used to outline recruitment challenges and effective web-based and offline strategies as well as students’ use of the intervention. A basic analysis of intervention effects was conducted using a Bayesian linear mixed model, with Bayes factors reported as the effect size. Results: Direct recruitment through students’ email addresses via the central student administration was the most effective strategy. Data from 35 participants were analyzed (individually guided: n=14, 40%; automatically guided: n=8, 23%; care as usual: n=13, 37%). Use of the intervention was low, with an average of 3 out of 7 sessions (SD 2.9) completed. The analyses did not suggest any intervention effects other than anecdotal evidence (all Bayes factors10≤2.7). Conclusions: This report adds to the existing literature on recruitment challenges specific to the student population. Testing the feasibility of recruitment measures and the greater involvement of the target population in their design, as well as shifting from direct to indirect prevention, can potentially help future studies in the field. In addition, this report demonstrates an alternative basic analytical strategy for underpowered randomized controlled trials. Trial Registration: International Clinical Trials Registry Platform NTR6562; https://tinyurl.com/4rbexzrk International Registered Report Identifier (IRRID): RR2-10.1186/s13063-018-2477-y %M 36515986 %R 10.2196/40892 %U https://www.jmir.org/2022/12/e40892 %U https://doi.org/10.2196/40892 %U http://www.ncbi.nlm.nih.gov/pubmed/36515986 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e41606 %T The Relationship Between Physical Activity and Mobile Phone Addiction Among Adolescents and Young Adults: Systematic Review and Meta-analysis of Observational Studies %A Xiao,Wen %A Wu,Jinlong %A Yip,Joanne %A Shi,Qiuqiong %A Peng,Li %A Lei,Qiwen Emma %A Ren,Zhanbing %+ College of Physical Education, Shenzhen University, No 3588 Nanhai Road, Nanshan District, Shenzhen, 518060, China, 86 0755 265347, rzb@szu.edu.cn %K mobile phone addiction %K physical activity %K adolescents %K young adults %K systematic review %K phone addiction %K association %K correlation %K phone use %D 2022 %7 14.12.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Previous studies have reported a potential negative correlation between physical activity (PA) and mobile phone addiction (MPA) among adolescents and young adults. To date, the strength of this correlation has not been well characterized. Objective: This review and meta-analysis aimed to synthesize available empirical studies to examine the correlations between PA and MPA among adolescents and young adults. We also explored several potential moderators, including time of data collection, country or region, and type of population, associated with the relationship between PA and MPA. Methods: Four electronic databases (PubMed, Scopus, PsycINFO, and Web of Science) were searched from database inception to March 2022 to identify relevant studies. The pooled Pearson correlation coefficients and their corresponding 95% CIs for the relationship between PA and MPA were calculated using the inverse variance method. The methodological quality of the included cross-sectional studies was determined based on the Joanna Briggs Institute appraisal checklist. The study conformed to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-analyses) guidelines. Results: In total, 892 relevant articles were identified, of which 22 were selected based on the inclusion and exclusion criteria. The final meta-analysis included 17 of the 22 studies. Results of random effects modeling revealed a moderate correlation between PA and MPA among adolescents and young adults (summary r=–0.243, P<.001). Sensitivity and publication bias analyses further demonstrated the robustness of our results. All the included studies were scored as high quality with a low risk of bias. Subgroup analysis further indicated that none of the hypothesized moderators (time of data collection, country or region, and type of population) significantly affected the relationship between PA and MPA, as confirmed by the mixed effects analysis. In addition, in the data collection subgroups, medium effect sizes were obtained for data collected before COVID-19 (r=–0.333, P<.001) and data collected during COVID-19 (r=–0.207, P<.001). In subgroup analyses for country or region, the correlation coefficient for China and other developing regions showed a similarly moderate effect size (r=–0.201, P<.001 and r= –0.217, P<.001, respectively). However, the effect sizes for developed regions were not significant (r=–0.446, P=.39). In a subgroup analysis based on the type of population, we found that the effect size for young adults was moderate (r=–0.250, P<.001). However, that of adolescents was not significant (r=–0.129, P=.24). Conclusions: Our results demonstrate a moderately negative relationship between PA and MPA among young adults. The strength of this relationship was not influenced by the time of data collection, country or region, or type of population. %M 36515994 %R 10.2196/41606 %U https://publichealth.jmir.org/2022/12/e41606 %U https://doi.org/10.2196/41606 %U http://www.ncbi.nlm.nih.gov/pubmed/36515994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e40723 %T Efficacy of the Mental Health App Intellect to Reduce Stress: Randomized Controlled Trial With a 1-Month Follow-up %A Toh,Sean Han Yang %A Tan,Jessalin Hui Yan %A Kosasih,Feodora Roxanne %A Sündermann,Oliver %+ Intellect Pte Ltd, 171 Tras St, #02-179 Union Building, Singapore, S079025, Singapore, 65 93571995, oliver@intellect.co %K mobile health %K mHealth %K randomized controlled trial %K RCT %K self-guided interventions %K cognitive behavioral therapy %K CBT %K stress coping %K stress management %K university students %K psychological mindedness %K coping self-efficacy %K mobile phone %D 2022 %7 14.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Excessive stress is a major global health concern, particularly in young adults. Short skills-focused self-guided interventions (SGIs) on smartphones are a scalable way to improve stress-coping skills at the population level. Objective: In this randomized controlled trial, we aimed to examine the possible efficacy of a recently developed stress-coping SGI (Intellect) in improving psychological distress, relative to an active control group and 2 potential moderators of this predicted relationship (ie, psychological mindedness [PM] and coping self-efficacy [CSE]). Methods: University students (N=321) were randomly assigned to either an 8-day SGI on stress-coping or an active control group. Self-reported measures were obtained at baseline, after the intervention, and at the 1-month follow-up. The primary outcome was psychological stress (Psychological Stress Measure-9). Secondary outcomes were anxiety (Generalized Anxiety Disorder-7) and depressive symptoms (Patient Health Questionnaire-9). PM and CSE were assessed as potential moderators at baseline. Results: The final sample (n=264) included 188 (71.2%) female, 66 (25%) male, 7 (2.7%) nonbinary, and 3 (1.1%) others participants with a mean age of 22.5 (SD 5.41) years. The intervention group reported significantly lower perceived stress (partial eta–squared [ηp2]=0.018; P=.03) and anxiety (ηp2=0.019; P=.03) levels after intervention relative to the active control group. The effects on perceived stress levels remained statistically significant at the 1-month follow-up (ηp2=0.015; P=.05). Students with the lowest CSE and highest PM experienced the fastest decline in perceived stress levels (β=6.37, 95% Cl 2.98-9.75). Improvements in anxiety levels were not observed at 1-month follow-up. Similarly, no intervention effects were found for depression levels at postintervention and follow-up periods. Conclusions: This study provides evidence that the Intellect stress-coping SGI is effective in reducing perceived stress and anxiety levels among university students. Mobile health apps are brief, scalable, and can make important contributions to public mental health. Trial Registration: ClinicalTrials.gov NCT04978896; https://www.clinicaltrials.gov/ct2/show/NCT04978896 %M 36515984 %R 10.2196/40723 %U https://formative.jmir.org/2022/12/e40723 %U https://doi.org/10.2196/40723 %U http://www.ncbi.nlm.nih.gov/pubmed/36515984 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e43192 %T Understanding the Role of Support in Digital Mental Health Programs With Older Adults: Users’ Perspective and Mixed Methods Study %A Borghouts,Judith %A Eikey,Elizabeth V %A De Leon,Cinthia %A Schueller,Stephen M %A Schneider,Margaret %A Stadnick,Nicole A %A Zheng,Kai %A Wilson,Lorraine %A Caro,Damaris %A Mukamel,Dana B %A Sorkin,Dara H %+ Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 949 438 1337, eeikey@health.ucsd.edu %K older adults %K mental health %K digital mental health intervention %K human support %D 2022 %7 13.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health interventions have the potential to increase mental health support among isolated older adults. However, the older adult population can experience several barriers to accessing and using digital health resources and may need extra support to experience its benefits. Objective: This paper aimed to understand what older adults experience as an important aspect of support during engagement in a digital mental health program. The program entailed 3 months of staff support to participate in digital literacy training and engage with the digital mental health platform myStrength, which offers support for a range of mental health challenges, including depression and anxiety. Methods: A total of 30 older adults participated in surveys and interviews to assess their experience of participating in a digital mental health program provided by county mental health services. As part of the program, participants attended 4 classes of digital literacy training, had access to the digital mental health platform myStrength for 2 months with staff support (and 10 months after the program without support), and received support from program staff during the entire 3-month program. Survey data were analyzed using descriptive statistics, and interview data were analyzed using thematic analysis. Results: A thematic analysis of the interview data revealed that participants valued ongoing support in 3 main areas: technical support to assist them in using technology, guided support to remind them to use myStrength and practice skills they had learned, and social support to enable them to connect with others through the program. Furthermore, participants reported that social connections was the most important aspect of the program and that they were mainly motivated to participate in the program because it was recommended to them by trusted others such as a community partner or because they believed it could potentially help others. Conclusions: Our findings can be used to inform the design of future digital mental health programs for older adults who may have unique support needs in terms of dedicated technical support and ongoing guided support to use technology and social support to increase social connectedness. %M 36512387 %R 10.2196/43192 %U https://formative.jmir.org/2022/12/e43192 %U https://doi.org/10.2196/43192 %U http://www.ncbi.nlm.nih.gov/pubmed/36512387 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e38049 %T The Effectiveness of Internet-Guided Self-help Interventions to Promote Physical Activity Among Individuals With Depression: Systematic Review %A Tang,Yiling %A Gierc,Madelaine %A Lam,Raymond W %A Liu,Sam %A Faulkner,Guy %+ School of Kinesiology, University of British Columbia, 6081 University Blvd, Vancouver, BC, V6T 1Z1, Canada, 1 6048222211, yilingtt@student.ubc.ca %K physical activity %K eHealth %K mobile health %K mHealth %K depression %K systematic review %K internet %K mobile phone %D 2022 %7 12.12.2022 %9 Review %J JMIR Ment Health %G English %X Background: Depression is a prevalent and debilitating mental disorder and a leading cause of disability worldwide. Physical activity (PA) interventions have been shown to alleviate depressive symptoms. However, not all patients have access to PA programing tailored for depression. Internet-guided self-help (IGSH) interventions may be an effective option for increasing PA among people with depression who cannot or prefer not to access supervised exercise treatment. Objective: We aimed to evaluate the effectiveness of IGSH interventions in increasing PA and alleviating depressive symptoms in people with depression. Methods: A systematic literature search was conducted for randomized controlled trials and quasiexperimental studies using 9 electronic databases. The review was registered in PROSPERO (2020 CRD42020221713). Results: A total of 4 randomized controlled trials (430 participants) met the inclusion criteria. Of these, 3 were web-based and 1 was app-based. Three studies found IGSH interventions to have medium to large effects on decreasing depressive symptoms but not on increasing PA compared with waitlist or usual care. One study showed increased self-reported PA but no significant difference in depressive symptoms in the intervention group compared with the control group. Goal setting was the most common behavior change technique used in the interventions. Dropout rates within the intervention groups were relatively low (0%-19%). Conclusions: Our findings suggested that IGSH PA interventions are feasible and have the potential to reduce depressive symptoms in people with depression. More well-designed and tailored interventions with different combinations of behavior change techniques, particularly those targeting the emotion domain, are needed to assess the overall effectiveness and feasibility of using IGSH interventions to increase PA among people with depression. Trial Registration: PROSPERO CRD42020221713; https://tinyurl.com/ysaua5bu %M 36508243 %R 10.2196/38049 %U https://mental.jmir.org/2022/12/e38049 %U https://doi.org/10.2196/38049 %U http://www.ncbi.nlm.nih.gov/pubmed/36508243 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 12 %P e39727 %T Efficacy of Internet-Based Acceptance and Commitment Therapy for Depressive Symptoms, Anxiety, Stress, Psychological Distress, and Quality of Life: Systematic Review and Meta-analysis %A Han,Areum %A Kim,Tae Hui %+ Department of Psychiatry, Yonsei Wonju Medical College, Ilsan-ro 20, Wonju, 26426, Republic of Korea, 82 337410534, gooddr@yonsei.ac.kr %K acceptance and commitment therapy %K anxiety %K depression %K internet-based intervention %K meta-analysis %K psychological distress %K quality of life %K stress %K systematic review %D 2022 %7 9.12.2022 %9 Review %J J Med Internet Res %G English %X Background: Acceptance and commitment therapy (ACT) is an empirically supported transdiagnostic approach that involves mindfulness processes and behavior change processes for valued living. Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to assess the efficacy of internet-based ACT (iACT) for depressive symptoms, anxiety, stress, psychological distress, and quality of life (QoL). Methods: PubMed, CINAHL, PsycINFO, and SCOPUS databases were searched to identify relevant RCTs published up to June 5, 2021. The included RCTs were assessed using the Cochrane Collaboration risk-of-bias tool. The use of either a random effects model or fixed effects model was determined using I2 statistic values for heterogeneity. Subgroup analyses were conducted according to the type of control group, the use of therapist guidance, delivery modes, and the use of targeted participants, when applicable. Results: A total of 39 RCTs met the inclusion criteria. Meta-analyses found small effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL at the immediate posttest and follow-up. There was no significant effect of iACT on stress at follow-up. Subgroup analyses showed small to medium effects of iACT on all the outcomes at the immediate posttest and follow-up compared with the passive control groups. In contrast, subgroup analyses that compared iACT with active control groups found no differences between groups on stress, psychological distress, and QoL at the immediate posttest or on depressive symptoms, anxiety, and stress at follow-up. In addition, subgroup analyses conducted according to the use of therapist guidance, delivery modes, and the use of targeted participants found no statistically significant subgroup differences among studies in all the outcomes, except for the subgroup difference among studies according to the use of targeted participants for depressive symptoms at the immediate posttest (ie, a statistically significant, larger effect of iACT when studies targeted people with depressive symptoms). The overall risk of bias across the studies was unclear. Conclusions: The findings of this study contribute to the body of evidence regarding the effects of iACT on depressive symptoms, anxiety, stress, psychological distress, and QoL and may be applicable in any population, as ACT is a transdiagnostic approach. Few studies have compared iACT with active control conditions, especially for stress and psychological distress at the immediate posttest and follow-up. In addition, the active control conditions varied among the included studies. Further high-quality studies are needed to better understand whether iACT is comparable or superior to other evidence-based interventions, such as cognitive behavioral therapy, in decreasing depressive symptoms, anxiety, stress, and psychological distress and improving QoL. %M 36485030 %R 10.2196/39727 %U https://www.jmir.org/2022/12/e39727 %U https://doi.org/10.2196/39727 %U http://www.ncbi.nlm.nih.gov/pubmed/36485030 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 12 %P e39047 %T Use of an Ingestible, Sensor-Based Digital Adherence System to Strengthen the Therapeutic Relationship in Serious Mental Illness %A Richey,Anabel G %A Kovacs,Ildiko %A Browne,Sara %+ Department of Medicine, University of California, San Diego, 9452 Medical Center Dr, La jolla, CA, 92037, United States, 1 858 822 6563, shbrowne@health.ucsd.edu %K patient-physician relationship %K ingestible sensor %K mental health %K serious mental illness %K antipsychotic %K medication adherence %K digital adherence %K therapy %K digital intervention %K digital mental health %D 2022 %7 2.12.2022 %9 Viewpoint %J JMIR Ment Health %G English %X Serious mental illness is a chronic condition that requires long-term pharmacological treatment. Adherence to oral antipsychotic medication has specific nuances that affects patients and physicians alike. For patients with serious mental illness, nonadherence increases their risk of hospitalization and relapse. Nonadherence is a formidable barrier for physicians in accurately assessing medication efficacy and helping patients achieve their fullest potential. A digital adherence system approved by the Food and Drug Administration can provide near–real time aripiprazole ingestion information. The system records ingestions through an embedded ingestible sensor in oral aripiprazole, which sends a transient local signal to a patch worn on the patient’s torso that is then stored on a paired smartphone app. With patient permission, these data can be viewed remotely by their physician, along with a patient’s mood, activity, and time spent resting. Such data are able to do the following: reveal broad patterns of medication adherence behavior to the patient as well as their physician; help physicians and patients understand and create more realistic expectations for adherence; promote discussion of treatment options; and minimize therapeutic appointment time devoted to determining actual adherence, thereby maximizing the time available to address each patient’s distinctive reasons for their adherence pattern. Crucially, extra time created during appointments can be used to strengthen the therapeutic relationship, which may translate into both improvements in adherence and patient attitude toward their medication. Future investigations are needed to examine how this technology impacts the development of training and best practice guidelines for its use. Otherwise, the potential benefits of this technology may be lost, or worse, inadequate and inappropriate use may harm the therapeutic relationship. %M 36459392 %R 10.2196/39047 %U https://mental.jmir.org/2022/12/e39047 %U https://doi.org/10.2196/39047 %U http://www.ncbi.nlm.nih.gov/pubmed/36459392 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e38799 %T Public Trust in Artificial Intelligence Applications in Mental Health Care: Topic Modeling Analysis %A Shan,Yi %A Ji,Meng %A Xie,Wenxiu %A Lam,Kam-Yiu %A Chow,Chi-Yin %+ Nantong University, No 9, Seyuan Rd, Nantong, 226019, China, 86 15558121896, victorsyhz@hotmail.com %K public trust %K public opinion %K AI application %K artificial intelligence %K mental health care %K topic modeling %K topic %K theme %K term %K visualization %K user feedback %K user review %K Google Play %K health app: mHealth %K mobile health %K digital health %K eHealth %K mental health %K mental illness %K mental disorder %D 2022 %7 2.12.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mental disorders (MDs) impose heavy burdens on health care (HC) systems and affect a growing number of people worldwide. The use of mobile health (mHealth) apps empowered by artificial intelligence (AI) is increasingly being resorted to as a possible solution. Objective: This study adopted a topic modeling (TM) approach to investigate the public trust in AI apps in mental health care (MHC) by identifying the dominant topics and themes in user reviews of the 8 most relevant mental health (MH) apps with the largest numbers of reviewers. Methods: We searched Google Play for the top MH apps with the largest numbers of reviewers, from which we selected the most relevant apps. Subsequently, we extracted data from user reviews posted from January 1, 2020, to April 2, 2022. After cleaning the extracted data using the Python text processing tool spaCy, we ascertained the optimal number of topics, drawing on the coherence scores and used latent Dirichlet allocation (LDA) TM to generate the most salient topics and related terms. We then classified the ascertained topics into different theme categories by plotting them onto a 2D plane via multidimensional scaling using the pyLDAvis visualization tool. Finally, we analyzed these topics and themes qualitatively to better understand the status of public trust in AI apps in MHC. Results: From the top 20 MH apps with the largest numbers of reviewers retrieved, we chose the 8 (40%) most relevant apps: (1) Wysa: Anxiety Therapy Chatbot; (2) Youper Therapy; (3) MindDoc: Your Companion; (4) TalkLife for Anxiety, Depression & Stress; (5) 7 Cups: Online Therapy for Mental Health & Anxiety; (6) BetterHelp-Therapy; (7) Sanvello; and (8) InnerHour. These apps provided 14.2% (n=559), 11.0% (n=431), 13.7% (n=538), 8.8% (n=356), 14.1% (n=554), 11.9% (n=468), 9.2% (n=362), and 16.9% (n=663) of the collected 3931 reviews, respectively. The 4 dominant topics were topic 4 (cheering people up; n=1069, 27%), topic 3 (calming people down; n=1029, 26%), topic 2 (helping figure out the inner world; n=963, 25%), and topic 1 (being an alternative or complement to a therapist; n=870, 22%). Based on topic coherence and intertopic distance, topics 3 and 4 were combined into theme 3 (dispelling negative emotions), while topics 2 and 1 remained 2 separate themes: theme 2 (helping figure out the inner world) and theme 1 (being an alternative or complement to a therapist), respectively. These themes and topics, though involving some dissenting voices, reflected an overall high status of trust in AI apps. Conclusions: This is the first study to investigate the public trust in AI apps in MHC from the perspective of user reviews using the TM technique. The automatic text analysis and complementary manual interpretation of the collected data allowed us to discover the dominant topics hidden in a data set and categorize these topics into different themes to reveal an overall high degree of public trust. The dissenting voices from users, though only a few, can serve as indicators for health providers and app developers to jointly improve these apps, which will ultimately facilitate the treatment of prevalent MDs and alleviate the overburdened HC systems worldwide. %M 36459412 %R 10.2196/38799 %U https://humanfactors.jmir.org/2022/4/e38799 %U https://doi.org/10.2196/38799 %U http://www.ncbi.nlm.nih.gov/pubmed/36459412 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39501 %T The Relationship Between the Big Five Personality Traits and the Theory of Planned Behavior in Using Mindfulness Mobile Apps: Cross-sectional Survey %A Kim,Sunghak %A Park,Jin Young %A Chung,Kyungmi %+ Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, 50-1, Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 10 4234 3442, chungkyungmi@yuhs.ac %K personality traits %K Theory of Planned Behavior %K mindfulness %K mobile apps %K mental health %D 2022 %7 30.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mindfulness has emerged as a promising approach toward improving mental health. Interest in mindfulness mobile app services has also increased in recent years. Understanding the determinants of mindfulness behavior is essential to predict people’s utilization of mindfulness mobile apps and beneficial for developing and implementing relevant intervention strategies. Nevertheless, little has been done to determine the predictors of mindfulness behavior. Objective: This study investigates the association between the Big Five personality traits and the Theory of Planned Behavior (TPB) variables in the context of using mindfulness mobile apps to explore the potential indirect effects of conscientiousness and neuroticism on people’s behavioral intention for mindfulness, mediated by their attitude toward mindfulness, subjective norm about mindfulness, and perceived behavior control over mindfulness. Methods: The authors conducted an online, cross-sectional survey in December 2021. Structural equation modeling was conducted to evaluate the overall model fit and test possible linkages among conscientiousness, neuroticism, attitude toward mindfulness, subjective norm about mindfulness, perceived behavior control over mindfulness, and behavioral intention for mindfulness. Bootstrapping mediation analyses were also conducted to test the potential mediating effect in the model. Results: A total of 297 Korean participants’ responses (153 males and 144 females) were analyzed. The proposed model had a good fit. Conscientiousness was correlated with attitude toward mindfulness (β=.384, P<.001), subjective norm about mindfulness (β=.249, P<.001), and perceived behavior control over mindfulness (β=.443, P<.001). Neuroticism was not correlated with attitude toward mindfulness (β=−.072, P=.28), but was correlated with subjective norm about mindfulness (β=.217, P=.003) and perceived behavior control over mindfulness (β=−.235, P<.001). Attitude toward mindfulness (β=.508, P<.001), subjective norm about mindfulness (β=.132, P=.01), and perceived behavior control over mindfulness (β=.540, P<.001) were separately correlated with behavioral intention for mindfulness. Conscientiousness was not directly correlated with behavioral intention for mindfulness (β=−.082, P=.27), whereas neuroticism was directly correlated with behavioral intention for mindfulness (β=.194, P=.001). Conscientiousness was indirectly linked with behavioral intention for mindfulness through attitude toward mindfulness (B=0.171, 95% CI 0.103-0.251) and perceived behavior control over mindfulness (B=0.198, 95% CI 0.132-0.273) but not through subjective norm about mindfulness (B=0.023, 95% CI −0.002 to 0.060). Neuroticism was indirectly linked with behavioral intention for mindfulness via perceived behavior control over mindfulness (B=−0.138, 95% CI −0.197 to −0.088) but not via subjective norm about mindfulness (B=0.021, 95% CI −0.002 to 0.059). Conclusions: The results show that the integration of the Big Five personality traits and TPB constructs is useful in predicting the use of mindfulness mobile apps. Focusing on conscientiousness and neuroticism in developing information dissemination and implementation strategies for enhancing mindfulness behavior using mobile apps may lead to the successful promotion of mindfulness mobile apps and adherence to mindfulness techniques. %M 36449344 %R 10.2196/39501 %U https://www.jmir.org/2022/11/e39501 %U https://doi.org/10.2196/39501 %U http://www.ncbi.nlm.nih.gov/pubmed/36449344 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e37827 %T A Web-Based Self-help Intervention for Coping With the Loss of a Partner: Protocol for Randomized Controlled Trials in 3 Countries %A Brodbeck,Jeannette %A Jacinto,Sofia %A Gouveia,Afonso %A Mendonça,Nuno %A Madörin,Sarah %A Brandl,Lena %A Schokking,Lotte %A Rodrigues,Ana Maria %A Gonçalves,Judite %A Mooser,Bettina %A Marques,Marta M. %A Isaac,Joana %A Nogueira,Vasco %A Matos Pires,Ana %A van Velsen,Lex %+ Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, Bern, CH-3012, Switzerland, 41 313843805, jeannette.brodbeck@unibe.ch %K bereavement %K cognitive behavioral therapy %K CBT %K cost-effectiveness %K electronic mental health %K grief %K technology acceptance %D 2022 %7 30.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The death of a partner is a critical life event in later life, which requires grief work as well as the development of a new perspective for the future. Cognitive behavioral web-based self-help interventions for coping with prolonged grief have established their efficacy in decreasing symptoms of grief, depression, and loneliness. However, no study has tested the efficacy for reducing grief after losses occurring less than 6 months ago and the role of self-tailoring of the content. Objective: This study aims to evaluate the clinical efficacy and acceptance of a web-based self-help intervention to support the grief process of older adults who have lost their partner. It will compare the outcomes, adherence, and working alliance in a standardized format with those in a self-tailored delivery format and investigate the effects of age, time since loss, and severity of grief at baseline as predictors. Focus groups to understand user experience and a cost-effectiveness analysis will complement the study. Methods: The study includes 3 different randomized control trials. The trial in Switzerland comprises a waitlist control group and 2 active arms consisting of 2 delivery formats, standardized and self-tailored. In the Netherlands and in Portugal, the trials follow a 2-arm design that will be, respectively, complemented with focus groups on technology acceptance and cost-effectiveness analysis. The main target group will consist of adults aged >60 years from the general population in Switzerland (n≥85), the Netherlands (n≥40), and Portugal (n≥80) who lost their partner and seek help for coping with grief symptoms, psychological distress, and adaptation problems in daily life. The trials will test the intervention’s clinical efficacy for reducing grief (primary outcome) and depression symptoms and loneliness (secondary outcomes) after the intervention. Measurements will take place at baseline (week 0), after the intervention (week 10), and at follow-up (week 20). Results: The trials started in March 2022 and are expected to end in December 2022 or when the needed sample size is achieved. The first results are expected by January 2023. Conclusions: The trials will provide insights into the efficacy and acceptance of a web-based self-help intervention among older adults who have recently lost a partner. Results will extend the knowledge on the role of self-tailoring, working alliance, and satisfaction in the effects of the intervention. Finally, the study will suggest adaptations to improve the acceptance of web-based self-help interventions for older mourners and explore the cost-effectiveness of this intervention. Limitations include a self-selective sample and the lack of cross-cultural comparisons. Trial Registration: Switzerland: ClinicalTrials.gov NCT05280041; https://clinicaltrials.gov/ct2/show/NCT05280041; Portugal: ClinicalTrials.gov NCT05156346; https://clinicaltrials.gov/ct2/show/NCT05156346 International Registered Report Identifier (IRRID): PRR1-10.2196/37827 %M 36449341 %R 10.2196/37827 %U https://www.researchprotocols.org/2022/11/e37827 %U https://doi.org/10.2196/37827 %U http://www.ncbi.nlm.nih.gov/pubmed/36449341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e41288 %T Identifying Sleep Disorders From Search Engine Activity: Combining User-Generated Data With a Clinically Validated Questionnaire %A Cohen Zion,Mairav %A Gescheit,Iddo %A Levy,Nir %A Yom-Tov,Elad %+ Microsoft Research, 3 Alan Turing St, Herzeliya, 4672415, Israel, 972 779391359, eladyt@microsoft.com %K sleep disorders %K search engine queries %K search advertising %K internet %K Bing %K sleep %K machine learning %K questionnaire %D 2022 %7 23.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep disorders are experienced by up to 40% of the population but their diagnosis is often delayed by the availability of specialists. Objective: We propose the use of search engine activity in conjunction with a validated web-based sleep questionnaire to facilitate wide-scale screening of prevalent sleep disorders. Methods: Search advertisements offering a web-based sleep disorder screening questionnaire were shown on the Bing search engine to individuals who indicated an interest in sleep disorders. People who clicked on the advertisements and completed the sleep questionnaire were identified as being at risk for 1 of 4 common sleep disorders. A machine learning algorithm was applied to previous search engine queries to predict their suspected sleep disorder, as identified by the questionnaire. Results: A total of 397 users consented to participate in the study and completed the questionnaire. Of them, 132 had sufficient past query data for analysis. Our findings show that diurnal patterns of people with sleep disorders were shifted by 2-3 hours compared to those of the controls. Past query activity was predictive of sleep disorders, approaching an area under the receiver operating characteristic curve of 0.62-0.69, depending on the sleep disorder. Conclusions: Targeted advertisements can be used as an initial screening tool for people with sleep disorders. However, search engine data are seemingly insufficient as a sole method for screening. Nevertheless, we believe that evaluable web-based information, easily collected and processed with little effort on part of the physician and with low burden on the individual, can assist in the diagnostic process and possibly drive people to seek sleep assessment and diagnosis earlier than they currently do. %M 36416870 %R 10.2196/41288 %U https://www.jmir.org/2022/11/e41288 %U https://doi.org/10.2196/41288 %U http://www.ncbi.nlm.nih.gov/pubmed/36416870 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 11 %P e39079 %T Health Needs for Suicide Prevention and Acceptance of e-Mental Health Interventions in Adolescents and Young Adults: Qualitative Study %A Blattert,Lisa %A Armbruster,Christoph %A Buehler,Eva %A Heiberger,Andrea %A Augstein,Patrick %A Kaufmann,Sarina %A Reime,Birgit %A , %+ Scientific Institute of Office-Based Haematologists and Oncologists (WINHO), Vor den Siebenburgen 2, Köln, 50676, Germany, 49 221933191918, blattert@winho.de %K suicide prevention %K e-mental health %K peer support %K adolescents and young adults %K health needs %K acceptance %K qualitative data analysis %K suicide %K mental health %K teens %K adolescent %K young adult %K vulnerable %K behavior %K Germany %K rural %K intervention %K formative %K digital %K online %D 2022 %7 23.11.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescence is a phase of higher vulnerability for suicidal behavior. In Germany, almost 500 adolescents and young adults aged 15-25 years commit suicide each year. Youths in rural areas are characterized by a higher likelihood of poorer mental health. In rural areas, appropriate support for adolescents and young adults in mental health crises is difficult to access. The general acceptability of digital communication in youths can make the provision of an eHealth tool a promising strategy. Objective: The aim of this study was to explore the health needs regarding suicide prevention for adolescents and young adults in rural areas of Germany and Switzerland and to identify characteristics of suitable e-mental health interventions. Methods: This study reports on a qualitative secondary analysis of archived data, which had been collected through formative participatory research. Using 32 semistructured interviews (individually or in groups of 2) with 13 adolescents and young adults (aged 18-25 years) and 23 experts from relevant fields, we applied a deductive-inductive methodological approach and used qualitative content analyses according to Kuckartz (2016). Results: Experts as well as adolescents and young adults have reported health needs in digital suicide prevention. The health needs for rural adolescents and young adults in crises were characterized by several categories. First, the need for suicide prevention in general was highlighted. Additionally, the need for a peer concept and web-based suicide prevention were stressed. The factors influencing the acceptability of a peer-driven, web-based support were related to low-threshold access, lifelike intervention, anonymity, and trustworthiness. Conclusions: The results suggest a need for suicide prevention services for adolescents and young adults in this rural setting. Peer-driven and web-based suicide prevention services may add an important element of support during crises. By establishing such a service, an improvement in mental health support and well-being could be enabled. These services should be developed with the participation of the target group, taking anonymity, trustworthiness, and low-threshold access into account. %M 36416884 %R 10.2196/39079 %U https://mental.jmir.org/2022/11/e39079 %U https://doi.org/10.2196/39079 %U http://www.ncbi.nlm.nih.gov/pubmed/36416884 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 11 %P e37394 %T Positive Affective Recovery in Daily Life as a Momentary Mechanism Across Subclinical and Clinical Stages of Mental Disorder: Experience Sampling Study %A Ader,Leonie %A Schick,Anita %A Simons,Claudia %A Delespaul,Philippe %A Myin-Germeys,Inez %A Vaessen,Thomas %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 621 1703 1930, ulrich.reininghaus@zi-mannheim.de %K experience sampling methodology %K ecological momentary assessment %K trajectory %K transdiagnostic %K resilience %K stress reactivity %K psychosis %K depression %D 2022 %7 23.11.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Identifying momentary risk and protective mechanisms may enhance our understanding and treatment of mental disorders. Affective stress reactivity is one mechanism that has been reported to be altered in individuals with early and later stages of mental disorder. Additionally, initial evidence suggests individuals with early and enduring psychosis may have an extended recovery period of negative affect in response to daily stressors (ie, a longer duration until affect reaches baseline levels after stress), but evidence on positive affective recovery as a putative protective mechanism remains limited. Objective: This study aimed to investigate trajectories of positive affect in response to stress across the continuum of mental disorder in a transdiagnostic sample. Methods: Using the Experience Sampling Method, minor activity-, event-, and overall stress and positive affect were assessed 10 times a day, with time points approximately 90 minutes apart on six consecutive days in a pooled data set including 367 individuals with a mental disorder, 217 individuals at risk for a severe mental disorder, and 227 controls. Multilevel analysis and linear contrasts were used to investigate trajectories of positive affect within and between groups. Results: Baseline positive affect differed across groups, and we observed stress reactivity in positive affect within each group. We found evidence for positive affective recovery after reporting activity- or overall stress within each group. While controls recovered to baseline positive affect about 90 minutes after stress, patients and at-risk individuals required about 180 minutes to recover. However, between-group differences in the affective recovery period fell short of significance (all P>.05). Conclusions: The results provide first evidence that positive affective recovery may be relevant within transdiagnostic subclinical and clinical stages of mental disorder, suggesting that it may be a potential target for mobile health interventions fostering resilience in daily life. %M 36416883 %R 10.2196/37394 %U https://mental.jmir.org/2022/11/e37394 %U https://doi.org/10.2196/37394 %U http://www.ncbi.nlm.nih.gov/pubmed/36416883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40719 %T Mental Health Chatbot for Young Adults With Depressive Symptoms During the COVID-19 Pandemic: Single-Blind, Three-Arm Randomized Controlled Trial %A He,Yuhao %A Yang,Li %A Zhu,Xiaokun %A Wu,Bin %A Zhang,Shuo %A Qian,Chunlian %A Tian,Tian %+ Institute of Applied Psychology, College of Education, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin, 300354, China, 86 13752183496, yangli@tju.edu.cn %K chatbot %K conversational agent %K depression %K mental health %K mHealth %K digital medicine %K randomized controlled trial %K evaluation %K cognitive behavioral therapy %K young adult %K youth %K health service %K mobile health %K COVID-19 %D 2022 %7 21.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression has a high prevalence among young adults, especially during the COVID-19 pandemic. However, mental health services remain scarce and underutilized worldwide. Mental health chatbots are a novel digital technology to provide fully automated interventions for depressive symptoms. Objective: The purpose of this study was to test the clinical effectiveness and nonclinical performance of a cognitive behavioral therapy (CBT)–based mental health chatbot (XiaoE) for young adults with depressive symptoms during the COVID-19 pandemic. Methods: In a single-blind, 3-arm randomized controlled trial, participants manifesting depressive symptoms recruited from a Chinese university were randomly assigned to a mental health chatbot (XiaoE; n=49), an e-book (n=49), or a general chatbot (Xiaoai; n=50) group in a ratio of 1:1:1. Participants received a 1-week intervention. The primary outcome was the reduction of depressive symptoms according to the 9-item Patient Health Questionnaire (PHQ-9) at 1 week later (T1) and 1 month later (T2). Both intention-to-treat and per-protocol analyses were conducted under analysis of covariance models adjusting for baseline data. Controlled multiple imputation and δ-based sensitivity analysis were performed for missing data. The secondary outcomes were the level of working alliance measured using the Working Alliance Questionnaire (WAQ), usability measured using the Usability Metric for User Experience-LITE (UMUX-LITE), and acceptability measured using the Acceptability Scale (AS). Results: Participants were on average 18.78 years old, and 37.2% (55/148) were female. The mean baseline PHQ-9 score was 10.02 (SD 3.18; range 2-19). Intention-to-treat analysis revealed lower PHQ-9 scores among participants in the XiaoE group compared with participants in the e-book group and Xiaoai group at both T1 (F2,136=17.011; P<.001; d=0.51) and T2 (F2,136=5.477; P=.005; d=0.31). Better working alliance (WAQ; F2,145=3.407; P=.04) and acceptability (AS; F2,145=4.322; P=.02) were discovered with XiaoE, while no significant difference among arms was found for usability (UMUX-LITE; F2,145=0.968; P=.38). Conclusions: A CBT-based chatbot is a feasible and engaging digital therapeutic approach that allows easy accessibility and self-guided mental health assistance for young adults with depressive symptoms. A systematic evaluation of nonclinical metrics for a mental health chatbot has been established in this study. In the future, focus on both clinical outcomes and nonclinical metrics is necessary to explore the mechanism by which mental health chatbots work on patients. Further evidence is required to confirm the long-term effectiveness of the mental health chatbot via trails replicated with a longer dose, as well as exploration of its stronger efficacy in comparison with other active controls. Trial Registration: Chinese Clinical Trial Registry ChiCTR2100052532; http://www.chictr.org.cn/showproj.aspx?proj=135744 %M 36355633 %R 10.2196/40719 %U https://www.jmir.org/2022/11/e40719 %U https://doi.org/10.2196/40719 %U http://www.ncbi.nlm.nih.gov/pubmed/36355633 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 11 %P e41800 %T Efficacy of the Mental Health App “Intellect” to Improve Body Image and Self-compassion in Young Adults: A Randomized Controlled Trial With a 4-Week Follow-up %A Ong,Wen Yi %A Sündermann,Oliver %+ Department of Psychology, National University of Singapore, 9 Arts Link, Block AS4, Singapore, 117572, Singapore, 65 93571995, oliver@intellect.co %K body image %K body image program %K mobile health app %K mHealth app %K mobile-based interventions %K dissonance-based interventions %K self-compassion %D 2022 %7 21.11.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Body image concerns are prevalent among young adults, who may be vulnerable to developing body image concerns because of particular risk factors associated with this life period. With technological advancements, digital mobile health (mHealth) apps are cost-effective and scalable interventions. Thus, mHealth apps can be explored as a form of prevention effort to alleviate body image concerns in young adults. Objective: In this randomized controlled trial, we examined the effectiveness of a self-guided mHealth app in improving body image and self-compassion in a sample of university students. Methods: Participants (N=310) were randomized to a 9-day self-guided body image and self-compassion mHealth app (n=149) and to an active waitlist control group (n=161), where they completed a similarly structured 9-day program on cooperation. Both programs consisted of content learning and activities such as quizzes, with the number and length of activities matched for both programs. Measures were obtained at baseline, upon completion of the programs (after the intervention), and at 4-week follow-up. Results: The intervention group for female participants reported significant reduction in body dissatisfaction (P<.001) and improvements in body appreciation (P<.001) and self-compassion (P=.001) compared with the active waitlist control group after the intervention. Similarly, for male participants after the intervention, a significant reduction was found in the intervention group in body dissatisfaction (P<.001) after the intervention as well as improvements in body appreciation (P=.02) and self-compassion (P=.047). The effects were maintained at 4-week follow-up for female participants on body dissatisfaction (P<.001), body appreciation (P<.001), and self-compassion (P=.02) but not for male participants. On body image risk factors, significant reductions were found for female participants after the intervention for thin-ideal internalization (P<.001), peer pressure (P=.002), and media pressure (P<.001) after the intervention, while the effects were only maintained for thin-ideal internalization (P=.008) and media pressure (P=.01) at 4-week follow-up, compared with the active waitlist control group. As for male participants, no intervention effects were found both after the intervention and at follow-up for all body image risk factors of muscularity internalization, peer pressure, and media pressure. Both apps were acceptable and participants engaged equally across the intervention and active waitlist control groups, as indicated on a measure of app engagement (P=.76). Conclusions: This study provides preliminary evidence for a self-guided mHealth app in improving body image concerns and self-compassion in young adult university students. Future studies should include longer follow-ups, and examine its effects with the wider populations of young adults. Trial Registration: ClinicalTrials.gov NCT04977973; https://clinicaltrials.gov/ct2/show/NCT04977973 %M 36409542 %R 10.2196/41800 %U https://mhealth.jmir.org/2022/11/e41800 %U https://doi.org/10.2196/41800 %U http://www.ncbi.nlm.nih.gov/pubmed/36409542 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e40261 %T A Conversational, Virtual, Avatar-Led Cognitive Behavioral Therapy App Intervention for Improving the Quality of Life and Mental Health of People With Epilepsy: Protocol for a Randomized Controlled Trial %A Burbach,Frank %A Lecce,Francesca %A Allen,Victoria M E %A Porter,Catherine M %+ Healios Ltd, 4a Tileyard Studios Tileyard Road Kings Cross, London, N7 9AH, United Kingdom, 44 330 124 4222, frank.burbach@healios.org.uk %K epilepsy %K mental health %K anxiety %K depression %K quality of life %K cognitive behavioral therapy %K digital therapy %K smartphone %K mobile phone %K app %D 2022 %7 21.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Epilepsy is a common neurological disorder affecting about 1 in 100 people in the United Kingdom. Many individuals experience a lower quality of life as a result of their epilepsy diagnosis and are more likely to develop mental health problems, such as anxiety and depression. Medical interventions for this client group tend to focus on the treatment of seizures, whereas mental health disorders often remain undiagnosed and untreated. Early identification and treatment of mental health difficulties in people with epilepsy are vital to ensure better outcomes and improvements in quality of life. Objective: The aim of this exploratory randomized controlled trial is to evaluate whether an 8-week cognitive behavioral therapy–based intervention delivered through a mobile app—ThinkNinja for Epilepsy—is a clinically effective tool to improve quality of life, mental health, and emotional well-being in a large sample of people with epilepsy and anxiety or comorbid anxiety and depression. Methods: The study aims to recruit 184 individuals, 18 to 65 years of age, with a self-reported diagnosis of epilepsy and anxiety or comorbid anxiety and depression. Participants will be randomly assigned to the ThinkNinja for Epilepsy app condition (arm A) or the waiting-list control group (arm B). Participants in arm A will receive access to the ThinkNinja for Epilepsy app first. After 8 weeks, participants in arm B will receive the same full access to the ThinkNinja for Epilepsy app as the participants in arm A. This design will allow an initial between-subjects analysis between the two conditions as well as a within-subject analysis including all participants. The primary outcome is participants’ quality of life, measured by the 10-item patient-weighted Quality of Life in Epilepsy questionnaire. The secondary outcomes include measures of anxiety, using the 7-item Generalized Anxiety Disorder assessment; depression, using the 9-item Patient Health Questionnaire; medication adherence, using the Medication Adherence Questionnaire; and impression of change, using the Patient Global Impression of Change questionnaire. Results: Recruitment for this study began in March 2022 and was completed in October 2022. We expect data collection to be finalized by May 2023 and study results to be available within 12 months of the final data collection date. Results of the study will be written up as soon as possible thereafter, with the intention of publishing the outcomes in high-quality peer-reviewed journals. Conclusions: This study aims to determine the clinical efficacy and safety of the ThinkNinja for Epilepsy intervention at improving the quality of life, mental health, and emotional well-being of people with epilepsy. The findings from our study will hopefully contribute to addressing the critical gap in universal provision and accessibility of mental health and emotional well-being support for people with epilepsy. Trial Registration: ISRCTN Registry 16270209 (04/03/2022); https://www.isrctn.com/ISRCTN16270209 International Registered Report Identifier (IRRID): DERR1-10.2196/40261 %M 36409536 %R 10.2196/40261 %U https://www.researchprotocols.org/2022/11/e40261 %U https://doi.org/10.2196/40261 %U http://www.ncbi.nlm.nih.gov/pubmed/36409536 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e41480 %T Time Spent Gaming, Device Type, Addiction Scores, and Well-being of Adolescent English Gamers in the 2021 OxWell Survey: Latent Profile Analysis %A Skripkauskaite,Simona %A Fazel,Mina %A , %+ Department of Experimental Psychology, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Oxford, OX2 6GG, United Kingdom, 44 01865 271444, simona.skripkauskaite@psych.ox.ac.uk %K gaming %K adolescents %K latent profile analysis %K mobile phone %K well-being %K mental ill-health %K mental health %K digital technology %D 2022 %7 18.11.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The shift in the last decades to screen-based and increasingly web-based gaming activity has raised concerns about its impact on the development of children and adolescents. Despite decades of research into gaming and related psychosocial effects, the question remains how best to identify what degree or context of gaming may be a cause for concern. Objective: This study aimed to classify adolescents into gamer profiles based on both gaming behaviors and well-being. Once we distinguished the different gamer profiles, we aimed to explore whether membership to a specific profile could be predicted based on a range of personal characteristics and experiences that could then help identify those at risk. Methods: We explored gaming and well-being in an adolescent school population (aged 12-18 years) in England as part of the 2021 OxWell student survey. Self-report measures of time spent playing games on computers or consoles, time spent playing games on mobile phones, the Game Addiction Scale, and the Warwick-Edinburgh Mental Well-being Scale were used to classify adolescent heavy gamers (playing games for at least 3.5 hours a day) using latent profile analysis. We used multinomial logistic regression analysis to predict the profile membership based on a range of personal characteristics and experiences. Results: In total, 12,725 participants answered the OxWell gaming questions. Almost one-third (3970/12,725, 31.2%) indicated that they play games for at least 3.5 hours a day. The correlation between time spent playing video games overall and well-being was not significant (P=.41). The latent profile analysis distinguished 6 profiles of adolescent heavy gamers: adaptive computer gamers (1747/3970, 44%); casual computer gamers (873/3970, 22%); casual phone gamers (595/3970, 15%); unknown device gamers (476/3970, 12%); maladaptive computer gamers (238/3970, 6%); and maladaptive phone gamers (79/3970, 2%). In comparison with adaptive computer gamers, maladaptive phone gamers were mostly female (odds ratio [OR] 0.08, 95% CI 0.03-0.21) and were more likely to have experienced abuse or neglect (OR 3.18, 95% CI 1.34-7.55). Maladaptive computer gamers, who reported gaming both on their mobile phones and on the computer, were mostly male and more likely to report anxiety (OR 2.25, 95% CI 1.23-4.12), aggressive behavior (OR 2.83, 95% CI 1.65-4.88), and web-based gambling (OR 2.18, 95% CI 1.24-3.81). Conclusions: A substantial number of adolescents are spending ≥3.5 hours gaming each day, with almost 1 in 10 (317/3970, 8%) reporting co-occurring gaming and well-being issues. Long hours gaming using mobile phones, particularly common in female gamers, may signal poorer functioning and indicate a need for additional support. Although increased time gaming might be changing how adolescents spend their free time and might thus have public health implications, it does not seem to relate to co-occurring well-being issues or mental ill-health for the majority of adolescent gamers. %M 36399378 %R 10.2196/41480 %U https://pediatrics.jmir.org/2022/4/e41480 %U https://doi.org/10.2196/41480 %U http://www.ncbi.nlm.nih.gov/pubmed/36399378 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e39248 %T Estimating the Economic Value of Automated Virtual Reality Cognitive Therapy for Treating Agoraphobic Avoidance in Patients With Psychosis: Findings From the gameChange Randomized Controlled Clinical Trial %A Altunkaya,James %A Craven,Michael %A Lambe,Sinéad %A Beckley,Ariane %A Rosebrock,Laina %A Dudley,Robert %A Chapman,Kate %A Morrison,Anthony %A O'Regan,Eileen %A Grabey,Jenna %A Bergin,Aislinn %A Kabir,Thomas %A Waite,Felicity %A Freeman,Daniel %A Leal,José %+ Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Oxford, OX3 7LF, United Kingdom, 44 1865 289263, jose.leal@dph.ox.ac.uk %K gameChange %K virtual reality %K National Health Service %K NHS %K cost-effectiveness %K economic evaluation %K maximum price %D 2022 %7 18.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: An automated virtual reality cognitive therapy (gameChange) has demonstrated its effectiveness to treat agoraphobia in patients with psychosis, especially for high or severe anxious avoidance. Its economic value to the health care system is not yet established. Objective: In this study, we aimed to estimate the potential economic value of gameChange for the UK National Health Service (NHS) and establish the maximum cost-effective price per patient. Methods: Using data from a randomized controlled trial with 346 patients with psychosis (ISRCTN17308399), we estimated differences in health-related quality of life, health and social care costs, and wider societal costs for patients receiving virtual reality therapy in addition to treatment as usual compared with treatment as usual alone. The maximum cost-effective prices of gameChange were calculated based on UK cost-effectiveness thresholds. The sensitivity of the results to analytical assumptions was tested. Results: Patients allocated to gameChange reported higher quality-adjusted life years (0.008 QALYs, 95% CI –0.010 to 0.026) and lower NHS and social care costs (–£105, 95% CI –£1135 to £924) compared with treatment as usual (£1=US $1.28); however, these differences were not statistically significant. gameChange was estimated to be worth up to £341 per patient from an NHS and social care (NHS and personal social services) perspective or £1967 per patient from a wider societal perspective. In patients with high or severe anxious avoidance, maximum cost-effective prices rose to £877 and £3073 per patient from an NHS and personal social services perspective and societal perspective, respectively. Conclusions: gameChange is a promising, cost-effective intervention for the UK NHS and is particularly valuable for patients with high or severe anxious avoidance. This presents an opportunity to expand cost-effective psychological treatment coverage for a population with significant health needs. Trial Registration: ISRCTN Registry ISRCTN17308399; https://www.isrctn.com/ISRCTN17308399 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-031606 %M 36399379 %R 10.2196/39248 %U https://www.jmir.org/2022/11/e39248 %U https://doi.org/10.2196/39248 %U http://www.ncbi.nlm.nih.gov/pubmed/36399379 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38984 %T Addiction Symptom Network of Young Internet Users: Network Analysis %A Lu,Jianxia %A Zhang,Qinhan %A Zhong,Na %A Chen,Jin %A Zhai,Yujia %A Guo,Lei %A Lu,Chunlei %A Chen,Tianzhen %A Jiang,Zhongli %A Zheng,Hui %+ Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, 200030, China, 86 18267908575, zh.dmtr@gmail.com %K internet addiction %K Internet Addiction Test %K network analysis %K adolescents %D 2022 %7 10.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: An increasing number of people are becoming addicted to the internet as a result of overuse. The Internet Addiction Test (IAT) is a popular tool for evaluating internet use behaviors. The interaction between different symptoms and the relationship between IAT and clinical diagnostic criteria are not well understood. Objective: This study aimed to explore the core symptoms of internet addiction (IA) and the correlation between different symptoms of the IA symptom network. Network analysis was also conducted to explore the association between the IAT scale and the Diagnostic and Statistical Manual of Mental Disorders–5th edition (DSM-5) criteria for IA. Methods: We recruited 4480 internet users (aged 14-24 years), and they completed the IAT. The final analysis included 63.50% (2845/4480) of the participants after screening the submitted questionnaires. Participants were classified into IA group and non-IA (NIA) group. By using partial correlation with Lasso regularization networks, we identified the core symptoms of IA in each group and compared the group differences in network properties (strength, closeness, and betweenness). Then, we analyzed the symptom networks of the DSM-5 diagnostic criteria and IAT scale for IA. Results: A total of 12.47% (355/2845) of the patients were in the IA group and 87.52% (2490/2845) of the patients were in the NIA group, and both groups were evaluated for the following nodes: IAT_06 (school work suffers; strength=0.511), IAT_08 (job performance suffers; strength=0.531), IAT_15 (fantasize about being on the web; strength=0.474), IAT_17 (fail to stop being on the web; strength=0.526), and IAT_12 (fear about boredom if offline; strength=0.502). The IA groups had a stronger edge between IAT_09 (defensive or secretive about being on the web) and IAT_18 (hidden web time) than the NIA groups. The items in DSM-5 had a strong association with IAT_12 (weight=−0.066), IAT_15 (weight=−0.081), IAT_17 (weight=−0.106), IAT_09 (weight=−0.198), and IAT_18 (weight=−0.052). Conclusions: The internet use symptom network of the IA group is significantly different from that of the NIA group. Nodes IAT_06 (school work affected) and IAT_08 (work performance affected) are the resulting symptoms affected by other symptoms, whereas nodes IAT_12 (fear about boredom if offline), IAT_17 (inability to stop being on the web), and IAT_15 (fantasize about being on the web) are key symptoms that activate other symptoms of IA and are strongly linked to the inability to control the intention to play games in the DSM-5. %M 36355402 %R 10.2196/38984 %U https://www.jmir.org/2022/11/e38984 %U https://doi.org/10.2196/38984 %U http://www.ncbi.nlm.nih.gov/pubmed/36355402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e41721 %T Mental Health Outcomes for Youths With Public Versus Private Health Insurance Attending a Telehealth Intensive Outpatient Program: Quality Improvement Analysis %A Gliske,Kate %A Berry,Katie R %A Ballard,Jaime %A Evans-Chase,Michelle %A Solomon,Phyllis L %A Fenkel,Caroline %+ Charlie Health, 233 E Main St., Suite 401, Bozeman, MT, 59715, United States, 1 952 334 1411, kate.gliske@charliehealth.com %K telehealth %K telepsychiatry %K telemedicine %K intensive outpatient %K remote outpatient %K mental health %K quality improvement %K routine outcome monitoring %K mental health treatment %K patient outcome %K outpatient program %K youth %K young adult %K depression %K suicidal ideation %K health outcome %K outcome monitoring %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 exacerbated a growing mental health crisis among youths and young adults, worsened by a lack of existing in-person options for high-acuity care. The emergence and growth of remote intensive outpatient programs (IOPs) is a solution to overcome geographic limitations to care. However, it remains unclear whether remote IOPs engender equivalent clinical outcomes among youths with public insurance (eg, Medicaid) versus private insurance (eg, commercial) given the disparities found in previous research on place-based treatment in both clinical and engagement outcomes. Objective: This analysis sought to establish, as part of ongoing quality improvement efforts, whether engagement and clinical outcomes among adolescents and young adults attending remote IOP treatment differed between youths with public and those with private insurance. The identification of disparities by payer type was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. Methods: Pearson chi-square analyses and independent 2-tailed t tests were used to establish that the 2 groups defined by insurance type were equivalent on clinical outcomes (depression, suicidal ideation, and nonsuicidal self-injury [NSSI]) at intake and compare changes in clinical outcomes. McNemar chi-square analyses and repeated-measure 2-tailed t tests were used to assess changes in clinical outcomes between intake and discharge in the sample overall. In total, 495 clients who attended the remote IOP for youths and young adults in 14 states participated in ≥7 treatment sessions, and completed intake and discharge surveys between July 2021 and April 2022 were included in the analysis. Results: Overall, the youths and young adults in the remote IOP attended a median of 91% of their scheduled group sessions (mean 85.9%, SD 16.48%) and reported significantly fewer depressive symptoms at discharge (t447=12.51; P<.001). McNemar chi-square tests of change indicated significant reductions from intake to discharge in suicidal ideation (N=470, χ21=104.4; P<.001), with nearly three-quarters of youths who reported active suicidal ideation at intake (200/468, 42.7%) no longer reporting it at discharge (142/200, 71%), and in NSSI (N=430, χ21=40.7; P<.001), with more than half of youths who reported NSSI at intake (205/428, 47.9%) reporting lower self-harm at discharge (119/205, 58%). No significant differences emerged by insurance type in attendance (median public 89%, median private 92%; P=.10), length of stay (t416=−0.35; P=.73), or reductions in clinical outcomes (depressive symptom severity: t444=−0.87 and P=.38; active suicidal ideation: N=200, χ21=0.6 and P=.49; NSSI frequency: t426=−0.98 and P=.33). Conclusions: Our findings suggest that youths and young adults who participated in remote IOP had significant reductions in depression, suicidal ideation, and NSSI. Given access to the same remote high-acuity care, youths and young adults on both public and private insurance engaged in programming at comparable rates and achieved similar improvements in clinical outcomes. %M 36355428 %R 10.2196/41721 %U https://formative.jmir.org/2022/11/e41721 %U https://doi.org/10.2196/41721 %U http://www.ncbi.nlm.nih.gov/pubmed/36355428 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e40347 %T Determination of Markers of Successful Implementation of Mental Health Apps for Young People: Systematic Review %A Bear,Holly Alice %A Ayala Nunes,Lara %A DeJesus,John %A Liverpool,Shaun %A Moltrecht,Bettina %A Neelakantan,Lakshmi %A Harriss,Elinor %A Watkins,Edward %A Fazel,Mina %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, United Kingdom, 44 01865613127, holly.bear@psych.ox.ac.uk %K adolescent mental health %K smartphones %K mobile apps %K apps %K implementation science %K mobile phone %D 2022 %7 9.11.2022 %9 Review %J J Med Internet Res %G English %X Background: Smartphone apps have the potential to address some of the current issues facing service provision for young people’s mental health by improving the scalability of evidence-based mental health interventions. However, very few apps have been successfully implemented, and consensus on implementation measurement is lacking. Objective: This review aims to determine the proportion of evidence-based mental health and well-being apps that have been successfully adopted and sustained in real-world settings. A secondary aim is to establish if key implementation determinants such as coproduction, acceptability, feasibility, appropriateness, and engagement contribute toward successful implementation and longevity. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an electronic search of 5 databases in 2021 yielded 18,660 results. After full-text screening, 34 articles met the full eligibility criteria, providing data on 29 smartphone apps studied with individuals aged 15 to 25 years. Results: Of 34 studies, only 10 (29%) studies were identified that were evaluating the effectiveness of 8 existing, commercially available mental health apps, and the remaining 24 (71%) studies reported the development and evaluation of 21 newly developed apps, of which 43% (9/21) were available, commercially or otherwise (eg, in mental health services), at the time of enquiry. Most studies addressed some implementation components including adoption, acceptability, appropriateness, feasibility, and engagement. Factors including high cost, funding constraints, and lengthy research processes impeded implementation. Conclusions: Without addressing common implementation drivers, there is considerable redundancy in the translation of mobile mental health research findings into practice. Studies should embed implementation strategies from the outset of the planned research, build collaborations with partners already working in the field (academic and commercial) to capitalize on existing interventions and platforms, and modify and evaluate them for local contexts or target problems and populations. Trial Registration: PROSPERO CRD42021224365; https://tinyurl.com/4umpn85f %M 36350704 %R 10.2196/40347 %U https://www.jmir.org/2022/11/e40347 %U https://doi.org/10.2196/40347 %U http://www.ncbi.nlm.nih.gov/pubmed/36350704 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 11 %P e38911 %T Text Topics and Treatment Response in Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder: Text Mining Study %A Mylläri,Sanna %A Saarni,Suoma Eeva %A Ritola,Ville %A Joffe,Grigori %A Stenberg,Jan-Henry %A Solbakken,Ole André %A Czajkowski,Nikolai Olavi %A Rosenström,Tom %+ Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PO Box 21, Haartmaninkatu 3 E, H218, Helsinki, 00014, Finland, 358 407678891, sanna.myllari@helsinki.fi %K iCBT %K CBT %K psychotherapy %K internet therapy %K anxiety %K topic modeling %K natural language processing %D 2022 %7 9.11.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Text mining methods such as topic modeling can offer valuable information on how and to whom internet-delivered cognitive behavioral therapies (iCBT) work. Although iCBT treatments provide convenient data for topic modeling, it has rarely been used in this context. Objective: Our aims were to apply topic modeling to written assignment texts from iCBT for generalized anxiety disorder and explore the resulting topics’ associations with treatment response. As predetermining the number of topics presents a considerable challenge in topic modeling, we also aimed to explore a novel method for topic number selection. Methods: We defined 2 latent Dirichlet allocation (LDA) topic models using a novel data-driven and a more commonly used interpretability-based topic number selection approaches. We used multilevel models to associate the topics with continuous-valued treatment response, defined as the rate of per-session change in GAD-7 sum scores throughout the treatment. Results: Our analyses included 1686 patients. We observed 2 topics that were associated with better than average treatment response: “well-being of family, pets, and loved ones” from the data-driven LDA model (B=–0.10 SD/session/∆topic; 95% CI –016 to –0.03) and “children, family issues” from the interpretability-based model (B=–0.18 SD/session/∆topic; 95% CI –0.31 to –0.05). Two topics were associated with worse treatment response: “monitoring of thoughts and worries” from the data-driven model (B=0.06 SD/session/∆topic; 95% CI 0.01 to 0.11) and “internet therapy” from the interpretability-based model (B=0.27 SD/session/∆topic; 95% CI 0.07 to 0.46). Conclusions: The 2 LDA models were different in terms of their interpretability and broadness of topics but both contained topics that were associated with treatment response in an interpretable manner. Our work demonstrates that topic modeling is well suited for iCBT research and has potential to expose clinically relevant information in vast text data. %M 36350678 %R 10.2196/38911 %U https://www.jmir.org/2022/11/e38911 %U https://doi.org/10.2196/38911 %U http://www.ncbi.nlm.nih.gov/pubmed/36350678 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e40286 %T Adapting DIALOG+ in a School Setting—A Tool to Support Well-being and Resilience in Adolescents Living in Postconflict Areas During the COVID-19 Pandemic: Protocol for a Cluster Randomized Exploratory Study %A Gómez-Restrepo,Carlos %A Sarmiento-Suárez,María José %A Alba-Saavedra,Magda %A Bird,Victoria Jane %A Priebe,Stefan %A van Loggerenberg,Francois %+ The Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, Newham Centre for Mental Health, London, E13 8SP, United Kingdom, 44 2078825555, f.vanloggerenberg@qmul.ac.uk %K mental health %K mental disorder %K eHealth %K digital health %K digital intervention %K psychosocial intervention %K resilience %K psychological support %K psychosocial well-being %K mental well-being %K resource-oriented approach %K computer-mediated intervention %K armed conflict %K post-conflict %K adolescent health %K adolescent %K adolescence %K child %K youth %K school %K teacher %K student %K acceptability %K feasibility %K vulnerable %D 2022 %7 9.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Colombia has a long history of an armed conflict that has severely affected communities with forced internal displacement and violence. Victims of violence and armed conflicts have higher rates of mental health disorders, and children and adolescents are particularly affected. However, the mental health needs of this population are often overlooked, especially in low- and middle-Income countries, where scarcity of resources exacerbates the problem that has been further compounded by the global COVID-19 pandemic. Thus, special attention should be paid to the development of interventions that target this population. Objective: Our research aims to adapt an existing patient-centered digital intervention called DIALOG+ from a clinical setting to an educational setting using stakeholders’ (teachers’ and students’) perspectives. We aim to evaluate the feasibility, acceptability, and estimated effect of implementing this intervention as a tool for the identification and mobilization of personal and social resources to mitigate the impact of social difficulties and to promote mental well-being. Methods: We will conduct an exploratory mixed methods study in public schools of postconflict areas in Tolima, Colombia. The study consists of 3 phases: adaptation, exploration, and consolidation of the DIALOG+ tool. The adaptation phase will identify possible changes that the intervention requires on the basis of data from focus groups with teachers and students. The exploration phase will be an exploratory cluster randomized trial with teachers and school counselors to assess the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in school settings. Adolescents’ data about mental health symptoms and wellness will be collected before and after DIALOG+ implementation. During this phase, teachers or counselors who were part of the intervention group will share their opinions through the think-aloud method. Lastly, the consolidation phase will consist of 2 focus groups with teachers and students to discuss their experiences and to understand acceptability. Results: Study recruitment was completed in March 2022, and follow-up is anticipated to last through November 2022. Conclusions: This exploratory study will evaluate the acceptability, feasibility, and estimated effect of DIALOG+ for adolescents in postconflict school settings in Colombia. The use of this technology-supported tool aims to support interactions between teachers or counselors and students and to provide an effective student-centered communication guide. This is an innovative approach in both the school and the postconflict contexts that could help improve the mental health and wellness of adolescents in vulnerable zones in Colombia. Subsequent studies will be needed to evaluate the effectiveness of DIALOG+ in an educational context as a viable option to reduce the gap and inequities of mental health care access. Trial Registration: ISRCTN Registry ISRCTN14396374; https://www.isrctn.com/ISRCTN14396374?q=ISRCTN14396374 International Registered Report Identifier (IRRID): DERR1-10.2196/40286 %M 36350703 %R 10.2196/40286 %U https://www.researchprotocols.org/2022/11/e40286 %U https://doi.org/10.2196/40286 %U http://www.ncbi.nlm.nih.gov/pubmed/36350703 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e39912 %T User Engagement Within an Online Peer Support Community (Depression Connect) and Recovery-Related Changes in Empowerment: Longitudinal User Survey %A Smit,Dorien %A Vrijsen,Janna N %A Broekman,Theo %A Groeneweg,Bart %A Spijker,Jan %+ Pro Persona Mental Health Care, Pro Persona Research, Depression Expertise Centre, Nijmeegsebaan 61, Nijmegen, 6525 DX, Netherlands, 31 647074551, d.smit@propersona.nl %K depression %K online peer support community %K internet support group %K experiential knowledge %K self-management %K empowerment %K user engagement %K longitudinal user survey %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The chronic nature of depression and limited availability of evidence-based treatments emphasize the need for complementary recovery-oriented services, such as peer support interventions (PSIs). Peer support is associated with positive effects on clinical and personal recovery from mental illness, but little is known about the processes of engagement that foster change, and studies targeting individuals with depression specifically are limited. Objective: This study aimed to evaluate whether the level of user engagement, assessed on several dimensions, in an online peer support community for individuals with depression promotes empowerment and the use of self-management strategies and reduces symptom severity and disability. Methods: In a longitudinal survey conducted from June 2019 to September 2020, we analyzed the data of the users of Depression Connect (DC), an online peer support community hosted by the Dutch Patient Association for Depression and the Pro Persona Mental Health Care institute, on measures of empowerment, self-management, depression, and disability. Of the 301 respondents, 49 (16.3%) respondents completed the survey again after 3 months and 74 (24.6%) respondents, after 6 months. Analysis of 3 parameters (ie, total time spent on the platform, number of page views, and number of posts) derived from their data logs yielded 4 engagement profiles. Linear mixed models were fitted to determine whether the outcomes had significantly changed over time and differed for the various profiles. Results: Baseline engagement with the online peer support community was “very low” (177/301, 58.8%) or “low” (87/301, 28.9%) for most of the participants, with few showing “medium” (30/301, 9.9%) or “high” engagement patterns (7/301, 2.3%), while user profiles did not differ in demographic and clinical characteristics. Empowerment, self-management, depressive symptoms, and disability improved over time, but none were associated with the intensity or nature of user engagement. Conclusions: With most DC members showing very low to low engagement and only a few being identified as high-engaged users, it is likely that this flexibility in use frequency is what provides value to online PSI users. In other more formal supportive environments for depression, a certain level of engagement is predetermined either by their organizational or by their societal context; at DC, users can adapt the intensity and nature of their engagement to their current needs on their personal road to recovery. This study added to the current knowledge base on user engagement for PSIs because previous studies targeting depression with an online format focused on active users, precluding passive and flexible engagement. Future studies should explore the content and quality of the interactions in online PSIs to identify optimal user engagement as a function of current, self-reported clinical parameters and reasons to engage in the PSI. %M 36322110 %R 10.2196/39912 %U https://formative.jmir.org/2022/11/e39912 %U https://doi.org/10.2196/39912 %U http://www.ncbi.nlm.nih.gov/pubmed/36322110 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e38460 %T Brief App-Based Cognitive Behavioral Therapy for Anxiety Symptoms in Psychiatric Inpatients: Feasibility Randomized Controlled Trial %A Sharma,Gaurav %A Schlosser,Lisa %A Jones,Brett D M %A Blumberger,Daniel M %A Gratzer,David %A Husain,M Omair %A Mulsant,Benoit H %A Rappaport,Lance %A Stergiopoulos,Vicky %A Husain,Muhammad Ishrat %+ Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada, 1 416 979 6948, mr.sharma@mail.utoronto.ca %K inpatient %K mental health %K mental disorder %K psychiatry %K psychiatric %K smartphone app %K cognitive behavioral therapy %K CBT %K anxiety %K mobile app %K mobile health %K mHealth %K health app %K digital health %K eHealth %K feasibility study %K randomized controlled trial %K RCT %K feasibility %K acceptability %D 2022 %7 2.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychiatric inpatients often have limited access to psychotherapeutic education or skills for managing anxiety, a common transdiagnostic concern in severe and acute mental illness. COVID-19–related restrictions further limited access to therapy groups on inpatient psychiatric units. App-based interventions may improve access, but evidence supporting the feasibility of their use, acceptability, and effectiveness in psychiatric inpatient settings is limited. MindShift CBT is a free app based on cognitive behavioral therapy principles with evidence for alleviating anxiety symptoms in the outpatient setting. Objective: We aimed to recruit 24 participants from an acute general psychiatric inpatient ward to a 1-month randomized control study assessing the feasibility and acceptability of providing patients with severe and acute mental illness access to the MindShift CBT app for help with managing anxiety symptoms. Methods: Recruitment, data collection, analysis, and interpretation were completed collaboratively by clinician and peer researchers. Inpatients were randomized to two conditions: treatment as usual (TAU) versus TAU plus use of the MindShift CBT app over 6 days. We collected demographic and quantitative data on acceptability and usability of the intervention. Symptoms of depression, anxiety, and psychological distress were measured in pre- and poststudy surveys for preliminary signals of efficacy. We conducted individual semistructured interviews with participants in the MindShift CBT app group at the end of their trial period, which were interpreted using a standardized protocol for thematic analysis. Results: Over 4 weeks, 33 inpatients were referred to the study, 24 consented to participate, 20 were randomized, and 11 completed the study. Of the 9 randomized participants who did not complete the study, 7 were withdrawn because they were discharged or transferred prior to study completion, with a similar distribution among both conditions. Among the enrolled patients, 65% (13/20) were admitted for a psychotic disorder and no patient was admitted primarily for an anxiety disorder. The average length of stay was 20 days (SD 4.4; range 3-21) and 35% (7/20) of patients were involuntarily admitted to hospital. Small sample sizes limited accurate interpretation of the efficacy data. Themes emerging from qualitative interviews included acceptability and usability of the app, and patient agency associated with voluntary participation in research while admitted to hospital. Conclusions: Our study benefitted from collaboration between peer and clinician researchers. Due to rapid patient turnover in the acute inpatient setting, additional flexibility in recruitment and enrollment is needed to determine the efficacy of using app-based psychotherapy on an acute psychiatric ward. Despite the limited sample size, our study suggests that similar interventions may be feasible and acceptable for acutely unwell inpatients. Further study is needed to compare the efficacy of psychotherapeutic apps with existing standards of care in this setting. Trial Registration: ClinicalTrials.gov NCT04841603; https://clinicaltrials.gov/ct2/show/NCT04841603 %M 36322113 %R 10.2196/38460 %U https://formative.jmir.org/2022/11/e38460 %U https://doi.org/10.2196/38460 %U http://www.ncbi.nlm.nih.gov/pubmed/36322113 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 11 %P e36496 %T Cost-Utility and Cost-effectiveness of MoodSwings 2.0, an Internet-Based Self-management Program for Bipolar Disorder: Economic Evaluation Alongside a Randomized Controlled Trial %A Chatterton,Mary Lou %A Lee,Yong Yi %A Berk,Lesley %A Mohebbi,Mohammadreza %A Berk,Michael %A Suppes,Trisha %A Lauder,Sue %A Mihalopoulos,Cathrine %+ Institute for Health Transformation, Deakin University, Locked Bag 20001, Geelong, 3220, Australia, 61 03 52278409, mchatter@deakin.edu.au %K economic evaluation %K cost-effectiveness %K cost-utility %K clinical trial %K bipolar disorder %K psychoeducation %K cognitive behavioral therapy %K internet intervention %K mania %K depression %K psychiatry %K neuroscience %K mental disorders %D 2022 %7 1.11.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-delivered psychosocial interventions can overcome barriers to face-to-face psychosocial care, but limited evidence supports their cost-effectiveness for people with bipolar disorders (BDs). Objective: This study aimed to conduct within-trial cost-effectiveness and cost-utility analyses of an internet-based intervention for people with BD, MoodSwings 2.0, from an Australian health sector perspective. Methods: MoodSwings 2.0 included an economic evaluation alongside an international, parallel, and individually stratified randomized controlled trial comparing an internet-based discussion forum (control; group 1), a discussion forum plus internet-based psychoeducation (group 2), and a discussion forum plus psychoeducation and cognitive behavioral tools (group 3). The trial enrolled adults (aged 21 to 65 years) with a diagnosis of BD assessed by telephone using a structured clinical interview. Health sector costs included intervention delivery and additional health care resources used by participants over the 12-month trial follow-up. Outcomes included depression symptoms measured by the Montgomery-Åsberg Depression Rating Scale (MADRS; the trial primary outcome) and quality-adjusted life years (QALYs) calculated using the short-form 6-dimension instrument derived from the 12-item version of the short-form health survey. Average incremental cost-effectiveness (cost per MADRS score) and cost-utility (cost per QALY) ratios were calculated using estimated mean differences between intervention and control groups from linear mixed effects models in the base case. Results: In total, 304 participants were randomized. Average health sector cost was lowest for group 2 (Aus $9431, SD Aus $8540; Aus $1=US $0.7058) compared with the control group (Aus $15,175, SD Aus $17,206) and group 3 (Aus $15,518, SD Aus $30,523), but none was statistically significantly different. The average QALYs were not significantly different among the groups (group 1: 0.627, SD 0.062; group 2: 0.618, SD 0.094; and group 3: 0.622, SD 0.087). The MADRS scores were previously shown to differ significantly between group 2 and the control group at all follow-up time points (P<.05). Group 2 was dominant (lower costs and greater effects) compared with the control group for average incremental cost per point decrease in MADRS score over 12 months (95% CI dominated to Aus $331). Average cost per point change in MADRS score for group 3 versus the control group was dominant (95% CI dominant to Aus $22,585). Group 2 was dominant (95% CI Aus $43,000 to dominant) over the control group based on lower average health sector cost and average QALY benefit of 0.012 (95% CI –0.009 to 0.033). Group 3, compared with the control group, had an average incremental cost-effectiveness ratio of dominant (95% CI dominated to Aus $19,978). Conclusions: Web-based psychoeducation through MoodSwings 2.0 has the potential to be a cost-effective intervention for people with BD. Additional research is needed to understand the lack of effectiveness for the addition of cognitive behavioral tools with the group 3 intervention. %M 36318243 %R 10.2196/36496 %U https://mental.jmir.org/2022/11/e36496 %U https://doi.org/10.2196/36496 %U http://www.ncbi.nlm.nih.gov/pubmed/36318243 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e40268 %T Long-term Effectiveness and Predictors of Transdiagnostic Internet-Delivered Cognitive Behavioral Therapy for Emotional Disorders in Specialized Care: Secondary Analysis of a Randomized Controlled Trial %A González-Robles,Alberto %A Roca,Pablo %A Díaz-García,Amanda %A García-Palacios,Azucena %A Botella,Cristina %+ Department of Psychology and Sociology, Universidad de Zaragoza, Atarazanas 4, Teruel, 44003, Spain, 34 978618154 ext 861154, gonzaleza@unizar.es %K transdiagnostic %K anxiety %K depression %K long term %K predictors %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Transdiagnostic internet-delivered cognitive behavioral therapy (iCBT) for emotional disorders has been shown to be effective in specialized care in the short term. However, less is known about its long-term effects in this specific setting. In addition, predictors of long-term effectiveness may help to identify what treatments are more suitable for certain individuals. Objective: This study aimed to analyze the long-term effectiveness of transdiagnostic iCBT compared with that of treatment as usual (TAU) in specialized care and explore predictors of long-term effectiveness. Methods: Mixed models were performed to analyze the long-term effectiveness and predictors of transdiagnostic iCBT (n=99) versus TAU (n=101) in public specialized mental health care. Outcomes included symptoms of depression and anxiety, health-related quality of life (QoL), behavioral inhibition and behavioral activation, comorbidity, and diagnostic status (ie, loss of principal diagnosis) from baseline to 1-year follow-up. Sociodemographic characteristics (sex, age, and education) and clinical variables (principal diagnosis, comorbidity, and symptom severity at baseline) were selected as predictors of long-term changes. Results: Compared with baseline, transdiagnostic iCBT was more effective than TAU in improving symptoms of depression (b=–4.16, SE 1.80, 95% CI –7.68 to –0.67), health-related QoL (b=7.63, SE 3.41, 95% CI 1.00-14.28), diagnostic status (b=–0.24, SE 0.09, 95% CI –1.00 to –0.15), and comorbidity at 1-year follow-up (b=–0.58, SE 0.22, 95% CI –1.00 to –0.15). From pretreatment assessment to follow-up, anxiety symptoms improved in both transdiagnostic iCBT and TAU groups, but no significant differences were found between the groups. Regarding the predictors of the long-term effectiveness of transdiagnostic iCBT compared with that of TAU, higher health-related QoL at follow-up was predicted by a baseline diagnosis of anxiety, male sex, and the use of psychiatric medication; fewer comorbid disorders at follow-up were predicted by older age and higher baseline scores on health-related QoL; and fewer depressive symptoms at follow-up were predicted by baseline diagnosis of depression. However, this pattern was not observed for baseline anxiety diagnoses and anxiety symptoms. Conclusions: The results suggest that transdiagnostic iCBT is more effective than TAU to target depressive symptoms among patients with emotional disorders. Anxiety symptoms remained stable at 1-year follow-up, with no differences between the groups. Results on predictors suggest that some groups of patients may obtain specific gains after transdiagnostic iCBT. Specifically, and consistent with the literature, patients with baseline depression improved their depression scores at follow-up. However, this pattern was not found for baseline anxiety disorders. More studies on the predictor role of sociodemographic and clinical variables in long-term outcomes of transdiagnostic iCBT are warranted. Future studies should focus on studying the implementation of transdiagnostic iCBT in Spanish public specialized mental health care. Trial Registration: ClinicalTrials.gov NCT02345668; https://clinicaltrials.gov/ct2/show/NCT02345668 %M 36315227 %R 10.2196/40268 %U https://mental.jmir.org/2022/10/e40268 %U https://doi.org/10.2196/40268 %U http://www.ncbi.nlm.nih.gov/pubmed/36315227 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40946 %T Examining Mental Workload Relating to Digital Health Technologies in Health Care: Systematic Review %A Kremer,Lisanne %A Lipprandt,Myriam %A Röhrig,Rainer %A Breil,Bernhard %+ Faculty of Health Care, Niederrhein University of Applied Sciences, Reinarzstr. 49, Krefeld, 47805, Germany, 49 2151 8226678, Lisanne.Kremer@hs-niederrhein.de %K mental workload %K mental workload measurement %K assessment %K health care professional %K health information system(s) %K digital health technology %K systematic review %D 2022 %7 28.10.2022 %9 Review %J J Med Internet Res %G English %X Background: The workload in health care is increasing and hence, mental health issues are on the rise among health care professionals (HCPs). The digitization of patient care could be related to the increase in stress levels. It remains unclear whether the health information system or systems and digital health technologies (DHTs) being used in health care relieve the professionals or whether they represent a further burden. The mental construct that best describes this burden of technologies is mental workload (MWL). The measurement methods of MWL are particularly relevant in this sensitive setting. Objective: This review aimed to address 2 different but related objectives: identifying the factors that contribute to the MWL of HCPs when using DHT and examining and exploring the applied assessments for the measurement of MWL with a special focus on eye tracking. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement, we conducted a systematic review and processed a literature search in the following databases: MEDLINE (PubMed), Web of Science, Academic Search Premier and CINAHL (EBSCO), and PsycINFO. Studies were eligible if they assessed the MWL of HCPs related to DHT. The review was conducted as per the following steps: literature search, article selection, data extraction, quality assessment (using the Standard Quality Assessment Criteria for Evaluation Primary Research Papers From a Variety of Fields [QualSyst]), data analysis, and data synthesis (narrative and tabular). The process was performed by 2 reviewers (in cases of disagreement, a third reviewer was involved). Results: The literature search process resulted in 25 studies that fit the inclusion criteria and examined the MWL of health care workers resulting from the use of DHT in health care settings. Most studies had sample sizes of 10-50 participants, were conducted in the laboratory, and had quasi-experimental or cross-sectional designs. The main results can be grouped into two categories: assessment methods and factors related to DHT that contribute to MWL. Most studies applied subjective methods for the assessment of MWL. Eye tracking did not play a major role in the selected studies. The factors contributing to a higher MWL were clustered into organizational and systemic factors. Conclusions: Our review of 25 papers shows a diverse assessment approach toward the MWL of HCPs related to DHT as well as 2 groups of relevant contributing factors to MWL. Our results are limited in terms of interpretability and causality due to methodological weaknesses of the included studies and may be limited by some shortcomings in the search process. Future research should concentrate on adequate assessments of the MWL of HCPs dependent on the setting, the evaluation of quality criteria, and further assessment of the contributing factors to MWL. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021233271; https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42021233271 %M 36306159 %R 10.2196/40946 %U https://www.jmir.org/2022/10/e40946 %U https://doi.org/10.2196/40946 %U http://www.ncbi.nlm.nih.gov/pubmed/36306159 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e40410 %T The Best Predictor of the Future—the Metaverse, Mental Health, and Lessons Learned From Current Technologies %A Benrimoh,David %A Chheda,Forum D %A Margolese,Howard C %+ Department of Psychiatry, McGill University, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada, 1 5144637813, david.benrimoh@mail.mcgill.ca %K metaverse %K mental health %K social media %K virtual reality %K VR %K digital experience %K human interaction %K mental health risk %K teleworking %K assisted therapy %K teletherapy %K benefits %K safety %K mental health problems %K data security %K privacy %K protection %K user safety %K safety regulations %K mobile phone %D 2022 %7 28.10.2022 %9 Viewpoint %J JMIR Ment Health %G English %X The metaverse—a virtual world accessed via virtual reality technology—has been heralded as the next key digital experience. It is meant to provide the next evolution of human interaction after social media and telework. However, in the context of the growing awareness of the risks to mental health posed by current social media technologies, there is a great deal of uncertainty as to the potential effects of this new technology on mental health. This uncertainty is compounded by a lack of clarity regarding what form the metaverse will ultimately take and how widespread its application will be. Despite this, given the nascent state of the metaverse, there is an opportunity to plan the research and regulatory approaches needed to understand it and promote its positive effects while protecting vulnerable groups. In this viewpoint, we examine the following three current technologies whose functions comprise a portion of what the metaverse seeks to accomplish: teleworking, virtual reality, and social media. We attempted to understand in what ways the metaverse may have similar benefits and pitfalls to these technologies but also how it may fundamentally differ from them. These differences suggest potential research questions to be addressed in future work. We found that current technologies have enabled tools such as virtual reality–assisted therapy, avatar therapy, and teletherapy, which have had positive effects on mental health care, and that the metaverse may provide meaningful improvements to these tools. However, given its similarities to social media and its expansion upon the social media experience, the metaverse raises some of the same concerns that we have with social media, such as the possible exacerbation of certain mental health problems. These concerns led us to consider questions such as how the users will be protected and what regulatory mechanisms will be put in place to ensure user safety. Although clear answers to these questions are challenging in this early phase of metaverse research, in this viewpoint, we use the context provided by comparator technologies to provide recommendations to maximize the potential benefits and limit the putative harms of the metaverse. We hope that this paper encourages discussions among researchers and policy makers. %M 36306155 %R 10.2196/40410 %U https://mental.jmir.org/2022/10/e40410 %U https://doi.org/10.2196/40410 %U http://www.ncbi.nlm.nih.gov/pubmed/36306155 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e39998 %T Screening for Generalized Anxiety Disorder From Acoustic and Linguistic Features of Impromptu Speech: Prediction Model Evaluation Study %A Teferra,Bazen Gashaw %A Borwein,Sophie %A DeSouza,Danielle D %A Rose,Jonathan %+ The Edward S Rogers Sr Department of Electrical and Computer Engineering, University of Toronto, 10 King’s College Road, Toronto, ON, M5S 3G4, Canada, 1 4169786992, bazen.teferra@mail.utoronto.ca %K mental health %K generalized anxiety disorder %K impromptu speech %K acoustic features %K linguistic features %K anxiety prediction %K mobile phone %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Frequent interaction with mental health professionals is required to screen, diagnose, and track mental health disorders. However, high costs and insufficient access can make frequent interactions difficult. The ability to assess a mental health disorder passively and at frequent intervals could be a useful complement to the conventional treatment. It may be possible to passively assess clinical symptoms with high frequency by characterizing speech alterations collected using personal smartphones or other wearable devices. The association between speech features and mental health disorders can be leveraged as an objective screening tool. Objective: This study aimed to evaluate the performance of a model that predicts the presence of generalized anxiety disorder (GAD) from acoustic and linguistic features of impromptu speech on a larger and more generalizable scale than prior studies did. Methods: A total of 2000 participants were recruited, and they participated in a single web-based session. They completed the Generalized Anxiety Disorder-7 item scale assessment and provided an impromptu speech sample in response to a modified version of the Trier Social Stress Test. We used the linguistic and acoustic features that were found to be associated with anxiety disorders in previous studies along with demographic information to predict whether participants fell above or below the screening threshold for GAD based on the Generalized Anxiety Disorder-7 item scale threshold of 10. Separate models for each sex were also evaluated. We reported the mean area under the receiver operating characteristic (AUROC) from a repeated 5-fold cross-validation to evaluate the performance of the models. Results: A logistic regression model using only acoustic and linguistic speech features achieved a significantly greater prediction accuracy than a random model did (mean AUROC 0.57, SD 0.03; P<.001). When separately assessing samples from female participants, we observed a mean AUROC of 0.55 (SD 0.05; P=.01). The model constructed from the samples from male participants achieved a mean AUROC of 0.57 (SD 0.07; P=.002). The mean AUROC increased to 0.62 (SD 0.03; P<.001) on the all-sample data set when demographic information (age, sex, and income) was included, indicating the importance of demographics when screening for anxiety disorders. The performance also increased for the female sample to a mean of 0.62 (SD 0.04; P<.001) when using demographic information (age and income). An increase in performance was not observed when demographic information was added to the model constructed from the male samples. Conclusions: A logistic regression model using acoustic and linguistic speech features, which have been suggested to be associated with anxiety disorders in prior studies, can achieve above-random accuracy for predicting GAD. Importantly, the addition of basic demographic variables further improves model performance, suggesting a role for speech and demographic information to be used as automated, objective screeners of GAD. %M 36306165 %R 10.2196/39998 %U https://formative.jmir.org/2022/10/e39998 %U https://doi.org/10.2196/39998 %U http://www.ncbi.nlm.nih.gov/pubmed/36306165 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e41445 %T Feasibility of Digital Cognitive Behavioral Therapy for Depressed Older Adults With the Moodbuster Platform: Protocol for 2 Pilot Feasibility Studies %A Amarti,Khadicha %A Schulte,Mieke H J %A Kleiboer,Annet %A Van Genugten,Claire Rosalie %A Oudega,Mardien %A Sonnenberg,Caroline %A Gonçalves,Gonçalo C %A Rocha,Artur %A Riper,Heleen %+ Clinical Psychology Section, Department of Clinical, Neuro- and Developmental Psychology, Vrije Universiteit, De Boelelaan 1117, Amsterdam, 1081 HV, Netherlands, 31 020 59 83 348, k.amarti@vu.nl %K iCBT %K study protocol %K feasibility study %K acceptance %K satisfaction %K usability %K engagement %K depression severity %K older adults %D 2022 %7 25.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Internet-based interventions can be effective in the treatment of depression. However, internet-based interventions for older adults with depression are scarce, and little is known about their feasibility and effectiveness. Objective: To present the design of 2 studies aiming to assess the feasibility of internet-based cognitive behavioral treatment for older adults with depression. We will assess the feasibility of an online, guided version of the Moodbuster platform among depressed older adults from the general population as well as the feasibility of a blended format (combining integrated face-to-face sessions and internet-based modules) in a specialized mental health care outpatient clinic. Methods: A single-group, pretest-posttest design will be applied in both settings. The primary outcome of the studies will be feasibility in terms of (1) acceptance and satisfaction (measured with the Client Satisfaction Questionnaire-8), (2) usability (measured with the System Usability Scale), and (3) engagement (measured with the Twente Engagement with eHealth Technologies Scale). Secondary outcomes include (1) the severity of depressive symptoms (measured with the 8-item Patient Health Questionnaire depression scale), (2) participant and therapist experience with the digital technology (measured with qualitative interviews), (3) the working alliance between patients and practitioners (from both perspectives; measured with the Working Alliance Inventory–Short Revised questionnaire), (4) the technical alliance between patients and the platform (measured with the Working Alliance Inventory for Online Interventions–Short Form questionnaire), and (5) uptake, in terms of attempted and completed modules. A total of 30 older adults with mild to moderate depressive symptoms (Geriatric Depression Scale 15 score between 5 and 11) will be recruited from the general population. A total of 15 older adults with moderate to severe depressive symptoms (Geriatric Depression Scale 15 score between 8 and 15) will be recruited from a specialized mental health care outpatient clinic. A mixed methods approach combining quantitative and qualitative analyses will be adopted. Both the primary and secondary outcomes will be further explored with individual semistructured interviews and synthesized descriptively. Descriptive statistics (reported as means and SDs) will be used to examine the primary and secondary outcome measures. Within-group depression severity will be analyzed using a 2-tailed, paired-sample t test to investigate differences between time points. The interviews will be recorded and analyzed using thematic analysis. Results: The studies were funded in October 2019. Recruitment started in September 2022. Conclusions: The results of these pilot studies will show whether this platform is feasible for use by the older adult population in a blended, guided format in the 2 settings and will represent the first exploration of the size of the effect of Moodbuster in terms of decreased depressive symptoms. International Registered Report Identifier (IRRID): PRR1-10.2196/41445 %M 36282565 %R 10.2196/41445 %U https://www.researchprotocols.org/2022/10/e41445 %U https://doi.org/10.2196/41445 %U http://www.ncbi.nlm.nih.gov/pubmed/36282565 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e40488 %T The Efficacy of a Web-Based Stress Management Intervention for Employees Experiencing Adverse Working Conditions and Occupational Self-efficacy as a Mediator: Randomized Controlled Trial %A Nixon,Patricia %A Ebert,David Daniel %A Boß,Leif %A Angerer,Peter %A Dragano,Nico %A Lehr,Dirk %+ Department of Health Psychology and Applied Biological Psychology, Institute of Psychology, Leuphana University, Universitätsallee 1, Lueneburg, 21335, Germany, 49 41316772720, lehr@leuphana.de %K occupational eMental health %K stress %K occupational self-efficacy %K effort-reward imbalance %K randomized controlled trial %D 2022 %7 20.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Work stress is highly prevalent and puts employees at risk for adverse health consequences. Web-based stress management interventions (SMIs) promoting occupational self-efficacy might be a feasible approach to aid employees to alleviate this burden and to enable them to improve an unbalanced situation between efforts and rewards at work. Objective: The first aim of this randomized controlled trial was to investigate the efficacy of a web-based SMI for employees perceiving elevated stress levels and an effort-reward imbalance in comparison to a waitlist control (WLC) group. Second, we investigated whether the efficacy of an SMI could be explained by an increase in occupational self-efficacy and whether this personal resource enables employees to change adverse working conditions. Methods: A total of 262 employees reporting effort-reward imbalance scores over 0.715 and elevated stress levels (10-item Perceived Stress Scale [PSS-10] score ≥22) were randomly assigned to either the intervention group (IG; SMI) or the WLC group. The primary outcome was perceived stress measured using the PSS-10. The secondary outcomes included mental and work-related health measures. Four different mediation analyses were conducted with occupational self-efficacy, efforts, and rewards as mediators. After eligibility screening, data were collected web based at baseline (T1), 7 weeks (T2) and 6 months (T3). Results: Study participation was completed by 80% (105/130, 80.8%) in the IG and 90% (119/132, 90.2%) in the WLC group. Analyses of covariance revealed that stress reduction was significantly higher for the SMI group compared with the WLC group at T2 (d=0.87, 95% CI 0.61-1.12, P<.001) and T3 (d=0.65, 95% CI 0.41-0.90, P<.001). Mediation analyses indicated that occupational self-efficacy mediated the beneficial effect of the SMI on stress directly. Furthermore, the analyses revealed a significant indirect effect of occupational self-efficacy via rewards (b=0.18, t259=4.52, P<.001), but not via efforts (b=0.01, t259=0.27, P>.05) while efforts still had a negative impact on stress (b=0.46, t257=2.32, P<.05). Conclusions: The SMI was effective in reducing stress and improving occupational self-efficacy in employees despite them experiencing an effort-reward imbalance at work. Results from mediation analyses suggest that fostering personal resources such as occupational self-efficacy contributes to the efficacy of the SMI and enables employees to achieve positive changes regarding the rewarding aspects of the workplace. However, the SMI seemed to neither directly nor indirectly impact efforts, suggesting that person-focused interventions might not be sufficient and need to be complemented by organizational-focused interventions to comprehensively improve mental health in employees facing adverse working conditions. Trial Registration: German Clinical Trials Register DRKS00005990; https://tinyurl.com/23fmzfu3 %M 36264607 %R 10.2196/40488 %U https://www.jmir.org/2022/10/e40488 %U https://doi.org/10.2196/40488 %U http://www.ncbi.nlm.nih.gov/pubmed/36264607 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38963 %T Assessment of the Popularity and Perceived Effectiveness of Smartphone Tools That Track and Limit Smartphone Use: Survey Study and Machine Learning Analysis %A Aboujaoude,Elias %A Vera Cruz,Germano %A Rochat,Lucien %A Courtois,Robert %A Ben Brahim,Farah %A Khan,Riaz %A Khazaal,Yasser %+ Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, 401 Quarry Rd, Stanford, CA, 94305, United States, 1 650 498 9111, eaboujaoude@stanford.edu %K smartphone addiction %K internet addiction %K internet gaming disorder %K smartphone tools %K telepsychiatry %K machine learning %K telemedicine %K social media %K digital mental health interventions %K mobile phone %D 2022 %7 20.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Problematic smartphone use, like problematic internet use, is a condition for which treatment is being sought on the web. In the absence of established treatments, smartphone-provided tools that monitor or control smartphone use have become increasingly popular, and their dissemination has largely occurred without oversight from the mental health field. Objective: We aimed to assess the popularity and perceived effectiveness of smartphone tools that track and limit smartphone use. We also aimed to explore how a set of variables related to mental health, smartphone use, and smartphone addiction may influence the use of these tools. Methods: First, we conducted a web-based survey in a representative sample of 1989 US-based adults using the crowdsourcing platform Prolific. Second, we used machine learning and other statistical tools to identify latent user classes; the association between latent class membership and demographic variables; and any predictors of latent class membership from covariates such as daily average smartphone use, social problems from smartphone use, smartphone addiction, and other psychiatric conditions. Results: Smartphone tools that monitor and control smartphone use were popular among participants, including parents targeting their children; for example, over two-thirds of the participants used sleep-related tools. Among those who tried a tool, the highest rate of perceived effectiveness was 33.1% (58/175). Participants who experienced problematic smartphone use were more likely to be younger and more likely to be female. Finally, 3 latent user classes were uncovered: nonusers, effective users, and ineffective users. Android operating system users were more likely to be nonusers, whereas younger adults and females were more likely to be effective users. The presence of psychiatric symptoms did not discourage smartphone tool use. Conclusions: If proven effective, tools that monitor and control smartphone use are likely to be broadly embraced. Our results portend well for the acceptability of mobile interventions in the treatment of smartphone-related psychopathologies and, potentially, non–smartphone-related psychopathologies. Better tools, targeted marketing, and inclusive design, as well as formal efficacy trials, are required to realize their potential. %M 36264627 %R 10.2196/38963 %U https://www.jmir.org/2022/10/e38963 %U https://doi.org/10.2196/38963 %U http://www.ncbi.nlm.nih.gov/pubmed/36264627 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e35837 %T Use of an Online Forum for Relatives of People With Psychosis and Bipolar Disorder: Mixed Methods Study %A Jones,Steven %A Atanasova,Dimitrinka %A Dodd,Susanna %A Flowers,Susan %A Rosala-Hallas,Anna %A Robinson,Heather %A Semino,Elena %A Lobban,Fiona %+ Spectrum Centre for Mental Health Research, Division of Health Research, Lancaster University, Health Innovation 1, Sir John Fisher Drive, Lancaster, LA1 4AT, United Kingdom, 44 1525 593382, s.jones7@lancaster.ac.uk %K psychosis %K bipolar disorder %K relative %K carer %K mental health %K forum %K online %K digital health %K Relatives Education and Coping Toolkit %K REACT %K trial %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Relatives of people with psychosis or bipolar disorder experience high levels of distress but are typically not offered the support they need. Online peer forums may offer a solution, but knowledge about who uses them, how, and why is limited. This study reported on online forum use during the Relatives Education and Coping Toolkit (REACT) trial. Objective: We aimed to report who used the forum and why; how sociodemographic factors are associated with participation; the relationship among frequency, type of use, and outcomes; and how the forum was used. Methods: The relationships between key sociodemographic characteristics, levels of forum use, and distress were statistically analyzed. We used thematic and semantic analyses to understand the reasons for relatives joining the forum and the key topics initiated by them. We also used the University Centre for Computer Corpus Research on Language Semantic Analysis System to compare how relatives and REACT supporters (moderators) used the forum. Results: A total of 348 participants with full forum use data from REACT were included in this study. The forum was accessed by 59.4% (207/348) of the relatives across the entire age range, with no significant associations between sociodemographic factors and forum participation, or between level or type of use and relatives’ distress levels. Relatives joined the forum primarily to find people in similar circumstances, express concerns, and talk about stressful events. Relatives were most concerned about recent events, negative emotions linked to caring, experiences of conflict or threat, and concerns about suicide. These posts underscored both the challenges the relatives were facing and the fact that they felt safe sharing them in this context. Conclusions: Although only a proportion of REACT participants engaged actively with its forum, they were widely distributed across age and other sociodemographic groupings. Relatives used the forum for information, support, and guidance and to offer detailed information about their experiences. The topics raised highlighted the burden carried by relatives and the potential value of easy-access, moderated, peer-supported forums in helping relatives to manage the challenges they faced. %M 36264621 %R 10.2196/35837 %U https://mental.jmir.org/2022/10/e35837 %U https://doi.org/10.2196/35837 %U http://www.ncbi.nlm.nih.gov/pubmed/36264621 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e39676 %T Tracking the Impact of COVID-19 and Lockdown Policies on Public Mental Health Using Social Media: Infoveillance Study %A Li,Minghui %A Hua,Yining %A Liao,Yanhui %A Zhou,Li %A Li,Xue %A Wang,Ling %A Yang,Jie %+ Department of Big Data in Health Science School of Public Health, Center of Clinical Big Data and Analytics of The Second Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Road, Hangzhou, 310058, China, 86 19157731185, jieynlp@gmail.com %K COVID-19 %K mental health %K social media %K Twitter %K topic model %K health care workers %D 2022 %7 13.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic and its corresponding preventive and control measures have increased the mental burden on the public. Understanding and tracking changes in public mental status can facilitate optimizing public mental health intervention and control strategies. Objective: This study aimed to build a social media–based pipeline that tracks public mental changes and use it to understand public mental health status regarding the pandemic. Methods: This study used COVID-19–related tweets posted from February 2020 to April 2022. The tweets were downloaded using unique identifiers through the Twitter application programming interface. We created a lexicon of 4 mental health problems (depression, anxiety, insomnia, and addiction) to identify mental health–related tweets and developed a dictionary for identifying health care workers. We analyzed temporal and geographic distributions of public mental health status during the pandemic and further compared distributions among health care workers versus the general public, supplemented by topic modeling on their underlying foci. Finally, we used interrupted time series analysis to examine the statewide impact of a lockdown policy on public mental health in 12 states. Results: We extracted 4,213,005 tweets related to mental health and COVID-19 from 2,316,817 users. Of these tweets, 2,161,357 (51.3%) were related to “depression,” whereas 1,923,635 (45.66%), 225,205 (5.35%), and 150,006 (3.56%) were related to “anxiety,” “insomnia,” and “addiction,” respectively. Compared to the general public, health care workers had higher risks of all 4 types of problems (all P<.001), and they were more concerned about clinical topics than everyday issues (eg, “students’ pressure,” “panic buying,” and “fuel problems”) than the general public. Finally, the lockdown policy had significant associations with public mental health in 4 out of the 12 states we studied, among which Pennsylvania showed a positive association, whereas Michigan, North Carolina, and Ohio showed the opposite (all P<.05). Conclusions: The impact of COVID-19 and the corresponding control measures on the public’s mental status is dynamic and shows variability among different cohorts regarding disease types, occupations, and regional groups. Health agencies and policy makers should primarily focus on depression (reported by 51.3% of the tweets) and insomnia (which has had an ever-increasing trend since the beginning of the pandemic), especially among health care workers. Our pipeline timely tracks and analyzes public mental health changes, especially when primary studies and large-scale surveys are difficult to conduct. %M 36191167 %R 10.2196/39676 %U https://www.jmir.org/2022/10/e39676 %U https://doi.org/10.2196/39676 %U http://www.ncbi.nlm.nih.gov/pubmed/36191167 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e37695 %T The Use of Close Friends on Instagram, Help-Seeking Willingness, and Suicidality Among Hong Kong Youth: Exploratory Sequential Mixed Methods Study %A Chen,Sikky Shiqi %A Lam,Tai Pong %A Lam,Kwok Fai %A Lo,Tak Lam %A Chao,David Vai Kiong %A Mak,Ki Yan %A Lam,Edmund Wing Wo %A Tang,Wai Sin %A Chan,Hoi Yan %A Yip,Paul Siu Fai %+ Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China, 852 25185688, tplam@hku.hk %K Close Friends %K private online expression %K help-seeking willingness %K suicide %K youth %D 2022 %7 12.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Social networking sites (SNSs) have gained popularity in recent years for help seeking and self-distress expression among adolescents. Although online suicidal expression is believed to have major benefits, various concerns have also been raised, particularly around privacy issues. Understanding youths’ help-seeking behavior on SNSs is critical for effective suicide prevention; however, most research neglects the impacts of the private SNS context. Objective: This study aims to examine youths’ private SNS use via the new Instagram feature, Close Friends, and its association with both online and offline help-seeking willingness as well as youths’ suicidality. Methods: This study employed an exploratory sequential mixed methods approach with a combination of explorative qualitative interviews and a systematic quantitative survey, targeting youth aged 15-19 years in Hong Kong. The motivations for utilizing Close Friends and concerns regarding online expression were addressed in the focus group and individual interviews (n=40). A cross-sectional survey (n=1676) was conducted subsequently with eligible secondary school students to examine the prevalence of Close Friends usage, their online and offline help-seeking willingness, and suicide-related experiences. Results: A total of 3 primary motives for using Close Friends were identified during interviews, including (1) interaction and help seeking, (2) release of negative emotions, and (3) ventilation and self-expression. Most participants also highlighted the privacy concerns associated with public online communication and the importance of contacting close friends for emotional support. Survey results showed that use of Close Friends was quite prevalent among adolescents (1163/1646, 70.66%), with around 46% (754/1646, 45.81%) of respondents being frequent users. Differences by gender and school academic banding were also revealed. Regarding help-seeking intentions, youths were generally positive about seeking help from peers and friends offline (1010/1266, 79.78%) yet negative about seeking assistance from online friends or professionals with whom they had not yet developed a real-world connection (173/1266, 13.67%). Most notably, frequencies of Close Friends usage were differentially associated with online and offline help-seeking willingness and youths’ suicidality. Compared with nonusers, those who had ever used the feature were more likely to seek offline support (adjusted odds ratios [AORs] 1.82-2.36), whereas heavy use of Close Friends was associated with increased odds of online help-seeking willingness (AOR 1.76, 95% CI 1.06-2.93) and a higher risk of suicidality (AOR 1.53, 95% CI 1.01-2.31). Conclusions: The popularity of Close Friends reflects the increasing need for private online expression among youth. This study demonstrates the importance of Close Friends for self-expression and private conversation and inadequacy of peer support for suicidal adolescents. Further research is needed to identify the causal relationship between Close Friends usage and help-seeking willingness to guide the advancement of suicide prevention strategies. Researchers and social media platforms may cooperate to co-design a risk monitoring system tailored to the private SNS context, assisting professionals in identifying youth at risk of suicide. %M 36223182 %R 10.2196/37695 %U https://www.jmir.org/2022/10/e37695 %U https://doi.org/10.2196/37695 %U http://www.ncbi.nlm.nih.gov/pubmed/36223182 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e35313 %T A Social Media Website (Supporting Our Valued Adolescents) to Support Treatment Uptake for Adolescents With Depression or Anxiety: Pilot Randomized Controlled Trial %A Radovic,Ana %A Li,Yaming %A Landsittel,Doug %A Odenthal,Kayla R %A Stein,Bradley D %A Miller,Elizabeth %+ Division of Adolescent and Young Adult Medicine, University of Pittsburgh Medical Center Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, 120 Lytton Ave, Suite 302, Pittsburgh, PA, 15213, United States, 1 412 692 7227, ana.radovic@chp.edu %K adolescent %K adolescent health services %K technology %K depression %K anxiety %D 2022 %7 7.10.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescents with depression or anxiety initiate mental health treatment in low numbers. Supporting Our Valued Adolescents (SOVA) is a peer support website intervention for adolescents seen in primary care settings and their parents with the goal of increasing treatment uptake through changing negative health beliefs, enhancing knowledge, offering peer emotional support, and increasing parent-adolescent communication about mental health. Objective: This pilot study aimed to refine recruitment and retention strategies, refine document intervention fidelity, and explore changes in study outcomes (the primary outcome being treatment uptake). Methods: We conducted a 2-group, single-blind, pilot randomized controlled trial in a single adolescent medicine clinic. Participants were aged 12 to 19 years with clinician-identified symptoms of depression or anxiety for which a health care provider recommended treatment. The patient and parent, if interested, were randomized to receive the SOVA websites and enhanced usual care (EUC) compared with EUC alone. Baseline, 6-week, and 3-month measures were collected using a web-based self-report survey and blinded electronic health record review. The main pilot outcomes assessed were the feasibility of recruitment and retention strategies. Implementation outcomes, intervention fidelity, missingness, and adequacy of safety protocols were documented. Descriptive statistics were used to summarize mental health service use and target measures with 2-sample t tests to compare differences between arms. Results: Less than half of the adolescents who were offered patient education material (195/461, 42.2%) were referred by their clinician to the study. Of 146 adolescents meeting the inclusion criteria, 38 completed the baseline survey, qualifying them for randomization, and 25 (66%, 95% CI 51%-81%) completed the 6-week measures. There was limited engagement in the treatment arm, with 45% (5/11) of adolescents who completed 6-week measures reporting accessing SOVA, and most of those who did not access cited forgetting as the reason. Changes were found in target factors at 6 weeks but not in per-protocol analyses. At 12 weeks, 83% (15/18) of adolescents randomized to SOVA received mental health treatment as compared with 50% (10/20) of adolescents randomized to EUC (P=.03). Conclusions: In this pilot trial of a peer support website intervention for adolescents with depression or anxiety, we found lower-than-expected study enrollment after recruitment. Although generalizability may be enhanced by not requiring parental permission for adolescent participation in the trials of mental health interventions, this may limit study recruitment and retention. We found that implementing education introducing the study into provider workflow was feasible and acceptable, resulting in almost 500 study referrals. Finally, although not the primary outcome, we found a signal for greater uptake of mental health treatment in the arm using the SOVA intervention than in the usual care arm. Trial Registration: ClinicalTrials.gov NCT03318666; https://clinicaltrials.gov/ct2/show/NCT03318666 International Registered Report Identifier (IRRID): RR2-10.2196/12117 %M 36206044 %R 10.2196/35313 %U https://mental.jmir.org/2022/10/e35313 %U https://doi.org/10.2196/35313 %U http://www.ncbi.nlm.nih.gov/pubmed/36206044 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e35466 %T Parents’ Perspectives on Their Relationship With Their Adolescent Children With Internet Addiction: Survey Study %A Horita,Hideki %A Seki,Yoichi %A Shimizu,Eiji %+ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan, 81 43 226 2027, horitah@iuhw.ac.jp %K internet addiction %K mental health %K parent-child relationship %D 2022 %7 5.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents of adolescents with internet addiction are confronted with their children’s internet problems on a daily basis. Parents may notice that adolescents with addiction may also have emotional and behavioral problems, including impulsivity and violence. Parenting styles have been found to be related to internet addiction. Objective: The purpose of this study is to investigate parents’ perspectives on their parenting style, relationship with their child, and the degree of internet addiction and emotional and behavioral problems of their child. Methods: A web survey was conducted with 600 parents of children between the ages of 12 and 17 years, from October 14 to 18, 2021, across Japan. Respondents were recruited by an internet research company and were asked to complete an anonymous online questionnaire. The survey was divided into two groups: 300 parents who answered “yes” to the question “Do you think your child is dependent on the internet?” and 300 parents who answered “no” to that question. Questionnaires were collected until each group had 300 participants. The questionnaire included (1) the Parent-Child Internet Addiction Test (PCIAT), (2) the daily time spent using the internet, (3) the Strengths and Difficulties Questionnaire (SDQ), (4) the Parenting Style and Dimensions Questionnaire (PSDQ), and (5) the Relationship Questionnaire (RQ) measuring self-report attachment style prototypes. Results: Mean scores of the PCIAT and the daily time spent using the internet for the group with probable internet addiction were significantly higher than those of the group without probable internet addiction (50%; P<.001). The total difficulties score from the SDQ for the group with probable internet addiction (mean 10.87, SD 5.9) was significantly higher than that for the group without probable internet addiction (mean 8.23, SD 5.64; P<.001). The mean score for authoritarian parenting from the PSDQ for the group with probable internet addiction (mean 2.1, SD 0.58) was significantly higher than that for the group without probable internet addiction (mean 2.1, SD 0.58; P<.001). Regarding the RQ, there were no significant differences between the two groups. Conclusions: Our findings suggest that parents who think their child is addicted to the internet may recognize emotional and behavioral problems of the child and have an authoritarian parenting style. %M 36197716 %R 10.2196/35466 %U https://pediatrics.jmir.org/2022/4/e35466 %U https://doi.org/10.2196/35466 %U http://www.ncbi.nlm.nih.gov/pubmed/36197716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e34403 %T Exploring Social Support in an Online Support Community for Tourette Syndrome and Tic Disorders: Analysis of Postings %A Soós,Mercédesz Judit %A Coulson,Neil S %A Davies,E Bethan %+ National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 0015 748 4238, bethan.davies@nottingham.ac.uk %K Tourette syndrome %K tic disorders %K social support %K online support communities %K online health communities %K thematic analysis %K online support %K peer support %K support group %K Tourette %K online health community %D 2022 %7 4.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Online support communities have become an accessible way of gaining social, emotional, and informational support from peers and may be particularly useful for individuals with chronic conditions. To date, there have been few studies exploring the online support available for tic disorders, such as Tourette syndrome. An exploratory study looking at users’ experiences with using online support communities for tic disorders suggested that members used such communities to share experiences, information, and strategies for tic management. Objective: To build on these preliminary findings, this study examined the provision of social support in an online community for Tourette syndrome. Methods: Data were collected from one publicly available online support community for Tourette syndrome and tics, from its inception to December 2019, by randomly selecting 10% of posts and their corresponding comments from each year for analysis. This resulted in 510 unique posts and 3802 comments posted from 1270 unique usernames. The data were analyzed using inductive thematic analysis. Results: The findings of this study suggest that users utilized the online community as a multifaceted virtual place where they could share and ask for information about tics, unload and share their feelings arising from living with Tourette syndrome, find people facing similar situations and experiences, and freely share the realities of living with Tourette syndrome. Conclusions: The results complement the findings from a preliminary study and suggest that online support communities have a potentially valuable role as a mechanism for sharing and gaining information on illness experiences from similar peers experiencing tics and can promote self-management of tics. Limitations and recommendations for future research are discussed. %M 36194454 %R 10.2196/34403 %U https://www.jmir.org/2022/10/e34403 %U https://doi.org/10.2196/34403 %U http://www.ncbi.nlm.nih.gov/pubmed/36194454 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e39710 %T Social Media Use and Health-Related Quality of Life Among Adolescents: Cross-sectional Study %A You,Yueyue %A Yang-Huang,Junwen %A Raat,Hein %A Van Grieken,Amy %+ Department of Public Health, Erasmus Medical Center, Doctor Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 10 7043498, a.vangrieken@erasmusmc.nl %K adolescents %K social media platforms %K social media %K health-related quality of life %K EuroQol 5-dimension questionnaire, youth version %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Using social media is a time-consuming activity of children and adolescents. Health authorities have warned that excessive use of social media can negatively affect adolescent social, physical, and psychological health. However, scientific findings regarding associations between time spent on social media and adolescent health-related quality of life (HRQoL) are not consistent. Adolescents typically use multiple social media platforms. Whether the use of multiple social media platforms impacts adolescent health is unclear. Objective: The aim of this study was to examine the relationship between social media use, including the number of social media platforms used and time spent on social media, and adolescent HRQoL. Methods: We analyzed the data of 3397 children (mean age 13.5, SD 0.4 years) from the Generation R Study, a population-based cohort study in the Netherlands. Children reported the number of social media platforms used and time spent on social media during weekdays and weekends separately. Children’s HRQoL was self-reported with the EuroQol 5-dimension questionnaire–youth version. Data on social media use and HRQoL were collected from 2015 to 2019. Multiple logistic and linear regressions were applied. Results: In this study, 72.6% (2466/3397) of the children used 3 or more social media platforms, and 37.7% (1234/3276) and 58.3% (1911/3277) of the children used social media at least 2 hours per day during weekdays and weekends, respectively. Children using more social media platforms (7 or more platforms) had a higher odds of reporting having some or a lot of problems on “having pain or discomfort” (OR 1.55, 95% CI 1.20 to 1.99) and “feeling worried, sad or unhappy” (OR 1.99, 95% CI 1.52 to 2.60) dimensions and reported lower self-rated health (β –3.81, 95% CI –5.54 to –2.09) compared with children who used 0 to 2 social media platforms. Both on weekdays and weekends, children spent more time on social media were more likely to report having some or a lot of problems on “doing usual activities,” “having pain or discomfort,” “feeling worried, sad or unhappy,” and report lower self-rated health (all P<.001). Conclusions: Our findings indicate that using more social media platforms and spending more time on social media were significantly related to lower HRQoL. We recommend future research to study the pathway between social media use and HRQoL among adolescents. %M 36194460 %R 10.2196/39710 %U https://mental.jmir.org/2022/10/e39710 %U https://doi.org/10.2196/39710 %U http://www.ncbi.nlm.nih.gov/pubmed/36194460 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e37342 %T Guided Internet-Delivered Treatment for Depression: Scoping Review %A Børtveit,Line %A Dechsling,Anders %A Sütterlin,Stefan %A Nordgreen,Tine %A Nordahl-Hansen,Anders %+ Faculty of Health, Welfare and Organisation, Østfold University College, Høgskolen i Østfold, Postboks 700, Halden, 1757, Norway, 47 93203985, linebortveit@gmail.com %K web-based therapy %K computer-assisted therapy %K internet %K digital interventions %K major depression %K mental health %K mobile phone %D 2022 %7 4.10.2022 %9 Review %J JMIR Ment Health %G English %X Background: Studies on guided internet-delivered treatment have demonstrated promising results for patients with depressive disorder. Objective: The aim of this study was to provide an overview of this research area and identify potential gaps in the research. Methods: In this scoping review, web-based databases were used to identify research papers published between 2010 and 2022 where guided internet-delivered treatment was administered to participants with depressive disorders, a standardized rating scale of depressive symptoms was used as the primary outcome measure, and the treatment was compared with a control condition. Results: A total of 111 studies were included, and an overview of the studies was provided. Several gaps in the research were identified regarding the design of the studies, treatments delivered, participant representation, and treatment completion. Conclusions: This review provides a comprehensive overview of the research area, and several research gaps were identified. The use of other designs and active control conditions is recommended. Future studies should provide access to treatment manuals, and more replications should be conducted. Researchers should aim to include underrepresented populations and provide reports of comorbidities. Definitions of adequate dosage, reports of completion rates, and reasons for treatment dropout are recommended for future studies. %M 36194467 %R 10.2196/37342 %U https://mental.jmir.org/2022/10/e37342 %U https://doi.org/10.2196/37342 %U http://www.ncbi.nlm.nih.gov/pubmed/36194467 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e41697 %T A Video-Delivered Family Therapeutic Intervention for Perinatal Women With Clinically Significant Depressive Symptoms and Family Conflict: Indicators of Feasibility and Acceptability %A Cluxton-Keller,Fallon %A Hegel,Mark T %+ Department of Psychiatry, Geisel School of Medicine, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 4724, Fallon.P.Cluxton-Keller@dartmouth.edu %K family intervention %K perinatal %K postnatal %K depression %K conflict %K telehealth %K family conflict %K family therapy %K family therapist %K video conferencing %K teleconference %K teleconferencing %K telemedicine %K virtual care %K mental health %K psychological health %K digital health intervention %K parenting %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Variation in family therapeutic intervention fidelity has an impact on outcomes. The use of video conferencing technology can strengthen therapist fidelity to family therapeutic interventions. Objective: This article explores indicators of feasibility and acceptability for a video-delivered family therapeutic intervention for perinatal women with depressive symptoms and family conflict. The objectives of this article are to describe indicators of feasibility, including therapist fidelity to the intervention and technological factors that relate to implementation of the intervention, as well as indicators of acceptability for participants of the intervention. Methods: The data included in this article are from an ongoing randomized trial of the Resilience Enhancement Skills Training (REST) video-delivered family therapeutic intervention. Participant recruitment and data collection are still underway for this clinical trial. Of the 106 participants who are currently enrolled in this study, 54 (51%) have been randomized to receive REST from May 2021 through July 2022. Currently, 2 therapists are delivering the intervention, and the training procedures for therapists are summarized herein. Therapist fidelity to the family therapeutic intervention was assessed in 67 audio recorded sessions. The training procedures were summarized for use of video conferencing technology by therapists and the 54 study participants. Knowledge of the video conferencing technology features was assessed in therapists and study participants by the number of attempts required to use the features. Participant responsiveness to the intervention was assessed by the percentage of attended sessions and percentage of complete homework assignments. Results: To date, both therapists have demonstrated high fidelity to the family therapeutic intervention and used all video conferencing technology features on their first attempt. The current participants required 1 to 3 attempts to use 1 or more of the video conferencing technology features. About 59% (n=32) of the current participants immediately accessed the features on the first attempt. Our results show that perinatal women attended all sessions, and their family members attended 80% of the sessions. To date, participants have completed 80% of the homework assignments. Conclusions: These early findings describe indicators of the feasibility and acceptability of the video-delivered family therapeutic intervention for use with this high priority population. Upon completion of recruitment and data collection, a subsequent article will include a mixed methods process evaluation of the feasibility and acceptability of the video-delivered family therapeutic intervention. Trial Registration: ClinicalTrials.gov NCT04741776; https://clinicaltrials.gov/ct2/show/NCT04741776 %M 36194458 %R 10.2196/41697 %U https://formative.jmir.org/2022/10/e41697 %U https://doi.org/10.2196/41697 %U http://www.ncbi.nlm.nih.gov/pubmed/36194458 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37746 %T Telehealth-Supported Decision-making Psychiatric Care for Suicidal Ideation: Longitudinal Observational Study %A O'Callaghan,Erin %A Mahrer,Nicole %A Belanger,Heather G %A Sullivan,Scott %A Lee,Christine %A Gupta,Carina T %A Winsberg,Mirène %+ Brightside Health Inc, 2471 Peralta St, Unit A, Oakland, CA, 94607, United States, 1 813 786 7685, heather.belanger@brightside.com %K telemedicine %K telehealth %K psychiatry %K mental health %K suicidal ideation %K depression %K anxiety %K suicide %K depressive disorder %K digital health %K eHealth %K psychiatric medication %K demographic %K psychiatric care %K decision-making %K decision support %D 2022 %7 30.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is a leading cause of death in the United States, and suicidal ideation (SI) is a significant precursor and risk factor for suicide. Objective: This study aimed to examine the impact of a telepsychiatric care platform on changes in SI over time and remission, as well as to investigate the relationship between various demographic and medical factors on SI and SI remission. Methods: Participants included 8581 US-based adults (8366 in the treatment group and 215 in the control group) seeking treatment for depression, anxiety, or both. The treatment group included patients who had completed at least 12 weeks of treatment and had received a prescription for at least one psychiatric medication during the study period. Providers prescribed psychiatric medications for each patient during their first session and received regular data on participants. They also received decision support at treatment onset via the digital platform, which leveraged an empirically derived proprietary precision-prescribing algorithm to give providers real-time care guidelines. Participants in the control group consisted of individuals who completed the initial enrollment data and completed surveys at baseline and 12 weeks but did not receive care. Results: Greater feelings of hopelessness, anhedonia, and feeling bad about oneself were most significantly correlated (r=0.24-0.37) with SI at baseline. Sleep issues and feeling tired or having low energy, although significant, had lower correlations with SI (r=0.13-0.14). In terms of demographic variables, advancing age and education were associated with less SI at baseline (r=−0.16) and 12 weeks (r=−0.10) but less improvement over time (r=−0.12 and −0.11, respectively). Although not different at baseline, the SI expression was evident in 34.4% (74/215) of the participants in the control group and 12.32% (1031/8366) of the participants in the treatment group at 12 weeks. Although the participants in the treatment group improved over time regardless of various demographic variables, participants in the control group with less education worsened over time, after controlling for age and depression severity. A model incorporating the treatment group, age, sex, and 8-item Patient Health Questionnaire scores was 77% accurate in its classification of complete remission. Those in the treatment group were 4.3 times more likely (odds ratio 4.31, 95% CI 2.88-6.44) to have complete SI remission than those in the control group. Female participants and those with advanced education beyond high school were approximately 1.4 times more likely (odds ratio 1.38, 95% CI 1.18-1.62) to remit than their counterparts. Conclusions: The results highlight the efficacy of an antidepressant intervention in reducing SI, in this case administered via a telehealth platform and with decision support, as well as the importance of considering covariates, or subpopulations, when considering SI. Further research and refinement, ideally via randomized controlled trials, are needed. %M 36178727 %R 10.2196/37746 %U https://formative.jmir.org/2022/9/e37746 %U https://doi.org/10.2196/37746 %U http://www.ncbi.nlm.nih.gov/pubmed/36178727 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e38239 %T Synthesis of the Evidence on What Works for Whom in Telemental Health: Rapid Realist Review %A Schlief,Merle %A Saunders,Katherine R K %A Appleton,Rebecca %A Barnett,Phoebe %A Vera San Juan,Norha %A Foye,Una %A Olive,Rachel Rowan %A Machin,Karen %A Shah,Prisha %A Chipp,Beverley %A Lyons,Natasha %A Tamworth,Camilla %A Persaud,Karen %A Badhan,Monika %A Black,Carrie-Ann %A Sin,Jacqueline %A Riches,Simon %A Graham,Tom %A Greening,Jeremy %A Pirani,Farida %A Griffiths,Raza %A Jeynes,Tamar %A McCabe,Rose %A Lloyd-Evans,Brynmor %A Simpson,Alan %A Needle,Justin J %A Trevillion,Kylee %A Johnson,Sonia %+ NIHR Mental Health Policy Research Unit, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, katherine.saunders@kcl.ac.uk %K telemental health %K remote care %K telemedicine %K mental health %K COVID-19 %K digital exclusion %K realist review %K telemedicine %K virtual care %K rapid realist review %K gray literature %K therapy %K health care staff %K digital consultation %K frontline staff %K children %K inpatient %K mobile phone %D 2022 %7 29.9.2022 %9 Review %J Interact J Med Res %G English %X Background: Telemental health (delivering mental health care via video calls, telephone calls, or SMS text messages) is becoming increasingly widespread. Telemental health appears to be useful and effective in providing care to some service users in some settings, especially during an emergency restricting face-to-face contact, such as the COVID-19 pandemic. However, important limitations have been reported, and telemental health implementation risks the reinforcement of pre-existing inequalities in service provision. If it is to be widely incorporated into routine care, a clear understanding is needed of when and for whom it is an acceptable and effective approach and when face-to-face care is needed. Objective: This rapid realist review aims to develop a theory about which telemental health approaches work (or do not work), for whom, in which contexts, and through what mechanisms. Methods: Rapid realist reviewing involves synthesizing relevant evidence and stakeholder expertise to allow timely development of context-mechanism-outcome (CMO) configurations in areas where evidence is urgently needed to inform policy and practice. The CMO configurations encapsulate theories about what works for whom and by what mechanisms. Sources included eligible papers from 2 previous systematic reviews conducted by our team on telemental health; an updated search using the strategy from these reviews; a call for relevant evidence, including “gray literature,” to the public and key experts; and website searches of relevant voluntary and statutory organizations. CMO configurations formulated from these sources were iteratively refined, including through discussions with an expert reference group, including researchers with relevant lived experience and frontline clinicians, and consultation with experts focused on three priority groups: children and young people, users of inpatient and crisis care services, and digitally excluded groups. Results: A total of 108 scientific and gray literature sources were included. From our initial CMO configurations, we derived 30 overarching CMO configurations within four domains: connecting effectively; flexibility and personalization; safety, privacy, and confidentiality; and therapeutic quality and relationship. Reports and stakeholder input emphasized the importance of personal choice, privacy and safety, and therapeutic relationships in telemental health care. The review also identified particular service users likely to be disadvantaged by telemental health implementation and a need to ensure that face-to-face care of equivalent timeliness remains available. Mechanisms underlying the successful and unsuccessful application of telemental health are discussed. Conclusions: Service user choice, privacy and safety, the ability to connect effectively, and fostering strong therapeutic relationships need to be prioritized in delivering telemental health care. Guidelines and strategies coproduced with service users and frontline staff are needed to optimize telemental health implementation in real-world settings. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO); CRD42021260910; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021260910 %M 35767691 %R 10.2196/38239 %U https://www.i-jmr.org/2022/2/e38239 %U https://doi.org/10.2196/38239 %U http://www.ncbi.nlm.nih.gov/pubmed/35767691 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e39686 %T Digital Interventions for Psychological Well-being in University Students: Systematic Review and Meta-analysis %A Ferrari,Madeleine %A Allan,Stephanie %A Arnold,Chelsea %A Eleftheriadis,Dina %A Alvarez-Jimenez,Mario %A Gumley,Andrew %A Gleeson,John F %+ Healthy Brain and Mind Research Centre, Australian Catholic University, 25a Barker Road, Strathfield campus, Sydney, 2135, Australia, 61 0297014726, madeleine.ferrari@acu.edu.au %K psychological well-being %K mental health %K university students %K higher education students %K college students %K digital intervention %K web-based intervention %K mobile phone %K meta-analysis %K systematic review %D 2022 %7 28.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Life at university provides important opportunities for personal growth; however, this developmental phase also coincides with the peak period of risk for the onset of mental health disorders. In addition, specific university lifestyle factors, including impaired sleep and academic and financial stress, are known to exacerbate psychological distress in students. As a result, university students have been identified as a vulnerable population who often experience significant barriers to accessing psychological treatment. Digital psychological interventions are emerging as a promising solution for this population, but their effectiveness remains unclear. Objective: This systematic review and meta-analysis aimed to assess digital interventions targeting psychological well-being among university students. Methods: Database searches were conducted on December 2, 2021, via Embase, MEDLINE, PsycINFO, and Web of Science. Results: A total of 13 eligible studies were identified, 10 (77%) of which were included in the meta-analysis. Mean pre-post effect sizes indicated that such interventions led to small and significant improvement in psychological well-being (Hedges g=0.32, 95% CI 0.23-0.4; P<.001). These effects remained, albeit smaller, when studies that included a wait-list control group were excluded (Hedges g=0.22, 95% CI 0.08-0.35; P=.002). An analysis of acceptance and commitment therapy approaches revealed small and significant effects (k=6; Hedges g=0.35, 95% CI 0.25-0.45; P<.001). Conclusions: Digital psychological interventions hold considerable promise for university students, although features that optimize service delivery and outcomes require further assessment. Trial Registration: PROSPERO CRD42020196654; https:/www.crd.york.ac.uk/prospero/display_record.php?RecordID=196654 %M 36169988 %R 10.2196/39686 %U https://www.jmir.org/2022/9/e39686 %U https://doi.org/10.2196/39686 %U http://www.ncbi.nlm.nih.gov/pubmed/36169988 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e38200 %T The Effects of Acute Virtual Reality Exergaming on Mood and Executive Function: Exploratory Crossover Trial %A Ochi,Genta %A Kuwamizu,Ryuta %A Fujimoto,Tomomi %A Ikarashi,Koyuki %A Yamashiro,Koya %A Sato,Daisuke %+ Department of Health and Sports, Niigata University of Health and Welfare, Kita-ku, Shimami-cho, 1398, Niigata, 950-3198, Japan, 81 025 257 4595, ochi@nuhw.ac.jp %K virtual reality %K exergaming %K exercise %K executive function %K physical activity %K mental health %D 2022 %7 28.9.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Virtual reality (VR) exergaming is a new intervention strategy to help humans engage in physical activity to enhance mood. VR exergaming may improve both mood and executive function by acting on the prefrontal cortex, expanding the potential benefits. However, the impact of VR exergaming on executive function has not been fully investigated, and associated intervention strategies have not yet been established. Objective: This study aims to investigate the effects of 10 minutes of VR exergaming on mood and executive function. Methods: A total of 12 participants played the exergame “FitXR” under 3 conditions: (1) a VR exergame condition (ie, exercise with a head-mounted display condition [VR-EX]) in which they played using a head-mounted display, (2) playing the exergame in front of a flat display (2D-EX), and (3) a resting condition in which they sat in a chair. The color-word Stroop task (CWST), which assesses executive function; the short form of the Profile of Mood States second edition (POMS2); and the short form of the Two-Dimensional Mood Scale (TDMS), which assess mood, were administered before and after the exercise or rest conditions. Results: The VR-EX condition increased the POMS2 vigor activity score (rest and VR-EX: t11=3.69, P=.003) as well as the TDMS arousal (rest vs 2D-EX: t11=5.34, P<.001; rest vs VR-EX: t11=5.99, P<.001; 2D-EX vs VR-EX: t11=3.02, P=.01) and vitality scores (rest vs 2D-EX: t11=3.74, P=.007; rest vs VR-EX: t11=4.84, P=.002; 2D-EX vs VR-EX: t11=3.53, P=.006), suggesting that VR exergaming enhanced mood. Conversely, there was no effect on CWST performance in either the 2D-EX or VR-EX conditions. Interestingly, the VR-EX condition showed a significant positive correlation between changes in CWST arousal and reaction time (r=0.58, P=.046). This suggests that the effect of exergaming on improving executive function may disappear under an excessively increased arousal level in VR exergaming. Conclusions: Our findings showed that 10 minutes of VR exergaming enhanced mood but did not affect executive function. This suggests that some VR content may increase cognitive demands, leading to psychological fatigue and cognitive decline as an individual approaches the limits of available attentional capacity. Future research must examine the combination of exercise and VR that enhances both brain function and mood. %M 36169992 %R 10.2196/38200 %U https://games.jmir.org/2022/3/e38200 %U https://doi.org/10.2196/38200 %U http://www.ncbi.nlm.nih.gov/pubmed/36169992 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e37776 %T Trends in Effectiveness of Organizational eHealth Interventions in Addressing Employee Mental Health: Systematic Review and Meta-analysis %A Stratton,Elizabeth %A Lampit,Amit %A Choi,Isabella %A Malmberg Gavelin,Hanna %A Aji,Melissa %A Taylor,Jennifer %A Calvo,Rafael A %A Harvey,Samuel B %A Glozier,Nick %+ Dyson School of Design Engineering, Imperial College London, Imperial College Rd, South Kensington,, London, SW7 9EG, United Kingdom, 44 20 7594 888, r.calvo@imperial.ac.uk %K eHealth %K mental health %K employee %K systematic review %K mobile phone %D 2022 %7 27.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Mental health conditions are considered the leading cause of disability, sickness absence, and long-term work incapacity. eHealth interventions provide employees with access to psychological assistance. There has been widespread implementation and provision of eHealth interventions in the workplace as an inexpensive and anonymous way of addressing common mental disorders. Objective: This updated review aimed to synthesize the literature on the efficacy of eHealth interventions for anxiety, depression, and stress outcomes in employee samples in organizational settings and evaluate whether their effectiveness has improved over time. Methods: Systematic searches of relevant articles published from 2004 to July 2020 of eHealth intervention trials (app- or web-based) focusing on the mental health of employees were conducted. The quality and bias of all studies were assessed. We extracted means and SDs from publications by comparing the differences in effect sizes (Hedge g) in standardized mental health outcomes. We meta-analyzed these data using a random-effects model. Results: We identified a tripling of the body of evidence, with 75 trials available for meta-analysis from a combined sample of 14,747 articles. eHealth interventions showed small positive effects for anxiety (Hedges g=0.26, 95% CI 0.13-0.39; P<.001), depression (Hedges g=0.26, 95% CI 0.19-0.34; P<.001), and stress (Hedges g=0.25, 95% CI 0.17-0.34; P<.001) in employees’ after intervention, with similar effects seen at the medium-term follow-up. However, there was evidence of no increase in the effectiveness of these interventions over the past decade. Conclusions: This review and meta-analysis confirmed that eHealth interventions have a small positive impact on reducing mental health symptoms in employees. Disappointingly, we found no evidence that, despite the advances in technology and the enormous resources in time, research, and finance devoted to this area for over a decade, better interventions are being produced. Hopefully, these small effect sizes do not represent optimum outcomes in organizational settings. Trial Registration: PROSPERO CRD42020185859; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=185859 %M 36166285 %R 10.2196/37776 %U https://www.jmir.org/2022/9/e37776 %U https://doi.org/10.2196/37776 %U http://www.ncbi.nlm.nih.gov/pubmed/36166285 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38030 %T Digital Health Interventions for Depression and Anxiety Among People With Chronic Conditions: Scoping Review %A Shah,Amika %A Hussain-Shamsy,Neesha %A Strudwick,Gillian %A Sockalingam,Sanjeev %A Nolan,Robert P %A Seto,Emily %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON, M5T 3M6, Canada, 1 416 978 4326, amika.shah@mail.utoronto.ca %K depression %K anxiety %K multiple chronic conditions %K chronic disease %K mental health %K psychiatry %K digital health %K eHealth %K telehealth %K mobile health %K mHealth %K telemedicine %D 2022 %7 26.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Chronic conditions are characterized by their long duration (≥1 year), need for ongoing medical attention, and limitations in activities of daily living. These can often co-occur with depression and anxiety as common and detrimental comorbidities among the growing population living with chronic conditions. Digital health interventions (DHIs) hold promise in overcoming barriers to accessing mental health support for these individuals; however, the design and implementation of DHIs for depression and anxiety in people with chronic conditions are yet to be explored. Objective: This study aimed to explore what is known in the literature regarding DHIs for the prevention, detection, or treatment of depression and anxiety among people with chronic conditions. Methods: A scoping review of the literature was conducted using the Arksey and O’Malley framework. Searches of the literature published in 5 databases between 1990 and 2019 were conducted in April 2019 and updated in March 2021. To be included, studies must have described a DHI tested with, or designed for, the prevention, detection, or treatment of depression or anxiety in people with common chronic conditions (arthritis, asthma, diabetes mellitus, heart disease, chronic obstructive pulmonary disease, cancer, stroke, and Alzheimer disease or dementia). Studies were independently screened by 2 reviewers against the inclusion and exclusion criteria. Both quantitative and qualitative data were extracted, charted, and synthesized to provide a descriptive summary of the trends and considerations for future research. Results: Database searches yielded 11,422 articles across the initial and updated searches, 53 (0.46%) of which were included in this review. DHIs predominantly sought to provide treatment (44/53, 83%), followed by detection (5/53, 9%) and prevention (4/53, 8%). Most DHIs were focused on depression (36/53, 68%), guided (32/53, 60%), tailored to chronic physical conditions (19/53, 36%), and delivered through web-based platforms (20/53, 38%). Only 2 studies described the implementation of a DHI. Conclusions: As a growing research area, DHIs offer the potential to address the gap in care for depression and anxiety among people with chronic conditions; however, their implementation in standard care is scarce. Although stepped care has been identified as a promising model to implement efficacious DHIs, few studies have investigated the use of DHIs for depression and anxiety among chronic conditions using such models. In developing stepped care, we outlined DHI tailoring, guidance, and intensity as key considerations that require further research. %M 36155409 %R 10.2196/38030 %U https://www.jmir.org/2022/9/e38030 %U https://doi.org/10.2196/38030 %U http://www.ncbi.nlm.nih.gov/pubmed/36155409 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e38067 %T Assessing the Impact of Conversational Artificial Intelligence in the Treatment of Stress and Anxiety in Aging Adults: Randomized Controlled Trial %A Danieli,Morena %A Ciulli,Tommaso %A Mousavi,Seyed Mahed %A Silvestri,Giorgia %A Barbato,Simone %A Di Natale,Lorenzo %A Riccardi,Giuseppe %+ Signal & Interactive Systems Lab, Dipartimento di Ingegneria e Scienze dell'Informazione, Università degli Studi di Trento, via Sommarive 9, Povo di Trento - Trento, 38123, Italy, 39 5381237 ext 686, morena.danieli@unitn.it %K mental health care %K conversational artificial intelligence %K mobile health %K mHealth %K personal health care agent %D 2022 %7 23.9.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: While mental health applications are increasingly becoming available for large populations of users, there is a lack of controlled trials on the impacts of such applications. Artificial intelligence (AI)-empowered agents have been evaluated when assisting adults with cognitive impairments; however, few applications are available for aging adults who are still actively working. These adults often have high stress levels related to changes in their work places, and related symptoms eventually affect their quality of life. Objective: We aimed to evaluate the contribution of TEO (Therapy Empowerment Opportunity), a mobile personal health care agent with conversational AI. TEO promotes mental health and well-being by engaging patients in conversations to recollect the details of events that increased their anxiety and by providing therapeutic exercises and suggestions. Methods: The study was based on a protocolized intervention for stress and anxiety management. Participants with stress symptoms and mild-to-moderate anxiety received an 8-week cognitive behavioral therapy (CBT) intervention delivered remotely. A group of participants also interacted with the agent TEO. The participants were active workers aged over 55 years. The experimental groups were as follows: group 1, traditional therapy; group 2, traditional therapy and mobile health (mHealth) agent; group 3, mHealth agent; and group 4, no treatment (assigned to a waiting list). Symptoms related to stress (anxiety, physical disease, and depression) were assessed prior to treatment (T1), at the end (T2), and 3 months after treatment (T3), using standardized psychological questionnaires. Moreover, the Patient Health Questionnaire-8 and General Anxiety Disorders-7 scales were administered before the intervention (T1), at mid-term (T2), at the end of the intervention (T3), and after 3 months (T4). At the end of the intervention, participants in groups 1, 2, and 3 filled in a satisfaction questionnaire. Results: Despite randomization, statistically significant differences between groups were present at T1. Group 4 showed lower levels of anxiety and depression compared with group 1, and lower levels of stress compared with group 2. Comparisons between groups at T2 and T3 did not show significant differences in outcomes. Analyses conducted within groups showed significant differences between times in group 2, with greater improvements in the levels of stress and scores related to overall well-being. A general worsening trend between T2 and T3 was detected in all groups, with a significant increase in stress levels in group 2. Group 2 reported higher levels of perceived usefulness and satisfaction. Conclusions: No statistically significant differences could be observed between participants who used the mHealth app alone or within the traditional CBT setting. However, the results indicated significant differences within the groups that received treatment and a stable tendency toward improvement, which was limited to individual perceptions of stress-related symptoms. Trial Registration: ClinicalTrials.gov NCT04809090; https://clinicaltrials.gov/ct2/show/NCT04809090 %M 36149730 %R 10.2196/38067 %U https://mental.jmir.org/2022/9/e38067 %U https://doi.org/10.2196/38067 %U http://www.ncbi.nlm.nih.gov/pubmed/36149730 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39813 %T Comparing Professional and Consumer Ratings of Mental Health Apps: Mixed Methods Study %A Hudson,Georgie %A Negbenose,Esther %A Neary,Martha %A Jansli,Sonja M %A Schueller,Stephen M %A Wykes,Til %A Jilka,Sagar %+ Warwick Medical School, University of Warwick, Medical School Building, Coventry, CV4 7AL, United Kingdom, 44 7708715627, sagar.jilka@warwick.ac.uk %K well-being %K apps %K patient and public involvement %K coproduction %K mental health %K service user %K technology %K mobile health %K mHealth %K digital %K mobile phone %D 2022 %7 23.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As the number of mental health apps has grown, increasing efforts have been focused on establishing quality tailored reviews. These reviews prioritize clinician and academic views rather than the views of those who use them, particularly those with lived experiences of mental health problems. Given that the COVID-19 pandemic has increased reliance on web-based and mobile mental health support, understanding the views of those with mental health conditions is of increasing importance. Objective: This study aimed to understand the opinions of people with mental health problems on mental health apps and how they differ from established ratings by professionals. Methods: A mixed methods study was conducted using a web-based survey administered between December 2020 and April 2021, assessing 11 mental health apps. We recruited individuals who had experienced mental health problems to download and use 3 apps for 3 days and complete a survey. The survey consisted of the One Mind PsyberGuide Consumer Review Questionnaire and 2 items from the Mobile App Rating Scale (star and recommendation ratings from 1 to 5). The consumer review questionnaire contained a series of open-ended questions, which were thematically analyzed and using a predefined protocol, converted into binary (positive or negative) ratings, and compared with app ratings by professionals and star ratings from app stores. Results: We found low agreement between the participants’ and professionals’ ratings. More than half of the app ratings showed disagreement between participants and professionals (198/372, 53.2%). Compared with participants, professionals gave the apps higher star ratings (3.58 vs 4.56) and were more likely to recommend the apps to others (3.44 vs 4.39). Participants’ star ratings were weakly positively correlated with app store ratings (r=0.32, P=.01). Thematic analysis found 11 themes, including issues of user experience, ease of use and interactivity, privacy concerns, customization, and integration with daily life. Participants particularly valued certain aspects of mental health apps, which appear to be overlooked by professional reviewers. These included functions such as the ability to track and measure mental health and providing general mental health education. The cost of apps was among the most important factors for participants. Although this is already considered by professionals, this information is not always easily accessible. Conclusions: As reviews on app stores and by professionals differ from those by people with lived experiences of mental health problems, these alone are not sufficient to provide people with mental health problems with the information they desire when choosing a mental health app. App rating measures must include the perspectives of mental health service users to ensure ratings represent their priorities. Additional work should be done to incorporate the features most important to mental health service users into mental health apps. %M 36149733 %R 10.2196/39813 %U https://formative.jmir.org/2022/9/e39813 %U https://doi.org/10.2196/39813 %U http://www.ncbi.nlm.nih.gov/pubmed/36149733 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39013 %T Resilience in Web-Based Mental Health Communities: Building a Resilience Dictionary With Semiautomatic Text Analysis %A Kang,Yong-Bin %A McCosker,Anthony %A Kamstra,Peter %A Farmer,Jane %+ Australian Research Council (ARC) Centre of Excellence for Automated Decision-Making and Society (ADM+S), Swinburne University of Technology, John St, Hawthorn, Victoria, 3122, Australia, 61 3 9214 5904, ykang@swin.edu.au %K resilience dictionary %K mental health %K peer-support forum %K topic modeling %K text analysis %K content moderation %D 2022 %7 22.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Resilience is an accepted strengths-based concept that responds to change, adversity, and crises. This concept underpins both personal and community-based preventive approaches to mental health issues and shapes digital interventions. Online mental health peer-support forums have played a prominent role in enhancing resilience by providing accessible places for sharing lived experiences of mental issues and finding support. However, little research has been conducted on whether and how resilience is realized, hindering service providers’ ability to optimize resilience outcomes. Objective: This study aimed to create a resilience dictionary that reflects the characteristics and realization of resilience within online mental health peer-support forums. The findings can be used to guide further analysis and improve resilience outcomes in mental health forums through targeted moderation and management. Methods: A semiautomatic approach to creating a resilience dictionary was proposed using topic modeling and qualitative content analysis. We present a systematic 4-phase analysis pipeline that preprocesses raw forum posts, discovers core themes, conceptualizes resilience indicators, and generates a resilience dictionary. Our approach was applied to a mental health forum run by SANE (Schizophrenia: A National Emergency) Australia, with 70,179 forum posts between 2018 and 2020 by 2357 users being analyzed. Results: The resilience dictionary and taxonomy developed in this study, reveal how resilience indicators (ie, “social capital,” “belonging,” “learning,” “adaptive capacity,” and “self-efficacy”) are characterized by themes commonly discussed in the forums; each theme’s top 10 most relevant descriptive terms and their synonyms; and the relatedness of resilience, reflecting a taxonomy of indicators that are more comprehensive (or compound) and more likely to facilitate the realization of others. The study showed that the resilience indicators “learning,” “belonging,” and “social capital” were more commonly realized, and “belonging” and “learning” served as foundations for “social capital” and “adaptive capacity” across the 2-year study period. Conclusions: This study presents a resilience dictionary that improves our understanding of how aspects of resilience are realized in web-based mental health forums. The dictionary provides novel guidance on how to improve training to support and enhance automated systems for moderating mental health forum discussions. %M 36136394 %R 10.2196/39013 %U https://formative.jmir.org/2022/9/e39013 %U https://doi.org/10.2196/39013 %U http://www.ncbi.nlm.nih.gov/pubmed/36136394 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e38449 %T Social Media Use and Health and Well-being of Lesbian, Gay, Bisexual, Transgender, and Queer Youth: Systematic Review %A Berger,Matthew N %A Taba,Melody %A Marino,Jennifer L %A Lim,Megan S C %A Skinner,S Rachel %+ Specialty of Child and Adolescent Health, The Children’s Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Corner Hawkesbury Road and, Hainsworth St, Westmead, 2145, Australia, 61 298403603, matthew.berger@health.nsw.gov.au %K lesbian, gay, bisexual, transgender, and queer %K LGBTQ %K adolescence %K youth %K well-being %K mental health %K social media %K identity %K support %K mobile phone %D 2022 %7 21.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals are at higher risk of poor mental health and well-being. Social media platforms can provide LGBTQ youths with a space that counters heteronormative environments and potentially supports mental health and well-being. Mental health includes an individual’s state of psychological and emotional well-being and not merely the absence of mental disorders. Objective: We sought to identify how LGBTQ youths and adolescents use social media for connection with other LGBTQ peers and groups, identity development, and social support and how these affect mental health and well-being. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures were used to guide this review. Searches were conducted in ACM Digital Library, CINAHL, Ovid Embase, Ovid MEDLINE, and Web of Science in March 2021. This review focused on LGBTQ youths aged 10 to 24 years. Included peer-reviewed studies must comprise social media; explore peer connection, identity development, or social support; and be published from 2012 onward. In total, 2 researchers extracted data and performed quality assessments independently using the Newcastle-Ottawa Scale for quantitative articles and the Critical Appraisal Skills Programme for qualitative articles. Qualitative synthesis was performed on articles that satisfied the eligibility criteria. Results: A total of 26 studies (n=15, 58% qualitative; n=8, 31% quantitative; n=3, 12% mixed methods) met the inclusion criteria. Of the 8 quantitative studies, 6 (75%) were cross-sectional, and 2 (25%) were cohort studies. All studies ranged from moderate to high quality. Social media was a popular tool used by LGBTQ youths to connect with LGBTQ communities. In qualitative data, we found that LGBTQ youths negotiated and explored identity and obtained support from peers on social media. Instagram, Tumblr, and Twitter were commonly used to access LGBTQ content owing to ease of anonymity. Identity management was the most studied social media affordance, important to LGBTQ youths for strategic disclosure. Key strategies for managing identities included being anonymous, censoring locations or content, restricting audiences, and using multiple accounts. Quantitative studies (3/8, 38%) showed that social media was associated with reduced mental health concerns and increased well-being among LGBTQ youths. Mental health concerns arising from social media use were attributed to discrimination, victimization, and policies that did not accommodate changed identities. Conclusions: We found that social media may support the mental health and well-being of LGBTQ youths through peer connection, identity management, and social support, but findings were limited by weaknesses in the evidence. More robust and longitudinal studies are needed to determine the relationship between social media use and LGBTQ mental health, particularly among adolescents. The findings may inform interventions to promote social media health literacy and the mental health and well-being of this vulnerable group. Trial Registration: PROSPERO CRD42020222535; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=222535 %M 36129741 %R 10.2196/38449 %U https://www.jmir.org/2022/9/e38449 %U https://doi.org/10.2196/38449 %U http://www.ncbi.nlm.nih.gov/pubmed/36129741 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e34602 %T A Digital Peer Support Platform to Translate Web-Based Peer Support for Emerging Adult Mental Well-being: Protocol for a Randomized Controlled Trial %A Yeo,GeckHong %A Chang,Weining %A Lee,Li Neng %A Oon,Matt %A Ho,Dean %+ N.1 Institute for Health, National University of Singapore, 28 Medical Drive, Singapore, 117456, Singapore, 65 66017766, lsighy@nus.edu.sg %K mental health %K digital health %K peer support intervention %K peer emotional disclosure %K randomized controlled trial %D 2022 %7 20.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health issues among emerging adults (aged 19-25 years) on a global scale have underscored the need to address their widespread experiences of depression and anxiety. As a result of the COVID-19 pandemic, emerging studies are being directed toward the development and deployment of digital peer emotional disclosure and support for the psychological well-being of emerging adults. However, it is important to explore the implementation and clinical effectiveness, as well as associated mechanisms of change, for optimal approaches in conducting digital peer support interventions for emerging adults’ psychological well-being. Objective: We describe a randomized controlled trial to evaluate the implementation and clinical effectiveness of Acceset, a digital peer support intervention to address emerging adult mental well-being. The intervention has 2 components. First, the digital peer support training equips befrienders (ie, peers who provide support) to harness 4 components of psychological well-being—mattering, selfhood, compassion, and mindfulness—to provide effective peer support for seekers (ie, peers who seek support). Second, Acceset incorporates psychological well-being digital markers and harnesses community engagement to drive emotional disclosure among peers. Methods: A total of 100 participants (aged 19-25 years) from the National University of Singapore will be recruited and randomized into 2 arms. In arm 1 (n=50), the seekers will use Acceset with befrienders (n=30) as well as moderators (n=30) for 3 weeks. Arm 2 comprises a wait-listed control group (n=50). A questionnaire battery will be used to monitor seekers and befrienders at 4 time points. These include baseline (before the intervention), 3 weeks (end of the intervention), and 6 and 9 weeks (carryover effect measurement). Implementation outcomes of the intervention will involve evaluation of the training curriculum with respect to adoption and fidelity as well as user acceptability of the Acceset platform and its feasibility for broader deployment. Clinical outcomes will include mattering, selfhood, compassion, mindfulness, perceived social support, and psychological well-being scores. Results: This protocol received National University of Singapore Institutional Ethics Review Board approval in October 2021. Recruitment will commence in January 2022. We expect data collection and analyses to be completed in June 2022. Preliminary findings are expected to be published in December 2022. The Cohen d index will be used for effect size estimation with a .05 (95% reliability) significance level and 80% power. Conclusions: This protocol considers a novel digital peer support intervention—Acceset—that incorporates components and digital markers of emerging adult mental well-being. Through the validation of the Acceset intervention, this study defines the parameters and conditions for digital peer support interventions for emerging adults. Trial Registration: ClinicalTrials.gov NCT05083676; https://clinicaltrials.gov/ct2/show/NCT05083676 International Registered Report Identifier (IRRID): PRR1-10.2196/34602 %M 36125855 %R 10.2196/34602 %U https://www.researchprotocols.org/2022/9/e34602 %U https://doi.org/10.2196/34602 %U http://www.ncbi.nlm.nih.gov/pubmed/36125855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39476 %T A Web-Based Positive Psychology App for Patients With Bipolar Disorder: Development Study %A Geerling,Bart %A Kelders,Saskia M %A Stevens,Anja W M M %A Kupka,Ralph W %A Bohlmeijer,Ernst T %+ Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 0622274351, b.geerling@dimence.nl %K bipolar disorder %K positive psychology %K cocreation %K mobile health %K mHealth %K web-based %K psychology %K bipolar %K intervention %K quality of life %K mental illness %K pilot %K self-esteem %K acceptance %K social isolation %K manic episode %K manic %K self-help %K positive %K mobile phone %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with bipolar disorder (BD) report lower quality of life and lower levels of well-being than the general population. Despite the growing availability of psychotherapeutic and self-management interventions, important unmet needs remain. These unmet needs are closely linked to positive psychology domains. Although a growing number of studies have evaluated the impact of positive psychology interventions (PPIs) on patients with severe mental illness in general, only few have addressed the application of positive psychology for BD. Objective: This study aimed to gain insight into the opinions of patients with BD and health care professionals about (web-based) PPIs for BD and to develop and pilot-test an app containing PPIs specifically designed for patients with BD. Methods: The study was conducted in accordance with the Center for eHealth and Disease Management road map principles and incorporated cocreation and designing for implementation. Data were collected using focus group discussions, questionnaires, rapid prototyping, and web-based feedback on a prototype from the participants. In total, 3 focus groups were conducted with 62% (8/13) of patients with BD and 38% (5/13) of professionals. The collected data were used to develop a smartphone app containing short PPIs. The content was based on PPIs for which a solid base of evidence is available. Finally, a pilot test was conducted to test the app. Results: Focus groups revealed that PPIs as part of the current BD treatment can potentially meet the following needs: offering hope, increasing self-esteem, expressing feelings, acceptance, and preventing social isolation. Some patients expressed concern that PPIs may provoke a manic or hypomanic episode by increasing positive affect. The pilot of the app showed that the PPIs are moderately to highly valued by the participants. There were no adverse effects such as increase in manic or hypomanic symptoms. Conclusions: With the systematic use of user involvement (patients and professionals) in all steps of the development process, we were able to create an app that can potentially fulfill some of the current unmet needs in the treatment of BD. We reached consensus among consumers and professionals about the potential benefits of PPIs to address the unmet needs of patients with BD. The use of PPI for BD is intriguing and can be usefully explored in further studies. We emphasize that more evaluation studies (quantitative and qualitative) that are focused on the effect of PPIs in the treatment of BD should be conducted. In addition, to establish the working mechanisms in BD, explorative, qualitative, designed studies are required to reveal whether PPIs can address unmet needs in BD. %M 35946327 %R 10.2196/39476 %U https://formative.jmir.org/2022/9/e39476 %U https://doi.org/10.2196/39476 %U http://www.ncbi.nlm.nih.gov/pubmed/35946327 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e39787 %T Waiting Lists for Psychotherapy and Provider Attitudes Toward Low-Intensity Treatments as Potential Interventions: Survey Study %A Peipert,Allison %A Krendl,Anne C %A Lorenzo-Luaces,Lorenzo %+ Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E 10th St, Bloomington, IN, 47405, United States, 1 812 855 2012, lolorenz@indiana.edu %K psychotherapy %K CBT %K cognitive behavioral therapy %K behavior therapy %K digital mental health %K self-help %K support group %K mental health %K digital health %K eHealth %K low-intensity intervention %K survey %K waiting list %K health system %K health care delivery %K health care professional %K care provider %K bibliotherapy %K attitude %K perception %K digital intervention %K web-based intervention %K depression %K anxiety %K mental disorder %D 2022 %7 16.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Common mental disorders, including depression and anxiety, are leading causes of disability worldwide. Digital mental health interventions, such as web-based self-help and other low-intensity treatments (LITs) that are not digital (eg, bibliotherapy), have the potential to reach many individuals by circumventing common barriers present in traditional mental health care. It is unclear how often LITs are used in clinical practice, or whether providers would be interested in their use for treatment waiting lists. Objective: The aims of this study were to (1) describe current practices for treatment waiting lists, (2) describe providers’ attitudes toward digital and nondigital LITs for patients on a waiting list, and (3) explore providers’ willingness to use digital and nondigital LITs and their decisions to learn about them. Methods: We surveyed 141 practicing mental health care providers (eg, therapists and psychologists) and provided an opportunity for them to learn about LITs. Results: Most participants reported keeping a waiting list. Few participants reported currently recommending digital or nondigital LITs, though most were willing to use at least one for patients on their waiting list. Attitudes toward digital and nondigital LITs were neutral to positive. Guided digital and nondigital LITs were generally perceived to be more effective but less accessible, and unguided interventions were perceived to be less effective but more accessible. Most participants selected to access additional information on LITs, with the most popular being web-based self-help. Conclusions: Results suggest providers are currently not recommending LITs for patients on treatment waiting lists but would be willing to recommend them. Future work should explore barriers and facilitators to implementing digital and nondigital LITs for patients on treatment waiting lists. %M 36112400 %R 10.2196/39787 %U https://formative.jmir.org/2022/9/e39787 %U https://doi.org/10.2196/39787 %U http://www.ncbi.nlm.nih.gov/pubmed/36112400 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e36978 %T Comparability of Patients in Trials of eHealth and Face-to-Face Psychotherapeutic Interventions for Depression: Meta-synthesis %A Aemissegger,Vera %A Lopez-Alcalde,Jesus %A Witt,Claudia M %A Barth,Jürgen %+ Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Sonneggstrasse 6, Zurich, 8091, Switzerland, 41 44 255 48 96, mail@juergen-barth.de %K depression %K mental health %K digital intervention %K eHealth %K web-based %K randomized controlled trial %K RCT %K meta-analysis %K epidemiology %K epidemiological %K depressive disorder %K mental illness %K mental condition %K mental disorder %K psychotherapy %K psychotherapeutic intervention %K CBT %K iCBT %K cognitive behavioral therapy %K face-to-face %K cognitive therapy %K interpersonal therapy %D 2022 %7 14.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Depressive disorders (DDs) are a public health problem. Face-to-face psychotherapeutic interventions are a first-line option for their treatment in adults. There is a growing interest in eHealth interventions to maximize accessibility for effective treatments. Thus, the number of randomized controlled trials (RCTs) of eHealth psychotherapeutic interventions has increased, and these interventions are being offered to patients. However, it is unknown whether patients with DDs differ in internet-based and face-to-face intervention trials. This information is essential to gain knowledge about eHealth trials’ external validity. Objective: We aimed to compare the baseline characteristics of patients with DDs included in the RCTs of eHealth and face-to-face psychotherapeutic interventions with a cognitive component. Methods: In this meta-epidemiological study, we searched 5 databases between 1990 and November 2017 (MEDLINE, Embase, PsycINFO, Google Scholar, and the database of Cuijpers et al). We included RCTs of psychotherapeutic interventions with a cognitive component (eg, cognitive therapy, cognitive behavioral therapy [CBT], or interpersonal therapy) delivered face-to-face or via the internet to adults with DDs. Each included study had a matching study for predefined criteria to allow a valid comparison of characteristics and was classified as a face-to-face (CBT) or eHealth (internet CBT) intervention trial. Two authors selected the studies, extracted data, and resolved disagreements by discussion. We tested whether predefined baseline characteristics differed in face-to-face and internet-based trials using a mixed-effects model and testing for differences with z tests (statistical significance set at .05). For continuous outcomes, we also estimated the difference in means between subgroups with 95% CI. Results: We included 58 RCTs (29 matching pairs) with 3846 participants (female: n=2803, 72.9%) and mean ages ranging from 20-74 years. White participants were the most frequent (from 63.6% to 100%). Other socioeconomic characteristics were poorly described. The participants presented DDs of different severity measured with heterogeneous instruments. Internet CBT trials had a longer depression duration at baseline (7.19 years higher, CI 95% 2.53-11.84; 10.0 vs 2.8 years; P=.002), but the proportion of patients with previous depression treatment was lower (24.8% vs 42%; P=.04). Subgroup analyses found no evidence of differences for the remaining baseline characteristics: age, gender, education, living area, depression severity, history of depression, actual antidepressant medication, actual physical comorbidity, actual mental comorbidity, study dropout, quality of life, having children, family status, and employment. We could not compare proficiency with computers due to the insufficient number of studies. Conclusions: The baseline characteristics of patients with DDs included in the RCTs of eHealth and face-to-face psychotherapeutic interventions are generally similar. However, patients in eHealth trials had a longer duration of depression, and a lower proportion had received previous depression treatment, which might indicate that eHealth trials attract patients who postpone earlier treatment attempts. Trial Registration: PROSPERO CRD42019085880; https://tinyurl.com/4xufwcyr %M 36103217 %R 10.2196/36978 %U https://www.jmir.org/2022/9/e36978 %U https://doi.org/10.2196/36978 %U http://www.ncbi.nlm.nih.gov/pubmed/36103217 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 9 %P e38463 %T Success4life Youth Empowerment for Promoting Well-being and Boosting Mental Health: Protocol for an Experimental Study %A Setia,Sajita %A Furtner,Daniel %A Bendahmane,Mounir %A Tichy,Michelle %+ Executive office, Transform Medical Communications, 184 Glasgow Street, Wanganui, 4500, New Zealand, 64 276175433, sajita.setia@transform-medcomms.com %K learned optimism %K mind power tool %K mental health %K success4life, positive psychology-based interventions, well-being %K youth empowerment %D 2022 %7 14.9.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is an increasingly alarming worsening of mental health among the youth. There remain significant unmet needs for developing innovative, evidence-based technology–enhanced, positive psychology interventions (PPIs) all-inclusive in targeting psychological distress and risk factors related to high-risk behavior commonly encountered in adolescents. Objective: We aim to assess the effectiveness of a hybrid (incorporating both synchronous and asynchronous learning) and holistic (targeting social and emotional learning and tackling risk factors unique for this age group) PPI, “success4life youth empowerment,” in improving well-being in the youth. Methods: Students’ well-being will be assessed by the 5-item World Health Organization Well-Being Index, and hope will be assessed by the 6-item Children’s Hope Scale at week 0, week 8, and week 10, month 6, and month 12. Any improvement in well-being and hope will be measured, estimating the difference in postintervention (week 8 and week 10) and preintervention (week 0) scores by determining the P value and effect size using appropriate statistical tests. Results: This study includes 2 phases: pilot phase 1, delivered by the creators of the succcess4life youth empowerment modules and platform, and phase 2, which will consist of the estimation of scalability through the recruitment of trainers. We hope to start student recruitment by 2022 and aim to complete the results for phase 1 pilot testing by 2023. Conclusions: We anticipate that a primarily web-based, 10-week holistic PPI can support improvement in the mental wellness of the youth and has the potential for effective scalability. International Registered Report Identifier (IRRID): PRR1-10.2196/38463 %M 36041997 %R 10.2196/38463 %U https://www.researchprotocols.org/2022/9/e38463 %U https://doi.org/10.2196/38463 %U http://www.ncbi.nlm.nih.gov/pubmed/36041997 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e37287 %T Motive-Oriented, Personalized, Internet-Based Interventions for Depression: Nonclinical Experimental Study %A Bücker,Lara %A Berger,Thomas %A Bruhns,Alina %A Westermann,Stefan %+ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, Hamburg, 20246, Germany, 49 040 7410 55868, l.buecker@uke.de %K internet-based interventions %K depression %K adherence %K motive orientation %K personalization %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The low level of adherence in internet-based self-help interventions for depression suggests that in many existing programs, the motivational fit between the program and the user is unsatisfactory (eg, the user seeks autonomy, but the program provides directive guidance). Personalized, motive-oriented, self-help interventions could enable participants who interact with a program and its contents to have more engaging and less aversive experiences and thus increase adherence. Objective: In an experimental study with a nonclinical analogue sample, we aimed to test the hypotheses that a better motivational person-program fit is linked with higher anticipated adherence, working alliance, and satisfaction with the program. Methods: Motivational person-program fit was examined with respect to the 2 contrasting motives being autonomous and being supported. The hypotheses were tested by specifically varying the motivational person-program fit in a nonclinical sample (N=55), where participants were asked to work on, and subsequently evaluate, a limited set of individual pages of a self-help program with guidance (in the form of text messages) for depression. The sections of the self-help program were redesigned to either particularly address the autonomy motive or the support motive. For the quasi-experimental variation of the motivational person-program characteristics, we divided the 55 participants into 2 groups (autonomy group: n=27, 49%; support group: n=28, 51%) by screening method (using the Inventory of Approach and Avoidance Motivation), corresponding to the 2 motives. Both groups evaluated (in randomized order) 2 excerpts of the program—one that matched their motive (fit) and one that was contrary to it (no fit). Immediately after the evaluation of each excerpt, anticipated adherence, working alliance, and treatment satisfaction were assessed. Results: Regarding being supported, the satisfaction with or violation of this motive had an impact on (optimal) anticipated adherence as well as working alliance and satisfaction with the intervention; a congruent person-program fit resulted in significantly higher anticipated adherence (t27=3.00; P=.006), working alliance (t27=3.20; P=.003), and satisfaction (t27=2.86; P=.008) than a noncongruent fit. However, a similar impact could not be found for the motive being autonomous. Several correlations were found that supported our hypotheses (eg, for the congruent person-program fit autonomy motive and autonomy group, support satisfaction negatively correlated with optimal anticipated adherence). Conclusions: This first experimental study gives reason to assume that motive orientation may have a positive influence on adherence, working alliance, and satisfaction in internet-based self-help interventions for depression and other mental disorders. Future studies should conduct randomized controlled trials with clinical samples and assess clinical outcomes. %M 36098989 %R 10.2196/37287 %U https://formative.jmir.org/2022/9/e37287 %U https://doi.org/10.2196/37287 %U http://www.ncbi.nlm.nih.gov/pubmed/36098989 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e35620 %T Web-Based Mindfulness-Based Interventions for Well-being: Randomized Comparative Effectiveness Trial %A Sylvia,Louisa G %A Lunn,Mitchell R %A Obedin-Maliver,Juno %A McBurney,Robert N %A Nowell,W Benjamin %A Nosheny,Rachel L %A Mularski,Richard A %A Long,Millie D %A Merkel,Peter A %A Pletcher,Mark J %A Tovey,Roberta E %A Scalchunes,Christopher %A Sutphen,Rebecca %A Martin,Ann S %A Horn,Elizabeth J %A O'Boyle,Megan %A Pitch,Lisa %A Seid,Michael %A Redline,Susan %A Greenebaum,Sophie %A George,Nevita %A French,Noah J %A Faria,Caylin M %A Puvanich,Nicha %A Rabideau,Dustin J %A Selvaggi,Caitlin A %A Yu,Chu %A Faraone,Stephen V %A Venkatachalam,Shilpa %A McCall,Debbe %A Terry,Sharon F %A Deckersbach,Thilo %A Nierenberg,Andrew A %+ Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA, 02114, United States, 1 617 643 4804, lsylvia2@mgh.harvard.edu %K mindfulness %K well-being %K web %K control trial %K clinical trial %K cognitive therapy %K intervention %K mental health %K mindful %K eHealth %K mobile phone %D 2022 %7 12.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mindfulness can improve overall well-being by training individuals to focus on the present moment without judging their thoughts. However, it is unknown how much mindfulness practice and training are necessary to improve well-being. Objective: The primary aim of this study was to determine whether a standard 8-session web-based mindfulness-based cognitive therapy (MBCT) program, compared with a brief 3-session mindfulness intervention, improved overall participant well-being. In addition, we sought to explore whether the treatment effects differed based on the baseline characteristics of the participants (ie, moderators). Methods: Participants were recruited from 17 patient-powered research networks, web-based communities of stakeholders interested in a common research area. Participants were randomized to either a standard 8-session MBCT or a brief 3-session mindfulness training intervention accessed on the web. The participants were followed for 12 weeks. The primary outcome of the study was well-being, as measured by the World Health Organization—Five Well-Being Index. We hypothesized that MBCT would be superior to a brief mindfulness training. Results: We randomized 4411 participants, 3873 (87.80%) of whom were White and 3547 (80.41%) of female sex assigned at birth. The mean baseline World Health Organization—Five Well-Being Index score was 50.3 (SD 20.7). The average self-reported well-being in each group increased over the intervention period (baseline to 8 weeks; model-based slope for the MBCT group: 0.78, 95% CI 0.63-0.93, and brief mindfulness group: 0.76, 95% CI 0.60-0.91) as well as the full study period (ie, intervention plus follow-up; baseline to 20 weeks; model-based slope for MBCT group: 0.41, 95% CI 0.34-0.48; and brief mindfulness group: 0.33, 95% CI 0.26-0.40). Changes in self-reported well-being were not significantly different between MBCT and brief mindfulness during the intervention period (model-based difference in slopes: −0.02, 95% CI −0.24 to 0.19; P=.80) or during the intervention period plus 12-week follow-up (−0.08, 95% CI −0.18 to 0.02; P=.10). During the intervention period, younger participants (P=.05) and participants who completed a higher percentage of intervention sessions (P=.005) experienced greater improvements in well-being across both interventions, with effects that were stronger for participants in the MBCT condition. Attrition was high (ie, 2142/4411, 48.56%), which is an important limitation of this study. Conclusions: Standard MBCT improved well-being but was not superior to a brief mindfulness intervention. This finding suggests that shorter mindfulness programs could yield important benefits across the general population of individuals with various medical conditions. Younger people and participants who completed more intervention sessions reported greater improvements in well-being, an effect that was more pronounced for participants in the MBCT condition. This finding suggests that standard MBCT may be a better choice for younger people as well as treatment-adherent individuals. Trial Registration: ClinicalTrials.gov NCT03844321; https://clinicaltrials.gov/ct2/show/NCT03844321 %M 36094813 %R 10.2196/35620 %U https://www.jmir.org/2022/9/e35620 %U https://doi.org/10.2196/35620 %U http://www.ncbi.nlm.nih.gov/pubmed/36094813 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e36662 %T Content and Effectiveness of Web-Based Treatments for Online Behavioral Addictions: Systematic Review %A Park,Jennifer J %A King,Daniel L %A Wilkinson-Meyers,Laura %A Rodda,Simone N %+ School of Population Health, The University of Auckland, Building 507, 22-30 Park Ave, Grafton, Auckland, 1023, New Zealand, 64 210 822 6685, jpar956@aucklanduni.ac.nz %K systematic review %K gambling %K gaming %K internet intervention %K pornography %K treatment %K social media %D 2022 %7 9.9.2022 %9 Review %J JMIR Ment Health %G English %X Background: Very few people seek in-person treatment for online behavioral addictions including gaming and gambling or problems associated with shopping, pornography use, or social media use. Web-based treatments have the potential to address low rates of help seeking due to their convenience, accessibility, and capacity to address barriers to health care access (eg, shame, stigma, cost, and access to expert care). However, web-based treatments for online behavioral addictions have not been systematically evaluated. Objective: This review aimed to systematically describe the content of web-based treatments for online behavioral addictions and describe their therapeutic effectiveness on symptom severity and consumption behavior. Methods: A database search of MEDLINE, Embase, PsycInfo, Web of Science, Cochrane Central Register of Controlled Trials, and Google Scholar was conducted in June 2022. Studies were eligible if the study design was a randomized controlled trial or a pre-post study with at least 1 web-based intervention arm for an online behavioral addiction and if the study included the use of a validated measure of problem severity, frequency, or duration of online behavior. Data on change techniques were collected to analyze intervention content, using the Gambling Intervention System of CharacTerization. Quality assessment was conducted using the Effective Public Health Practice Project Quality Assessment Tool. Results: The review included 12 studies with 15 intervention arms, comprising 7 randomized controlled trials and 5 pre-post studies. The primary focus of interventions was gaming (n=4), followed by internet use inclusive of screen time and smartphone use (n=3), gambling (n=3), and pornography (n=2). A range of different technologies were used to deliver content, including websites (n=6), email (n=2), computer software (n=2), social media messaging (n=1), smartphone app (n=1), virtual reality (n=1), and videoconferencing (n=1). Interventions contained 15 different change techniques with an average of 4 per study. The techniques most frequently administered (>30% of intervention arms) were cognitive restructuring, relapse prevention, motivational enhancement, goal setting, and social support. Assessment of study quality indicated that 7 studies met the criteria for moderate or strong global ratings, but only 8 out of 12 studies evaluated change immediately following the treatment. Across included studies, two-thirds of participants completed after-treatment evaluation, and one-quarter completed follow-up evaluation. After-intervention evaluation indicated reduced severity (5/9, 56%), frequency (2/3, 67%), and duration (3/7, 43%). Follow-up evaluation indicated that 3 pre-post studies for gaming, gambling, and internet use demonstrated reduced severity, frequency, and duration of consumption. At 3-month evaluation, just 1 pre-post study indicated significant change to mental health symptoms. Conclusions: Web-based treatments for online behavioral addictions use an array of mechanisms to deliver cognitive and behavioral change techniques. Web-based treatments demonstrate promise for short-term reduction in symptoms, duration, or frequency of online addictive behaviors. However, there is limited evidence on the effectiveness of web-based treatments over the longer term due to the absence of controlled trials. %M 36083612 %R 10.2196/36662 %U https://mental.jmir.org/2022/9/e36662 %U https://doi.org/10.2196/36662 %U http://www.ncbi.nlm.nih.gov/pubmed/36083612 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 9 %P e36432 %T The Helpfulness of Web-Based Mental Health and Well-being Forums for Providing Peer Support for Young People: Cross-sectional Exploration %A Banwell,Emily %A Hanley,Terry %A De Ossorno Garcia,Santiago %A Mindel,Charlotte %A Kayll,Thomas %A Sefi,Aaron %+ Manchester Institute of Education, University of Manchester, Ellen Wilkinson Building, Oxford Road, Manchester, M15 6JA, United Kingdom, emily.banwell@manchester.ac.uk %K adolescent mental health %K peer support %K web-based forums %K web-based mental health %D 2022 %7 9.9.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people are increasingly seeking out web-based support for their mental health and well-being. Peer support forums are popular with this age group, with young individuals valuing the fact that the forums are available 24/7, providing a safe and anonymous space for exploration. Currently, little systematic evaluation of the helpfulness of such forums in providing support has been conducted. Objective: This study examined the helpfulness of the support offered within web-based mental health and well-being peer support forums for young people. It specifically investigated the self-reported user ratings of helpfulness reported through the completion of a developing experience measure. The ratings will be used to consider further development of the measure and reflect upon the overall helpfulness of the forums as indicated by the reported scores. Methods: The study used routinely collected practice-based outcome data from web-based mental health forums for young people. These forums are hosted by the UK-based web-based therapy and support service, Kooth. A cross-sectional design was used to explore—using a range of inferential statistical measures—the outcomes reported by those accessing the forums using a Peer Online Community Experience Measure (POCEM). To consider the helpfulness in general, 23,443 POCEMs completed in 2020 were used. A second data set of 17,137 completed POCEMs from the same year was used to consider whether various engagement indicators had an impact upon the helpfulness rating. Results: Female users aged between 11 and 16 years predominantly completed the POCEM. This is in keeping with the majority of those using the service. In total, 74.6% (8240/11,045) of the scores on the POCEM indicated that the individuals found the posts helpful. An ANOVA indicated that male users were more likely to report obtaining intrapersonal support, whereas female users obtained interpersonal support. Furthermore, the POCEM scores reflected the internal consistency of the measure and provided an insight into the way that young people made use of the peer support resource; for instance, posts that were rated more helpful were correlated with spending longer time reading them, and the topics discussed varied throughout the day with more mental health issues being discussed later at night. Conclusions: The results seem to demonstrate that, overall, the young people involved in this study found web-based peer support helpful. They indicate that peer support can provide an important strand of care within a supportive mental health ecosystem, particularly during time periods when in-person support is typically closed. However, limitations were noted, suggesting that caution is needed when interpreting the results of this study. Although such services are incredibly well used, they have received little research attention to date. As such, further investigation into what constitutes helpful and unhelpful peer support is needed. %M 36083629 %R 10.2196/36432 %U https://formative.jmir.org/2022/9/e36432 %U https://doi.org/10.2196/36432 %U http://www.ncbi.nlm.nih.gov/pubmed/36083629 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e40637 %T Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons %A Peynenburg,Vanessa %A Hadjistavropoulos,Heather %A Thiessen,David %A Titov,Nickolai %A Dear,Blake %+ Department of Psychology, University of Regina, 3737 Wascana Parkway Drive, Regina, SK, S4S 0A2, Canada, 1 306 585 5133, hadjista@uregina.ca %K postsecondary students %K transdiagnostic %K boosters %K motivational interviewing %K internet-delivered cognitive behavioral therapy %D 2022 %7 7.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-delivered cognitive behavioral therapy (ICBT) can improve access to mental health care for students, although high attrition rates are concerning and little is known about long-term outcomes. Motivational interviewing (MI) exercises and booster lessons can improve engagement and outcomes in face-to-face cognitive behavioral therapy. Objective: This study aimed to examine the use of pretreatment MI exercises and booster lessons in ICBT for postsecondary students. Methods: In this factorial trial (factor 1: web-based MI before treatment; factor 2: self-guided booster lesson 1 month after treatment), 308 clients were randomized to 1 of 4 treatment conditions, with 277 (89.9%) clients starting treatment. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing course). Primary outcomes included changes in depression, anxiety, and perceived academic functioning from before treatment to after treatment and at the 1-month and 3-month follow-ups. Results: Overall, 54% (150/277) of students completed treatment and reported large improvements in symptoms of depression and anxiety and small improvements in academic functioning after treatment, which were maintained at the 1-month and 3-month follow-ups. Pretreatment MI did not contribute to better treatment completion or engagement, although small between-group effects favored MI for reductions in depression (Cohen d=0.23) and anxiety (Cohen d=0.25) after treatment. Only 30.9% (43/139) of students randomized to one of the booster conditions accessed the booster. Overall, no main effects were found for the booster. Subanalyses revealed that clients who accessed the booster had larger decreases in depressive symptoms (Cohen d=0.31) at the 3-month follow-up. No interactions were found between MI and the booster. Conclusions: Rather than offering MI before treatment, clients may experience more benefits from MI exercises later in ICBT when motivation wanes. The low uptake of the self-guided booster limited our conclusions regarding its effectiveness. Future research should examine offering a booster for a longer duration after treatment, with therapist support and a longer follow-up period. Trial Registration: ClinicalTrials.gov NCT04264585; https://clinicaltrials.gov/ct2/show/NCT04264585 %M 36069785 %R 10.2196/40637 %U https://www.jmir.org/2022/9/e40637 %U https://doi.org/10.2196/40637 %U http://www.ncbi.nlm.nih.gov/pubmed/36069785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e36577 %T The Clinical Effectiveness of Blended Cognitive Behavioral Therapy Compared With Face-to-Face Cognitive Behavioral Therapy for Adult Depression: Randomized Controlled Noninferiority Trial %A Mathiasen,Kim %A Andersen,Tonny E %A Lichtenstein,Mia Beck %A Ehlers,Lars Holger %A Riper,Heleen %A Kleiboer,Annet %A Roessler,Kirsten K %+ Research Unit for Telepsychiatry and E-Mental Health, Department of Clinical Research, University of Southern Denmark, Heden 11, Odense, 5000, Denmark, 45 61677747, kmathiasen@health.sdu.dk %K depression %K depressive disorder, major %K cognitive therapy %K CBT %K treatment outcome %K blended care %K blended cognitive behavioral therapy %K effectiveness %K Denmark %D 2022 %7 7.9.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) has been demonstrated to be cost- and clinically effective. There is a need, however, for increased therapist contact for some patient groups. Combining iCBT with traditional face-to-face (FtF) consultations in a blended format may produce a new treatment format (B-CBT) with multiple benefits from both traditional CBT and iCBT, such as individual adaptation, lower costs than traditional therapy, wide geographical and temporal availability, and possibly lower threshold to implementation. Objective: The primary aim of this study is to compare directly the clinical effectiveness of B-CBT with FtF-CBT for adult major depressive disorder. Methods: A 2-arm randomized controlled noninferiority trial compared B-CBT for adult depression with treatment as usual (TAU). The trial was researcher blinded (unblinded for participants and clinicians). B-CBT comprised 6 sessions of FtF-CBT alternated with 6-8 web-based CBT self-help modules. TAU comprised 12 sessions of FtF-CBT. All participants were aged 18 or older and met the diagnostic criteria for major depressive disorder and were recruited via a national iCBT clinic. The primary outcome was change in depression severity on the 9-item Patient Health Questionnaire (PHQ-9). Secondary analyses included client satisfaction (8-item Client Satisfaction Questionnaire [CSQ-8]), patient expectancy (Credibility and Expectancy Questionnaire [CEQ]), and working (Working Alliance Inventory [WAI] and Technical Alliance Inventory [TAI]). The primary outcome was analyzed by a mixed effects model including all available data from baseline, weekly measures, 3-, 6, and 12-month follow-up. Results: A total of 76 individuals were randomized, with 38 allocated to each treatment group. Age ranged from 18 to 71 years (SD 13.96) with 56 (74%) females. Attrition rate was 20% (n=15), which was less in the FtF-CBT group (n=6, 16%) than in the B-CBT group (n=9, 24%). As many as 53 (70%) completed 9 or more sessions almost equally distributed between the groups (nFtF-CBT=27, 71%; nB-CBT=26, 68%). PHQ-9 reduced 11.38 points in the FtF-CBT group and 8.10 in the B-CBT group. At 6 months, the mean difference was a mere 0.17 points. The primary analyses confirmed large and significant within-group reductions in both groups (FtF-CBT: β=–.03; standard error [SE] 0.00; P<.001 and B-CBT: β=–.02; SE 0.00; P<.001). A small but significant interaction effect was observed between groups (β=.01; SE 0.00; P=.03). Employment status influenced the outcome differently between groups, where the B-CBT group was seen to profit more from not being full-time employed than the FtF group. Conclusions: With large within-group effects in both treatment arms, the study demonstrated feasibility of B-CBT in Denmark. At 6 months’ follow-up, there appeared to be no difference between the 2 treatment formats, with a small but nonsignificant difference at 12 months. The study seems to demonstrate that B-CBT is capable of producing treatment effects that are close to FtF-CBT and that completion rates and satisfaction rates were comparable between groups. However, the study was limited by small sample size and should be interpreted with caution. Trial Registration: ClinicalTrials.gov NCT02796573; https://clinicaltrials.gov/ct2/show/NCT02796573 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-016-1140-y %M 36069798 %R 10.2196/36577 %U https://www.jmir.org/2022/9/e36577 %U https://doi.org/10.2196/36577 %U http://www.ncbi.nlm.nih.gov/pubmed/36069798 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 9 %P e39454 %T Effectiveness and Minimum Effective Dose of App-Based Mobile Health Interventions for Anxiety and Depression Symptom Reduction: Systematic Review and Meta-Analysis %A Lu,Sheng-Chieh %A Xu,Mindy %A Wang,Mei %A Hardi,Angela %A Cheng,Abby L %A Chang,Su-Hsin %A Yen,Po-Yin %+ Department of Symptom Research, University of Texas MD Anderson Cancer Center, 6565 MD Anderson Blvd, Houston, TX, 77030, United States, 1 7137944453, Slu4@mdanderson.org %K mental health %K mobile health %K smartphone apps %K intervention dose effectiveness %K systematic review and meta-analysis %D 2022 %7 7.9.2022 %9 Review %J JMIR Ment Health %G English %X Background: Mobile health (mHealth) apps offer new opportunities to deliver psychological treatments for mental illness in an accessible, private format. The results of several previous systematic reviews support the use of app-based mHealth interventions for anxiety and depression symptom management. However, it remains unclear how much or how long the minimum treatment “dose” is for an mHealth intervention to be effective. Just-in-time adaptive intervention (JITAI) has been introduced in the mHealth domain to facilitate behavior changes and is positioned to guide the design of mHealth interventions with enhanced adherence and effectiveness. Objective: Inspired by the JITAI framework, we conducted a systematic review and meta-analysis to evaluate the dose effectiveness of app-based mHealth interventions for anxiety and depression symptom reduction. Methods: We conducted a literature search on 7 databases (ie, Ovid MEDLINE, Embase, PsycInfo, Scopus, Cochrane Library (eg, CENTRAL), ScienceDirect, and ClinicalTrials, for publications from January 2012 to April 2020. We included randomized controlled trials (RCTs) evaluating app-based mHealth interventions for anxiety and depression. The study selection and data extraction process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We estimated the pooled effect size using Hedge g and appraised study quality using the revised Cochrane risk-of-bias tool for RCTs. Results: We included 15 studies involving 2627 participants for 18 app-based mHealth interventions. Participants in the intervention groups showed a significant effect on anxiety (Hedge g=–.10, 95% CI –0.14 to –0.06, I2=0%) but not on depression (Hedge g=–.08, 95% CI –0.23 to 0.07, I2=4%). Interventions of at least 7 weeks’ duration had larger effect sizes on anxiety symptom reduction. Conclusions: There is inconclusive evidence for clinical use of app-based mHealth interventions for anxiety and depression at the current stage due to the small to nonsignificant effects of the interventions and study quality concerns. The recommended dose of mHealth interventions and the sustainability of intervention effectiveness remain unclear and require further investigation. %M 36069841 %R 10.2196/39454 %U https://mental.jmir.org/2022/9/e39454 %U https://doi.org/10.2196/39454 %U http://www.ncbi.nlm.nih.gov/pubmed/36069841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e36986 %T Use of Social Media Data to Diagnose and Monitor Psychotic Disorders: Systematic Review %A Lejeune,Alban %A Robaglia,Benoit-Marie %A Walter,Michel %A Berrouiguet,Sofian %A Lemey,Christophe %+ Unité de Recherche Clinique Intersectorielle, Hôpital de Bohars, Centre Hospitalier Régional Universitaire de Brest, Route de Ploudalmézeau, Bohars, 29820, France, 33 6389910008, alban.lejeune@gmail.com %K schizophrenia %K psychotic disorders %K psychiatric disorders %K artificial intelligence %K AI %K machine learning %K neural network %K social media %D 2022 %7 6.9.2022 %9 Review %J J Med Internet Res %G English %X Background: Schizophrenia is a disease associated with high burden, and improvement in care is necessary. Artificial intelligence (AI) has been used to diagnose several medical conditions as well as psychiatric disorders. However, this technology requires large amounts of data to be efficient. Social media data could be used to improve diagnostic capabilities. Objective: The objective of our study is to analyze the current capabilities of AI to use social media data as a diagnostic tool for psychotic disorders. Methods: A systematic review of the literature was conducted using several databases (PubMed, Embase, Cochrane, PsycInfo, and IEEE Xplore) using relevant keywords to search for articles published as of November 12, 2021. We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria to identify, select, and critically assess the quality of the relevant studies while minimizing bias. We critically analyzed the methodology of the studies to detect any bias and presented the results. Results: Among the 93 studies identified, 7 studies were included for analyses. The included studies presented encouraging results. Social media data could be used in several ways to care for patients with schizophrenia, including the monitoring of patients after the first episode of psychosis. We identified several limitations in the included studies, mainly lack of access to clinical diagnostic data, small sample size, and heterogeneity in study quality. We recommend using state-of-the-art natural language processing neural networks, called language models, to model social media activity. Combined with the synthetic minority oversampling technique, language models can tackle the imbalanced data set limitation, which is a necessary constraint to train unbiased classifiers. Furthermore, language models can be easily adapted to the classification task with a procedure called “fine-tuning.” Conclusions: The use of social media data for the diagnosis of psychotic disorders is promising. However, most of the included studies had significant biases; we therefore could not draw conclusions about accuracy in clinical situations. Future studies need to use more accurate methodologies to obtain unbiased results. %M 36066938 %R 10.2196/36986 %U https://www.jmir.org/2022/9/e36986 %U https://doi.org/10.2196/36986 %U http://www.ncbi.nlm.nih.gov/pubmed/36066938 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 3 %P e34230 %T Examining the Effectiveness of Web-Based Interventions to Enhance Resilience in Health Care Professionals: Systematic Review %A Henshall,Catherine %A Ostinelli,Edoardo %A Harvey,Jade %A Davey,Zoe %A Aghanenu,Bemigho %A Cipriani,Andrea %A Attenburrow,Mary-Jane %+ Oxford School of Nursing and Midwifery, Oxford Brookes University, Headington Campus, Marston Road Site, Jack Straw's Ln, Marston, Oxford, OX3 0FL, United Kingdom, 44 7768 918298, chenshall@brookes.ac.uk %K resilience %K health care professionals %K depression %K psychological stress %K internet %K mental health %D 2022 %7 6.9.2022 %9 Review %J JMIR Med Educ %G English %X Background: Internationally, the impact of continued exposure to workplace environmental and psychological stressors on health care professionals’ mental health is associated with increased depression, substance misuse, sleep disorders, and posttraumatic stress. This can lead to staff burnout, poor quality health care, and reduced patient safety outcomes. Strategies to improve the psychological health and well-being of health care staff have been highlighted as a critical priority worldwide. The concept of resilience for health care professionals as a tool for negotiating workplace adversity has gained increasing prominence. Objective: This systematic review aims to examine the effectiveness of web-based interventions to enhance resilience in health care professionals. Methods: We searched the PubMed, CINAHL, PsycINFO, and Ovid SP databases for relevant records published after 1990 until July 2021. We included studies that focused on internet-delivered interventions aiming at enhancing resilience. Study quality was assessed with the Risk of Bias 2 tool for randomized controlled trial designs and Joanna Briggs Institute critical appraisal tool for other study designs. The protocol was registered on PROSPERO (International Prospective Register of Systematic Reviews; CRD42021253190). PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. Results: A total of 8 studies, conducted between 2014 and 2020 and involving 1573 health care workers, were included in the review. In total, 4 randomized controlled trial designs and 4 pre- and postdesign studies were conducted across a range of international settings and health care disciplines. All of these studies aimed to evaluate the impact of web-based interventions on resilience or related symptoms in health care professionals involved in patient-facing care. Interventions included various web-based formats and therapeutic approaches over variable time frames. One randomized controlled trial directly measured resilience, whereas the remaining 3 used proxy measures to measure psychological concepts linked to resilience. Three pretest and posttest studies directly measured resilience, whereas the fourth study used a proxy resilience measure. Owing to the heterogeneity of outcome measures and intervention designs, meta-analysis was not possible, and qualitative data synthesis was undertaken. All studies found that resilience or proxy resilience levels were enhanced in health care workers following the implementation of web-based interventions. The overall risk of bias of all 8 studies was low. Conclusions: The findings indicate that web-based interventions designed to enhance resilience may be effective in clinical practice settings and have the potential to provide support to frontline staff experiencing prolonged workplace stress across a range of health care professional groups. However, the heterogeneity of included studies means that findings should be interpreted with caution; more web-based interventions need rigorous testing to further develop the evidence base. Trial Registration: PROSPERO CRD42021253190; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=253190 %M 36066962 %R 10.2196/34230 %U https://mededu.jmir.org/2022/3/e34230 %U https://doi.org/10.2196/34230 %U http://www.ncbi.nlm.nih.gov/pubmed/36066962 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38716 %T Insights Into Needs and Preferences for Mental Health Support on Social Media and Through Mobile Apps Among Black Male University Students: Exploratory Qualitative Study %A Williams,Kofoworola D A %A Wijaya,Clarisa %A Stamatis,Caitlin A %A Abbott,Gabriel %A Lattie,Emily G %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Drive, 10th floor, Chicago, IL, 60611, United States, 1 (312) 503 2922, kofoworola.williams@northwestern.edu %K Black or African American men %K college %K mental health %K social media %K mobile apps %K mobile phone %D 2022 %7 31.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Black college-aged men are less likely than their peers to use formal, therapeutic in-person services for mental health concerns. As the use of mobile technologies and social media platforms is steadily increasing, it is important to conduct work that examines the future utility of digital tools and technologies to improve access to and uptake of mental health services for Black men and Black men in college. Objective: The aim of this study was to identify and understand college-attending Black men’s needs and preferences for using digital health technologies and social media for stress and mental health symptom management. Methods: Interviews were conducted with Black male students (N=11) from 2 racially diverse universities in the Midwestern United States. Participants were asked questions related to their current mental health needs and interest in using social media platforms and mobile-based apps for their mental health concerns. A thematic analysis was conducted. Results: Four themes emerged from the data: current stress relief strategies, technology-based support needs and preferences (subthemes: mobile-based support and social media–based support), resource information dissemination considerations (subthemes: information-learning expectations and preferences and information-sharing preferences and behaviors), and technology-based mental health support design considerations (subtheme: relatability and representation). Participants were interested in using social media and digital technologies for their mental health concerns and needs, for example, phone notifications and visual-based mental health advertisements that promote awareness. Relatability in the context of representation was emphasized as a key factor for participants interested in using digital mental health tools. Examples of methods for increasing relatability included having tools disseminated by minority-serving organizations and including components explicitly portraying Black men engaging in mental health support strategies. The men also discussed wanting to receive recommendations for stress relief that have been proven successful, particularly for Black men. Conclusions: The findings from this study provide insights into design and dissemination considerations for future work geared toward developing mental health messaging and digital interventions for young Black men. %M 36044261 %R 10.2196/38716 %U https://formative.jmir.org/2022/8/e38716 %U https://doi.org/10.2196/38716 %U http://www.ncbi.nlm.nih.gov/pubmed/36044261 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e39182 %T The Effects of Internet-Based Acceptance and Commitment Therapy on Process Measures: Systematic Review and Meta-analysis %A Han,Areum %A Kim,Tae Hui %+ Department of Psychiatry, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon province, 26426, Republic of Korea, 82 337410534, gooddr@yonsei.ac.kr %K acceptance and commitment therapy %K process measure %K internet-based intervention %K digital mental health %K meta-analysis %K mindfulness %K systematic review %D 2022 %7 30.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Acceptance and commitment therapy (ACT) is based on a psychological flexibility model that encompasses 6 processes: acceptance, cognitive defusion, self-as-context, being present, values, and committed action. Objective: This systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to examine the effects of internet-based ACT (iACT) on process measures. Methods: A comprehensive search was conducted using 4 databases. The quality of the included RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. A random-effects or fixed-effects model was used. Subgroup analyses for each outcome were conducted according to the type of control group, use of therapist guidance, delivery modes, and use of targeted participants, when applicable. Results: A total of 34 RCTs met the inclusion criteria. This meta-analysis found that iACT had a medium effect on psychological flexibility and small effects on mindfulness, valued living, and cognitive defusion at the immediate posttest. In addition, iACT had a small effect on psychological flexibility at follow-up. The overall risk of bias across studies was unclear. Conclusions: Relatively few studies have compared the effects of iACT with active control groups and measured the effects on mindfulness, valued living, and cognitive defusion. These findings support the processes of change in iACT, which mental health practitioners can use to support the use of iACT. %M 36040783 %R 10.2196/39182 %U https://www.jmir.org/2022/8/e39182 %U https://doi.org/10.2196/39182 %U http://www.ncbi.nlm.nih.gov/pubmed/36040783 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e38261 %T Predictors of Dropout in a Digital Intervention for the Prevention and Treatment of Depression in Patients With Chronic Back Pain: Secondary Analysis of Two Randomized Controlled Trials %A Moshe,Isaac %A Terhorst,Yannik %A Paganini,Sarah %A Schlicker,Sandra %A Pulkki-Råback,Laura %A Baumeister,Harald %A Sander,Lasse B %A Ebert,David Daniel %+ Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 63, Helsinki, 00014, Finland, 358 406324442, isaac.moshe@helsinki.fi %K adherence %K dropout %K law of attrition %K attrition %K digital health %K internet intervention %K depression %K back pain %K comorbidity %K mental health %K eHealth %K mobile phone %D 2022 %7 30.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is a common comorbid condition in individuals with chronic back pain (CBP), leading to poorer treatment outcomes and increased medical complications. Digital interventions have demonstrated efficacy in the prevention and treatment of depression; however, high dropout rates are a major challenge, particularly in clinical settings. Objective: This study aims to identify the predictors of dropout in a digital intervention for the treatment and prevention of depression in patients with comorbid CBP. We assessed which participant characteristics may be associated with dropout and whether intervention usage data could help improve the identification of individuals at risk of dropout early on in treatment. Methods: Data were collected from 2 large-scale randomized controlled trials in which 253 patients with a diagnosis of CBP and major depressive disorder or subclinical depressive symptoms received a digital intervention for depression. In the first analysis, participants’ baseline characteristics were examined as potential predictors of dropout. In the second analysis, we assessed the extent to which dropout could be predicted from a combination of participants’ baseline characteristics and intervention usage variables following the completion of the first module. Dropout was defined as completing <6 modules. Analyses were conducted using logistic regression. Results: From participants’ baseline characteristics, lower level of education (odds ratio [OR] 3.33, 95% CI 1.51-7.32) and both lower and higher age (a quadratic effect; age: OR 0.62, 95% CI 0.47-0.82, and age2: OR 1.55, 95% CI 1.18-2.04) were significantly associated with a higher risk of dropout. In the analysis that aimed to predict dropout following completion of the first module, lower and higher age (age: OR 0.60, 95% CI 0.42-0.85; age2: OR 1.59, 95% CI 1.13-2.23), medium versus high social support (OR 3.03, 95% CI 1.25-7.33), and a higher number of days to module completion (OR 1.05, 95% CI 1.02-1.08) predicted a higher risk of dropout, whereas a self-reported negative event in the previous week was associated with a lower risk of dropout (OR 0.24, 95% CI 0.08-0.69). A model that combined baseline characteristics and intervention usage data generated the most accurate predictions (area under the receiver operating curve [AUC]=0.72) and was significantly more accurate than models based on baseline characteristics only (AUC=0.70) or intervention usage data only (AUC=0.61). We found no significant influence of pain, disability, or depression severity on dropout. Conclusions: Dropout can be predicted by participant baseline variables, and the inclusion of intervention usage variables may improve the prediction of dropout early on in treatment. Being able to identify individuals at high risk of dropout from digital health interventions could provide intervention developers and supporting clinicians with the ability to intervene early and prevent dropout from occurring. %M 36040780 %R 10.2196/38261 %U https://www.jmir.org/2022/8/e38261 %U https://doi.org/10.2196/38261 %U http://www.ncbi.nlm.nih.gov/pubmed/36040780 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37851 %T Digital Interventions to Enhance Readiness for Psychological Therapy: Scoping Review %A Jardine,Jacinta %A Bowman,Robert %A Doherty,Gavin %+ School of Computer Science and Statistics, Trinity College Dublin, Hamilton Building, College Green, Dublin, D02 W272, Ireland, 353 861505715, jjardine@tcd.ie %K readiness for change %K stages of change %K digital %K motivation %K engagement %K uptake %K mental health %K mental illness %K mobile phone %D 2022 %7 30.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Psychological therapy is an effective treatment method for mental illness; however, many people with mental illness do not seek treatment or drop out of treatment early. Increasing client uptake and engagement in therapy is key to addressing the escalating global problem of mental illness. Attitudinal barriers, such as a lack of motivation, are a leading cause of low engagement in therapy. Digital interventions to increase motivation and readiness for change hold promise as accessible and scalable solutions; however, little is known about the range of interventions being used and their feasibility as a means to increase engagement with therapy. Objective: This review aimed to define the emerging field of digital interventions to enhance readiness for psychological therapy and detect gaps in the literature. Methods: A literature search was conducted in PubMed, PsycINFO, PsycARTICLES, Scopus, Embase, ACM Guide to Computing Literature, and IEEE Xplore Digital Library from January 1, 2006, to November 30, 2021. The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology was applied. Publications were included when they concerned a digitally delivered intervention, a specific target of which was enhancing engagement with further psychological treatment, and when this intervention occurred before the target psychological treatment. Results: A total of 45 publications met the inclusion criteria. The conditions included depression, unspecified general mental health, comorbid anxiety and depression, smoking, eating disorders, suicide, social anxiety, substance use, gambling, and psychosis. Almost half of the interventions (22/48, 46%) were web-based programs; the other formats included screening tools, videos, apps, and websites. The components of the interventions included psychoeducation, symptom assessment and feedback, information on treatment options and referrals, client testimonials, expectation management, and pro-con lists. Regarding feasibility, of the 16 controlled studies, 7 (44%) measuring actual behavior or action showed evidence of intervention effectiveness compared with controls, 7 (44%) found no differences, and 2 (12%) indicated worse behavioral outcomes. In general, the outcomes were mixed and inconclusive owing to variations in trial designs, control types, and outcome measures. Conclusions: Digital interventions to enhance readiness for psychological therapy are broad and varied. Although these easily accessible digital approaches show potential as a means of preparing people for therapy, they are not without risks. The complex nature of stigma, motivation, and individual emotional responses toward engaging in treatment for mental health difficulties suggests that a careful approach is needed when developing and evaluating digital readiness interventions. Further qualitative, naturalistic, and longitudinal research is needed to deepen our knowledge in this area. %M 36040782 %R 10.2196/37851 %U https://www.jmir.org/2022/8/e37851 %U https://doi.org/10.2196/37851 %U http://www.ncbi.nlm.nih.gov/pubmed/36040782 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39387 %T Predicting Psychological Symptoms When Facebook’s Digital Well-being Features Are Used: Cross-sectional Survey Study %A Barsova,Tamara %A Cheong,Zi Gi %A Mak,Ann R %A Liu,Jean CJ %+ Yale-NUS College, 28 College Avenue West, #01-501, Singapore, 138533, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K mental health %K social media %K digital well-being %K depression %K anxiety %K stress %D 2022 %7 29.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prior research has linked social media usage to poorer mental health. To address these concerns, social media platforms have introduced digital well-being tools to help users monitor their engagement. Nonetheless, little is known about the effectiveness of these tools. Objective: In this study, we focused on Facebook to assess users’ awareness and usage of the following six Facebook well-being tools: the Unfollow, Snooze, Off-Facebook Activity, Your Time on Facebook, Set Daily Reminders, and Notification Settings features. Additionally, we examined whether the use of these tools was associated with better mental health outcomes. Methods: We conducted a cross-sectional survey of 598 Facebook users. The survey comprised questions about (1) baseline Facebook use, (2) the adoption of Facebook’s digital well-being tools, and (3) participant demographics. These were used to predict the primary outcome measure—scores on the 21-item Depression, Anxiety, and Stress Scale. Results: Most participants (580/598, 97%) knew about Facebook’s digital well-being tools, but each tool was used by only 17.4% (104/598) to 55.5% (332/598) of participants. In turn, the use of two tools was associated with better well-being; although participants who spent more time on Facebook reported higher levels of depression, anxiety, and stress, those who managed their feed content or notifications by using the Unfollow or Notification Settings features had lower scores on each of these measures. However, the use of the Snooze, Off-Facebook Activity, Your Time on Facebook, or Set Time Reminder features was not associated with lower depression, anxiety, or stress scores. Conclusions: Of the 6 Facebook digital well-being tools, only 2 were associated with better mental health among users. This underscores the complexity of designing social media platforms to promote user welfare. Consequently, we urge further research into understanding the efficacy of various digital well-being tools. Trial Registration: ClinicalTrials.gov NCT04967846; https://clinicaltrials.gov/ct2/show/study/NCT04967846 %M 36036971 %R 10.2196/39387 %U https://formative.jmir.org/2022/8/e39387 %U https://doi.org/10.2196/39387 %U http://www.ncbi.nlm.nih.gov/pubmed/36036971 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e25716 %T Self-help Digital Interventions Targeted at Improving Psychological Well-being in Young People With Perceived or Clinically Diagnosed Reduced Well-being: Systematic Review %A Babbage,Camilla M %A Jackson,Georgina M %A Davies,E Bethan %A Nixon,Elena %+ National Institute for Health and Care Research (NIHR) MindTech Medtech Co-operative, Mental Health & Clinical Neurosciences, Institute of Mental Health, University of Nottingham, University Of Nottingham Innovation Park, Nottingham, NG7 2TU, United Kingdom, 44 1158232438, Camilla.Babbage@nottingham.ac.uk %K digital health interventions %K psychological well-being %K mental well-being %K mental disorders %K mental health %K children and young people %K self-help %K systematic review %D 2022 %7 26.8.2022 %9 Review %J JMIR Ment Health %G English %X Background: Levels of well-being are declining, whereas rates of mental health problems remain high in young people. The World Health Organization defines mental health as not merely the absence of mental disorder but also includes social and psychological well-being as integral to positive mental health, highlighting that mental health is applicable to young people with mental health conditions and those without a diagnosis of a mental health condition. Reduced mental well-being have been identified in studies of young people with clinical populations, as well as in populations consisting of nonclinical young people. Self-help digital interventions can be delivered at mass at a low cost and without the need for trained input, thereby facilitating access to support for well-being. Self-help interventions are effective in young people with mental health conditions, but systematic reviews of such studies have been limited to randomized controlled trials, have not included reduced well-being as an inclusion criterion, and do not consider engagement factors such as retention. Objective: The objective of this study was to systematically review all controlled studies of digitally delivered, self-administered interventions for young people aged 9 to 25 years, with perceived or clinically diagnosed reduced psychological well-being. Participant retention and effectiveness of the interventions were also explored. Methods: A systematic search of the PsycInfo, EMBASE, Cochrane, Scopus, and MEDLINE databases from inception to 2021, reference searches of relevant papers, and gray literature was carried out for digitally controlled studies conducted with young people with perceived or clinically diagnosed reduced well-being, aimed at improving psychological well-being. Data were extracted to identify the effectiveness and retention rates of the interventions and the quality of the studies. Results: Overall, 1.04% (12/1153) of studies met the inclusion criteria: 83% (10/12) of studies were randomized controlled trials and 17% (2/12) were controlled pre-post studies. Most (6/12, 50%) studies aimed to improve symptoms of depression; 3 interventions aimed at both anxiety and depressive symptoms and 2 studies aimed at improving social functioning difficulties. Owing to the high risk of bias across interventions and lack of similar outcome measures, a meta-analysis was not conducted. Retention rates across studies were regarded as good, with moderate to high retention. Overall, the findings indicated that predominantly self-administered self-help interventions improved well-being in the areas targeted by the intervention and identified additional areas of well-being that were positively affected by interventions. Few interventions supported psychological well-being that was different from those used by young people with a clinical diagnosis of mental illness or young people from neurodiverse backgrounds. Conclusions: The findings, along with the advantages of self-help interventions, highlight the need for upscaling self-help interventions to better support vulnerable populations of young people who experience poor psychological well-being. Trial Registration: PROSPERO CRD42019129321; https://tinyurl.com/4fb2t4fz %M 36018675 %R 10.2196/25716 %U https://mental.jmir.org/2022/8/e25716 %U https://doi.org/10.2196/25716 %U http://www.ncbi.nlm.nih.gov/pubmed/36018675 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e36000 %T Effects of a WeChat-Based Life Review Program for Patients With Digestive System Cancer: 3-Arm Parallel Randomized Controlled Trial %A Zheng,Meihua %A Zhang,Xiaoling %A Xiao,Huimin %+ School of Nursing, Fujian Medical University, No 1 Xuefu North Road, University Town, Shangjie Town, Minhou County, Fuzhou City, Fujian Province, 350122, China, 86 13860692061, huimin_xiao@126.com %K digestive system cancer %K life review %K digital technology %K anxiety %K depression %K hope %K self-transcendence %K cancer %K randomized controlled trial %K distress %K psychological %K digestive system %D 2022 %7 25.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with digestive system cancer often experience psychospiritual distress. Life review is an evidence-based psychological intervention for patients with cancer, but the effects of digital life review programs are unclear, especially for patients with digestive system cancer. Objective: We examined the effects of a WeChat-based life review program on the psychospiritual well-being of patients with digestive system cancer. Methods: This study was a 3-arm parallel randomized controlled trial. Eligible patients with digestive system cancer were recruited from a university hospital in Fujian, China. They were randomized to a life review group and 2 control groups. All participants received routine care, and the life review group also received the 4-week WeChat-based life review program. Control group 1 also received a 4-week program of friendly visiting. Anxiety, depression, hope, and self-transcendence were measured at baseline and 2 days, 1 month, and 6 months after the intervention. Results: A total of 150 participants were randomly allocated to the WeChat-based life review group (n=50), control group 1 (n=50), or control group 2 (n=50). The overall dropout rate was 10% (15/150), and 92% (46/50) of participants in the the life review group completed the intervention. Significant interaction effects for time and group membership were found for anxiety (P<.001), depression (P<.001), hope (P<.001), and self-transcendence (P<.001) at all follow-up time points. For anxiety and depression, the scores did not differ significantly between the life review group and control group 1 on day 2 (P=.80 for anxiety, P=.51 for depression), but the scores were significantly lower in the life review group at month 1 and month 6 (P=.02 for anxiety at both months 1 and 6; P=.003 and P<.001 for depression at months 1 and 6, respectively). Significant increases in hope and self-transcendence were revealed in the life review group compared to control group participants at all follow-up sessions. Conclusions: The WeChat-based life review program was effective in reducing anxiety and depressive symptoms and in improving the level of hope and self-transcendence among patients with digestive system cancer. Though friendly visiting can also help to relieve anxiety, its effects are short-term. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IOR-17011998; https://tinyurl.com/5acycpd4 %M 36006665 %R 10.2196/36000 %U https://www.jmir.org/2022/8/e36000 %U https://doi.org/10.2196/36000 %U http://www.ncbi.nlm.nih.gov/pubmed/36006665 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 8 %P e31744 %T Health Care Workers’ Need for Headspace: Findings From a Multisite Definitive Randomized Controlled Trial of an Unguided Digital Mindfulness-Based Self-help App to Reduce Healthcare Worker Stress %A Taylor,Heather %A Cavanagh,Kate %A Field,Andy P %A Strauss,Clara %+ School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QH, United Kingdom, 44 01273 876638, c.y.strauss@sussex.ac.uk %K self-help %K mindfulness %K randomized control trial %K health care worker %K National Health Service %K NHS %K doctors %K nurses %K stress %K mental health %K burnout %K mobile phone %D 2022 %7 25.8.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care workers experience high stress. Accessible, affordable, and effective approaches to reducing stress are lacking. In-person mindfulness-based interventions can reduce health care worker stress but are not widely available or accessible to busy health care workers. Unguided, digital, mindfulness-based self-help (MBSH) interventions show promise and can be flexibly engaged with. However, their effectiveness in reducing health care worker stress has not yet been explored in a definitive trial. Objective: This study aimed to investigate the effectiveness of an unguided digital MBSH app (Headspace) in reducing health care worker stress. Methods: This was a definitive superiority randomized controlled trial with 2182 National Health Service staff in England recruited on the web and allocated in a 1:1 ratio to fully automated Headspace (n=1095, 50.18%) or active control (Moodzone; n=1087, 49.82%) for 4.5 months. Outcomes were subscales of the Depression, Anxiety, and Stress (primary outcome) Scale short form; Short Warwick Edinburgh Mental Well-being Scale; Maslach Burnout Inventory; 15-item Five-Facet Mindfulness Questionnaire minus Observe items; Self-Compassion Scale–Short Form; Compassionate Love Scale; Penn State Worry Questionnaire; Brooding subscale of the Ruminative Response Scale; and sickness absence. Results: Intention-to-treat analyses found that Headspace led to greater reductions in stress over time than Moodzone (b=–0.31, 95% CI –0.47 to –0.14; P<.001), with small effects. Small effects of Headspace versus Moodzone were found for depression (b=–0.24, 95% CI –0.40 to –0.08; P=.003), anxiety (b=–0.19, 95% CI –0.32 to –0.06; P=.004), well-being (b=0.14, 95% CI 0.05-0.23; P=.002), mindfulness (b=0.22, 95% CI 0.09-0.34; P=.001), self-compassion (b=0.48, 95% CI 0.33-0.64; P<.001), compassion for others (b=0.02, 95% CI 0.00-0.04; P=.04), and worry (b=–0.30, 95% CI –0.51 to –0.09; P=.005) but not for burnout (b=–0.19, –0.04, and 0.13, all 95% CIs >0; P=.65, .67, and .35), ruminative brooding (b=–0.06, 95% CI –0.12 to 0.00; P=.06), or sickness absence (γ=0.09, 95% CI –0.18 to 0.34). Per-protocol effects of Headspace (454/1095, 41.46%) versus Moodzone (283/1087, 26.03%) over time were found for stress, self-compassion, and compassion for others but not for the other outcomes. Engagement (practice days per week) and improvements in self-compassion during the initial 1.5-month intervention period mediated pre- to postintervention improvements in stress. Improvements in mindfulness, rumination, and worry did not mediate pre- to postintervention improvements in stress. No serious adverse events were reported. Conclusions: An unguided digital MBSH intervention (Headspace) can reduce health care workers’ stress. Effect sizes were small but could have population-level benefits. Unguided digital MBSH interventions can be part of the solution to reducing health care worker stress alongside potentially costlier but potentially more effective in-person mindfulness-based interventions, nonmindfulness courses, and organizational-level interventions. Trial Registration: International Standard Randomised Controlled Trial Number ISRCTN15424185; https://tinyurl.com/rv9en5kc %M 36006668 %R 10.2196/31744 %U https://mhealth.jmir.org/2022/8/e31744 %U https://doi.org/10.2196/31744 %U http://www.ncbi.nlm.nih.gov/pubmed/36006668 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e37837 %T Multi-operator Self-exclusion as a Harm Reduction Measure in Problem Gambling: Retrospective Clinical Study on Gambling Relapse Despite Self-exclusion %A Håkansson,Anders %A Åkesson,Gunny %+ Clinical Research Unit, Competence Center Addiction, Malmö Addiction Center, Region Skåne, Södra Tullgatan 4, plan 6, Malmö, 20502, Sweden, 46 40333883, anders_c.hakansson@med.lu.se %K web-based gambling %K gambling disorder %K behavioral addiction %K self-exclusion %K addiction %K gambling %K prevalence %K harm reduction %K abstain %K problem gambling %D 2022 %7 19.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Voluntary self-exclusion from gambling is a common harm reduction option for individuals with gambling problems. Multi-operator, nationwide self-exclusion services are rare, and a system introduced in the highly web-based gambling market of Sweden is a rare and recent example. However, where web-based casino gambling and web-based betting are the predominate gambling types in those seeking treatment, the risk of breaching one’s own self-exclusion through overseas web-based operators may also be high. Objective: This study aims to assess the prevalence of a nationwide Spelpaus (“gambling break”) self-exclusion and the prevalence of gambling despite self-exclusion in patients seeking treatment for gambling disorder in 2021. Methods: Health care documentation of recent treatment seekers (January 1 through September 1, 2021, N=85) in a Swedish treatment facility was reviewed for data regarding problematic gambling types reported, history of self-exclusion, and history of breaching of that self-exclusion. Results: Common problem gambling types were web-based casino gambling (49/74, 66%) and sports betting (19/74, 26%). The majority who participated in this study (62/85, 73%) were men. All women reported web-based casino gambling. Self-exclusion through Spelpaus was common (60/74, 81%). Among self-excluders, gambling despite self-exclusion was common (41/60, 68%), most commonly on unlicensed gambling websites. Conclusions: The nationwide, multi-operator self-exclusion service of Sweden appears to reach many patients with a gambling disorder. However, the remaining gambling options in an web-based gambling setting present a major challenge despite self-exclusion. The recent data calls for further treatment efforts and potential improvements in services aiming to help voluntary self-excluders abstain from gambling. %M 35984678 %R 10.2196/37837 %U https://mental.jmir.org/2022/8/e37837 %U https://doi.org/10.2196/37837 %U http://www.ncbi.nlm.nih.gov/pubmed/35984678 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35661 %T Apprentices’ Attitudes Toward Using a Mental Health Mobile App to Support Healthy Coping: Mixed Methods Study %A Choi,Isabella %A Petrie,Katherine %A Einboden,Rochelle %A Collins,Daniel %A Ryan,Rose %A Johnston,David %A Harvey,Samuel B %A Glozier,Nicholas %A Wray,Alexis %A Deady,Mark %+ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Level 5 Professor Marie Bashir Centre, Missenden Road, Camperdown, Sydney, 2050, Australia, 61 0286277240, isabella.choi@sydney.edu.au %K apprentice %K coping strategies %K mental health %K app %K wellbeing %K focus group %K coping behaviour %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Apprenticeships are a common pathway for young people transitioning into the workforce. Apprentices often face many employment-related challenges and have high levels of psychological distress, drug and alcohol use, and suicidal ideation. Little is known about the attitudes of apprentices toward using smartphone apps to support their mental health and the content that would engage them. Objective: This study explored (1) apprentices’ interest in using an app to support their mental health and (2) the healthy coping strategies used to manage their mental well-being in the face of workplace challenges, in order to inform future app content. Methods: A mixed methods study was conducted with 54 apprentices (50/54 male, 93%) with a mean age of 22.7 (SD 5.7) years. Participants completed a survey on preferred ways of using an app to support mental health. Across 8 focus groups, participants were asked to describe healthy strategies they used to cope with occupational stressors. Results: Only 11% (6/54) of participants currently used a well-being app, but there was high interest in using an app to support their friends (47/54 participants, 87%) and develop self-help strategies to manage or prevent mental health issues (42/54 participants, 78%). Four major types of coping behaviors were identified: (1) social connection for disclosure, advice, and socializing; (2) pleasurable activities, such as engaging in hobbies, time-outs, and developing work-life separation; (3) cognitive approaches, including defusing from thoughts and cognitive reframing; and (4) self-care approaches, including exercise, a healthy diet, and getting adequate sleep. Conclusions: There is interest among apprentices to use an app with a positive well-being focus that helps them to develop self-management skills and support their friends. Apprentices utilized a range of healthy behaviors to cope with workplace stressors that can be incorporated into mental health apps to improve uptake and engagement. However, many of the preferred coping strategies identified are not those focused on by currently available apps, indicating the need for more targeted digital interventions for this group. %M 35980733 %R 10.2196/35661 %U https://humanfactors.jmir.org/2022/3/e35661 %U https://doi.org/10.2196/35661 %U http://www.ncbi.nlm.nih.gov/pubmed/35980733 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e39519 %T Social Media Use and Well-being With Bipolar Disorder During the COVID-19 Pandemic: Path Analysis %A Pollock Star,Ariel %A Bachner,Yaacov G %A Cohen,Bar %A Haglili,Ophir %A O'Rourke,Norm %+ Department of Epidemiology, Biostatistics and Community Health Sciences, School of Public Health, Ben-Gurion University of the Negev, P.O. Box 653, Be'er Sheva, Israel, 972 08 647 7301, ORourke@bgu.ac.il %K bipolar disorder %K COVID-19 %K life satisfaction %K loneliness %K social media use %K social media %K Facebook %K social support %K mental health %K mental illness %K mental disorder %K social media advertising %K advertising %K advertisement %K mania %K hypo/mania %K manic %K depressive %K depression %D 2022 %7 18.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Reliable and consistent social support is associated with the mental health and well-being of persons with severe mental illness, including bipolar disorder (BD). Yet the COVID-19 pandemic and associated social distancing measures (eg, shelter in place) reduced access to regular social contacts, while social media use (SMU) increased concomitantly. Little is currently known about associations between the well-being of adults with BD and different types of SMU (eg, passive and active). Objective: For this study, we had two goals. First, we report descriptive information regarding SMU by persons with BD during COVID-19 (all platforms). Specific to Facebook, we next developed and tested a hypothesized model to identify direct and indirect associations between BD symptoms, social support, loneliness, life satisfaction, and SMU. Responses were collected during the global spread of the Delta variant and prior/concurrent with the Omicron variant, 20 months after the World Health Organization declared COVID-19 a global pandemic. Methods: Over 8 weeks, we obtained responses from an international sample of 102 adults with BD using the Qualtrics online platform. Most had previously participated in the BADAS (Bipolar Affective Disorders and older Adults) Study (n=89, 87.3%); the remainder were recruited specifically for this research (n=13, 2.7%). The subsamples did not differ in age (t100=1.64; P=.10), gender (χ22=0.2; P=.90), socioeconomic status (χ26=9.9; P=.13), or time since BD diagnosis (t97=1.27; P=.21). Both were recruited using social media advertising micro-targeted to adults with BD. On average, participants were 53.96 (SD 13.22, range 20-77) years of age, they had completed 15.4 (SD 4.28) years of education, and were diagnosed with BD 19.6 (SD 10.31) years ago. Path analyses were performed to develop and test our hypothesized model. Results: Almost all participants (n=95, 93.1%) reported having both Facebook and LinkedIn accounts; 91.2% (n=93) reported regular use of either or both. During the pandemic, most (n=62, 60.8%) reported accessing social media several times a day; 36.3% (n=37) reported using social media more often since the emergence of COVID-19. Specific to Facebook, the model we hypothesized differed somewhat from what emerged. The resulting model suggests that symptoms of depression predict loneliness and, inversely, social support and life satisfaction. Social support predicts social Facebook use, whereas passive Facebook use predicts life satisfaction. Symptoms of depression emerged as indirect predictors of SMU via social support. Conclusions: Our findings suggest that the operational definition of passive-active SMU requires further analysis and refinement. In contrast to theory, passive Facebook use appears positively associated with well-being among certain populations. Longitudinal data collection over multiple points is required to identify associations between BD symptoms, SMU, and well-being over time. %M 35980726 %R 10.2196/39519 %U https://formative.jmir.org/2022/8/e39519 %U https://doi.org/10.2196/39519 %U http://www.ncbi.nlm.nih.gov/pubmed/35980726 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e34705 %T Detecting Potentially Harmful and Protective Suicide-Related Content on Twitter: Machine Learning Approach %A Metzler,Hannah %A Baginski,Hubert %A Niederkrotenthaler,Thomas %A Garcia,David %+ Section for the Science of Complex Systems, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria, 43 159991 ext 604, metzler@csh.ac.at %K suicide prevention %K Twitter %K social media %K machine learning %K deep learning %D 2022 %7 17.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Research has repeatedly shown that exposure to suicide-related news media content is associated with suicide rates, with some content characteristics likely having harmful and others potentially protective effects. Although good evidence exists for a few selected characteristics, systematic and large-scale investigations are lacking. Moreover, the growing importance of social media, particularly among young adults, calls for studies on the effects of the content posted on these platforms. Objective: This study applies natural language processing and machine learning methods to classify large quantities of social media data according to characteristics identified as potentially harmful or beneficial in media effects research on suicide and prevention. Methods: We manually labeled 3202 English tweets using a novel annotation scheme that classifies suicide-related tweets into 12 categories. Based on these categories, we trained a benchmark of machine learning models for a multiclass and a binary classification task. As models, we included a majority classifier, an approach based on word frequency (term frequency-inverse document frequency with a linear support vector machine) and 2 state-of-the-art deep learning models (Bidirectional Encoder Representations from Transformers [BERT] and XLNet). The first task classified posts into 6 main content categories, which are particularly relevant for suicide prevention based on previous evidence. These included personal stories of either suicidal ideation and attempts or coping and recovery, calls for action intending to spread either problem awareness or prevention-related information, reporting of suicide cases, and other tweets irrelevant to these 5 categories. The second classification task was binary and separated posts in the 11 categories referring to actual suicide from posts in the off-topic category, which use suicide-related terms in another meaning or context. Results: In both tasks, the performance of the 2 deep learning models was very similar and better than that of the majority or the word frequency classifier. BERT and XLNet reached accuracy scores above 73% on average across the 6 main categories in the test set and F1-scores between 0.69 and 0.85 for all but the suicidal ideation and attempts category (F1=0.55). In the binary classification task, they correctly labeled around 88% of the tweets as about suicide versus off-topic, with BERT achieving F1-scores of 0.93 and 0.74, respectively. These classification performances were similar to human performance in most cases and were comparable with state-of-the-art models on similar tasks. Conclusions: The achieved performance scores highlight machine learning as a useful tool for media effects research on suicide. The clear advantage of BERT and XLNet suggests that there is crucial information about meaning in the context of words beyond mere word frequencies in tweets about suicide. By making data labeling more efficient, this work has enabled large-scale investigations on harmful and protective associations of social media content with suicide rates and help-seeking behavior. %M 35976193 %R 10.2196/34705 %U https://www.jmir.org/2022/8/e34705 %U https://doi.org/10.2196/34705 %U http://www.ncbi.nlm.nih.gov/pubmed/35976193 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e37640 %T Appropriate Use and Operationalization of Adherence to Digital Cognitive Behavioral Therapy for Depression and Anxiety in Youth: Systematic Review %A Li,Sophie H %A Achilles,Melinda R %A Werner-Seidler,Aliza %A Beames,Joanne R %A Subotic-Kerry,Mirjana %A O'Dea,Bridianne %+ Black Dog Institute and School of Psychology, The University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 411116615, s.h.li@blackdog.org.au %K adherence %K youth %K digital %K cognitive behavioral therapy %K review %K mobile phone %D 2022 %7 17.8.2022 %9 Review %J JMIR Ment Health %G English %X Background: Digital, self-guided cognitive behavioral therapy (CBT) interventions circumvent many barriers to in-person therapy for young people (aged 12-24 years), although adherence to these interventions is low. The absence or insufficient disclosure of recommendations or instructions for appropriate use may account for this. As such, many young people may not self-administer these interventions appropriately or receive the optimal degree of treatment. Objective: This systematic review aims to synthesize the literature on digital CBT for depression and anxiety in young people to describe how appropriate use has been defined and communicated to users as instructions for use, to describe how adherence has been measured, and to determine the associations between adherence and treatment outcomes. Methods: A systematic review was conducted with 2 reviewers (SHL and MRA) extracting data independently. Overall, 4 electronic databases (Embase, MEDLINE, PsycINFO, and Cochrane Library) were searched in April 2021 for studies that met the following inclusion criteria: participants aged between 12 and 24 years, evaluated a digital CBT intervention targeting depression or anxiety, and reported instructions or recommendations for use or measures of adherence. Studies that evaluated non-CBT interventions or cognitive- or behavioral-only interventions were excluded. Methodological quality was assessed using the Cochrane Risk of Bias Tool and the Integrated Quality Criteria for the Review of Multiple Study Designs. Results: There were 32 manuscripts that met the inclusion criteria, of which 28 (88%) were unique studies (N=16,578 youths). Definitions of appropriate use varied among the different interventions in terms of intended recipients, duration and frequency of use, and the features used to support engagement and adherence to appropriate use definitions. Reporting of appropriate use definitions in studies was inconsistent, with no study systematically describing components of appropriate use or providing information on how recommendations for use were relayed to users. Most often, definitions of appropriate use were derived from the study protocol and descriptions of intervention features. Adherence was mostly operationalized as the degree of intervention completion; however, reporting of adherence data was heterogeneous. There was little evidence of an association between degree of use and outcomes in the 9 studies that examined this. Conclusions: Definitions of appropriate use are unique to each digital CBT intervention. However, statements of appropriate use are not systematically reported in the literature. Furthermore, the extent to which recommendations for use are communicated to users is not routinely reported. Despite unique definitions of appropriate use, adherence was most often generically operationalized as the degree of intervention completion and was not consistently associated with outcomes. We proposed a framework to promote systematic reporting of definitions of appropriate use for digital interventions to provide guidance to users and to assist the development of appropriate and nuanced measures of adherence. Trial Registration: PROSPERO CRD42020208668; https://tinyurl.com/4bu2yram %M 35976180 %R 10.2196/37640 %U https://mental.jmir.org/2022/8/e37640 %U https://doi.org/10.2196/37640 %U http://www.ncbi.nlm.nih.gov/pubmed/35976180 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e33545 %T Operationalizing Engagement With an Interpretation Bias Smartphone App Intervention: Case Series %A Ramadurai,Ramya %A Beckham,Erin %A McHugh,R Kathryn %A Björgvinsson,Thröstur %A Beard,Courtney %+ Department of Psychology, American University, 4400 Massachusetts Avenue NW, Washington, DC, 20016, United States, 1 202 885 8000, rr4748a@student.american.edu %K engagement %K mental health apps %K cognitive bias modification %K human support %K mobile health %K mHealth %K mobile phone %D 2022 %7 17.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Engagement with mental health smartphone apps is an understudied but critical construct to understand in the pursuit of improved efficacy. Objective: This study aimed to examine engagement as a multidimensional construct for a novel app called HabitWorks. HabitWorks delivers a personalized interpretation bias intervention and includes various strategies to enhance engagement such as human support, personalization, and self-monitoring. Methods: We examined app use in a pilot study (n=31) and identified 5 patterns of behavioral engagement: consistently low, drop-off, adherent, high diary, and superuser. Results: We present a series of cases (5/31, 16%) from this trial to illustrate the patterns of behavioral engagement and cognitive and affective engagement for each case. With rich participant-level data, we emphasize the diverse engagement patterns and the necessity of studying engagement as a heterogeneous and multifaceted construct. Conclusions: Our thorough idiographic exploration of engagement with HabitWorks provides an example of how to operationalize engagement for other mental health apps. %M 35976196 %R 10.2196/33545 %U https://mental.jmir.org/2022/8/e33545 %U https://doi.org/10.2196/33545 %U http://www.ncbi.nlm.nih.gov/pubmed/35976196 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e26615 %T A Game-Based School Program for Mental Health Literacy and Stigma on Depression (Moving Stories): Cluster Randomized Controlled Trial %A Tuijnman,Anouk %A Kleinjan,Marloes %A Olthof,Merlijn %A Hoogendoorn,Evert %A Granic,Isabela %A Engels,Rutger CME %+ Behavioural Science Institute, Radboud University Nijmegen, Postbus 9104, Nijmegen, 6500 HE, Netherlands, 31 243610082, anouk.tuijnman@ru.nl %K depression %K help-seeking behavior %K helping behavior %K health literacy %K stigma %K video games %K adolescence %K secondary schools %K mental health %K digital health %D 2022 %7 17.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depressive symptoms are highly prevalent among adolescents in Western countries. However, although treatment for depressive symptoms is available, many adolescents do not seek help when they need it. Important barriers to help-seeking among adolescents include low mental health literacy and high stigma. Therefore, we have developed a game-based school program, Moving Stories, which combines mental health literacy training for depression with contact with someone with lived experience both in the digital and nondigital world. Objective: The aim of this study is to conduct a first test of the effectiveness of the newly developed game-based program, Moving Stories, using a cluster randomized controlled trial. Methods: A total of 185 adolescents participated, divided over 10 classes from 4 schools. Half of the classes were randomly selected to follow the Moving Stories program, whereas the other half were in the control group, where no intervention was provided. The adolescents filled out digital questionnaires at 4 time points, with questions on mental health literacy, stigma, depressive symptoms, and the program itself (before the program, after the program, 3-month follow-up, and 6-month follow-up). Using R (R Foundation for Statistical Computing), we ran linear mixed-effects models for all continuous outcome variables and generalized linear mixed-effects models for all binary outcome variables. Results: Compared with the control group, participants in the Moving Stories group improved after the program in personal stigma (b=−0.53, 95% CI −1.02 to −0.03; t179.16=−2.08; P=.04). Effects on personal stigma lasted over time (3-month follow-up: b=−0.57, 95% CI −1.11 to −0.03; t174.39=−2.07; P=.04). Most adolescents in the Moving Stories group participated in the introduction (97/99, 98%) and contact session (93/99, 94%), played the game for 4 or 5 days (83/99, 83%), and indicated that they would recommend the game to their peers (90/98, 92%). Conclusions: The results of this study show the potential of Moving Stories as a stigma reduction program. With changes in the program to improve its effects on mental health literacy, Moving Stories could be implemented in schools to improve help-seeking in adolescents and reduce the negative consequences and burden of depressive symptoms. Trial Registration: Dutch Trial Register NTR7033; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7033 International Registered Report Identifier (IRRID): RR2-10.2196/11255 %M 35976200 %R 10.2196/26615 %U https://mental.jmir.org/2022/8/e26615 %U https://doi.org/10.2196/26615 %U http://www.ncbi.nlm.nih.gov/pubmed/35976200 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37973 %T The Effects of Internet-Based Storytelling Programs (Amazing Adventure Against Stigma) in Reducing Mental Illness Stigma With Mediation by Interactivity and Stigma Content: Randomized Controlled Trial %A Fong,Tiffany H C %A Mak,Winnie W S %+ Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong, Hong Kong, 852 39436577, wwsmak@psy.cuhk.edu.hk %K mental illness stigma %K internet-based %K interactivity %K storytelling %K social distance %K microaggression %D 2022 %7 12.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental illness stigma has been a global concern, owing to its adverse effects on the recovery of people with mental illness, and may delay help-seeking for mental health because of the concern of being stigmatized. With technological advancement, internet-based interventions for the reduction of mental illness stigma have been developed, and these effects have been promising. Objective: This study aimed to examine the differential effects of internet-based storytelling programs, which varied in the levels of interactivity and stigma content, in reducing mental illness stigma. Methods: Using an experimental design, this study compared the effects of 4 storytelling websites that varied in the levels of interactivity and stigma content. Specifically, the conditions included an interactive website with stigma-related content (combo condition), a noninteractive website with stigma-related content (stigma condition), an interactive website without stigma-related content (interact condition), and a noninteractive website without stigma-related content (control condition). Participants were recruited via mass emails to all students and staff of a public university and via social networking sites. Eligible participants were randomized into the following four conditions: combo (n=67), stigma (n=65), interact (n=64), or control (n=67). The participants of each group viewed the respective web pages at their own pace. Public stigma, microaggression, and social distance were measured on the web before the experiment, after the experiment, and at the 1-week follow-up. Perceived autonomy and immersiveness, as mediators, were assessed after the experiment. Results: Both the combo (n=66) and stigma (n=65) conditions were effective in reducing public stigma and microaggression toward people with mental illness after the experiment and at the 1-week follow-up. However, none of the conditions had significant time×condition effects in reducing the social distance from people with mental illness. The interact condition (n=64) significantly reduced public stigma after the experiment (P=.02) but not at the 1-week follow-up (P=.22). The control condition (n=67) did not significantly reduce all outcomes associated with mental illness stigma. Perceived autonomy was found to mediate the effect of public stigma (P=.56), and immersiveness mediated the effect of microaggression (P=.99). Conclusions: Internet-based storytelling programs with stigma-related content and interactivity elicited the largest effects in stigma reduction, including reductions in public stigma and microaggression, although only its difference with internet-based storytelling programs with stigma-related content was not statistically significant. In other words, although interactivity could strengthen the stigma reduction effect, stigma-related content was more critical than interactivity in reducing stigma. Future stigma reduction efforts should prioritize the production of effective stigma content on their web pages, followed by considering the value of incorporating interactivity in future internet-based storytelling programs. Trial Registration: ClinicalTrials.gov NCT05333848; https://clinicaltrials.gov/ct2/show/NCT05333848 %M 35969460 %R 10.2196/37973 %U https://www.jmir.org/2022/8/e37973 %U https://doi.org/10.2196/37973 %U http://www.ncbi.nlm.nih.gov/pubmed/35969460 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e36620 %T Understanding Engagement in Digital Mental Health and Well-being Programs for Women in the Perinatal Period: Systematic Review Without Meta-analysis %A Davis,Jacqueline A %A Ohan,Jeneva L %A Gibson,Lisa Y %A Prescott,Susan L %A Finlay-Jones,Amy L %+ Telethon Kids Institute, 15 Hospital Avenue, Nedlands, 6009, Australia, 61 478173989, jackie.davis@telethonkids.org.au %K digital interventions %K perinatal %K mental health %K well-being %K logic model %K systematic review %K mobile phone %D 2022 %7 9.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Pregnancy and the postnatal period can be a time of increased psychological distress, which can be detrimental to both the mother and the developing child. Digital interventions are cost-effective and accessible tools to support positive mental health in women during the perinatal period. Although studies report efficacy, a key concern regarding web-based interventions is the lack of engagement leading to drop out, lack of participation, or reduced potential intervention benefits. Objective: This systematic review aimed to understand the reporting and levels of engagement in studies of digital psychological mental health or well-being interventions administered during the perinatal period. Specific objectives were to understand how studies report engagement across 4 domains specified in the Connect, Attend, Participate, and Enact (CAPE) model, make recommendations on best practices to report engagement in digital mental health interventions (DMHIs), and understand levels of engagement in intervention studies in this area. To maximize the utility of this systematic review, we intended to develop practical tools for public health use: to develop a logic model to reference the theory of change, evaluate the studies using the CAPE framework, and develop a guide for future data collection to enable consistent reporting in digital interventions. Methods: This systematic review used the Cochrane Synthesis Without Meta-analysis reporting guidelines. This study aimed to identify studies reporting DMHIs delivered during the perinatal period in women with subclinical mood symptoms. A systematic database search was used to identify relevant papers using the Ovid Platform for MEDLINE, PsycINFO, EMBASE, Scopus, Web of Science, and Medical Subject Headings on Demand for all English-language articles published in the past 10 years. Results: Searches generated a database of 3473 potentially eligible studies, with a final selection of 16 (0.46%) studies grouped by study design. Participant engagement was evaluated using the CAPE framework and comparable variables were described. All studies reported at least one engagement metric. However, the measures used were inconsistent, which may have contributed to the wide-ranging results. There was insufficient reporting for enactment (ie, participants’ real-world use of intervention skills), with only 38% (6/16) of studies clearly recording longer-term practice through postintervention interviews. The logic model proposes ways of conceptualizing and reporting engagement details in DMHIs more consistently in the future. Conclusions: The perinatal period is the optimal time to intervene with strength-based digital tools to build positive mental health. Despite the growing number of studies on digital interventions, few robustly explore engagement, and there is limited evidence of long-term skill use beyond the intervention period. Our results indicate variability in the reporting of both short- and long-term participant engagement behaviors, and we recommend the adoption of standardized reporting metrics in future digital interventions. Trial Registration: PROSPERO CRD42020162283; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=162283 %M 35943773 %R 10.2196/36620 %U https://www.jmir.org/2022/8/e36620 %U https://doi.org/10.2196/36620 %U http://www.ncbi.nlm.nih.gov/pubmed/35943773 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 8 %P e37818 %T Emotion-Based Reinforcement Attention Network for Depression Detection on Social Media: Algorithm Development and Validation %A Cui,Bin %A Wang,Jian %A Lin,Hongfei %A Zhang,Yijia %A Yang,Liang %A Xu,Bo %+ College of Computer Science and Technology, Dalian University of Technology, Number 2, Linggong Road, Ganjingzi District, Dalian, Liaoning 116024, China, 86 13604119266, wangjian@dlut.edu.cn %K depression detection %K emotional semantic features %K social media %K sentence-level attention %K emotion-based reinforcement %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Depression detection has recently received attention in the field of natural language processing. The task aims to detect users with depression based on their historical posts on social media. However, existing studies in this area use the entire historical posts of the users and select depression indicator posts. Moreover, these methods fail to effectively extract deep emotional semantic features or simply concatenate emotional representation. To solve this problem, we propose a model to extract deep emotional semantic features and select depression indicator posts based on the emotional states. Objective: This study aims to develop an emotion-based reinforcement attention network for depression detection of users on social media. Methods: The proposed model is composed of 2 components: the emotion extraction network, which is used to capture deep emotional semantic information, and the reinforcement learning (RL) attention network, which is used to select depression indicator posts based on the emotional states. Finally, we concatenated the output of these 2 parts and send them to the classification layer for depression detection. Results: Experimental results of our model on the multimodal depression data set outperform the state-of-the-art baselines. Specifically, the proposed model achieved accuracy, precision, recall, and F1-score of 90.6%, 91.2%, 89.7%, and 90.4%, respectively. Conclusions: The proposed model utilizes historical posts of users to effectively identify users’ depression tendencies. The experimental results show that the emotion extraction network and the RL selection layer based on emotional states can effectively improve the accuracy of detection. In addition, sentence-level attention layer can capture core posts. %M 35943770 %R 10.2196/37818 %U https://medinform.jmir.org/2022/8/e37818 %U https://doi.org/10.2196/37818 %U http://www.ncbi.nlm.nih.gov/pubmed/35943770 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 8 %P e39516 %T The Effect of Mental Health App Customization on Depressive Symptoms in College Students: Randomized Controlled Trial %A Six,Stephanie G %A Byrne,Kaileigh A %A Aly,Heba %A Harris,Maggie W %+ Department of Psychology, Clemson University, 418 Brackett Hall, Clemson University, Clemson, SC, 29634-0001, United States, 1 864 656 3935, kaileib@clemson.edu %K depression %K mental health apps %K customization %K personalization %K cognitive behavioral therapy %K avatars %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health apps have shown promise in improving mental health symptoms, including depressive symptoms. However, limited research has been aimed at understanding how specific app features and designs can optimize the therapeutic benefits and adherence to such mental health apps. Objective: The primary purpose of this study is to investigate the effect of avatar customization on depressive symptoms and adherence to use a novel cognitive behavioral therapy (CBT)–based mental health app. The secondary aim is to examine whether specific app features, including journaling, mood tracking, and reminders, affect the usability of the mental health app. Methods: College students were recruited from a university study recruitment pool website and via flyer advertisements throughout campus. A total of 94 participants completed a randomized controlled trial in which they were randomized to either customization or no customization version of the app. Customization involved personalizing a virtual avatar and a travel vehicle to one’s own preferences and use of one’s name throughout the app. Participants completed a 14-day trial using a novel CBT-based mental health app called AirHeart. Self-report scores for depressive symptoms, anxiety, and stress were measured at baseline and after the intervention. Postintervention survey measures also included usability and avatar identification questionnaires. Results: Of the 94 enrolled participants, 83 (88%) completed the intervention and postintervention assessments. AirHeart app use significantly reduced symptoms of depression (P=.006) from baseline to the end of the 2-week intervention period for all participants, regardless of the customization condition. However, no differences in depressive symptoms (P=.17) or adherence (P=.80) were observed between the customization (39/83, 47%) and no customization (44/83, 53%) conditions. The frequency of journaling, usefulness of mood tracking, and helpfulness of reminders were not associated with changes in depressive symptoms or adherence (P>.05). Exploratory analyses showed that there were 3 moderate positive correlations between avatar identification and depressive symptoms (identification: r=−0.312, P=.02; connection: r=−0.305, P=.02; and lack of relatability: r=0.338, P=.01). Conclusions: These results indicate that CBT mental health apps, such as AirHeart, have the potential to reduce depressive symptoms over a short intervention period. The randomized controlled trial results demonstrated that customization of app features, such as avatars, does not further reduce depressive symptoms over and above the CBT modules and standard app features, including journal, reminders, and mood tracking. However, further research elucidating the relationship between virtual avatar identification and mental health systems is needed as society becomes increasingly more digitized. These findings have potential implications for improving the optimization of mental health app designs. Trial Registration: Open Science Framework t28gm; https://osf.io/t28gm %M 35943788 %R 10.2196/39516 %U https://mental.jmir.org/2022/8/e39516 %U https://doi.org/10.2196/39516 %U http://www.ncbi.nlm.nih.gov/pubmed/35943788 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35482 %T Adding an App-Based Intervention to the Cognitive Behavioral Analysis System of Psychotherapy in Routine Outpatient Psychotherapy Treatment: Proof-of-Concept Study %A Netter,Anna-Lena %A Beintner,Ina %A Brakemeier,Eva-Lotta %+ Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Gutenberg Strasse 18, Marburg, 32035, Germany, 49 64212823757, anna-lena.netter@uni-marburg.de %K Cognitive Behavioral Analysis System of Psychotherapy %K persistent depressive disorder %K blended therapy %K internet and mobile-based Interventions %K routine clinical care %K eHealth %K mobile phone %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an empirically supported psychotherapeutic treatment developed specifically for persistent depressive disorder. However, given the high rates of nonresponse and relapse, there is a need for optimization. Studies suggest that outcomes can be improved by increasing the treatment dose via, for example, the continuous web-based application of therapy strategies between sessions. The strong emphasis in CBASP on the therapeutic relationship, combined with limited therapeutic availabilities, encourages the addition of web-based interventions to face-to-face therapy in terms of blended therapy. Objective: The aim of this study was to test an app-based intervention called CBASPath, which was designed to be used as a blended therapy tool. CBASPath offers 8 sequential modules with app-based exercises to facilitate additional engagement with the therapy content and a separate exercise to conduct situational analyses within the app at any time. Methods: CBASPath was tested in an open pilot study as part of routine outpatient CBASP treatment. Participating patients were asked to report their use patterns and blended use (integrated use of the app as part of therapy sessions) at 3 assessment points over the 6-month test period and rate the usability and quality of and their satisfaction with CBASPath. Results: The results of the pilot trial showed that 93% (12/13) of participants used CBASPath as a blended tool during their therapy and maintained this throughout the study period. Overall, they reported good usability and quality ratings along with high user satisfaction. All participants showed favorable engagement with CBASPath; however, the frequency of use differed widely among the participants and assessment points. Situational analysis was used by all participants, and the number of completed modules ranged from 1 to 7. All participants reported blended use, although the frequency of integration in the face-to-face sessions varied widely. Conclusions: Our findings suggest that the digital augmentation of complex and highly interactive CBASP therapy in the form of blended therapy with CBASPath is feasible in routine outpatient care. Therapeutic guidance might contribute to high adherence and increase patient self-management. A few adjustments, such as saving entries directly in the app, could facilitate higher user engagement. A randomized controlled trial is now needed to investigate the efficacy and added value of this blended approach. In the long term, CBASPath could help optimize persistent depressive disorder treatment and reduce relapse by intensifying therapy and providing long-term patient support through the app. %M 35943764 %R 10.2196/35482 %U https://formative.jmir.org/2022/8/e35482 %U https://doi.org/10.2196/35482 %U http://www.ncbi.nlm.nih.gov/pubmed/35943764 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e36213 %T Supporting Self-management and Quality of Life in Bipolar Disorder With the PolarUs App (Alpha): Protocol for a Mixed Methods Study %A Michalak,Erin E %A Barnes,Steven J %A Morton,Emma %A O'Brien,Heather L %A Murray,Greg %A Hole,Rachelle %A Meyer,Denny %+ Department of Psychiatry, University of British Columbia, 420-5950 University Blvd, Vancouver, BC, V6T1Z3, Canada, 1 604 827 3393, erin.michalak@ubc.ca %K eHealth %K mobile health %K mHealth %K bipolar disorder %K self-management %K engagement %K mobile phone %D 2022 %7 4.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Quality of life (QoL) is increasingly being recognized as a key outcome of interventions for bipolar disorder (BD). Mobile phone apps can increase access to evidence-based self-management strategies and provide real-time support. However, although individuals with lived experiences desire support with monitoring and improving broader health domains, existing BD apps largely target mood symptoms only. Further, evidence from the broader mobile health (mHealth) literature has shown that the desires and goals of end users are not adequately considered during app development, and as a result, engagement with mental health apps is suboptimal. To capitalize on the potential of apps to optimize wellness in BD, there is a need for interventions developed in consultation with real-world users designed to support QoL self-monitoring and self-management. Objective: This mixed methods pilot study was designed to evaluate the alpha version of the newly developed PolarUs app, developed to support QoL self-monitoring and self-management in people with BD. Co-designed using a community-based participatory research framework, the PolarUs app builds on the web-based adaptation of a BD-specific QoL self-assessment measure and integrates material from a web-based portal providing information on evidence-informed self-management strategies in BD. The primary objectives of this project were to evaluate PolarUs app feasibility (via behavioral use metrics), the impact of PolarUs (via the Brief Quality of Life in Bipolar Disorder scale, our primary outcome measure), and explore engagement with the PolarUs app (via quantitative and qualitative methods). Methods: Participants will be residents of North America (N=150), aged >18 years, with a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnosis of BD type 1, BD type 2, or BD not otherwise specified as assessed by structured diagnostic interview. An embedded mixed methods research design will be adopted; qualitative interviews with a purposefully selected subsample (approximately, n=30) of participants will be conducted to explore in more depth feasibility, impact, and engagement with the PolarUs app over the 12-week study period. Results: At the time of publication of this protocol, the development of the alpha version of the PolarUs app was complete. Participant enrollment has begun in June 2022. Data collection is expected to be completed by December 2022. Conclusions: Beyond contributing knowledge on the feasibility and impact of a novel app to support QoL and self-management in BD, this study will also provide new insights related to engagement with mHealth apps. Furthermore, it will function as a case study of successful co-design between people with BD, health care providers, and BD researchers, providing a template for the future use of community-based participatory research frameworks in mHealth intervention development. The results will be used to further refine the PolarUs app and inform the design of a larger clinical trial. International Registered Report Identifier (IRRID): PRR1-10.2196/36213 %M 35925666 %R 10.2196/36213 %U https://www.researchprotocols.org/2022/8/e36213 %U https://doi.org/10.2196/36213 %U http://www.ncbi.nlm.nih.gov/pubmed/35925666 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e36936 %T A Biofeedback-Based Mobile App With Serious Games for Young Adults With Anxiety in the United Arab Emirates: Development and Usability Study %A Almeqbaali,Mariam %A Ouhbi,Sofia %A Serhani,Mohamed Adel %A Amiri,Leena %A Jan,Reem K %A Zaki,Nazar %A Sharaf,Ayman %A Al Helali,Abdulla %A Almheiri,Eisa %+ Department of Information Systems and Security, College of Information Technology, United Arab Emirates University, Sheik Khalifa Bin Zayed St, Al Ain, Abu Dhabi, United Arab Emirates, 971 3 7135572, serhanim@uaeu.ac.ae %K connected mental health %K mental health %K anxiety %K digital game %K biofeedback %K app %K serious game %K gaming %K gamification %K young adult %K user-centered design %K stress %K stress relief %K user-centred design %K youth %K user feedback %K user experience %K usability %K user need %K development %K mHealth %K mobile health %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Following the outbreak of COVID-19, several studies have reported that young adults encountered a rise in anxiety symptoms, which could negatively affect their quality of life. Promising evidence suggests that mobile apps with biofeedback, serious games, breathing exercises, and positive messaging, among other features, are useful for anxiety self-management and treatment. Objective: This study aimed to develop and evaluate the usability of a biofeedback-based app with serious games for young adults with anxiety in the United Arab Emirates (UAE). Methods: This study consists of two phases: Phase I describes the design and development of the app, while Phase II presents the results of a usability evaluation by experts. To elicit the app’s requirements during Phase I, we conducted (1) a survey to investigate preferences of young adults in the UAE for mobile games for stress relief; (2) an analysis of serious games for anxiety; and (3) interviews with mental health professionals and young adults in the UAE. In Phase II, five experts tested the usability of the developed app using a set of Nielsen’s usability heuristics. Results: A fully functional biofeedback-based app with serious games was co-designed with mental health professionals. The app included 4 games (ie, a biofeedback game, card game, arcade game, and memory game), 2 relaxation techniques (ie, a breathing exercise and yoga videos), and 2 additional features (ie, positive messaging and a mood tracking calendar). The results of Phase II showed that the developed app is efficient, simple, and easy to use. Overall, the app design scored an average of 4 out of 5. Conclusions: The elicitation techniques used in Phase I resulted in the development of an easy-to-use app for the self-management of anxiety. Further research is required to determine the app’s usability and effectiveness in the target population. %M 35916692 %R 10.2196/36936 %U https://games.jmir.org/2022/3/e36936 %U https://doi.org/10.2196/36936 %U http://www.ncbi.nlm.nih.gov/pubmed/35916692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e35685 %T Feasibility of Text Messages for Enhancing Therapeutic Engagement Among Youth and Caregivers Initiating Outpatient Mental Health Treatment: Mixed Methods Study %A Jerrott,Susan %A Clark,Sharon %A Chorney,Jill %A Coulombe,Aimee %A Wozney,Lori %+ Mental Health and Addictions Program, Nova Scotia Health, 300 Pleasant Street, EC Purdy Building, Dartmouth, NS, B2Y 3S3, Canada, 1 902 449 0603, lori.wozney@nshealth.ca %K text messaging %K youth %K mental health %K waiting list %K informatics %K health behavior %K self-care %K mental health literacy %K caregivers %K transdiagnostic %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Pathways to mental health services for youth are generally complex and often involve numerous contact points and lengthy delays. When starting treatment, there are a host of barriers that contribute to low rates of therapeutic engagement. Automated text messages offer a convenient, low-cost option for information sharing and skill building, and they can potentially activate positive behaviors in youth and caregivers prior to beginning formal therapy. To date, there is little evidence for the feasibility of initiating transdiagnostic text messages during the early stages of youth and caregiver contact with community outpatient mental health services. Objective: To develop and test the feasibility of implementing 2 novel text messaging campaigns aimed at youth clients and their caregivers during the early stages of engaging with outpatient mental health services. Methods: A multidisciplinary panel of experts developed two 12-message interventions with youth and caregivers prior to deployment. Each message included a link to an external interactive or multimedia resource to extend skill development. Enrollment of youth aged 13 to 18 years, their caregivers, or both occurred at 2 early treatment timepoints. At both time points, text messages were delivered automatically 2 times a week for 6 weeks. Analytics and survey data were collected in 2 phases, between January and March 2020 and between January and May 2021. Enrollment, willingness to persist in using the intervention, engagement, satisfaction, perceived value, and impact were measured. Descriptive statistics were used to summarize youth and caregiver outcomes. Results: A total of 41 caregivers and 36 youth consented to participate. Follow-up survey response rates were 54% (22/41) and 44%, (16/36) respectively. Over 1500 text messages were sent throughout the study. More than three-quarters (14/16, 88%) of youth reported that they learned something new and noticed a change in themselves due to receiving the texts; the same proportion (14/16, 88%) of youth said they would recommend the text messages to others. Youth ranked the first text message, related to coping with difficult emotions, as the most helpful of the series. Caregivers reported acting differently due to receiving the texts. Over two-thirds of caregivers were satisfied with the texts (16/22, 73%) and would recommend them to others (16/22, 73%). Caregivers perceived diverse levels of value in the text topics, with 9 of the 12 caregiver texts rated by at least one caregiver as the most helpful. Conclusions: Results are preliminary but show that brief, core skill–focused text messages for youth clients and caregivers in community outpatient mental health services are feasible. Both youth and caregivers reported promising knowledge and behavior change with exposure to only 12 messages over 6 weeks. A larger study with statistical power to detect changes in both perceived helpfulness and engagement is required to confirm the effectiveness of this type of transdiagnostic intervention. %M 35738559 %R 10.2196/35685 %U https://formative.jmir.org/2022/8/e35685 %U https://doi.org/10.2196/35685 %U http://www.ncbi.nlm.nih.gov/pubmed/35738559 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e36405 %T Using the Transformative Storytelling Technique to Generate Empowering Narratives for Informal Caregivers: Semistructured Interviews, Thematic Analysis, and Method Demonstration %A Petrovic,Milica %A Bonanno,Silvia %A Landoni,Marta %A Ionio,Chiara %A Hagedoorn,Mariët %A Gaggioli,Andrea %+ ExperienceLab, Università Cattolica del Sacro Cuore, Largo A Gemmeli 1, Milan, 20123, Italy, 39 3497366542, milica.petrovic@unicatt.it %K informal care %K story %K storytelling %K stories %K patient narrative %K digital narrative %K informal caregiver %K caregiver %K caregiving %K transformative storytelling technique %K audio stories %K audio story %K digital health %K eHealth %K empower %K fiction %K life narrative %K audio narrative %K self-help %K user-centered design %K human-centered design %K innovation in mental health %K mental health %K therapy %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The transformative storytelling technique is an innovative top-down approach to narrative therapy that aims to provide building blocks for creating flourishing narratives for target groups or populations. This approach acts as a facilitator for implementing the human-centered design in developing digital self-help tools for larger samples or target groups. Objective: This study applied the transformative storytelling technique, as a new approach in mental health, to develop empowering audio narratives for informal caregivers. Methods: A narrative inquiry was conducted with 17 informal caregivers (16 women and 1 man) who completed a semistructured interview, “Caregiver Life Story,” acquiring information about the beginning of the role, rising action, and critical point of the role. The participants’ ages ranged from 41 to 84 years, with all participants providing care for at least a 6-month period. This inquiry was guided by the transformative storytelling technique, and aimed to collect data relevant to creating fictional stories based on real-life themes. Results: Twenty-five overall themes were distinguished across three a priori–set categories, providing narrative building blocks for the informal caregiver life stories. The final empowering caregiver life story was created as an example for this study, demonstrating the application of the transformative storytelling technique in an informal care context. Conclusions: The creation of empowering stories for populations or target groups in mental health care requires a unified and guided approach that will follow clear guidelines and storytelling principles. The transformative storytelling technique is a first of its kind in the mental health context, representing an initial step in enabling and supporting the creation of meaningful stories and the development of relatable, but productive, narratives. Such narratives have the potential to serve across media and digital platforms for supporting and improving well-being, and potentially triggering self-change in the target group or population. %M 35802492 %R 10.2196/36405 %U https://formative.jmir.org/2022/8/e36405 %U https://doi.org/10.2196/36405 %U http://www.ncbi.nlm.nih.gov/pubmed/35802492 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e39094 %T An Identity-Affirming Web Application to Help Sexual and Gender Minority Youth Cope With Minority Stress: Pilot Randomized Controlled Trial %A Bauermeister,Jose %A Choi,Seul Ki %A Bruehlman-Senecal,Emma %A Golinkoff,Jesse %A Taboada,Arianna %A Lavra,Joshua %A Ramazzini,Lionel %A Dillon,Fred %A Haritatos,Jana %+ Department of Family and Community Health, University of Pennsylvania, 418 Curie Blvd, Suite 222L, Philadelphia, PA, 19104, United States, 1 215 898 9993, bjose@upenn.edu %K lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority %K LGBTQ+ %K youth %K adolescence %K discrimination %K minority stress %K mental health %K resilience %K sexual and gender minority %K SGM %K intersectionality %D 2022 %7 1.8.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Efficacious mental health interventions for sexual and gender minority youth have had limited reach, given their delivery as time-intensive, in-person sessions. Internet-based interventions may facilitate reach to sexual and gender minority youth; however, there is little research examining their efficacy. Objective: This study aims to describe the results of a pilot randomized controlled trial of imi, a web application designed to improve mental health by supporting lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity affirmation, coping self-efficacy, and coping skill practice. Methods: Sexual and gender minority youth (N=270) aged 13 to 19 (mean 16.5, SD 1.5) years and living in the United States were recruited through Instagram advertisements. Approximately 78% (210/270) of the sample identified as racial or ethnic minorities. Participants were randomized in a 1:1 fashion to the full imi intervention web application (treatment; 135/270, 50%) or a resource page–only version of the imi site (control; 135/270, 50%). The imi application covered four topical areas: gender identity; lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity; stress and coping; and internalized homophobia and transphobia. Participants explored these areas by engaging with informational resources, exercises, and peer stories at a self-guided pace. Both arms were assessed via web-based surveys at baseline and 4-week follow-up for intervention satisfaction, stress appraisals (ie, challenge, threat, and resource), coping skills (ie, instrumental support, positive reframing, and planning), and mental health symptoms among other outcomes. Main intent-to-treat analyses compared the arms at week 4, controlling for baseline values on each outcome. Results: Survey retention was 90.4% (244/270) at week 4. Participants in the treatment arm reported greater satisfaction with the intervention than participants in the control arm (t241=–2.98; P=.003). The treatment arm showed significantly greater improvement in challenge appraisals (ie, belief in one’s coping abilities) than the control (Cohen d=0.26; P=.008). There were no differences between the arms for threat (d=0.10; P=.37) or resource (d=0.15; P=.14) appraisals. The treatment arm showed greater increases in coping skills than the control arm (instrumental support: d=0.24, P=.005; positive reframing: d=0.27, P=.02; planning: d=0.26, P=.02). Mental health symptoms improved across both the treatment and control arms; however, there were no differences between arms. Within the treatment arm, higher engagement with imi (≥5 sessions, >10 minutes, or >10 pages) predicted greater improvement in stress appraisals (all P values <.05). Conclusions: The results provide initial evidence that asynchronous psychosocial interventions delivered via a web application to sexual and gender minority youth can support their ability to cope with minority stress. Further research is needed to examine the long-term effects of the imi application. Trial Registration: ClinicalTrials.gov NCT05061966; https://clinicaltrials.gov/ct2/show/NCT05061966 %M 35916700 %R 10.2196/39094 %U https://www.jmir.org/2022/8/e39094 %U https://doi.org/10.2196/39094 %U http://www.ncbi.nlm.nih.gov/pubmed/35916700 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e36665 %T Initial Psychometric Properties of 7 NeuroUX Remote Ecological Momentary Cognitive Tests Among People With Bipolar Disorder: Validation Study %A Moore,Raeanne C %A Parrish,Emma M %A Van Patten,Ryan %A Paolillo,Emily %A Filip,Tess F %A Bomyea,Jessica %A Lomas,Derek %A Twamley,Elizabeth W %A Eyler,Lisa T %A Depp,Colin A %+ Department of Psychiatry, University of California San Diego, 220 Dickinson St. Ste B (8231), San Diego, CA, 92103-8231, United States, 1 949 933 8063, r6moore@health.ucsd.edu %K neuropsychology %K mobile health %K ambulatory assessment %K ecological momentary assessment %K practice effects %K validity %K testing %K serious mental illness %K mobile phone %D 2022 %7 29.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: As smartphone technology has become nearly ubiquitous, there is a growing body of literature suggesting that ecological momentary cognitive testing (EMCT) offers advantages over traditional pen-and-paper psychological assessment. We introduce a newly developed platform for the self-administration of cognitive tests in ecologically valid ways. Objective: The aim of this study is to develop a Health Insurance Portability and Accountability Act–compliant EMCT smartphone-based platform for the frequent and repeated testing of cognitive abilities in everyday life. This study examines the psychometric properties of 7 mobile cognitive tests covering domains of processing speed, visual working memory, recognition memory, and response inhibition within our platform among persons with and without bipolar disorder (BD). Ultimately, if shown to have adequate psychometric properties, EMCTs may be useful in research on BD and other neurological and psychiatric illnesses. Methods: A total of 45 persons with BD and 21 demographically comparable healthy volunteer participants (aged 18-65 years) completed smartphone-based EMCTs 3 times daily for 14 days. Each EMCT session lasted approximately 1.5 minutes. Only 2 to 3 tests were administered in any given session, no test was administered more than once per day, and alternate test versions were administered in each session. Results: The mean adherence to the EMCT protocol was 69.7% (SD 20.5%), resulting in 3965 valid and complete tests across the full sample. Participants were significantly more likely to miss tests on later versus earlier study days. Adherence did not differ by diagnostic status, suggesting that BD does not interfere with EMCT participation. In most tests, age and education were related to EMCT performance in expected directions. The average performances on most EMCTs were moderately to strongly correlated with the National Institutes of Health Toolbox Cognition Battery. Practice effects were observed in 5 tests, with significant differences in practice effects by BD status in 3 tests. Conclusions: Although additional reliability and validity data are needed, this study provides initial psychometric support for EMCTs in the assessment of cognitive performance in real-world contexts in BD. %M 35904876 %R 10.2196/36665 %U https://www.jmir.org/2022/7/e36665 %U https://doi.org/10.2196/36665 %U http://www.ncbi.nlm.nih.gov/pubmed/35904876 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 7 %P e34254 %T The Impact of Mobile Technology-Delivered Interventions on Youth Well-being: Systematic Review and 3-Level Meta-analysis %A Conley,Colleen S %A Raposa,Elizabeth B %A Bartolotta,Kate %A Broner,Sarah E %A Hareli,Maya %A Forbes,Nicola %A Christensen,Kirsten M %A Assink,Mark %+ Department of Psychology, Loyola University Chicago, 1032 W. Sheridan Road, Chicago, IL, 60660, United States, 1 7735083603, cconley@luc.edu %K meta-analysis %K mental health %K well-being %K intervention %K treatment %K youth %K technology %K smartphone %K mobile phone %K app %K mobile health %D 2022 %7 29.7.2022 %9 Review %J JMIR Ment Health %G English %X Background: Rates of mental health problems among youth are high and rising, whereas treatment seeking in this population remains low. Technology-delivered interventions (TDIs) appear to be promising avenues for broadening the reach of evidence-based interventions for youth well-being. However, to date, meta-analytic reviews on youth samples have primarily been limited to computer and internet interventions, whereas meta-analytic evidence on mobile TDIs (mTDIs), largely comprising mobile apps for smartphones and tablets, have primarily focused on adult samples. Objective: This study aimed to evaluate the effectiveness of mTDIs for a broad range of well-being outcomes in unselected, at-risk, and clinical samples of youth. Methods: The systematic review used 5 major search strategies to identify 80 studies evaluating 83 wellness- and mental health-focused mTDIs for 19,748 youth (mean age 2.93-26.25 years). We conducted a 3-level meta-analysis on the full sample and a subsample of the 38 highest-quality studies. Results: Analyses demonstrated significant benefits of mTDIs for youth both at posttest (g=0.27) and follow-up (range 1.21-43.14 weeks; g=0.26) for a variety of psychosocial outcomes, including general well-being and distress, symptoms of diverse psychological disorders, psychosocial strategies and skills, and health-related symptoms and behaviors. Effects were significantly moderated by the type of comparison group (strongest for no intervention, followed by inert placebo or information-only, and only marginal for clinical comparison) but only among the higher-quality studies. With respect to youth characteristics, neither gender nor pre-existing mental health risk level (not selected for risk, at-risk, or clinical) moderated effect sizes; however, effects increased with the age of youth in the higher-quality studies. In terms of intervention features, mTDIs in these research studies were effective regardless of whether they included various technological features (eg, tailoring, social elements, or gamification) or support features (eg, orientation, reminders, or coaching), although the use of mTDIs in a research context likely differs in important ways from their use when taken up through self-motivation, parent direction, peer suggestion, or clinician referral. Only mTDIs with a clear prescription for frequent use (ie, at least once per week) showed significant effects, although this effect was evident only in the higher-quality subsample. Moderation analyses did not detect statistically significant differences in effect sizes based on the prescribed duration of mTDI use (weeks or sessions), and reporting issues in primary studies limited the analysis of completed duration, thereby calling for improved methodology, assessment, and reporting to clarify true effects. Conclusions: Overall, this study’s findings demonstrate that youth can experience broad and durable benefits of mTDIs, delivered in a variety of ways, and suggest directions for future research and development of mTDIs for youth, particularly in more naturalistic and ecologically valid settings. %M 35904845 %R 10.2196/34254 %U https://mental.jmir.org/2022/7/e34254 %U https://doi.org/10.2196/34254 %U http://www.ncbi.nlm.nih.gov/pubmed/35904845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e31803 %T Item Response Theory Analyses of Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Criteria Adapted to Screen Use Disorder: Exploratory Survey %A Boudard,Mathieu %A Alexandre,Jean-Marc %A Kervran,Charlotte %A Jakubiec,Louise %A Shmulewitz,Dvora %A Hasin,Deborah %A Fournet,Lucie %A Rassis,Christophe %A Claverie,Patrice %A Serre,Fuschia %A Auriacombe,Marc %+ Sanpsy (Sleep Addiction and Neuropsychiatry), CNRS (Centre National de la Recherche Scientifique), UMR (Unité Mixte de Recherche) 6033, University of Bordeaux, 146, rue Léo Saignat, Bordeaux, 33076, France, 33 607764371, marc.auriacombe@u-bordeaux.fr %K screen media use %K screen addiction %K internet gaming disorder %K screen use disorder %K Item Response Theory %D 2022 %7 27.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Screen use is part of daily life worldwide and morbidity related to excess use of screens has been reported. Some use of screens in excess could indicate a screen use disorder (ScUD). An integrative approach to ScUD could better fit the polymodal reality of screens, and concurrent problems with screens, than a split approach, activity by activity. In that paradigm, a pragmatic and operationalized approach to study a potential ScUD requires the use of common criteria, for all screens and activities done on screens, in a single questionnaire. Objective: Our goals were (1) to describe screen uses in a general population sample and (2) to test the unidimensionality, local independence, and psychometric properties of the 9 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) internet gaming disorder (IGD) criteria adapted to screen use in a community sample. We hypothesized that the 9 DSM-5 IGD criteria adapted to ScUD would show unidimensionality, local independence, and good discrimination, with criteria distributed on the severity continuum. Methods: This cross-sectional survey in a French suburban city targeted adults and adolescents. A self-administered questionnaire covered the main types of screens used and their use for various activities in the past month. Presence of ScUD diagnostic criteria in past 12 months was also self-evaluated in the questionnaire. Factor and 2-parameter Item Response Theory analysis were used to investigate the dimensionality, local independence, and psychometric properties of the ScUD criteria. Results: Among the 300 participants, 171 (57.0%) were female (mean age 27 years), 297 (99.0%) used screens, 134 (44.7%) reported at least one criterion (potential problem users), and 5 (1.7%) reported 5 or more criteria and endorsed an ScUD. The most endorsed criteria were loss of control (60/300, 20.0%) and preoccupation (52/300, 17.3%). Screen types used and screen activities differed between participants with no ScUD criteria and those with at least one ScUD criterion. The latter were more likely to have a computer as the most used screen type, and more video gaming, communication/social network, and watching news and research of information as activities. Unidimensionality was confirmed by all fit indices. Local independence was confirmed by the absence of residual correlation between the items. Criteria had relatively high factor loading, with loss of interest in other recreational activities having the highest. However, criteria with the lowest factor loading all remained above the cut-offs, sanctioning unidimensionality. Most discriminating criteria were loss of interests, preoccupation, deceive/cover up, and risk/lose relationship/opportunities, which also provided the most information on the measurement of the latent trait. Conclusions: We described screen uses in a French community sample and have shown that the adaptation of the DSM-5 IGD to “ScUD” has good psychometric validity and is discriminating, confirming our hypothesis. We suggest to use those criteria to assess potential “ScUD.” Further studies should determine if all criteria are needed and whether others should be added. %M 35896018 %R 10.2196/31803 %U https://www.jmir.org/2022/7/e31803 %U https://doi.org/10.2196/31803 %U http://www.ncbi.nlm.nih.gov/pubmed/35896018 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e34700 %T Design of a Game-Based Training Environment to Enhance Mental Health Care Professionals’ Skills in Using e–Mental Health: Multiple Methods User Requirements Analysis %A Bierbooms,Joyce %A Feijt,Milou A %A IJsselsteijn,Wijnand A %A Bongers,Inge M B %+ Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. box 90153, Tilburg, 5000 LE, Netherlands, 31 48354735, J.J.P.A.Bierbooms@tilburguniversity.edu %K serious gaming %K e–mental health %K mental health care %K skill development %K game design %K user requirements %K mobile phone %D 2022 %7 27.7.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: A major factor hampering the adoption of technology in mental health care is a lack of knowledge and skills. Serious gaming offers a potentially effective strategy to enhance the skills needed through experiencing and learning-by-doing in a playful way. However, serious gaming solutions are not widely available for mental health care. Therefore, the development of a game-based training environment in mental health care was pursued in a design project. The first step in such a design project is to identify user requirements that should be met. Objective: This study aims to deliver user requirements that inform the design of a game-based training environment for mental health care professionals. This environment aims to support mental health care professionals’ knowledge and skill enhancement regarding the use of e–mental health (eMH); for example, video calling, mobile apps, web-based treatment modules, and techniques such as virtual or augmented reality. Methods: We used an exploratory multiple methods design consisting of a web-based questionnaire, co-design sessions, and interviews. To ensure a good representation of the target user group, professionals from various disciplines within mental health care were included in the research. The multiple methods design facilitates a broad view of user needs and in-depth knowledge of specific design requirements. We describe the protocol for this research project in a protocol paper published in the JMIR Research Protocols in February 2021. Results: The user requirements analysis revealed three types of users for the envisioned game-based training environment: mental health care professionals who want to learn about the basic possibilities of eMH, mental health care professionals who want to develop their eMH skills to the next level, and mental health care professionals who want to experiment with new technologies. This reflects the diversity of needs that were identified, as well as the need to develop a diversity of suitable scenarios in the environment. User requirements analysis shows that the focus of a training environment should be on increasing knowledge about the possibilities of eMH, focusing on experiencing the benefits in particular situations, and building confidence in using eMH in a therapeutic setting. This requires careful consideration of the suitable game characteristics. Conclusions: Improvement of mental health care professionals’ skills in eMH requires an environment that is user driven and flexible, and simultaneously incorporates contextual factors that are relevant for its implementation in practice. This user requirements analysis contributes to the understanding of the issues that should be considered in the development of a game-based training environment. This shows that there are multiple and diverse learning needs among mental health care professionals. Various client populations, services, and situations demand various options for training. International Registered Report Identifier (IRRID): RR2-10.2196/18815 %M 35896032 %R 10.2196/34700 %U https://games.jmir.org/2022/3/e34700 %U https://doi.org/10.2196/34700 %U http://www.ncbi.nlm.nih.gov/pubmed/35896032 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e38919 %T Smartphone App Delivery of a Just-In-Time Adaptive Intervention for Adult Gamblers (Gambling Habit Hacker): Protocol for a Microrandomized Trial %A Rodda,Simone N %A Bagot,Kathleen L %A Merkouris,Stephanie S %A Youssef,George %A Lubman,Dan I %A Thomas,Anna C %A Dowling,Nicki A %+ Psychology and Neuroscience, Auckland University of Technology, 90 Akoranga Drive, Auckland, 0627, New Zealand, 64 99219999, simone.rodda@aut.ac.nz %K Just-In-Time Adaptive Intervention %K JITAI %K ecological momentary assessment %K EMA %K ecological momentary intervention %K EMI %K gambling %K behavior change technique %K implementation intentions %K action planning %K coping planning %K microrandomized trial %K mobile phone %D 2022 %7 26.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with gambling problems frequently report repeated unsuccessful attempts to change their behavior. Although many behavior change techniques are available to individuals to reduce gambling harm, they can be challenging to implement or maintain. The provision of implementation support tailored for immediate, real-time, individualized circumstances may improve attempts at behavior change. Objective: We aimed to develop and evaluate a Just-In-Time Adaptive Intervention (JITAI) for individuals who require support to adhere to their gambling limits. JITAI development is based on the principles of the Health Action Process Approach with delivery, in alignment with the principles of self-determination theory. The primary objective was to determine the effect of action- and coping planning compared with no intervention on the goal of subsequently adhering to gambling expenditure limits. Methods: Gambling Habit Hacker is delivered as a JITAI providing in-the-moment support for adhering to gambling expenditure limits (primary proximal outcome). Delivered via a smartphone app, this JITAI delivers tailored behavior change techniques related to goal setting, action planning, coping planning, and self-monitoring. The Gambling Habit Hacker app will be evaluated using a 28-day microrandomized trial. Up to 200 individuals seeking support for their own gambling from Australia and New Zealand will set a gambling expenditure limit (ie, goal). They will then be asked to complete 3 time-based ecological momentary assessments (EMAs) per day over a 28-day period. EMAs will assess real-time adherence to gambling limits, strength of intention to adhere to goals, goal self-efficacy, urge self-efficacy, and being in high-risk situations. On the basis of the responses to each EMA, participants will be randomized to the control (a set of 25 self-enactable strategies containing names only and no implementation information) or intervention (self-enactable strategy implementation information with facilitated action- and coping planning) conditions. This microrandomized trial will be supplemented with a 6-month within-group follow-up that explores the long-term impact of the app on gambling expenditure (primary distal outcome) and a range of secondary outcomes, as well as an evaluation of the acceptability of the JITAI via postintervention surveys, app use and engagement indices, and semistructured interviews. This trial has been approved by the Deakin University Human Research Ethics Committee (2020-304). Results: The intervention has been subject to expert user testing, with high acceptability scores. The results will inform a more nuanced version of the Gambling Habit Hacker app for wider use. Conclusions: Gambling Habit Hacker is part of a suite of interventions for addictive behaviors that deliver implementation support grounded in lived experience. This study may inform the usefulness of delivering implementation intentions in real time and in real-world settings. It potentially offers people with gambling problems new support to set their gambling intentions and adhere to their limits. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12622000497707; www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=383568 International Registered Report Identifier (IRRID): DERR1-10.2196/38919 %M 35881441 %R 10.2196/38919 %U https://www.researchprotocols.org/2022/7/e38919 %U https://doi.org/10.2196/38919 %U http://www.ncbi.nlm.nih.gov/pubmed/35881441 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e38942 %T Impacts of Digital Care Programs for Musculoskeletal Conditions on Depression and Work Productivity: Longitudinal Cohort Study %A Costa,Fabíola %A Janela,Dora %A Molinos,Maria %A Moulder,Robert %A Bento,Vírgilio %A Lains,Jorge %A Scheer,Justin %A Yanamadala,Vijay %A Cohen,Steven %A Dias Correia,Fernando %+ SWORD Health Inc, 65 E Wadsworth Park Drive, Suite 230, Draper, UT, 84020, United States, 1 385 308 8034, fcorreia@swordhealth.com %K musculoskeletal %K pain %K depression %K anxiety %K mental health %K comorbidity %K productivity %K digital health %K remote care %K rehabilitation %K telehealth %K telemedicine %K eHealth %K digital health %K digital care %K multimodal %K digital intervention %K recovery %K engagement %K activities of daily living %K work %K job %K occupational health %K longitudinal cohort %D 2022 %7 25.7.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Comorbidity between musculoskeletal (MSK) pain and depression is highly common, and is associated with a greater symptom burden and greater loss of work productivity than either condition alone. Multimodal care programs tackling both physical and mental health components may maximize productivity recovery and return to work. Digital delivery of such programs can facilitate access, ensure continuity of care, and enhance patient engagement. Objective: The aim of this study was to assess the impact of a completely remote multimodal digital care program (DCP) for MSK pain on mental health and work-related outcomes stratified by baseline depression levels. Methods: Ad hoc analysis of an interventional, single-arm, cohort study of individuals with MSK pain undergoing a DCP was performed. Three subgroups with different baseline depression severity levels were established based on responses to the Patient Health Questionnaire (PHQ-9): cluster 1 (score<5: minimal depression), cluster 2 (scores 5-10: mild depression), and cluster 3 (score≥10: moderate depression). The mean changes in depression, anxiety, fear-avoidance beliefs, work productivity, and activity impairment and adherence between baseline and end of program (8-12 weeks) were assessed across subgroups by latent growth curve analysis. Results: From a total of 7785 eligible participants, 6137 (78.83%) were included in cluster 1, 1158 (14.87%) in cluster 2, and 490 (6.29%) in cluster 3. Significant improvements in depression and anxiety scores were observed in clusters 2 and 3 but not in cluster 1, with average end-of-the program scores in clusters 2 and 3 below the initially defined cluster thresholds (score of 5 and 10, respectively). All clusters reported significant improvements in productivity impairment scores (mean changes from –16.82, 95% CI –20.32 to –13.42 in cluster 1 to –20.10, 95% CI –32.64 to –7.57 in cluster 3). Higher adherence was associated with higher improvements in depression in clusters 2 and 3, and with greater recovery in activities of daily living in cluster 3. Overall patient satisfaction was 8.59/10.0 (SD 1.74). Conclusions: A multimodal DCP was able to promote improvements in productivity impairment scores comparable to those previously reported in the literature, even in participants with comorbid depression and anxiety. These results reinforce the need to follow a biopsychosocial framework to optimize outcomes in patients with MSK pain. Trial Registration: ClinicalTrials.gov NCT04092946; https://clinicaltrials.gov/ct2/show/NCT04092946 %M 35714099 %R 10.2196/38942 %U https://www.jmir.org/2022/7/e38942 %U https://doi.org/10.2196/38942 %U http://www.ncbi.nlm.nih.gov/pubmed/35714099 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e39004 %T Single-Session Interventions Embedded Within Tumblr: Acceptability, Feasibility, and Utility Study %A Dobias,Mallory L %A Morris,Robert R %A Schleider,Jessica L %+ Department of Psychology, Stony Brook University, Psychology Building B-363, Stony Brook, NY, 11794-2500, United States, 1 512 818 9040, mallory.dobias@stonybrook.edu %K web-based intervention %K internet intervention %K digital intervention %K single-session intervention %K mental health %D 2022 %7 25.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing mental health treatments are insufficient for addressing mental health needs at scale, particularly for teenagers, who now seek mental health information and support on the web. Single-session interventions (SSIs) may be particularly well suited for dissemination as embedded web-based support options that are easily accessible on popular social platforms. Objective: We aimed to evaluate the acceptability and effectiveness of three SSIs, each with a duration of 5 to 8 minutes (Project Action Brings Change, Project Stop Adolescent Violence Everywhere, and REFRAME)—embedded as Koko minicourses on Tumblr—to improve three key mental health outcomes: hopelessness, self-hate, and the desire to stop self-harm behavior. Methods: We used quantitative data (ie, star ratings and SSI completion rates) to evaluate acceptability and short-term utility of all 3 SSIs. Paired 2-tailed t tests were used to assess changes in hopelessness, self-hate, and the desire to stop future self-harm from before to after the SSI. Where demographic information was available, the analyses were restricted to teenagers (13-19 years). Examples of positive and negative qualitative user feedback (ie, written text responses) were provided for each program. Results: The SSIs were completed 6179 times between March 2021 and February 2022. All 3 SSIs generated high star ratings (>4 out of 5 stars), with high completion rates (approximately 25%-57%) relative to real-world completion rates among other digital self-help interventions. Paired 2-tailed t tests detected significant pre-post reductions in hopelessness for those who completed Project Action Brings Change (P<.001, Cohen dz=−0.81, 95% CI −0.85 to −0.77) and REFRAME (P<.001, Cohen dz=−0.88, 95% CI −0.96 to −0.80). Self-hate significantly decreased (P<.001, Cohen dz=−0.67, 95% CI −0.74 to −0.60), and the desire to stop self-harm significantly increased (P<.001, Cohen dz=0.40, 95% CI 0.33 to 0.47]) from before to after the completion of Project Stop Adolescent Violence Everywhere. The results remained consistent across sensitivity analyses and after correcting for multiple tests. Examples of positive and negative qualitative user feedback point toward future directions for SSI research. Conclusions: Very brief SSIs, when embedded within popular social platforms, are one promising and acceptable method for providing free, scalable, and potentially helpful mental health support on the web. Considering the unique barriers to mental health treatment access that many teenagers face, this approach may be especially useful for teenagers without access to other mental health supports. %M 35877163 %R 10.2196/39004 %U https://formative.jmir.org/2022/7/e39004 %U https://doi.org/10.2196/39004 %U http://www.ncbi.nlm.nih.gov/pubmed/35877163 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 7 %P e34168 %T Peer-Presented Versus Mental Health Service Provider–Presented Mental Health Outreach Programs for University Students: Randomized Controlled Trial %A Bastien,Laurianne %A Boke,Bilun Naz %A Mettler,Jessica %A Zito,Stephanie %A Di Genova,Lina %A Romano,Vera %A Lewis,Stephen P %A Whitley,Rob %A Iyer,Srividya N %A Heath,Nancy L %+ Department of Educational and Counselling Psychology, McGill University, 3700 McTavish, Montreal, QC, H3A 1Y9, Canada, 1 5143981232, laurianne.bastien@mail.mcgill.ca %K web-based mental health outreach %K resilience building %K university student %K peer-presented %K mental health service provider–presented %K mental health %K outreach %K resilience %K student %K service provider %K randomized controlled trial %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: University students are reporting concerning levels of mental health distress and challenges. University mental health service provider initiatives have been shown to be effective in supporting students’ mental health, but these services are often resource-intensive. Consequently, new approaches to service delivery, such as web-based and peer support initiatives, have emerged as cost-effective and efficient approaches to support university students. However, these approaches have not been sufficiently evaluated for effectiveness or acceptability in university student populations. Objective: Thus, the overarching goal of this study was to evaluate a mental health service provider–presented versus peer-presented web-based mental health resilience–building video outreach program against a wait-list comparison group. Methods: Participants were 217 undergraduate students (mean age 20.44, SD 1.98 years; 171/217, 78.8% women) who were randomly assigned to one of the intervention groups (mental health service provider–presented: 69/217, 31.8%; peer-presented: 73/217, 33.6%) or the wait-list comparison group (75/217, 34.6%). Participants in the intervention groups were asked to watch 3 brief skill-building videos addressing strategies for building mental health resilience, whereas the comparison group was wait-listed. The mental health service provider–presented and peer-presented video series were identical in content, with presenters using a script to ensure consistency across delivery methods, but the videos differed in that they were either presented by mental health service providers or university students (peers). All participants were asked to complete web-based self-report measures of stress, coping self-efficacy, social support, social connectedness, mindfulness, and quality of life at baseline (time 1), 6 weeks later (time 2, after the intervention), and 1-month follow-up (time 3). Results: Results from a series of 2-way ANOVAs found no significant differences in outcomes among any of the 3 groups. Surprisingly, a main effect of time revealed that all students improved on several well-being outcomes. In addition, results for program satisfaction revealed that both the mental health service provider–presented and peer-presented programs were rated very highly and at comparable levels. Conclusions: Thus, findings suggest that a web-based mental health resilience–building video outreach program may be acceptable for university students regardless of it being mental health service provider–presented or peer-presented. Furthermore, the overall increases in well-being across groups, which coincided with the onset and early weeks of the COVID-19 pandemic, suggest an unexpected pattern of response among university students to the early period of the pandemic. Limitations and barriers as well as research implications are discussed. Trial Registration: ClinicalTrials.gov NCT05454592; https://clinicaltrials.gov/ct2/show/NCT05454592 %M 35762935 %R 10.2196/34168 %U https://mental.jmir.org/2022/7/e34168 %U https://doi.org/10.2196/34168 %U http://www.ncbi.nlm.nih.gov/pubmed/35762935 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 3 %P e38300 %T An Investigation of Virtual Reality Nature Experiences in Patients With Metastatic Breast Cancer: Secondary Analysis of a Randomized Controlled Trial %A Chin,Stanley %A Cavadino,Alana %A Akroyd,Amelia %A Tennant,Geraldine %A Dobson,Rosie %A Gautier,Adele %A Reynolds,Lisa %+ Department of Psychological Medicine, The University of Auckland, Private Bag 92019, Victoria Street West, Auckland, 1142, New Zealand, 64 9234938, l.reynolds@auckland.ac.nz %K metastatic breast cancer %K virtual reality %K nature connectedness %K intervention %K quality of life %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Connection with nature has well-established physical and psychological benefits. However, women with metastatic breast cancer (MBC) are often unable to access nature because of physical limitations, psychological barriers, and treatment demands. Virtual reality (VR) nature experiences offer an alternative means of connecting with nature and may be of particular benefit to patients with cancer who are house- or hospital-bound. Objective: This study aims to explore whether VR nature experiences are associated with physical and psychological benefits for women with MBC who are disconnected with nature. Methods: This secondary analysis of a previous randomized controlled crossover trial recruited participants from the emailing lists of breast cancer support organizations. Participants were provided VR headsets for daily use in their homes for over 3 weeks. In the first week, participants used 1 of 2 VR nature experiences (Ripple or Happy Place) daily, followed by a 1-week washout period, before using the other VR experience every day for the final week. Outcomes assessed changes between baseline and postintervention scores in quality of life (EQ-5D-5L), pain (Brief Pain Inventory Short Form), fatigue (Functional Assessment of Chronic Illness Therapy-fatigue), depression (Depression, Anxiety, and Stress Scale-depression), anxiety (Depression, Anxiety, and Stress Scale-anxiety), and spiritual well-being (Functional Assessment of Chronic Illness Therapy- Spiritual Well-being) and investigated whether benefits were greater in participants who were not strongly connected with nature at baseline. Results: A total of 38 women with MBC completed the VR interventions and were included in the analyses. Participants reported significantly less fatigue (P=.001), less depression (P<.001), and greater quality of life (P=.02) following the interventions than at baseline. Women with a weaker connection to nature reported greater fatigue (P=.03), depression (P=.006), and anxiety (P=.001), and poorer spirituality (P=.004) than their strongly connected counterparts. Only those with a weaker baseline connection with nature showed improvements in depression following the intervention (P=.03), with similar trends observed in fatigue (P=.07) and quality of life (P=.10). Conclusions: This study provides preliminary evidence that feeling connected with nature is associated with better physical and psychological status in patients with MBC and that VR nature interventions might be beneficial for this clinical population. Future studies should focus on activities that encourage connection with nature (rather than simply exposure to nature) and investigate the aspects of VR nature interventions that have the greatest therapeutic potential. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001480178; https://tinyurl.com/et6z3vac %M 35867398 %R 10.2196/38300 %U https://cancer.jmir.org/2022/3/e38300 %U https://doi.org/10.2196/38300 %U http://www.ncbi.nlm.nih.gov/pubmed/35867398 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e36956 %T Association Between Care Modality and Use With Treatment Response Among Members Accessing Virtual Mental Health Services: Real-world Observational Study %A Shih,Emily %A Aylward,Brandon S %A Kunkle,Sarah %A Graziani,Grant %+ Ginger, 116 New Montgomery St. Suite 500, San Francisco, CA, 94105, United States, 1 855 446 4374, eshih@ginger.io %K behavioral coaching %K engagement %K mental health %K telehealth %K treatment response %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing bottleneck in mental health care, as the demand for services has outpaced the availability of mental health professionals. Consequently, many health systems have shifted to teletherapy as a scalable approach to increasing accessibility to care. Within these care models, various treatment modalities (eg, coaching and clinical care) are used to deliver support for anxiety and depression. However, more research is needed to better understand the differences in treatment responses. Objective: The purpose of this study was to examine the association between different care modalities and the levels of use with symptom score changes for members seeking virtual care services. Methods: We conducted an observational study of 4219 members who accessed Ginger, an on-demand mental health service, between September 2020 and September 2021. Using a mobile app, members can access text-based behavioral health coaching and virtual clinical services. This study focused on members with clinically elevated depression or anxiety levels at baseline. Logistic regressions were used to assess the association between care modalities and the levels of use with treatment response in depression and anxiety, using the Patient Health Questionnaire and Generalized Anxiety Disorder Assessment, respectively. Results: Of the 4219 members, 1623 (38.47%) demonstrated a full response to depression, and 1684 (39.91%) demonstrated a full response to anxiety. Members who completed care (ie, text-based coaching, virtual clinical therapy, hybrid of coaching, and clinical care) beyond the introductory session showed significantly increased odds of a full response compared with those who completed only limited care. Members who completed a hybrid of care had the highest odds of improvement; the odds of showing a full response in depression were 2.31 times higher (95% CI 1.91-2.80; P<.001) and in anxiety were 2.23 times higher (95% CI 1.84-2.70; P<.001) compared with members who completed limited care. For members who completed only coaching or clinical care, the largest effects were observed among those with high use. For members who completed a hybrid care program, we observed similar treatment responses across all levels of use. Conclusions: Our real-world study found that members who completed text-based coaching achieved full treatment responses at similar rates compared with members who completed virtual clinical care and members who completed a hybrid of care. There were no significant differences in the predicted probabilities of full treatment response between coaching and clinical care. Generally, the odds for a full response were highest among members with high use within each care modality; however, there were no differences in full-response treatment odds across levels of use with hybrid care. The results support the utility of digital behavioral health interventions and further highlight text-based coaching protocols as an accessible and suitable option when considering virtual care for treating anxiety and depression. %M 35867401 %R 10.2196/36956 %U https://formative.jmir.org/2022/7/e36956 %U https://doi.org/10.2196/36956 %U http://www.ncbi.nlm.nih.gov/pubmed/35867401 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 7 %P e36358 %T Evaluating the Efficacy of a Guided and Unguided Internet-Based Self-help Intervention for Chronic Loneliness: Protocol for a 3-Arm Randomized Controlled Trial %A Seewer,Noëmi %A Skoko,Andrej %A Käll,Anton %A Andersson,Gerhard %A Luhmann,Maike %A Berger,Thomas %A Krieger,Tobias %+ Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 31 684 40 35, noemi.seewer@unibe.ch %K loneliness %K subjective social isolation %K internet-based intervention %K self-help %K guidance %K online %K mobile phone %D 2022 %7 22.7.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Loneliness, or perceived social isolation, is prevalent in both the general population and clinical practice. Although loneliness has repeatedly been associated with mental and physical health, research on interventions that reduce loneliness effectively is still rather scarce. Objective: This study aims to evaluate the efficacy of a guided and an unguided version of the same internet-based cognitive behavioral self-help program for loneliness (SOLUS-D) for adults. Methods: A total of 250 participants will be randomly assigned to 1 of 2 intervention groups (SOLUS-D with guidance or SOLUS-D without guidance) or a wait-list control group (2:2:1 allocation ratio). Adult participants experiencing high levels of loneliness will be recruited from the general population. Individuals currently experiencing at least moderately severe depressive symptoms, an ongoing severe substance use disorder, previous or current bipolar or psychotic disorder, or acute suicidality will be excluded from the trial. Assessments will take place at baseline, 5 weeks (midassessment), and 10 weeks (postassessment). The primary outcome is loneliness assessed using the 9-item University of California, Los Angeles Loneliness Scale at the posttreatment time point. Secondary outcomes include depressive symptoms, symptoms of social anxiety, satisfaction with life, social network size, and variables assessing cognitive bias and social behavior. The maintenance of potentially achieved gains will be assessed and compared at 6 and 12 months after randomization in the 2 active conditions. Potential moderators and mediators will be tested exploratorily. Data will be analyzed on an intention-to-treat basis. Results: Recruitment and data collection started in May 2021 and are expected to be completed by 2022, with the 12-month follow-up to be completed by 2023. As of the time of submission of the manuscript, 134 participants were randomized. Conclusions: This 3-arm randomized controlled trial will add to the existing research on the efficacy of loneliness interventions. Furthermore, it will shed light on the role of human guidance in internet-based treatments for individuals with increased levels of loneliness and the possible mechanisms of change. If SOLUS-D proves effective, it could provide a low-threshold, cost-efficient method of helping and supporting individuals with increased levels of loneliness. Trial Registration: ClinicalTrials.gov NCT04655196; https://clinicaltrials.gov/ct2/show/NCT04655196 International Registered Report Identifier (IRRID): DERR1-10.2196/36358 %M 35867403 %R 10.2196/36358 %U https://www.researchprotocols.org/2022/7/e36358 %U https://doi.org/10.2196/36358 %U http://www.ncbi.nlm.nih.gov/pubmed/35867403 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e35636 %T Preliminary Real-World Evidence Supporting the Efficacy of a Remote Neurofeedback System in Improving Mental Health: Retrospective Single-Group Pretest-Posttest Study %A Whitehead,Jocelyne C %A Neeman,Ron %A Doniger,Glen M %+ Integrated Program in Neuroscience, McGill University, 845 Rue Sherbrooke O, Montreal, QC, H3A 0G4, Canada, 1 866 994 3210, jocelyne.whitehead@mail.mcgill.ca %K EEG biofeedback %K remote care %K neurofeedback %K attention-deficit/hyperactivity disorder %K delta/alpha ratio %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Neurofeedback training (NFT) has been shown to be effective in treating several disorders (eg, attention-deficit/hyperactivity disorder [ADHD], anxiety, and depression); however, little is currently known regarding the effectiveness of remote NFT systems. Objective: This retrospective study provides real-world data (N=593) to assess the efficacy of app-based remote NFT in improving brain health and cognitive performance. Methods: Improvement was measured from pre- to postintervention of in-app assessments that included validated symptom questionnaires (the 12-item General Health Questionnaire, the ADHD Rating Scale IV, the Adult ADHD Self-Report Scale, the 7-item Generalized Anxiety Disorder scale, and the 9-item Patient Health Questionnaire), a cognitive test of attention and executive functioning (ie, continuous performance task), and resting electroencephalography (EEG) markers. Clinically significant improvement was evaluated using standard approaches. Results: The greatest improvement was reported for the anxiety questionnaire, for which 69% (68/99) of participants moved from abnormal to healthy score ranges. Overall, adult and child participants who engaged in neurofeedback to improve attention and executive functions demonstrated improved ADHD scores and enhanced performance on a cognitive (ie, response inhibition) task. Adults with ADHD additionally demonstrated elevated delta/alpha and theta/alpha ratios at baseline and a reduction in the delta/alpha ratio indicator following neurofeedback. Conclusions: Preliminary findings suggest the efficacy of app-based remote neurofeedback in improving mental health, given the reduced symptom severity from pre- to postassessment for general psychological health, ADHD, anxiety, and depression, as well as adjusted resting EEG neural markers for individuals with symptoms of ADHD. Collectively, this supports the utility of the in-app assessment in monitoring behavioral and neural indices of mental health. %M 35802411 %R 10.2196/35636 %U https://formative.jmir.org/2022/7/e35636 %U https://doi.org/10.2196/35636 %U http://www.ncbi.nlm.nih.gov/pubmed/35802411 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e30230 %T Feasibility of Mobile Health and Social Media–Based Interventions for Young Adults With Early Psychosis and Clinical Risk for Psychosis: Survey Study %A Franco,Olivia H %A Calkins,Monica E %A Giorgi,Salvatore %A Ungar,Lyle H %A Gur,Raquel E %A Kohler,Christian G %A Tang,Sunny X %+ Feinstein Institutes for Medical Research, Northwell Health, 75-59 263rd St, Glen Oaks, NY, 11004, United States, 1 631 786 3737, stang3@northwell.edu %K social media %K psychosis %K clinical high risk %K technology %K digital health %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital technology, the internet, and social media are increasingly investigated as promising means for monitoring symptoms and delivering mental health treatment. These apps and interventions have demonstrated preliminary acceptability and feasibility, but previous reports suggest that access to technology may still be limited among individuals with psychotic disorders relative to the general population. Objective: We evaluated and compared access to and use of technology and social media in young adults with psychotic disorders (PD), young adults with clinical risk for psychosis (CR), and psychosis-free youths (PF). Methods: Participants were recruited through a coordinated specialty care clinic dedicated toward early psychosis as well as ongoing studies. We surveyed 21 PD, 23 CR, and 15 PF participants regarding access to technology and use of social media, specifically Facebook and Twitter. Statistical analyses were conducted in R. Categorical variables were compared among groups using Fisher exact test, continuous variables were compared using 1-way ANOVA, and multiple linear regressions were used to evaluate for covariates. Results: Access to technology and social media were similar among PD, CR, and PF participants. Individuals with PD, but not CR, were less likely to post at a weekly or higher frequency compared to PF individuals. We found that decreased active social media posting was unique to psychotic disorders and did not occur with other psychiatric diagnoses or demographic variables. Additionally, variation in age, sex, and White versus non-White race did not affect posting frequency. Conclusions: For young people with psychosis spectrum disorders, there appears to be no “technology gap” limiting the implementation of digital and mobile health interventions. Active posting to social media was reduced for individuals with psychosis, which may be related to negative symptoms or impairment in social functioning. %M 35802420 %R 10.2196/30230 %U https://formative.jmir.org/2022/7/e30230 %U https://doi.org/10.2196/30230 %U http://www.ncbi.nlm.nih.gov/pubmed/35802420 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 7 %P e34102 %T Awareness, Acceptability, and Perceived Effectiveness of Text-Based Therapy Among Graduate Students: Cross-sectional Study %A Blair,Samari A %A Brockmann,Andrea N %A Arroyo,Kelsey M %A Carpenter,Chelsea A %A Ross,Kathryn M %+ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 100165, Gainesville, FL, 32610, United States, 1 352 294 8433, kmross@phhp.ufl.edu %K mental health %K text-based therapy %K graduate students %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research has suggested that there is a mental health crisis occurring among graduate students in the United States. Moreover, many students go without effective treatment owing to the limited availability of mental and behavioral health resources on college campuses. Text-based therapy may represent a viable method for increasing access to mental health support for graduate students, but little is known regarding its acceptability in this population. Objective: The purpose of this study was to assess how graduate students perceive text-based therapy and their likelihood of seeking out this form of therapy. Methods: In total, 265 graduate students completed a cross-sectional web-based survey that included multiple-choice and open-ended questions assessing their perceptions of text-based therapy and the likelihood of seeking out this form of therapy. Chi-square tests, ANOVAs, and nonparametric Wilcoxon signed-rank tests were used to examine differences in multiple-choice questions. The constant comparative method was used for qualitative analyses of the open-ended question responses. Results: Participants (n=265) were predominately non-Hispanic White (166/265, 62.6%) and female (167/265, 63%) with a mean age of 28.3 (SD 5.1) years. Over half of the participants (139/265, 52.5%) were not aware that text-based therapy existed; however, 65.3% (173/265) reported that they would consider using text-based services, if available. In comparison to face-to-face therapy, participants reported being less likely to seek out text-based therapy and perceived it as less effective (P<.001). Qualitative results indicated that participants were concerned about the ability to effectively communicate and build rapport through text-based therapy and thought that this modality may be more effective for some mental and behavioral health concerns than others. Moreover, participants noted that text-based therapy would be best implemented as a way to supplement, rather than replace, face-to-face services. Conclusions: Altogether, the results of this study suggest that text-based therapy holds the potential to increase access to and use of mental and behavioral health services; however, graduate students remain concerned about its effectiveness and the optimal methods of implementation. Future research should investigate how therapeutic processes (eg, effective communication and rapport-building) can be facilitated in digital environments and how text-based therapy could be best implemented to supplement and extend, rather than replace, face-to-face services. %M 35797098 %R 10.2196/34102 %U https://mhealth.jmir.org/2022/7/e34102 %U https://doi.org/10.2196/34102 %U http://www.ncbi.nlm.nih.gov/pubmed/35797098 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e32103 %T Perspectives of Patients and Therapists on Social Media and Digital Data Use in Mental Health Therapy: Thematic Analysis %A Southwick,Lauren %A Suh,Rebecca %A Kranzler,Elissa %A Bradley,Megan %A Merchant,Raina M %+ University of Pennsylvania, 3600 Civic Center Blvd, Philadelphia, PA, 19014, United States, 1 9145826995, lauren.southwick@pennmedicine.upenn.edu %K social media %K digital health %K digital data %K mental health therapy %K mobile phone %D 2022 %7 7.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Incorporating insights from social media into the patient-provider encounter is increasingly being explored in health care settings. Less is known about the utility of these data in mental health therapy. Objective: This study aims to prospectively investigate and characterize how social media and digital data are used in mental health therapy from both the patient and mental health therapist perspective. Methods: Patients enrolled in mental health therapy and mental health therapists were interviewed using a semistructured interview guide. All interviews were transcribed and coded using a deductive framework analysis. Themes and subthemes were identified. Participants completed a sociodemographic survey, while mental health therapists also completed a behavioral norms and elicitation survey. Results: Seventeen participants, that is, 8 (48%) mental health therapists and 9 (52%) patients were interviewed. Overall, participants identified 4 themes and 9 subthemes. Themes were current data collection practices, social media and digital data in therapy, advantages of social media and digital data in therapy, and disadvantages of social media and digital data in therapy. Most subthemes were related to the advantages and disadvantages of incorporating digital data in mental health therapy. Advantage subthemes included convenience, objective, builds rapport, and user-friendliness while disadvantage subthemes were nonreflective, ethically ambiguous, and nongeneralizable. The mental health therapists' behavioral norms and elicitation survey found that injunctive and descriptive normative beliefs mapped onto 2 advantage subthemes: convenience and objectivity. Conclusions: This qualitative pilot study established the advantages and disadvantages of social media and digital data use in mental health therapy. Patients and therapists highlighted similar concerns and uses. This study indicated that overall, both patients and therapists are interested in and are comfortable to use and discuss social media and digital data in mental health therapy. %M 35797103 %R 10.2196/32103 %U https://formative.jmir.org/2022/7/e32103 %U https://doi.org/10.2196/32103 %U http://www.ncbi.nlm.nih.gov/pubmed/35797103 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e29725 %T Bridging the Digital Divide in Psychological Therapies: Observational Study of Engagement With the SlowMo Mobile App for Paranoia in Psychosis %A Hardy,Amy %A Ward,Thomas %A Emsley,Richard %A Greenwood,Kathryn %A Freeman,Daniel %A Fowler,David %A Kuipers,Elizabeth %A Bebbington,Paul %A Garety,Philippa %+ Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, Henry Wellcome Building, London, SE5 8AF, United Kingdom, 44 2078485178, amy.hardy@kcl.ac.uk %K paranoia %K psychosis %K digital health %K apps %K human-centered design %K user experience %K adherence %K engagement %K therapy %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the “digital divide.” Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimize accessibility and bridge the “digital divide.” SlowMo is an effective, blended digital psychological therapy for paranoia in psychosis. Objective: This study explores the “digital divide” and mobile app engagement in the SlowMo randomized controlled trial. Methods: Digital literacy was assessed at baseline, and a multidimensional assessment of engagement (ie, adherence [via system analytics and self-report] and self-reported user experience) was conducted at 12 weeks after therapy. Engagement was investigated in relation to demographics (ie, gender, age, ethnicity, and paranoia severity). Results: Digital literacy data demonstrated that technology use and confidence were lower in Black people and older people (n=168). The engagement findings indicated that 80.7% (96/119) of therapy completers met the a priori analytics adherence criteria. However, analytics adherence did not differ by demographics. High rates of user experience were reported overall (overall score: mean 75%, SD 17.1%; n=82). No differences in user experience were found for ethnicity, age, or paranoia severity, although self-reported app use, enjoyment, and usefulness were higher in women than in men. Conclusions: This study identified technology-related inequalities related to age and ethnicity, which did not influence engagement with SlowMo, suggesting that the therapy design bridged the “digital divide.” Intervention design may moderate the influence of individual differences on engagement. We recommend the adoption of inclusive, human-centered design to reduce the impact of the “digital divide” on therapy outcomes. Trial Registration: ISRCTN Registry ISRCTN32448671; https://www.isrctn.com/ISRCTN32448671 %M 35776506 %R 10.2196/29725 %U https://humanfactors.jmir.org/2022/3/e29725 %U https://doi.org/10.2196/29725 %U http://www.ncbi.nlm.nih.gov/pubmed/35776506 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 6 %P e40147 %T Urgency for Digital Technologies to Support Caregivers. Comment on “Telehealth-Based Psychoeducation for Caregivers: The Family Intervention in Recent-Onset Schizophrenia Treatment Study” %A Eckardt,Jens Peter %+ Bedre Psykiatri Research Unit, Laederstræde 34, 4, Copenhagen, 1201, Denmark, 45 28943288, jp-mail@hotmail.com %K schizophrenia %K family psychoeducation %K caregiver burden %K recent-onset schizophrenia %K telehealth %D 2022 %7 30.6.2022 %9 Letter to the Editor %J JMIR Ment Health %G English %X %M 35771612 %R 10.2196/40147 %U https://mental.jmir.org/2022/6/e40147 %U https://doi.org/10.2196/40147 %U http://www.ncbi.nlm.nih.gov/pubmed/35771612 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33813 %T Therapeutic Alliance in Web-Based Treatment for Eating Disorders: Secondary Analysis of a Randomized Controlled Trial %A Stoeten,Claudia %A de Haan,Hein Arnoud %A Postel,Marloes Gerda %A Brusse-Keizer,Marjolein %A ter Huurne,Elke Daniëlle %+ Tactus Addiction Care, Keulenstraat 3, 7418 ET, Deventer, 7400 AD, Netherlands, 31 883822887, h.dehaan@tactus.nl %K therapeutic alliance %K TA %K treatment completion %K cognitive behavioral therapy %K CBT %K web-CBT %K eating disorders %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In face-to-face therapy for eating disorders, therapeutic alliance (TA) is an important predictor of symptom reduction and treatment completion. To date, however, little is known about TA during web-based cognitive behavioral therapy (web-CBT) and its association with symptom reduction, treatment completion, and the perspectives of patients versus therapists. Objective: This study aimed to investigate TA ratings measured at interim and after treatment, separately for patients and therapists; the degree of agreement between therapists and patients (treatment completers and noncompleters) for TA ratings; and associations between patient and therapist TA ratings and both eating disorder pathology and treatment completion. Methods: A secondary analysis was performed on randomized controlled trial data of a web-CBT intervention for eating disorders. Participants were 170 females with bulimia nervosa (n=33), binge eating disorder (n=68), or eating disorder not otherwise specified (n=69); the mean age was 39.6 (SD 11.5) years. TA was operationalized using the Helping Alliance Questionnaire (HAQ). Paired t tests were conducted to assess the change in TA from interim to after treatment. Intraclass correlations were calculated to determine cross-informant agreement with regard to HAQ scores between patients and therapists. A total of 2 stepwise regressive procedures (at interim and after treatment) were used to examine which HAQ scores predicted eating disorder pathology and therapy completion. Results: For treatment completers (128/170, 75.3%), the HAQ-total scores and HAQ-Helpfulness scores for both patients and therapists improved significantly from interim to post treatment. For noncompleters (42/170, 24.7%), all HAQ scores decreased significantly. For all HAQ scales, the agreement between patients and therapists was poor. However, the agreement was slightly better after treatment than at interim. Higher patient scores on the helpfulness subscale of the HAQ at interim and after treatment were associated with less eating disorder psychopathology. A positive association was found between the HAQ-total patient scores at interim and treatment completion. Finally, posttreatment HAQ-total patient scores and posttreatment HAQ-Helpfulness scores of therapists were positively associated with treatment completion. Conclusions: Our study showed that TA in web-CBT is predictive of eating disorder pathology and treatment completion. Of particular importance is patients’ confidence in their abilities as measured with the HAQ-Helpfulness subscale when predicting posttreatment eating disorder pathology and treatment completion. %M 35771608 %R 10.2196/33813 %U https://formative.jmir.org/2022/6/e33813 %U https://doi.org/10.2196/33813 %U http://www.ncbi.nlm.nih.gov/pubmed/35771608 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e38582 %T Dynamic Regulatory Processes in the Transition From Suicidal Ideation to Action in Adults Leaving Inpatient Psychiatric Care: Protocol for an Intensive Longitudinal Study %A Victor,Sarah E %A Christensen,Kirsten %A Johnson,Sheri L %A Van Allen,Jason %A Brick,Leslie A %+ Department of Psychological Sciences, Texas Tech University, Box 42051, Lubbock, TX, 79424, United States, 1 806 834 0340, sarah.victor@ttu.edu %K ecological momentary assessment %K suicidal ideation %K suicidal behavior %K actigraphy %K sleep %K cognitive control %K longitudinal %K affect %K impulsivity %D 2022 %7 30.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: US suicide rates have risen steadily in the past decade, and suicide risk is especially high in the months after discharge from inpatient psychiatric treatment. However, suicide research has lagged in examining dynamic within-person processes that contribute to risk over time among individuals known to be at high risk of suicide. Almost no research has examined how affective, cognitive, and physiological processes change over minutes, hours, or days to confer risk of suicidal behavior in daily life. Objective: This protocol describes a longitudinal study designed to examine real-world changes in risk of suicide across multiple assessment domains. Specifically, the study involves following adults known to be at high risk of suicide after discharge from inpatient psychiatric care using self-report, interview, actigraphy, and behavioral methods to identify proximal contributors to suicidal thoughts and behaviors. First, we hypothesize that negative affective experiences, which are featured in most major suicide theories, will comprise a latent factor indicative of psychache (emotional pain), which will predict increases in suicidal thinking over time. Second, we hypothesize that poor inhibitory control in the context of negative affective stimuli, as well as emotion-related impulsivity, will predict the transition from suicidal thinking to suicidal behavior over time. Third, we hypothesize that short sleep duration will precede within-person increases in suicidal ideation as well as increased odds of suicidal behavior among those reporting suicidal thoughts. Methods: The desired sample size is 130 adults with past-week suicidal thoughts or behaviors who are receiving inpatient psychiatric treatment. Participants will complete a battery of measures while on the inpatient unit to assess negative affective experiences, emotion-related impulsivity, inhibitory control, typical sleep patterns, and relevant covariates. After discharge from inpatient care, participants will complete 4 weeks of signal-contingent ecological momentary assessment surveys, as well as mobile behavioral measures of inhibitory control, while wearing an actigraphy device that will gather objective data on sleep. Participants will complete interviews regarding suicidal thoughts and behaviors at 4 and 8 weeks after discharge. Results: The study was funded by the National Institutes of Health in November 2020. Recruitment began in April 2021. Data analysis will begin after completion of data collection. Conclusions: This study will elucidate how affective, cognitive, and physiological risk factors contribute (or do not contribute) to within-person fluctuations in suicide risk in daily life, with important implications for extant theories of suicide. Of import, the examined risk factors are all modifiable; thus, the results will inform identification of key targets for just-in-time, flexible, personalized, digital interventions that can be used to decrease emotional distress and prevent suicide among those at highest risk. International Registered Report Identifier (IRRID): DERR1-10.2196/38582 %M 35771618 %R 10.2196/38582 %U https://www.researchprotocols.org/2022/6/e38582 %U https://doi.org/10.2196/38582 %U http://www.ncbi.nlm.nih.gov/pubmed/35771618 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 6 %P e33750 %T The Effectiveness of a Brief Telehealth and Smartphone Intervention for College Students Receiving Traditional Therapy: Longitudinal Study Using Ecological Momentary Assessment Data %A Taylor,Madison E %A Lozy,Olivia %A Conti,Kaileigh %A Wacha-Montes,Annmarie %A Bentley,Kate H %A Kleiman,Evan M %+ Department of Psychology, Rutgers, The State University of New Jersey, Tillet Hall, 53 Avenue E, Piscataway, NJ, 08854, United States, 1 717 394 1180, metaylor1116@gmail.com %K college students %K digital mental health %K brief interventions %D 2022 %7 29.6.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Brief interventions such as mental health apps and single-session interventions are increasingly popular, efficacious, and accessible delivery formats that may be beneficial for college students whose mental health needs may not be adequately met by college counseling centers. However, no studies so far have examined the effectiveness of these modes of treatment for college students who are already receiving traditional therapy, despite it being common among this population. Objective: The aim of this study was to compare the differences in self-reported momentary negative affect between college students in therapy and not in therapy who received a brief single-session intervention delivered by counseling center staff and a supplemental mobile app. Methods: Data for this study were drawn from E-Manage, a brief mobile health intervention geared toward college students. Participants in the study were 173 college students who indicated whether they had received therapy. We conducted a multilevel model to determine whether there were differences between those in therapy versus not in therapy in negative affect reported throughout the study. Following this, we conducted multilevel models with therapy status as the predictor and negative affect as the outcome. Results: Results of the multilevel model testing showed that the cross-level interaction between the time point (ie, pre- vs postexercise) and therapy status was significant (P=.008), with the reduction in negative affect from pre- to postexercise greater for those in therapy (b=–0.65, 95% CI –0.91 to –0.40; P<.001) than it was for those not in therapy (b=–0.31, 95% CI –0.43 to –0.19; P<.001). Therapy status was unassociated with both the pre-exercise (b=–1.69, 95% CI –3.51 to 0.13; P=.07) and postexercise (b=–1.37, 95% CI –3.17 to 0.43; P=.14) ratings of negative affect. Conclusions: These findings suggest that app-based and single-session interventions are also appropriate to use among college students who are receiving traditional therapy. A randomized controlled trial comparing students receiving therapy to students receiving therapy and E-Manage will be necessary to determine to what extent E-Manage contributed to the reductions in negative affect that therapy-attending college students experienced. %M 35767338 %R 10.2196/33750 %U https://mental.jmir.org/2022/6/e33750 %U https://doi.org/10.2196/33750 %U http://www.ncbi.nlm.nih.gov/pubmed/35767338 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e38162 %T Digital Screening and Automated Resource Identification System to Address COVID-19–Related Behavioral Health Disparities: Feasibility Study %A Stiles-Shields,Colleen %A Batts,Kathryn R %A Reyes,Karen M %A Archer,Joseph %A Crosby,Sharad %A Draxler,Janel M %A Lennan,Nia %A Held,Philip %+ Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, 1645 W Jackson Blvd, Suite 302, Chicago, IL, 60612, United States, 1 312 942 9998, colleen_stiles-shields@rush.edu %K digital mental health %K underserved %K health disparities %K COVID-19 %K screening %K referral %K mental health %K digital health %K feasibility study %K mobile app %K mHealth %K mobile health %K emotional need %K digital health tool %K health resource %K health care cost %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health (DMH) tools use technology (eg, websites and mobile apps) to conveniently deliver mental health resources to users in real time, reducing access barriers. Underserved communities facing health care provider shortages and limited mental health resources may benefit from DMH tools, as these tools can help improve access to resources. Objective: This study described the development and feasibility evaluation of the Emotional Needs Evaluation and Resource Guide for You (ENERGY) System, a DMH tool to meet the mental health and resource needs of youth and their families developed in the context of the COVID-19 pandemic. The ENERGY System offers a brief assessment of resource needs; problem-solving capabilities; and symptoms of depression, anxiety, trauma, and alcohol and substance use followed by automated, personalized feedback based on the participant’s responses. Methods: Individuals aged ≥15 years were recruited through community partners, community events, targeted electronic health record messages, and social media. Participants completed screening questions to establish eligibility, entered demographic information, and completed the ENERGY System assessment. Based on the participant’s responses, the ENERGY System immediately delivered digital resources tailored to their identified areas of need (eg, relaxation). A subset of participants also voluntarily completed the following: COVID-19 Exposure and Family Impact Survey (CEFIS) or COVID-19 Exposure and Family Impact Survey Adolescent and Young Adult Version (CEFIS-AYA); resource needs assessment; and feedback on their experience using the ENERGY System. If resource needs (eg, housing and food insecurity) were endorsed, lists of local resources were provided. Results: A total of 212 individuals accessed the ENERGY System link, of which 96 (45.3%) completed the screening tool and 86 (40.6%) received resources. Participant responses on the mental health screening questions triggered on average 2.04 (SD 1.94) intervention domains. Behavioral Activation/Increasing Activities was the most frequently launched intervention domain (56%, 54/96), and domains related to alcohol or substance use were the least frequent (4%, 4/96). The most frequently requested support areas were finances (33%, 32/96), transportation (26%, 25/96), and food (24%, 23/96). The CEFIS and CEFIS-AYA indicated higher than average impacts from the pandemic (ie, average scores >2.5). Participants were satisfied with the ENERGY System overall (65%, 39/60) as well as the length of time it took to answer the questions (90%, 54/60), which they found easy to answer (87%, 52/60). Conclusions: This study provided initial support for the feasibility of the ENERGY System, a DMH tool capable of screening for resource and mental health needs and providing automated, personalized, and free resources and techniques to meet the identified needs. Future studies should seek direct feedback from community members to further improve the ENERGY System and its dissemination to encourage use. %M 35696607 %R 10.2196/38162 %U https://formative.jmir.org/2022/6/e38162 %U https://doi.org/10.2196/38162 %U http://www.ncbi.nlm.nih.gov/pubmed/35696607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36521 %T Predictors of Disengagement and Symptom Improvement Among Adults With Depression Enrolled in Talkspace, a Technology-Mediated Psychotherapy Platform: Naturalistic Observational Study %A Darnell,Doyanne %A Pullmann,Michael D %A Hull,Thomas D %A Chen,Shiyu %A Areán,Patricia %+ Department of Psychiatry & Behavioral Sciences, University of Washington, 325 Ninth Avenue, Box 359911, Seattle, WA, 98104, United States, 1 206 744 9108, darnelld@uw.edu %K depression %K psychotherapy %K disengagement %K internet %K web-based %K technology-mediated psychotherapy %D 2022 %7 22.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression is a common psychiatric condition with an estimated lifetime prevalence for major depression of 16.6% in the US adult population and is effectively treated through psychotherapy. The widespread availability of the internet and personal devices such as smartphones are changing the landscape of delivery of psychotherapy; however, little is known about whether and for whom this type of therapy is beneficial, and whether having synchronous video-based sessions provides additional benefits to clients above and beyond messaging-based therapy. Objective: This study examined the outcomes associated with the use of a digital platform (Talkspace) for technology-mediated psychotherapy. We examined the duration of client engagement in therapy and client depression score trajectories over 16 weeks. We explored the association of client characteristics, therapist characteristics, and service plan type with time-to-disengagement and trajectories of change in depression scores. Methods: This naturalistic observational study assessed data collected routinely by the platform between January 2016 and January 2018 and examined psychotherapy outcomes among a large representative sample of adult clients with clinically significant depression. Treatment disengagement was defined as a lack of client-initiated communication for more than 4 weeks. Clients completed the Patient Health Questionnaire-8 item (PHQ-8) at intake and every 3 weeks via an in-app survey. Cox regression analysis was used to examine the time until and predictors of disengagement. Changes in depression scores and predictors of change over time were examined using mixed-effects regression. Results: The study included 5890 clients and 1271 therapists. Client scores on the PHQ-8 declined over time, with the average client improving from a score of 15 to below the clinical cutoff of 10 by week 6. At the same time point, 37% of clients had disengaged from the therapy. When combined into a final Cox regression model, those who were more likely to disengage were clients aged 18 to 25 years versus those aged ≥50 years (odds ratio [OR] 0.82, 95% CI 0.74-0.9; P<.001), had higher education (OR 1.14, 95% CI 1.06-1.22; P<.001), had been in therapy before (OR 1.09, 95% CI 1.02-1.17; P=.01), and were living with a partner but unmarried versus single (OR 1.14, 95% CI 1.02-1.27; P=.02). Having a therapist with >10 years of experience was related to lower odds of disengagement (OR 0.87, 95% CI 0.8-0.94; P=.01). When combined into a final regression model predicting improvement in depression scores over time, clients showing more improvement were those with an associate’s degree or higher (linear estimate=−0.07, P=.002) and higher intake PHQ-8 scores (estimate=3.73, P<.001). There were no differences based on the plan type. Conclusions: Our findings add to the growing literature showing the benefits of technology-mediated psychotherapy over a relatively brief period (16 weeks). %M 35731563 %R 10.2196/36521 %U https://formative.jmir.org/2022/6/e36521 %U https://doi.org/10.2196/36521 %U http://www.ncbi.nlm.nih.gov/pubmed/35731563 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 6 %P e35496 %T Conceptual Invariance, Trajectories, and Outcome Associations of Working Alliance in Unguided and Guided Internet-Based Psychological Interventions: Secondary Analysis of a Randomized Controlled Trial %A Luo,Xiaochen %A Bugatti,Matteo %A Molina,Lucero %A Tilley,Jacqueline L %A Mahaffey,Brittain %A Gonzalez,Adam %+ Department of Counseling Psychology, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95050, United States, 1 408 554 4000, xluo@scu.edu %K working alliance %K internet-based psychological interventions %K video support %K text support %K trajectory %K MyCompass %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The role of working alliance remains unclear for many forms of internet-based interventions (IBIs), a set of effective psychotherapy alternatives that do not require synchronous interactions between patients and therapists. Objective: This study examined the conceptual invariance, trajectories, and outcome associations of working alliance across an unguided IBI and guided IBIs that incorporated clinician support through asynchronous text messaging or video messaging. Methods: Adults with high education attainment (n=145) with subclinical levels of anxiety, stress, or depressive symptoms were randomized to 1 of 3 treatment conditions for 7 weeks. All participants received treatments from MyCompass, an unguided IBI using cognitive behavior therapy. Participants in condition 2 and 3 received supplemental, asynchronous clinician support through text and video, respectively. Working alliance with the IBIs was measured weekly using select items from the 12-item version of the Agnew Relationship Measure. Symptom and functional outcomes were assessed at baseline, at the end of treatment, and 1-month follow-up. Results: Working alliance with the IBIs was conceptually invariant across the 3 conditions. Working alliance followed a quadratic pattern of change over time for all conditions and declined significantly only in the text-support condition. After controlling for baseline symptoms, higher baseline levels of working alliance predicted less depression and less functional impairment at follow-up, whereas faster increases in working alliance predicted less worry at the end of treatment and at follow-up, all of which only occurred in the video-support condition. Conclusions: Working alliance with the IBIs was generally established in the initial sessions. Although working alliance is conceptually invariant across IBIs with or without clinician support, the associations between working alliance and treatment outcomes among IBIs may differ depending on clinician involvement and the modalities of support. Trial Registration: ClinicalTrials.gov NCT05122429; https://clinicaltrials.gov/ct2/show/NCT05122429 %M 35727626 %R 10.2196/35496 %U https://mental.jmir.org/2022/6/e35496 %U https://doi.org/10.2196/35496 %U http://www.ncbi.nlm.nih.gov/pubmed/35727626 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33036 %T Predicting Mental Health Status in Remote and Rural Farming Communities: Computational Analysis of Text-Based Counseling %A Antoniou,Mark %A Estival,Dominique %A Lam-Cassettari,Christa %A Li,Weicong %A Dwyer,Anne %A Neto,Abìlio de Almeida %+ The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, 2751, Australia, 61 2 9772 6673, m.antoniou@westernsydney.edu.au %K e-mental health %K text-based %K counseling %K Linguistic Inquiry and Word Count %K LIWC %K depression %K anxiety %K stress %D 2022 %7 21.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Australians living in rural and remote areas are at elevated risk of mental health problems and must overcome barriers to help seeking, such as poor access, stigma, and entrenched stoicism. e-Mental health services circumvent such barriers using technology, and text-based services are particularly well suited to clients concerned with privacy and self-presentation. They allow the client to reflect on the therapy session after it has ended as the chat log is stored on their device. The text also offers researchers an opportunity to analyze language use patterns and explore how these relate to mental health status. Objective: In this project, we investigated whether computational linguistic techniques can be applied to text-based communications with the goal of identifying a client’s mental health status. Methods: Client-therapist text messages were analyzed using the Linguistic Inquiry and Word Count tool. We examined whether the resulting word counts related to the participants’ presenting problems or their self-ratings of mental health at the completion of counseling. Results: The results confirmed that word use patterns could be used to differentiate whether a client had one of the top 3 presenting problems (depression, anxiety, or stress) and, prospectively, to predict their self-rated mental health after counseling had been completed. Conclusions: These findings suggest that language use patterns are useful for both researchers and clinicians trying to identify individuals at risk of mental health problems, with potential applications in screening and targeted intervention. %M 35727623 %R 10.2196/33036 %U https://formative.jmir.org/2022/6/e33036 %U https://doi.org/10.2196/33036 %U http://www.ncbi.nlm.nih.gov/pubmed/35727623 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e31029 %T A Reference Architecture for Data-Driven and Adaptive Internet-Delivered Psychological Treatment Systems: Software Architecture Development and Validation Study %A Mukhiya,Suresh Kumar %A Lamo,Yngve %A Rabbi,Fazle %+ Western Norway University of Applied Sciences, Inndalsveien 28, 5063 Bergen, Bergen, 5063, Norway, 47 55 58 58 00, itsmeskm99@gmail.com %K software architecture %K adaptive system %K IDPT system %K health care systems %K ICBT %K adaptive strategies %K personalized therapies %K reference architecture %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Internet-delivered psychological treatment (IDPT) systems are software applications that offer psychological treatments via the internet. Such IDPT systems have become one of the most commonly practiced and widely researched forms of psychotherapy. Evidence shows that psychological treatments delivered by IDPT systems can be an effective way of treating mental health morbidities. However, current IDPT systems have high dropout rates and low user adherence. The primary reason is that the current IDPT systems are not flexible, adaptable, and personalized as they follow a fixed tunnel-based treatment architecture. A fixed tunnel-based architecture follows predefined, sequential treatment content for every patient, irrespective of their context, preferences, and needs. Moreover, current IDPT systems have poor interoperability, making it difficult to reuse and share treatment materials. There is a lack of development and documentation standards, conceptual frameworks, and established (clinical) guidelines for such IDPT systems. As a result, several ad hoc forms of IDPT models exist. Consequently, developers and researchers have tended to reinvent new versions of IDPT systems, making them more complex and less interoperable. Objective: This study aimed to design, develop, and evaluate a reference architecture (RA) for adaptive systems that can facilitate the design and development of adaptive, interoperable, and reusable IDPT systems. Methods: This study was conducted in collaboration with a large interdisciplinary project entitled INTROMAT (Introducing Mental Health through Adaptive Technology), which brings together information and communications technology researchers, information and communications technology industries, health researchers, patients, clinicians, and patients’ next of kin to reach its vision. First, we investigated previous studies and state-of-the-art works based on the project’s problem domain and goals. On the basis of the findings from these investigations, we identified 2 primary gaps in current IDPT systems: lack of adaptiveness and limited interoperability. Second, we used model-driven engineering and Domain-Driven Design techniques to design, develop, and validate the RA for building adaptive, interoperable, and reusable IDPT systems to address these gaps. Third, based on the proposed RA, we implemented a prototype as the open-source software. Finally, we evaluated the RA and open-source implementation using empirical (case study) and nonempirical approaches (software architecture analysis method, expert evaluation, and software quality attributes). Results: This paper outlines an RA that supports flexible user modeling and the adaptive delivery of treatments. To evaluate the proposed RA, we developed an open-source software based on the proposed RA. The open-source framework aims to improve development productivity, facilitate interoperability, increase reusability, and expedite communication with domain experts. Conclusions: Our results showed that the proposed RA is flexible and capable of adapting interventions based on patients’ needs, preferences, and context. Furthermore, developers and researchers can extend the proposed RA to various health care interventions. %M 35723905 %R 10.2196/31029 %U https://humanfactors.jmir.org/2022/2/e31029 %U https://doi.org/10.2196/31029 %U http://www.ncbi.nlm.nih.gov/pubmed/35723905 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37008 %T Exploring Whether Addictions Counselors Recommend That Their Patients Use Websites, Smartphone Apps, or Other Digital Health Tools to Help Them in Their Recovery: Web-Based Survey %A Wray,Tyler B %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S. Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 14018636659, tyler_wray@brown.edu %K addiction %K alcohol %K drug use %K substance use %K adoption %K smartphone %K mobile health %K mHealth %K marketing %K dissemination %K counselor %K health care professional %K digital health %K eHealth %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Hundreds of smartphone apps or websites claiming to help those with addictions are available, but few have been tested for efficacy in changing clinically relevant addictions outcomes. Although most of these products are designed for self-facilitation by users struggling with addictions, counselors and other addictions treatment providers will likely play a critical role in facilitating adoption by integrating their use into counseling or recommending them to their patients. Yet, few studies have explored the practices of addictions counselors in using or recommending addictions-focused digital health tools in their work. Objective: The aim of this study was to understand whether addiction counselors are recommending that their patients use addictions-focused apps to help them in their recovery, and the factors that affect their desire to do so. Methods: Licensed addiction counselors practicing in the United States (N=112) were recruited from professional and scientific organizations of alcohol or drug counselors to complete a web-based survey. Results: In total, 74% (83/112) of counselors had recommended that their patients use a website or smartphone app to assist them in recovery, and those that had done so reported recommending an app with an average of 54% of their patients. The most commonly recommended app or website was SMARTRecovery.org (9%), I am Sober (8%), In the Rooms (7%), Insight Timer (4%), Calm (4%), Sober Tool (4%), Recovery Box (3%), and Sober Grid (3%). The most important reason that counselors recommended the websites or apps was that colleagues or patients told them they found it helpful (55%), followed by their workplaces recommending it (20%) and professional organizations recommending it (10%). Counselors’ intentions to recommend a hypothetical app were strongest for apps that had been tested in rigorous, scientific studies that showed they helped users stay sober or reduce their substance use; 94% (105/112) reported that they would “definitely” or “probably” use such an app. Conclusions: Most addictions counselors surveyed are already recommending that their patients use apps or websites to help them in their recovery, despite the paucity of available products that have evidence supporting their efficacy for addictions outcomes. One way that product developers could increase adoption among addictions treatment providers is to make efficacy testing a priority and to disseminate results through professional organizations and clinics. %M 35723917 %R 10.2196/37008 %U https://formative.jmir.org/2022/6/e37008 %U https://doi.org/10.2196/37008 %U http://www.ncbi.nlm.nih.gov/pubmed/35723917 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e36004 %T The Effects of Nonclinician Guidance on Effectiveness and Process Outcomes in Digital Mental Health Interventions: Systematic Review and Meta-analysis %A Leung,Calista %A Pei,Julia %A Hudec,Kristen %A Shams,Farhud %A Munthali,Richard %A Vigo,Daniel %+ Department of Psychiatry, Faculty of Medicine, University of British Columbia, 2255 Wesbrook Mall, Vancouver, BC, V6T2B8, Canada, 1 6048228048, daniel.vigo@ubc.ca %K digital mental health %K nonclinician guidance %K e-Mental health intervention %K internet-based intervention %K mental health %K task shifting %K digital health %K digital health intervention %K patient outcome %D 2022 %7 15.6.2022 %9 Review %J J Med Internet Res %G English %X Background: Digital mental health interventions are increasingly prevalent in the current context of rapidly evolving technology, and research indicates that they yield effectiveness outcomes comparable to in-person treatment. Integrating professionals (ie, psychologists and physicians) into digital mental health interventions has become common, and the inclusion of guidance within programs can increase adherence to interventions. However, employing professionals to enhance mental health programs may undermine the scalability of digital interventions. Therefore, delegating guidance tasks to paraprofessionals (peer supporters, technicians, lay counsellors, or other nonclinicians) can help reduce costs and increase accessibility. Objective: This systematic review and meta-analysis evaluates the effectiveness, adherence, and other process outcomes of nonclinician-guided digital mental health interventions. Methods: Four databases (MEDLINE, Embase, CINAHL, and PsycINFO) were searched for randomized controlled trials published between 2010 and 2020 examining digital mental health interventions. Three journals that focus on digital intervention were hand searched; gray literature was searched using ProQuest and the Cochrane Central Register of Control Trials (CENTRAL). Two researchers independently assessed risk of bias using the Cochrane risk-of-bias tool version 2. Data were collected on effectiveness, adherence, and other process outcomes, and meta-analyses were conducted for effectiveness and adherence outcomes. Nonclinician-guided interventions were compared with treatment as usual, clinician-guided interventions, and unguided interventions. Results: Thirteen studies qualified for inclusion. Nonclinician-guided interventions yielded higher posttreatment effectiveness outcomes when compared to conditions involving control programs (eg, online psychoeducation and monitored attention control) or wait-list controls (k=7, Hedges g=–0.73; 95% CI –1.08 to –0.38). There were also significant differences between nonclinician-guided interventions and unguided interventions (k=6, Hedges g=–0.17; 95% CI –0.23 to –0.11). In addition, nonclinician-guided interventions did not differ in effectiveness from clinician-guided interventions (k=3, Hedges g=0.08; 95% CI –0.01 to 0.17). These results suggest that guided digital mental health interventions are helpful to improve mental health outcomes regardless of the qualifications of the individual performing the intervention, and that the presence of a nonclinician guide improves effectiveness outcomes compared to having no guide. Nonclinician-guided interventions did not yield significantly different adherence outcomes when compared with unguided interventions (k=3, odds ratio 1.58; 95% CI 0.51 to 4.92), although a general trend of improved adherence was observed within nonclinician-guided interventions. Conclusions: Integrating paraprofessionals and nonclinicians appears to improve the outcomes of digital mental health interventions, and may also enhance adherence outcomes (though this trend was nonsignificant). Further research should focus on the specific types of tasks these paraprofessionals can successfully provide (ie, psychosocial support, therapeutic alliance, and technical augmentation) and their associated outcomes. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020191226; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=191226 %M 35511463 %R 10.2196/36004 %U https://www.jmir.org/2022/6/e36004 %U https://doi.org/10.2196/36004 %U http://www.ncbi.nlm.nih.gov/pubmed/35511463 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e37585 %T Usability Issues in Evidence-Based Psychosocial Interventions and Implementation Strategies: Cross-project Analysis %A Munson,Sean A %A Friedman,Emily C %A Osterhage,Katie %A Allred,Ryan %A Pullmann,Michael D %A Areán,Patricia A %A Lyon,Aaron R %A , %+ Department of Human Centered Design & Engineering, University of Washington, Campus Box 352315, Seattle, WA, 98195, United States, 1 206 221 7699, smunson@uw.edu %K evidence-based psychosocial interventions %K usability %K implementation strategies %K mental health %K human-centered design %K implementation science %D 2022 %7 14.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: People often prefer evidence-based psychosocial interventions (EBPIs) for mental health care; however, these interventions frequently remain unavailable to people in nonspecialty or integrated settings, such as primary care and schools. Previous research has suggested that usability, a concept from human-centered design, could support an understanding of the barriers to and facilitators of the successful adoption of EBPIs and support the redesign of EBPIs and implementation strategies. Objective: This study aimed to identify and categorize usability issues in EBPIs and their implementation strategies. Methods: We adapted a usability issue analysis and reporting format from a human-centered design. A total of 13 projects supported by the National Institute of Mental Health—funded Accelerating the Reach and Impact of Treatments for Youth and Adults with Mental Illness Center at the University of Washington used this format to describe usability issues for EBPIs and implementation strategies with which they were working. Center researchers used iterative affinity diagramming and coding processes to identify usability issue categories. On the basis of these categories and the underlying issues, we propose heuristics for the design or redesign of EBPIs and implementation strategies. Results: The 13 projects reported a total of 90 usability issues, which we categorized into 12 categories, including complex and/or cognitively overwhelming, required time exceeding available time, incompatibility with interventionist preference or practice, incompatibility with existing workflow, insufficient customization to clients/recipients, intervention buy-in (value), interventionist buy-in (trust), overreliance on technology, requires unavailable infrastructure, inadequate scaffolding for client/recipient, inadequate training and scaffolding for interventionists, and lack of support for necessary communication. These issues range from minor inconveniences that affect a few interventionists or recipients to severe issues that prevent all interventionists or recipients in a setting from completing part or all of the intervention. We propose 12 corresponding heuristics to guide EBPIs and implementation strategy designers in preventing and addressing these usability issues. Conclusions: Usability issues were prevalent in the studied EBPIs and implementation strategies. We recommend using the lens of usability evaluation to understand and address barriers to the effective use and reach of EBPIs and implementation strategies. International Registered Report Identifier (IRRID): RR2-10.2196/14990 %M 35700016 %R 10.2196/37585 %U https://www.jmir.org/2022/6/e37585 %U https://doi.org/10.2196/37585 %U http://www.ncbi.nlm.nih.gov/pubmed/35700016 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 6 %P e36012 %T Effectiveness and Cost-effectiveness of Online Brief Mindfulness-based Cognitive Therapy for the Improvement of Productivity in the Workplace: Study Protocol for a Randomized Controlled Trial %A Sado,Mitsuhiro %A Yamada,Masashi %A Ninomiya,Akira %A Nagaoka,Maki %A Goto,Naho %A Koreki,Akihiro %A Nakagawa,Atsuo %A Segal,Zindel %A Mimura,Masaru %+ Department of Neuropsychiatry, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 1608582, Japan, 81 0333531211 ext 62454, mitsusado@keio.jp %K mindfulness-based cognitive therapy %K mindfulness %K cognitive therapy %K occupational health %K workplace %K randomized controlled trial %K cost-effectiveness %K cost %K online %K internet-based %K eHealth %K mental health %K heath outcome %K work %K stress %K burnout %K productivity %K employee %D 2022 %7 13.6.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Numerous studies have demonstrated the effectiveness of mindfulness-based programs (MBPs) among both clinical and nonclinical populations. These data document positive impacts in the workplace, including reducing perceived stress and burnout and increasing well-being. However, the effectiveness for productivity, which is of most interest to managers and administrators, is still unclear. In addition, MBPs in the workplace tend to be modified by reducing the number of the program sessions or delivering content online to improve accessibility. To date, however, the impact of MBPs that feature these modifications on productivity in the workplace has not been investigated. Objective: The study aims to investigate the effectiveness and cost-effectiveness of online-delivered brief mindfulness-based cognitive therapy (bMBCT) for improving productivity and other work-related outcomes among healthy workers compared to the waitlist control. Methods: We will conduct a 4-week randomized controlled trial (RCT) with a 6-month follow-up. Employees are included in the study if they (1) are between the ages of 20 and 65 years and (2) work longer than 30 hours weekly. Employees are randomly allocated to either the bMBCT group or the waitlist control group. The primary outcome of the study is the mean difference of productivity measured by the World Health Organization Health and Work Performance Questionnaire (WHO-HPQ) between the groups at 4, 16, and 28 weeks. Secondary outcomes include several clinical outcomes and health economics evaluation. Results: We started recruiting participants in August 2021, and the intervention began in October 2021. A total of 104 participants have been enrolled in the study as of October 2021. The intervention is scheduled to be completed in December 2023. Data collection will be completed by the end of January 2024. Conclusions: The novelty of the study is that (1) it will investigate bMBCT’s effectiveness on productivity, which is still unclear, and (2) samples are recruited from 3 companies in different industries. The limitations of the study are that (1) all measures assessed are in self-report format and (2) we lack an active control group. This study has the potential to provide new data on the relationship between MBPs and occupational health and productivity. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000044721; https://tinyurl.com/4e2fh873 International Registered Report Identifier (IRRID): DERR1-10.2196/36012 %M 35387762 %R 10.2196/36012 %U https://www.researchprotocols.org/2022/6/e36012 %U https://doi.org/10.2196/36012 %U http://www.ncbi.nlm.nih.gov/pubmed/35387762 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e35260 %T Internet-Delivered Cognitive Behavioral Therapy in Patients With Irritable Bowel Syndrome: Systematic Review and Meta-Analysis %A Kim,Hyunjung %A Oh,Younjae %A Chang,Sun Ju %+ College of Nursing, Research Institute of Nursing Science, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 10 5226 8262, changsj@snu.ac.kr %K cognitive behavioral therapy %K irritable bowel syndrome %K internet %K symptom %K quality of life %D 2022 %7 10.6.2022 %9 Review %J J Med Internet Res %G English %X Background: Irritable bowel syndrome is a common functional gastrointestinal disorder that negatively affects all aspects of life. With the widespread use of the internet, internet-delivered cognitive behavioral therapy has been developed and applied to control symptoms and improve the quality of life of those with irritable bowel syndrome. However, few studies have systematically reviewed the effectiveness of internet-delivered cognitive behavioral therapy on irritable bowel syndrome. Objective: This study aimed to systematically review studies that examined the use of internet-delivered cognitive behavioral therapy in patients with irritable bowel syndrome and to evaluate the effects of internet-delivered cognitive behavioral therapy on the improvement of symptom severity, quality of life, psychological status, and cost-effectiveness. Methods: This meta-analysis involved the search of 6 databases for relevant publications. From the 1224 publications identified through database searches, 9 randomized controlled trials were finally included in the analysis. Results: The internet-delivered cognitive behavioral therapies including exposure-based cognitive behavioral therapy, cognitive behavioral therapy for self-management, and cognitive behavioral therapy for stress management were provided in 5 to 13 sessions for 5 to 10 weeks. Internet-delivered cognitive behavioral therapy had medium-to-large effects on symptom severity (standardized mean difference [SMD] –0.633; 95% CI –0.861 to –0.4304), quality of life (SMD 0.582; 95% CI 0.396-0.769), and cost-effectiveness (–0.372; 95% CI –0.704 to –0.039) at postintervention. The effects on symptom severity remained over time even after the intervention, short-term follow-up (SMD –0.391; 95% CI –0.560 to –0.221), and long-term follow-up (SMD –0.357; 95% CI –0.541 to –0.172). There was no significant difference in psychological status, including anxiety and depression, in those with irritable bowel syndrome compared to the controls during the postintervention period. Conclusions: This review demonstrates that internet-delivered cognitive behavioral therapy could be a cost-effective intervention for improving symptoms and the quality of life in patients with irritable bowel syndrome. However, studies are still insufficient regarding the use of internet-delivered cognitive behavioral therapy in these patients; therefore, more high-quality studies are required in the future. %M 35687389 %R 10.2196/35260 %U https://www.jmir.org/2022/6/e35260 %U https://doi.org/10.2196/35260 %U http://www.ncbi.nlm.nih.gov/pubmed/35687389 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e23879 %T Feasibility and Acceptability of Internet-Based Interpersonal Psychotherapy for Stress, Anxiety, and Depression in Prenatal Women: Thematic Analysis %A Bright,Katherine S %A Stuart,Scott %A Mcneil,Deborah A %A Murray,Lindsay %A Kingston,Dawn E %+ Faculty of Nursing, University of Calgary, PF2500B, 2500 University Drive NW,, Calgary, AB, T2N 1N4, Canada, 1 403 220 6262, ksbright@ucalgary.ca %K internet-based %K interpersonal psychotherapy %K mental health %K prenatal %K anxiety %K depression %K stress %K mobile phone %D 2022 %7 10.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Prenatal mental health is a global health concern. Despite the far-reaching impact of prenatal mental health issues, many women do not receive the psychological care they require. Women in their childbearing years are frequent users of the internet and smartphone apps. Prenatal women are prime candidates for internet-based support for mental health care. Objective: This study aimed to examine the feasibility and acceptability of internet-based interpersonal psychotherapy (IPT) for prenatal women. Methods: Semistructured interviews were conducted with women who had received internet-based IPT modules with guided support as a component of a randomized controlled trial evaluating the scale-up implementation of a digital mental health platform (The Healthy Outcomes of Pregnancy and Postpartum Experiences digital platform) for pregnant women. Qualitative thematic analysis was used to explore and describe women’s experiences. Data were analyzed for emerging themes, which were identified and coded. Results: A total of 15 prenatal women were interviewed to examine their experiences and views on the feasibility and acceptability of internet-based IPT modules. Participants found the content informative and appreciated the ways in which the digital mental health platform made the IPT modules accessible to users. Participants voiced some differing requirements regarding the depth and the way information was presented and accessed on the digital mental health platform. The important areas for improvement that were identified were acknowledging greater depth and clarity of content, the need for sociability and relationships, and refinement of the digital mental health platform to a smartphone app. Conclusions: This study provides useful evidence regarding treatment format and content preferences, which may inform future development. It also provides research data on the feasibility and acceptability of web-based applications for prenatal mental health care. Trial Registration: ClinicalTrials.gov NCT01901796; https://clinicaltrials.gov/ct2/show/NCT01901796 %M 35687403 %R 10.2196/23879 %U https://formative.jmir.org/2022/6/e23879 %U https://doi.org/10.2196/23879 %U http://www.ncbi.nlm.nih.gov/pubmed/35687403 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e33661 %T Video Game Addictive Symptom Level, Use Intensity, and Hedonic Experience: Cross-sectional Questionnaire Study %A Walia,Bhavneet %A Kim,Jeeyoon %A Ijere,Ignatius %A Sanders,Shane %+ Department of Public Health, Falk College, Syracuse University, 430B Barclay, White Hall, Syracuse, NY, 13244, United States, 1 3154433930, bwalia@syr.edu %K video game use %K addictive behaviors %K mental health %K video game addiction %K videogames %K addiction %K video games %D 2022 %7 9.6.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The effects of behavioral addiction to video games has received increasing attention in the literature, given increased use intensity among subgroups of video game players. Objective: This study seeks to empirically determine the relationship between intensity of video gaming and hedonic experience of the player. Methods: We conducted a survey of 835 individuals who regularly play video games to determine the relationship between intensity of use and hedonic experience. We divided the sample into quartiles by self-reported video game addictive symptom level (from the Internet Gaming Disorder Scale) and conducted polynomial regressions separately for each quartile. Results: We found that the higher video game addictive symptom level groups experienced a U-shaped (curvilinear) relationship between hedonic experience and intensity of play, whereas groups with lower video game addictive symptom levels exhibited no such relationship. The coefficients for the highest addictive symptom level group (quartile 4) for marginal effects for hours played per week and hours played per week squared were significantly negative (P=.005) and significantly positive (P=.004), respectively. Conclusions: Our results are consistent with sensitization and tolerance theories, which suggest that high-symptom groups experience frustration and disappointment until they achieve excessive dopamine release, at which point their hedonic experience is expected to improve with additional play. Conversely, low-symptom groups experience no such fall-and-rise pattern. This result is consistent with the outcome that members of the latter group play the game for the direct experience, such that their hedonic experience is more directly related to events occurring in the game than to the increasingly elusive pursuit of excessive dopamine release. We also find that high-symptom groups spend substantially more time and money to support video game use and are much more likely to engage in video game use at the expense of other important activities, such as working, sleeping, and eating. %M 35471995 %R 10.2196/33661 %U https://games.jmir.org/2022/2/e33661 %U https://doi.org/10.2196/33661 %U http://www.ncbi.nlm.nih.gov/pubmed/35471995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e34951 %T Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study %A Pace,Thaddeus W W %A Zeiders,Katharine H %A Cook,Stephanie H %A Sarsar,Evelyn D %A Hoyt,Lindsay T %A Mirin,Nicholas L %A Wood,Erica P %A Tatar,Raquel %A Davidson,Richard J %+ Division of Biobehavioral Health Science, College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ, 85721, United States, 1 520 626 3520, twwpace@arizona.edu %K firefighter %K meditation %K smartphone app %K anxiety %K cortisol %K digital health %K mobile health %K mHealth %K mental health %K burnout %K stress management %D 2022 %7 8.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world. Objective: To address occupational stressors confronting firefighters, we pilot tested a novel, cost-effective, smartphone app–based meditation intervention created by Healthy Minds Innovations that focused on mindfulness (awareness) training along with practices designed to cultivate positive relationships (connection), insight into the nature of the self (insight), and a sense of purpose in the context of challenge (purpose) with a sample of professional firefighters from a large metropolitan area in southwestern United States. Methods: A total of 35 participants were recruited from a closed online group listserv and completed the self-guided 10-unit meditation app over the course of 10 days, at 1 unit per day. We assessed anxiety symptoms, depression symptoms, burnout, and negative affect as well as saliva diurnal cortisol rhythm, an objective indicator of stress-related biology, before and after use of the meditation app. Results: This study demonstrated the meditation app was both feasible and acceptable for use by the majority of firefighters. We also found significant reductions in firefighters’ anxiety (P=.01), burnout (P=.05), and negative affect (P=.04), as well as changes in cortisol diurnal rhythm, such as waking cortisol (P=.02), from before to after use of the meditation app. Conclusions: Our study findings call for future research to demonstrate the efficacy of this meditation app to reduce psychological distress and burnout in firefighters. %M 35675115 %R 10.2196/34951 %U https://formative.jmir.org/2022/6/e34951 %U https://doi.org/10.2196/34951 %U http://www.ncbi.nlm.nih.gov/pubmed/35675115 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33734 %T Sociodemographic Characteristics Associated With an eHealth System Designed to Reduce Depressive Symptoms Among Patients With Breast or Prostate Cancer: Prospective Study %A Petros,Nuhamin Gebrewold %A Hadlaczky,Gergo %A Carletto,Sara %A Martinez,Sergio Gonzalez %A Ostacoli,Luca %A Ottaviano,Manuel %A Meyer,Björn %A Scilingo,Enzo Pasquale %A Carli,Vladimir %+ National Centre for Suicide Research and Prevention of Mental Ill-Health, Department of Learning, Informatics, Ethics and Management, Karolinska Institute, Granits väg 4, Stockholm, 171 65, Sweden, 46 707313324, nuhamin.petros@ki.se %K mental health %K depression %K eHealth %K usability %K breast cancer %K prostate cancer %K System Usability Scale %K SUS %K the user version of the Mobile App Rating Scale %K uMARS %K Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases %K NEVERMIND system %D 2022 %7 8.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth interventions have become a topic of interest in the field of mental health owing to their increased coordination and integration of different elements of care, in treating and preventing mental ill health in patients with somatic illnesses. However, poor usability, learnability, and user engagement might affect the effectiveness of an eHealth intervention. Identifying different sociodemographic characteristics that might be associated with higher perceived usability can help improve the usability of eHealth interventions. Objective: This study aimed to identify the sociodemographic characteristics that might be associated with the perceived usability of the NEVERMIND (Neurobehavioural Predictive and Personalised Modelling of Depressive Symptoms During Primary Somatic Diseases) eHealth system, comprising a mobile app and a sensorized shirt, in reducing comorbid depressive symptoms in patients with breast or prostate cancer. Methods: The study included a total of 129 patients diagnosed with breast (n=80, 62%) or prostate (n=49, 38%) cancer, who received a fully automated mobile app and sensorized shirt (NEVERMIND system). Sociodemographic data on age, sex, marital status, education level, and employment status were collected at baseline. Usability outcomes included the System Usability Scale (SUS), a subjective measure that covers different aspects of system usability; the user version of the Mobile App Rating Scale (uMARS), a user experience questionnaire; and a usage index, an indicator calculated from the number of days patients used the NEVERMIND system during the study period. Results: The analysis was based on 108 patients (n=68, 63%, patients with breast cancer and n=40, 37%, patients with prostate cancer) who used the NEVERMIND system for an average of 12 weeks and completed the study. The overall mean SUS score at 12 weeks was 73.4 (SD 12.5), which indicates that the NEVERMIND system has good usability, with no statistical differences among different sociodemographic characteristics. The global uMARS score was 3.8 (SD 0.3), and women rated the app higher than men (β=.16; P=.03, 95% CI 0.02-0.3), after adjusting for other covariates. No other sociodemographic characteristics were associated with higher uMARS scores. There was a statistical difference in the use of the NEVERMIND system between women and men. Women had significantly lower use (β=–0.13; P=.04, 95% CI −0.25 to −0.01), after adjusting for other covariates. Conclusions: The findings suggest that the NEVERMIND system has good usability according to the SUS and uMARS scores. There was a higher favorability of mobile apps among women than among men. However, men had significantly higher use of the NEVERMIND system. Despite the small sample size and low variability, there is an indication that the NEVERMIND system does not suffer from the digital divide, where certain sociodemographic characteristics are more associated with higher usability. Trial Registration: German Clinical Trials Register RKS00013391; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00013391 %M 35675116 %R 10.2196/33734 %U https://formative.jmir.org/2022/6/e33734 %U https://doi.org/10.2196/33734 %U http://www.ncbi.nlm.nih.gov/pubmed/35675116 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e33011 %T Media Use During the COVID-19 Pandemic: Cross-sectional Study %A Rivest-Beauregard,Marjolaine %A Fortin,Justine %A Guo,Connie %A Cipolletta,Sabrina %A Sapkota,Ram P %A Lonergan,Michelle %A Brunet,Alain %+ Division of Psychosocial Research, Douglas Mental Health University Institute, Perry Building, Third Floor, 6875 bd LaSalle, Montréal, QC, H4H 1R3, Canada, 1 514 761 6131 ext 3473, marjolaine.rivest-beauregard@mail.mcgill.ca %K media use %K support %K information-seeking behaviors %K trauma- and stressor-related symptoms %K COVID-19 %K media %K information-seeking %K behavior %K trauma %K stress %K symptom %K frequency %K risk %K distress %D 2022 %7 7.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Throughout the pandemic, the general population was encouraged to use media to be kept informed about sanitary measures while staying connected with others to obtain social support. However, due to mixed findings in the literature, it is not clear whether media use in such a context would be pathogenic or salutogenic. Objective: Therefore, the associations between COVID-19–related stressors and frequency of media use for information-seeking on trauma- and stressor-related (TSR) symptoms were examined while also investigating how social media use for support-seeking and peritraumatic distress interact with those variables. Methods: A path model was tested in a sample of 5913 adults who completed an online survey. Results: The number of COVID-19–related stressors (β=.25; P<.001) and extent of information-seeking through media (β=.24; P=.006) were significantly associated with the severity of TSR symptoms in bivariate comparisons. Associations between levels of peritraumatic distress and both COVID-19–related stressors and information-seeking through media, and social media use for support- and information-seeking through media were found (βCOVID-19 stressors: Peritraumatic Distress Inventory=.49, P<.001; βseeking information: Peritraumatic Distress Inventory=.70, P<.001; βseeking information–seeking support=.04, P<.001). Conclusions: Results suggest that exposure to COVID-19–related stressors and seeking COVID-19–related information through the media are associated with higher levels of peritraumatic distress that, in turn, lead to higher levels of TSR symptoms. Although exposure to the stress of the COVID-19 pandemic may be unavoidable, the frequency of COVID-19–related information consumption through various media should be approached with caution. %M 3553703 %R 10.2196/33011 %U https://www.jmir.org/2022/6/e33011 %U https://doi.org/10.2196/33011 %U http://www.ncbi.nlm.nih.gov/pubmed/3553703 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e30065 %T Computerized Psychological Interventions in Veterans and Service Members: Systematic Review of Randomized Controlled Trials %A Pearson,Rahel %A Carl,Emily %A Creech,Suzannah K %+ Veterans Health Administration Veterans Integrated Service Network 17, Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, 4800 Memorial Drive (151C), Waco, TX, 76711, United States, 1 2542975155, rahel.pearson@va.gov %K computer %K digital %K internet %K interventions %K veterans %K service members %K review %K mobile phone %D 2022 %7 3.6.2022 %9 Review %J J Med Internet Res %G English %X Background: Computerized psychological interventions can overcome logistical and psychosocial barriers to the use of mental health care in the Veterans Affairs and Department of Defense settings. Objective: In this systematic review, we aim to outline the existing literature, with the goal of describing: the scope and quality of the available literature, intervention characteristics, study methods, study efficacy, and study limitations and potential directions for future research. Methods: Systematic searches of two databases (PsycINFO and PubMed) using PRISMA (Preferred Reporting Item for Systematic Reviews and Meta-Analyses) guidelines were conducted from inception until November 15, 2020. The following inclusion criteria were used: the study was published in an English language peer-reviewed journal, participants were randomly allocated to a computerized psychological intervention or a control group (non–computerized psychological intervention active treatment or nonactive control group), an intervention in at least one treatment arm was primarily delivered through the computer or internet with or without additional support, participants were veterans or service members, and the study used validated measures to examine the effect of treatment on psychological outcomes. Results: This review included 23 studies that met the predefined inclusion criteria. Most studies were at a high risk of bias. Targeted outcomes, participant characteristics, type of support delivered, adherence, and participant satisfaction were described. Most of the examined interventions (19/24, 79%) yielded positive results. Study limitations included participant characteristics limiting study inference, high rates of attrition, and an overreliance on self-reported outcomes. Conclusions: Relatively few high-quality studies were identified, and more rigorous investigations are needed. Several recommendations for future research are discussed, including the adoption of methods that minimize attrition, optimize use, and allow for personalization of treatment. %M 35657663 %R 10.2196/30065 %U https://www.jmir.org/2022/6/e30065 %U https://doi.org/10.2196/30065 %U http://www.ncbi.nlm.nih.gov/pubmed/35657663 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e35086 %T An Intervention to Connect Patients With Psychosis and Volunteers via Smartphone (the Phone Pal): Development Study %A Pinto da Costa,Mariana %A , %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny, London, SE58AB, United Kingdom, 44 02078480002, mariana.pintodacosta@gmail.com %K intervention %K intervention development %K digital mental health %K psychosis %K severe mental illness %K volunteering %K volunteer %K mental health %K mental illness %K development %K design %K user centered design %K smartphone %K mobile phone %K mobile health %K mHealth %K MRC framework %K Medical Research Council framework %D 2022 %7 2.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Intervention development is a critical stage. However, evidence indicates that the substandard reporting of intervention details is widespread. Objective: This study aimed to provide an overview of the guiding frameworks, methodology, and stages for the design and construction of a new complex intervention—the Phone Pal. Methods: The intervention development process followed the Medical Research Council framework for developing complex interventions as well as the person-based approach. The intervention was developed following the evidence synthesis of a literature review, a focus group study, and a survey after consultation and input from advisory groups with a range of stakeholders, including patients, volunteers, clinicians, and academics. Results: The developed logic model outlines the contextual factors, intervention, mechanisms of change, and short- and long-term outcomes. The operationalized intervention required matching 1 patient with 1 volunteer to communicate with each other through a smartphone via SMS text messages, WhatsApp messages or email, and audio or video calls. Each participant was encouraged to communicate with their match at least once per week for a 12-week period using informal conversation. Conclusions: The systematic process and theoretically sound strategy through which this intervention was developed can provide insights to future researchers on the reality of developing and preparing the operationalization of a digital intervention using multiple components. %M 35653171 %R 10.2196/35086 %U https://formative.jmir.org/2022/6/e35086 %U https://doi.org/10.2196/35086 %U http://www.ncbi.nlm.nih.gov/pubmed/35653171 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e34479 %T Strategies for Implementing Occupational eMental Health Interventions: Scoping Review %A Bernard,Renaldo M %A Toppo,Claudia %A Raggi,Alberto %A de Mul,Marleen %A de Miquel,Carlota %A Pugliese,Maria Teresa %A van der Feltz-Cornelis,Christina M %A Ortiz-Tallo,Ana %A Salvador-Carulla,Luis %A Lukersmith,Sue %A Hakkaart-van Roijen,Leona %A Merecz-Kot,Dorota %A Staszewska,Kaja %A Sabariego,Carla %+ Swiss Paraplegic Research, Guido A. Zäch-Strasse 4, Nottwil, 6207, Switzerland, 41 419396654, renaldo.bernard@paraplegie.ch %K implementation %K mobile health %K mHealth %K mental health %K eMental health %K occupational health %K barriers %K facilitators %K scoping review %K mobile phone %D 2022 %7 1.6.2022 %9 Review %J J Med Internet Res %G English %X Background: The implementation of eMental health interventions, especially in the workplace, is a complex process. Therefore, learning from existing implementation strategies is imperative to ensure improvements in the adoption, development, and scalability of occupational eMental health (OeMH) interventions. However, the implementation strategies used for these interventions are often undocumented or inadequately reported and have not been systematically gathered across implementations in a way that can serve as a much-needed guide for researchers. Objective: The objective of this scoping review was to identify implementation strategies relevant to the uptake of OeMH interventions that target employees and detail the associated barriers and facilitation measures. Methods: A scoping review was conducted. The descriptive synthesis was guided by the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework and the Consolidated Framework for Implementation Research. Results: A total of 31 of 32,916 (0.09%) publications reporting the use of the web-, smartphone-, telephone-, and email-based OeMH interventions were included. In all, 98 implementation strategies, 114 barriers, and 131 facilitators were identified. The synthesis of barriers and facilitators produced 19 facilitation measures that provide initial recommendations for improving the implementation of OeMH interventions. Conclusions: This scoping review represents one of the first steps in a research agenda aimed at improving the implementation of OeMH interventions by systematically selecting, shaping, evaluating, and reporting implementation strategies. There is a dire need for improved reporting of implementation strategies and combining common implementation frameworks with more technology-centric implementation frameworks to fully capture the complexities of eHealth implementation. Future research should investigate a wider range of common implementation outcomes for OeMH interventions that also focus on a wider set of common mental health problems in the workplace. This scoping review’s findings can be critically leveraged by discerning decision-makers to improve the reach, effectiveness, adoption, implementation, and maintenance of OeMH interventions. %M 35648457 %R 10.2196/34479 %U https://www.jmir.org/2022/6/e34479 %U https://doi.org/10.2196/34479 %U http://www.ncbi.nlm.nih.gov/pubmed/35648457 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e32922 %T Web-Based Independent Versus Laboratory-Based Stop-Signal Task Performance: Within-Subjects Counterbalanced Comparison Study %A Poulton,Antoinette %A Chen,Li Peng Evelyn %A Dali,Gezelle %A Fox,Michael %A Hester,Robert %+ Melbourne School of Psychological Sciences, University of Melbourne, Redmond Barry Building, Parkville, 3010, Australia, 61 3 8344 6377, antoinette.poulton@unimelb.edu.au %K Stop-Signal Task %K response inhibition %K inhibitory control %K online assessment %K web-based assessment %K cognition %D 2022 %7 30.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Considered a facet of behavioral impulsivity, response inhibition facilitates adaptive and goal-directed behavior. It is often assessed using the Stop-Signal Task (SST), which is presented on stand-alone computers under controlled laboratory conditions. Sample size may consequently be a function of cost or time and sample diversity constrained to those willing or able to attend the laboratory. Statistical power and generalizability of results might, in turn, be impacted. Such limitations may potentially be overcome via the implementation of web-based testing. Objective: The aim of this study was to investigate if there were differences between variables derived from a web-based SST when it was undertaken independently—that is, outside the laboratory, on any computer, and in the absence of researchers—versus when it was performed under laboratory conditions. Methods: We programmed a web-based SST in HTML and JavaScript and employed a counterbalanced design. A total of 166 individuals (mean age 19.72, SD 1.85, range 18-36 years; 146/166, 88% female) were recruited. Of them, 79 undertook the independent task prior to visiting the laboratory and 78 completed the independent task following their laboratory visit. The average time between SST testing was 3.72 (SD 2.86) days. Dependent samples and Bayesian paired samples t tests were used to examine differences between laboratory-based and independent SST variables. Correlational analyses were conducted on stop-signal reaction times (SSRT). Results: After exclusions, 123 participants (mean age 19.73, SD 1.97 years) completed the SST both in the laboratory and independently. While participants were less accurate on go trials and exhibited reduced inhibitory control when undertaking the independent—compared to the laboratory-based—SST, there was a positive association between the SSRT of each condition (r=.48; P<.001; 95% CI 0.33-0.61). Conclusions: Findings suggest a web-based SST, which participants undertake on any computer, at any location, and in the absence of the researcher, is a suitable measure of response inhibition. %M 35635745 %R 10.2196/32922 %U https://www.jmir.org/2022/5/e32922 %U https://doi.org/10.2196/32922 %U http://www.ncbi.nlm.nih.gov/pubmed/35635745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34451 %T Findings and Guidelines on Provider Technology, Fatigue, and Well-being: Scoping Review %A Hilty,Donald M %A Armstrong,Christina M %A Smout,Shelby A %A Crawford,Allison %A Maheu,Marlene M %A Drude,Kenneth P %A Chan,Steven %A Yellowlees,Peter M %A Krupinski,Elizabeth A %+ Department of Psychiatry & Behavioral Sciences, University of California Davis School of Medicine, 2230 Stockton Boulevard, Sacramento, CA, 95817, United States, 1 626 375 7857, donh032612@gmail.com %K burnout %K screen fatigue %K technology fatigue %K well-being %K videoconferencing %K Zoom fatigue %K mobile phone %D 2022 %7 25.5.2022 %9 Review %J J Med Internet Res %G English %X Background: Video and other technologies are reshaping the delivery of health care, yet barriers related to workflow and possible provider fatigue suggest that a thorough evaluation is needed for quality and process improvement. Objective: This scoping review explored the relationship among technology, fatigue, and health care to improve the conditions for providers. Methods: A 6-stage scoping review of literature (from 10 databases) published from 2000 to 2020 that focused on technology, health care, and fatigue was conducted. Technologies included synchronous video, telephone, informatics systems, asynchronous wearable sensors, and mobile health devices for health care in 4 concept areas related to provider experience: behavioral, cognitive, emotional, and physical impact; workplace at the individual, clinic, hospital, and system or organizational levels; well-being, burnout, and stress; and perceptions regarding technology. Qualitative content, discourse, and framework analyses were used to thematically analyze data for developing a spectrum of health to risk of fatigue to manifestations of burnout. Results: Of the 4221 potential literature references, 202 (4.79%) were duplicates, and our review of the titles and abstracts of 4019 (95.21%) found that 3837 (90.9%) were irrelevant. A full-text review of 182 studies revealed that 12 (6.6%) studies met all the criteria related to technology, health care, and fatigue, and these studied the behavioral, emotional, cognitive, and physical impact of workflow at the individual, hospital, and system or organizational levels. Video and electronic health record use has been associated with physical eye fatigue; neck pain; stress; tiredness; and behavioral impacts related to additional effort owing to barriers, trouble with engagement, emotional wear and tear and exhaustion, cognitive inattention, effort, expecting problems, multitasking and workload, and emotional experiences (eg, anger, irritability, stress, and concern about well-being). An additional 14 studies that evaluated behavioral, emotional, and cognitive impacts without focusing on fatigue found high user ratings on data quality, accuracy, and processing but low satisfaction with clerical tasks, the effort required in work, and interruptions costing time, resulting in more errors, stress, and frustration. Our qualitative analysis suggests a spectrum from health to risk and provides an outline of organizational approaches to human factors and technology in health care. Business, occupational health, human factors, and well-being literature have not studied technology fatigue and burnout; however, their findings help contextualize technology-based fatigue to suggest guidelines. Few studies were found to contextually evaluate differences according to health professions and practice contexts. Conclusions: Health care systems need to evaluate the impact of technology in accordance with the Quadruple Aim to support providers’ well-being and prevent workload burden, fatigue, and burnout. Implementation and effectiveness approaches and a multilevel approach with objective measures for clinical, human factors, training, professional development, and administrative workflow are suggested. This requires institutional strategies and competencies to integrate health care quality, technology and well-being outcomes. %M 35612880 %R 10.2196/34451 %U https://www.jmir.org/2022/5/e34451 %U https://doi.org/10.2196/34451 %U http://www.ncbi.nlm.nih.gov/pubmed/35612880 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 5 %P e34154 %T Adolescent Health Promotion Interventions Using Well-Care Visits and a Smartphone Cognitive Behavioral Therapy App: Randomized Controlled Trial %A Nagamitsu,Shinichiro %A Kanie,Ayako %A Sakashita,Kazumi %A Sakuta,Ryoichi %A Okada,Ayumi %A Matsuura,Kencho %A Ito,Masaya %A Katayanagi,Akiko %A Katayama,Takashi %A Otani,Ryoko %A Kitajima,Tasuku %A Matsubara,Naoki %A Inoue,Takeshi %A Tanaka,Chie %A Fujii,Chikako %A Shigeyasu,Yoshie %A Ishii,Ryuta %A Sakai,Sayaka %A Matsuoka,Michiko %A Kakuma,Tatsuyuki %A Yamashita,Yushiro %A Horikoshi,Masaru %+ Department of Pediatrics, Fukuoka University Faculty of Medicine, 7-45-1, Nanakuma, Jonan-ku, Fukuoka, Japan, 81 92 801 1011, snagamit@fukuoka-u.ac.jp %K health promotion %K well-care visit %K cognitive behavioral therapy %K app %K randomized controlled trial %K RCT %K mobile phone %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescent health promotion is important in preventing risk behaviors and improving mental health. Health promotion during adolescence has been shown to contribute to the prevention of late onset of the mental health disease. However, scalable interventions have not been established yet. Objective: This study was designed to test the efficacy of two adolescent health promotion interventions: a well-care visit (WCV) with a risk assessment interview and counseling and self-monitoring with a smartphone cognitive behavioral therapy (CBT) app. Our hypothesis was that participants who had received both WCV and the CBT app would have better outcomes than those who had received only WCV or those who had not received any intervention. We conducted a prospective multi-institutional randomized controlled trial. Methods: Participants were 217 adolescents aged 13-18 years. They were randomly divided into two intervention groups (WCV group and WCV with CBT app group) and a nonintervention group. WCV comprised a standardized physical examination along with a structured interview and counseling for youth risk assessment, which was designed with reference to the Guideline for Health Supervision of Adolescents of Bright Futures. A smartphone-based CBT program was developed based on the CBT approach. The CBT app comprised a 1-week psychoeducation component and a 1-week self-monitoring component. During the CBT program, participants created several self-monitoring sheets based on the CBT model with five window panels: event, thoughts, feelings, body response, and actions. The primary outcome was the change in scores for depressive symptoms. Secondary outcomes included changes in scores for self-esteem, quality of life, self-monitoring, and an adolescent health promotion scale. These outcomes were evaluated at baseline and at 1, 2, and 4 months after baseline. The exploratory outcome was the presence of suicidal ideation during the observation period. Intervention effects were estimated using mixed effect models. Results: In total, 94% (204/217) of the participants completed the 4-month evaluation. Both intervention groups showed a significant effect in the form of reduced scores for depressive symptoms at 1 month in high school students; however, these effects were not observed at 2 and 4 months. The intervention effect was significantly more predominant in those scoring above cutoff for depressive symptoms. There was significantly less suicidal ideation in the intervention groups. As for secondary outcomes, there was significant increase in health promotion scale scores at the 4-month follow-up among junior high school students in the WCV group. Moreover, the CBT app was significantly effective in terms of obtaining self-monitoring skills and reducing depressive symptoms. Conclusions: Although adolescent health promotion interventions may have short-term benefits, the frequency of WCV and further revision of the CBT app should be considered to evaluate long-term effectiveness. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN 000036343; https://center6.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R000041246 %M 35604760 %R 10.2196/34154 %U https://mhealth.jmir.org/2022/5/e34154 %U https://doi.org/10.2196/34154 %U http://www.ncbi.nlm.nih.gov/pubmed/35604760 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e37451 %T Prevalence and Associated Factors of Problematic Use of Smartphones Among Adults in Qassim, Saudi Arabia: Cross-sectional Survey %A Al-Mohaimeed,Abdulrahman %A Alharbi,Mansour %A Mahmud,Ilias %+ Department of Public Health, College of Public Health and Health Informatics, Qassim University, King Abdulaziz Rd, Al Bukairiyah, 52741, Saudi Arabia, 966 594190118, i.emdadulhaque@qu.edu.sa %K smartphone %K smartphone addiction %K problematic use of smartphones %K mobile phone dependence %K problematic use of mobile phones %K Saudi Arabia %K addiction %K psychosocial %K cross-sectional survey %K psychological health %K student %K mental health %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Kingdom of Saudi Arabia (KSA) ranks third globally in smartphone use. Smartphones have made many aspects of life easier. However, the overuse of smartphones is associated with physical and psychosocial problems. Objective: The aim of this paper is to estimate the prevalence and associated factors of problematic use of smartphones among adults in the Qassim region of KSA. Methods: We enrolled 715 participants using cluster random sampling for this cross-sectional survey. We assessed the problematic use of smartphones using the short version of the Smartphone Addiction Scale. Results: We estimated the prevalence of problematic smartphone use among adults at 64% (453/708). Multivariable logistic regression analysis suggested that students are 3 times more likely to demonstrate problematic use compared with unemployed individuals (P=.03); adults using more than five apps are 2 times more likely to demonstrate problematic use compared to those using a maximum of three apps (P=.007). Protective factors against problematic smartphone use include using apps for academic (odds ratio [OR] 0.66; P=.04) or religious needs (OR 0.55; P=.007) and having a monthly family income of 5001-10,000 SAR (Saudi Riyal; US $1300-$2700; OR 0.46; P=.01) or 10,001-20,000 SAR (US $2700-$5400; OR 0.51; P=.03) compared to the <1501 SAR (US $400) income group. Conclusions: We reported a very high prevalence of problematic use of smartphones in KSA. Considering its negative impact on physical and psychosocial health, public health programs should develop preventive strategies. %M 35604756 %R 10.2196/37451 %U https://publichealth.jmir.org/2022/5/e37451 %U https://doi.org/10.2196/37451 %U http://www.ncbi.nlm.nih.gov/pubmed/35604756 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e30907 %T Screening Depressive Symptoms and Incident Major Depressive Disorder Among Chinese Community Residents Using a Mobile App–Based Integrated Mental Health Care Model: Cohort Study %A Zhang,Huimin %A Liao,Yuhua %A Han,Xue %A Fan,Beifang %A Liu,Yifeng %A Lui,Leanna M W %A Lee,Yena %A Subramaniapillai,Mehala %A Li,Lingjiang %A Guo,Lan %A Lu,Ciyong %A McIntyre,Roger S %+ Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, No.74, Zhongshan 2nd, Guangzhou, 510080, China, 86 020 87332477, luciyong@mail.sysu.edu.cn %K screening %K depressive symptoms %K incident major depressive disorder %K Chinese community residents %K electronic-based integrated mental health care model %D 2022 %7 20.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is associated with significant morbidity and human capital costs globally. Early screening for depressive symptoms and timely depressive disorder case identification and intervention may improve health outcomes and cost-effectiveness among affected individuals. China’s public and academic communities have reached a consensus on the need to improve access to early screening, diagnosis, and treatment of depression. Objective: This study aims to estimate the screening prevalence and associated factors of subthreshold depressive symptoms among Chinese residents enrolled in the cohort study using a mobile app–based integrated mental health care model and investigate the 12-month incidence rate and related factors of major depressive disorder (MDD) among those with subthreshold depressive symptoms. Methods: Data were drawn from the Depression Cohort in China (DCC) study. A total of 4243 community residents aged 18 to 64 years living in Nanshan district, Shenzhen city, in Guangdong province, China, were encouraged to participate in the DCC study when visiting the participating primary health care centers, and 4066 (95.83%) residents who met the DCC study criteria were screened for subthreshold depressive symptoms using the Patient Health Questionnaire-9 at baseline. Of the 4066 screened residents, 3168 (77.91%) with subthreshold depressive symptoms were referred to hospitals to receive a psychiatric diagnosis of MDD within 12 months. Sleep duration, anxiety symptoms, well-being, insomnia symptoms, and resilience were also investigated. The diagnosis of MDD was provided by trained psychiatrists using the Mini-International Neuropsychiatric Interview. Univariate and multivariate logistic regression models were performed to explore the potential factors related to subthreshold depressive symptoms at baseline, and Cox proportional hazards models were performed to explore the potential factors related to incident MDD. Results: Anxiety symptoms (adjusted odds ratio [AOR] 1.63, 95% CI 1.42-1.87) and insomnia symptoms (AOR 1.13, 95% CI 1.05-1.22) were associated with an increased risk of subthreshold depressive symptoms, whereas well-being (AOR 0.93, 95% CI 0.87-0.99) was negatively associated with depressive symptoms. During the follow-up period, the 12-month incidence rate of MDD among participants with subthreshold depressive symptoms was 5.97% (189/3168). After incorporating all significant variables from the univariate analyses, the multivariate Cox proportional hazards model reported that a history of comorbidities (adjusted hazard ratio [AHR] 1.49, 95% CI 1.04-2.14) and anxiety symptoms (AHR 1.13, 95% CI 1.09-1.17) were independently associated with an increased risk of incident MDD. The 5-item World Health Organization Well-Being Index was associated with a decreased risk of incident MDD (AHR 0.90, 95% CI 0.86-0.94). Conclusions: Elevated anxiety symptoms and unfavorable general well-being were significantly associated with subthreshold depressive symptoms and incident MDD among Chinese residents in Shenzhen. Early screening for subthreshold depressive symptoms and related factors may be helpful for identifying populations at high risk of incident MDD. %M 35594137 %R 10.2196/30907 %U https://www.jmir.org/2022/5/e30907 %U https://doi.org/10.2196/30907 %U http://www.ncbi.nlm.nih.gov/pubmed/35594137 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e33555 %T The Effects of a Virtual Reality–Based Training Program for Adolescents With Disruptive Behavior Problems on Cognitive Distortions and Treatment Motivation: Protocol for a Multiple Baseline Single-Case Experimental Design %A Klein Schaarsberg,Renée E %A Popma,Arne %A Lindauer,Ramón J L %A van Dam,Levi %+ Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam UMC location Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 0208901000, r.e.kleinschaarsberg@amsterdamumc.nl %K treatment motivation %K cognitive distortions %K reflective functioning %K disruptive behavior problems %K adolescence %K virtual reality %K single-case experimental design %D 2022 %7 20.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Serious disruptive behavior among adolescents is a prevalent and often persistent problem. This highlights the importance of adequate and effective treatment to help adolescents with disruptive behavior problems react less hostile and aggressive. In order to create a treatment environment in which behavioral change can be enhanced, treatment motivation plays an essential role. Regarding treatment itself, a focus on challenging self-serving cognitive distortions in order to achieve behavioral change is important. Street Temptations (ST) is a new training program that was developed to address both treatment motivation and cognitive distortions in adolescents with disruptive behavior problems. One of the innovative aspects of ST is the use of virtual reality (VR) techniques to provide adolescents during treatment with visually presented daily social scenarios to activate emotional engagement and dysfunctional cognitions. By using the VR scenarios as an integral starting point of ST’s sessions and transferring the power of the VR experience into playful and dynamic exercises to practice social perspective–taking, adolescents are encouraged to reflect on both their own behavior and that of others. This focus on reflection is grounded in ST’s main treatment mechanism to influence treatment motivation and cognitive distortions, namely, mentalizing (ie, reflective functioning). Objective: The aim of this study is to describe the research protocol to evaluate the effects of ST on treatment motivation and cognitive distortions. We take a closer look at the use of ST and the methodology used, namely, the repeated single-case experimental design (SCED). Methods: The effects of ST are studied through a multiple baseline SCED, using both quantitative and qualitative data. In total, 18 adolescents from secure residential youth care facilities and secondary special education schools are randomly assigned to 1 of the 3 different baseline conditions. Throughout the baseline phase (1, 2, or 3 weeks), intervention phase (4 weeks), and follow-up phase (1, 2, or 3 weeks), daily measurements on treatment motivation and cognitive distortions are conducted. Secondary study parameters are assessed before baseline, after intervention, and after follow-up. Qualitative data are collected after intervention, as well as at 3 months and 6 months after the intervention. Results: Data collection for this study started in November 2021 and is planned to be completed by August 2023. The results will be published in peer-reviewed journals and presented at national and international conferences. Conclusions: ST aims to improve the disruptive behavior problems of adolescents. This study will be the first to gain insights into the effectiveness of ST. The strengths of this study include its thorough and individually focused design (SCED), the focus on a residential as well as a secondary special education setting, and the ecological validity. The implications for practice are discussed. Trial Registration: Central Committee on Research Involving Human Subjects NL75545.029.20. Netherlands Trial Register NL9639; https://www.trialregister.nl/trial/9639 International Registered Report Identifier (IRRID): PRR1-10.2196/33555 %M 35594071 %R 10.2196/33555 %U https://www.researchprotocols.org/2022/5/e33555 %U https://doi.org/10.2196/33555 %U http://www.ncbi.nlm.nih.gov/pubmed/35594071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e36431 %T Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes From a Retrospective Longitudinal Observational Study %A Feusner,Jamie D %A Farrell,Nicholas R %A Kreyling,Jeremy %A McGrath,Patrick B %A Rhode,Andreas %A Faneuff,Ted %A Lonsway,Stephanie %A Mohideen,Reza %A Jurich,John E %A Trusky,Larry %A Smith,Stephen M %+ NOCD Inc, 225 N Michigan, Suite 1430, Chicago, IL, 60601, United States, 1 323 868 7211, jamie@nocdhelp.com %K digital behavioral health %K cognitive-behavioral therapy %K CBT %K exposure and ritual prevention %K ERP %K EX/RP %K digital health %K telehealth %K cognitive therapy %K obsessive compulsive disorder %K OCD %K clinical outcomes %K teletherapy %K remote therapy %K telemedicine %K obsessive compulsive %K symptom %K comorbid symptom %K comorbidity %K comorbidities %K video therapy %K virtual therapy %K clinical outcome %K patient outcome %K online therapy %K mobile health %K mHealth %K app based %K health app %K technology assisted %K messaging %D 2022 %7 19.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Exposure and response prevention, a type of cognitive-behavioral therapy, is an effective first-line treatment for obsessive-compulsive disorder (OCD). Despite extensive evidence of the efficacy of exposure and response prevention (ERP) from clinical studies and in real-world samples, it is still underused as a treatment. This is likely due to the limits to access to care that include the availability of adequately trained therapists, as well as geographical location, time, and cost barriers. To address these, NOCD created a digital behavioral health treatment for OCD using ERP delivered via video teletherapy and with technology-assisted elements including app-based therapy tools and between-session therapist messaging. Objective: We examined treatment outcomes in a large naturalistic sample of 3552 adults with a primary OCD diagnosis who received NOCD treatment. Methods: The treatment model consisted of twice-weekly, live, face-to-face video teletherapy ERP for 3 weeks, followed by 6 weeks of once-weekly brief video teletherapy check-ins for 30 minutes. Assessments were conducted at baseline, at midpoint after completion of 3 weeks of twice-weekly sessions, and at the end of 6 weeks of brief check-ins (endpoint). Longitudinal assessments were also obtained at 3, 6, 9, and 12 months after endpoint. Results: Treatment resulted in clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms (g=1.0; 95% CI 0.93 to 1.03) and a 62.9% response rate. Treatment also resulted in a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety, and a 37.3% mean reduction in stress symptoms. Quality of life improved by a mean of 22.7%. Reduction in OCD symptoms and response rates were similar for those with mild, moderate, or severe symptoms. The mean duration of treatment was 11.5 (SD 4.0) weeks, and the mean total therapist time was 10.6 (SD 1.1) hours. Improvements were maintained at 3, 6, 9, and 12 months. Conclusions: In this sample, representing the largest reported treated cohort of patients with OCD to date, video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life. Further, it achieved meaningful results in less than half the total therapist time compared with standard once-weekly outpatient treatment, an efficiency that represents substantial monetary and time savings. The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD. %M 35587365 %R 10.2196/36431 %U https://www.jmir.org/2022/5/e36431 %U https://doi.org/10.2196/36431 %U http://www.ncbi.nlm.nih.gov/pubmed/35587365 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e29183 %T Types of Racism and Twitter Users’ Responses Amid the COVID-19 Outbreak: Content Analysis %A Lloret-Pineda,Amanda %A He,Yuelu %A Haro,Josep Maria %A Cristóbal-Narváez,Paula %+ Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Rafael Bldg, 1st Fl, 42 Dr Antoni Pujades Street, Sant Boi de Llobregat, Barcelona, 08830, Spain, 34 93 640 63 50, a.lloret@pssjd.org %K COVID-19 %K racism %K Chinese %K advocacy %K Twitter %D 2022 %7 19.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: When the first COVID-19 cases were noticed in China, many racist comments against Chinese individuals spread. As there is a huge need to better comprehend why all of these targeted comments and opinions developed specifically at the start of the outbreak, we sought to carefully examine racism and advocacy efforts on Twitter in the first quarter of 2020 (January 15 to March 3, 2020). Objective: The first research question aimed to understand the main type of racism displayed on Twitter during the first quarter of 2020. The second research question focused on evaluating Twitter users’ positive and negative responses regarding racism toward Chinese individuals. Methods: Content analysis of tweets was utilized to address the two research questions. Using the NCapture browser link and NVivo software, tweets in English and Spanish were pulled from the Twitter data stream from January 15 to March 3, 2020. A total of 19,150 tweets were captured using the advanced Twitter search engine with the keywords and hashtags #nosoyunvirus, #imNotAVirus, #ChineseDon’tComeToJapan, #racism, “No soy un virus,” and “Racismo Coronavirus.” After cleaning the data, a total of 402 tweets were codified and analyzed. Results: The data confirmed clear sentiments of racism against Chinese individuals during the first quarter of 2020. The tweets displayed individual, cultural, and institutional racism. Individual racism was the most commonly reported form of racism, specifically displaying physical and verbal aggression. As a form of resistance, Twitter users created spaces for advocacy and activism. The hashtag “I am not a virus” helped to break stereotypes, prejudice, and discrimination on Twitter. Conclusions: Advocacy efforts were enormous both inside and outside the Chinese community; an allyship sentiment was fostered by some white users, and an identification with the oppression experienced by the Chinese population was expressed in the Black and Muslim worldwide communities. Activism through social media manifested through art, food sharing, and community support. %M 35446780 %R 10.2196/29183 %U https://formative.jmir.org/2022/5/e29183 %U https://doi.org/10.2196/29183 %U http://www.ncbi.nlm.nih.gov/pubmed/35446780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e38340 %T Deconstructing TikTok Videos on Mental Health: Cross-sectional, Descriptive Content Analysis %A Basch,Corey H %A Donelle,Lorie %A Fera,Joseph %A Jaime,Christie %+ Department of Public Health, William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K TikTok %K mental health %K adolescent %K social media %K short video apps %K content analysis %K digital health %K online health %K visual media %K descriptive content analysis %K mental distress %K health professional %K health care professional %D 2022 %7 19.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media platforms that are based on the creation of visual media, such as TikTok, are increasingly popular with adolescents. Online social media networks provide valuable opportunities to connect with each other to share experiences and strategies for health and wellness. Objective: The aim of this study was to describe the content of the hashtag #mentalhealth on TikTok. Methods: This cross-sectional, descriptive content analysis study included 100 videos with the hashtag #mentalhealth on TikTok. All videos that included the hashtag #mentalhealth were analyzed and coded for the presence of content categories. Additionally, the comments to each video were viewed and coded for content in the following themes: offering support or validation; mentioning experience with suicide or suicidal ideation; mentioning experience with self-harm; describing an experience with hospitalization for mental health issues; describing other mental health issues; and sharing coping strategies, experiences of healing, or ways to feel better. Results: Collectively, the 100 videos studied received 1,354,100,000 views; 266,900,000 likes; and 2,515,954 comments. On average, each video received 13,406,930.69 (SD 8,728,095.52) views; 2,657,425.74 (SD 1,449,920.45) likes; and 24,910.44 (SD 21,035.06) comments. The only content category observed in most (51/100, 51%) of the videos included in the sample was “general mental health.” The remaining content categories appeared in less than 50% of the sample. In total, 32% (32/100) of the videos sampled received more than the overall average number of likes (ie, more that 2.67 million likes). Among these 32 videos, 23 (72%) included comments offering support or validation and 20 (62%) included comments that described other mental health issues or struggles. Conclusions: With over 1 billion cumulative views, almost half of the assessed TikTok videos included in this study reported or expressed symptoms of mental distress. Future research should focus on the potential role of intervention by health care professionals on social media. %M 35588057 %R 10.2196/38340 %U https://formative.jmir.org/2022/5/e38340 %U https://doi.org/10.2196/38340 %U http://www.ncbi.nlm.nih.gov/pubmed/35588057 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e31800 %T Exploring the Risk of Suicide in Real Time on Spanish Twitter: Observational Study %A García-Martínez,Claudia %A Oliván-Blázquez,Bárbara %A Fabra,Javier %A Martínez-Martínez,Ana Belén %A Pérez-Yus,María Cruz %A López-Del-Hoyo,Yolanda %+ Department of Psychology and Sociology, University of Zaragoza, Institute for Health Research Aragón, Pedro Cerbuna, 12, Zaragoza, 50009, Spain, 34 630030125, yolandal@unizar.es %K suicide %K prevention %K social media %K Twitter %K emotional analysis %K eHealth %K big data %K content analysis %K emotional content %K risk factors %K mental health %K public health %K suicide prevention %D 2022 %7 17.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media is now a common context wherein people express their feelings in real time. These platforms are increasingly showing their potential to detect the mental health status of the population. Suicide prevention is a global health priority and efforts toward early detection are starting to develop, although there is a need for more robust research. Objective: We aimed to explore the emotional content of Twitter posts in Spanish and their relationships with severity of the risk of suicide at the time of writing the tweet. Methods: Tweets containing a specific lexicon relating to suicide were filtered through Twitter's public application programming interface. Expert psychologists were trained to independently evaluate these tweets. Each tweet was evaluated by 3 experts. Tweets were filtered by experts according to their relevance to the risk of suicide. In the tweets, the experts evaluated: (1) the severity of the general risk of suicide and the risk of suicide at the time of writing the tweet (2) the emotional valence and intensity of 5 basic emotions; (3) relevant personality traits; and (4) other relevant risk variables such as helplessness, desire to escape, perceived social support, and intensity of suicidal ideation. Correlation and multivariate analyses were performed. Results: Of 2509 tweets, 8.61% (n=216) were considered to indicate suicidality by most experts. Severity of the risk of suicide at the time was correlated with sadness (ρ=0.266; P<.001), joy (ρ=–0.234; P=.001), general risk (ρ=0.908; P<.001), and intensity of suicidal ideation (ρ=0.766; P<.001). The severity of risk at the time of the tweet was significantly higher in people who expressed feelings of defeat and rejection (P=.003), a desire to escape (P<.001), a lack of social support (P=.03), helplessness (P=.001), and daily recurrent thoughts (P=.007). In the multivariate analysis, the intensity of suicide ideation was a predictor for the severity of suicidal risk at the time (β=0.311; P=.001), as well as being a predictor for fear (β=–0.009; P=.01) and emotional valence (β=0.007; P=.009). The model explained 75% of the variance. Conclusions: These findings suggest that it is possible to identify emotional content and other risk factors in suicidal tweets with a Spanish sample. Emotional analysis and, in particular, the detection of emotional variations may be key for real-time suicide prevention through social media. %M 35579921 %R 10.2196/31800 %U https://publichealth.jmir.org/2022/5/e31800 %U https://doi.org/10.2196/31800 %U http://www.ncbi.nlm.nih.gov/pubmed/35579921 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e33817 %T The Association Between Sleep Disturbance and Suicidality in Psychiatric Inpatients Transitioning to the Community: Protocol for an Ecological Momentary Assessment Study %A Dewa,Lindsay H %A Pappa,Sofia %A Greene,Talya %A Cooke,James %A Mitchell,Lizzie %A Hadley,Molly %A Di Simplicio,Martina %A Woodcock,Thomas %A Aylin,Paul %+ School of Public Health, Imperial College London, Reynolds Building, St Dunstan's Road, London, W6 8RP, United Kingdom, 44 020 7594 0815, l.dewa@imperial.ac.uk %K sleep %K suicide %K psychiatric inpatient %K ecological momentary assessment %K EMA %K experience sampling %K coproduction %K sleep disturbance %K discharge %D 2022 %7 17.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients are at high risk of suicidal behavior and death by suicide immediately following discharge from inpatient psychiatric hospitals. Furthermore, there is a high prevalence of sleep problems in inpatient settings, which is associated with worse outcomes following hospitalization. However, it is unknown whether poor sleep is associated with suicidality following initial hospital discharge. Objective: Our study objective is to describe a protocol for an ecological momentary assessment (EMA) study that aims to examine the relationship between sleep and suicidality in discharged patients. Methods: Our study will use an EMA design based on a wearable device to examine the sleep-suicide relationship during the transition from acute inpatient care to the community. Prospectively discharged inpatients 18 to 35 years old with mental disorders (N=50) will be assessed for eligibility and recruited across 2 sites. Data on suicidal ideation, behavior, and imagery; nonsuicidal self-harm and imagery; defeat, entrapment, and hopelessness; affect; and sleep will be collected on the Pro-Diary V wrist-worn electronic watch for up to 14 days. Objective sleep and daytime activity will be measured using the inbuilt MotionWare software. Questionnaires will be administered face-to-face at baseline and follow up, and data will also be collected on the acceptability and feasibility of using the Pro-Diary V watch to monitor the transition following discharge. The study has been, and will continue to be, coproduced with young people with experience of being in an inpatient setting and suicidality. Results: South Birmingham Research Ethics Committee (21/WM/0128) approved the study on June 28, 2021. We expect to see a relationship between poor sleep and postdischarge suicidality. Results will be available in 2022. Conclusions: This protocol describes the first coproduced EMA study to examine the relationship between sleep and suicidality and to apply the integrated motivational volitional model in young patients transitioning from a psychiatric hospital to the community. We expect our findings will inform coproduction in suicidology research and clarify the role of digital monitoring of suicidality and sleep before and after initial hospital discharge. International Registered Report Identifier (IRRID): PRR1-10.2196/33817 %M 35579920 %R 10.2196/33817 %U https://www.researchprotocols.org/2022/5/e33817 %U https://doi.org/10.2196/33817 %U http://www.ncbi.nlm.nih.gov/pubmed/35579920 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35057 %T A Web-Based Stratified Stepped Care Mental Health Platform (TourHeart): Semistructured Interviews With Stakeholders %A Tsoi,Emily W S %A Mak,Winnie W S %A Ho,Connie Y Y %A Yeung,Gladys T Y %+ Department of Psychology, The Chinese University of Hong Kong, Room 354 Sino Building, Shatin, NT, China (Hong Kong), 852 39436577, wwsmak@cuhk.edu.hk %K stepped care %K recovery %K engagement %K eHealth %K mental health %K mental well-being %K psychological intervention %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: TourHeart, a web-based stratified stepped care mental health platform, is a one-stop solution that integrates psychoeducation and other well-being promotional tools for mental health promotion and mental illness prevention and evidence-based, low-intensity psychological interventions for the treatment of people with anxiety and depressive symptoms. Instead of focusing only on symptom reduction, the platform aims to be person-centered and recovery-oriented, and continual feedback from stakeholders is sought. Understanding the perspectives of users and service providers enables platform developers to fine-tune both the design and content of the services for enhanced service personalization and personal recovery. Objective: This qualitative study evaluated a web-based mental health platform by incorporating the perspectives of both users and service providers who administered the platform and provided coaching services. The platform included both web-based and offline services targeting adults along the mental health spectrum based on the two-continua model of mental health and mental illness. Methods: Interview questions were designed based on the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework (RE-AIM). Views on offline services, the design of the web-based platform, user experience, and the contents of the platform were explored using semistructured interviews. A total of 27 service users and 22 service providers were recruited using purposive criterion sampling. A hybrid thematic analysis was performed to identify salient aspects of users’ and providers’ experiences with and views of the platform. Results: Totally, 3 broad themes (namely, the quality of the platform, drivers for platform use, and coaching services) emerged from the interview data that highlighted users’ views of and experiences with the web-based platform. The platform’s general esthetics, operations, and contents were found to be critical features and drivers for continued use. Although coaching services were indispensable, participants preferred the autonomy and anonymity associated with web-based mental health services. Conclusions: This study highlights the importance of web-based mental health services being easy to navigate and understand, being user-centric, and providing adequate guidance in self-help. It also confirms existing design standards and recommendations and suggests that more rigorous, iterative user experience research and robust evaluation should be conducted in the future adaptation of web-based stratified stepped care services, so that they can be more personalized and better promote personal recovery. %M 35560109 %R 10.2196/35057 %U https://humanfactors.jmir.org/2022/2/e35057 %U https://doi.org/10.2196/35057 %U http://www.ncbi.nlm.nih.gov/pubmed/35560109 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e35535 %T Clinicians’ Attitudes Toward Telepsychology in Addiction and Mental Health Services, and Prediction of Postpandemic Telepsychology Uptake: Cross-sectional Study %A Zentner,Kristen %A Gaine,Graham %A Ethridge,Paige %A Surood,Shireen %A Abba-Aji,Adam %+ Clinical Supports and Services, Addiction & Mental Health, Alberta Health Services, 9942 108 St NW, Edmonton, AB, T5K 2J5, Canada, 1 780 342 7726, graham.gaine@albertahealthservices.ca %K mental health %K telepsychology %K clinician attitude %K unified theory of acceptance and use of technology %K therapeutic alliance %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in unprecedented uptake of telepsychology services; however, clinicians have mixed attitudes toward virtual technologies. Objective: This study (1) explored clinicians’ experiences of and intentions to use video, telephone, and in-person services, and (2) tested the utility of the unified theory of acceptance and use of technology (UTAUT) to predict clinicians’ intentions to offer telepsychology after the COVID-19 pandemic. Methods: Clinician satisfaction and therapeutic alliance were compared across in-person, video, and telephone services, while technology attitudes and intention to use after the pandemic were compared across video and telephone services among 118 addiction and mental health clinicians during the COVID-19 pandemic. Results: Clinicians reported more positive experiences with in-person services than both virtual technologies; further, clinicians reported greater positive experiences, attitudes, and intentions to use video services than telephone services across measures. Based on the UTAUT, performance expectancy positively predicted concurrent intentions to use video services (β=0.46; P<.001) and telephone services (β=0.35; P<.001) after the pandemic. Social influence (β=0.24; P=.004) and facilitating conditions (β=0.19; P=.03) additionally predicted the intention to use telephone services. Conclusions: Clinicians rated in-person services more positively than virtual technologies, with video services perceived more positively than telephone services. Performance expectancy was the primary facilitator of the uptake of both virtual modalities. %M 35559793 %R 10.2196/35535 %U https://formative.jmir.org/2022/5/e35535 %U https://doi.org/10.2196/35535 %U http://www.ncbi.nlm.nih.gov/pubmed/35559793 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e35159 %T Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review %A Philippe,Tristan J %A Sikder,Naureen %A Jackson,Anna %A Koblanski,Maya E %A Liow,Eric %A Pilarinos,Andreas %A Vasarhelyi,Krisztina %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada, 1 604 875 4111 ext 64710, Krisztina.Vasarhelyi@vch.ca %K digital health %K telepsychology %K computer-assisted therapy %K online therapy %K mobile applications %K mobile apps %K telemedicine %K telepsychiatry %K virtual reality exposure therapy %K mental health %K COVID-19 %D 2022 %7 12.5.2022 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. Objective: To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. Methods: We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. Results: Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. Conclusions: Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions. %M 35551058 %R 10.2196/35159 %U https://mental.jmir.org/2022/5/e35159 %U https://doi.org/10.2196/35159 %U http://www.ncbi.nlm.nih.gov/pubmed/35551058 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e33551 %T Internet-Delivered Interventions for Depression and Anxiety Symptoms in Children and Young People: Systematic Review and Meta-analysis %A Eilert,Nora %A Wogan,Rebecca %A Leen,Aisling %A Richards,Derek %+ e-Mental Health Group, School of Psychology, University of Dublin Trinity College, College Green, Dublin, D02 PN40, Ireland, 353 18961886, neilert@tcd.ie %K internet-delivered interventions %K children and young people %K depression %K anxiety %K digital health %D 2022 %7 12.5.2022 %9 Review %J JMIR Pediatr Parent %G English %X Background: Mental health difficulties in children and adolescents are highly prevalent; however, only a minority receive adequate mental health care. Internet-delivered interventions offer a promising opportunity to increase access to mental health treatment. Research has demonstrated their effectiveness as a treatment for depression and anxiety in adults. This work provides an up-to-date examination of the available intervention options and their effectiveness for children and young people (CYP). Objective: In this systematic review and meta-analysis, we aimed to determine the evidence available for the effectiveness of internet-delivered interventions for treating anxiety and depression in CYP. Methods: Systematic literature searches were conducted throughout November 2020 using PubMed, PsycINFO, and EBSCO academic search complete electronic databases to find outcome trials of internet-delivered interventions treating symptoms of anxiety and/or depression in CYP by being either directly delivered to the CYP or delivered via their parents. Studies were eligible for meta-analysis if they were randomized controlled trials. Risk of bias and publication biases were evaluated, and Hedges g between group effect sizes evaluating intervention effects after treatment were calculated. Meta-analyses used random-effects models as per protocol. Results: A total of 23 studies met the eligibility criteria for the systematic review, of which 16 were included in the meta-analyses, including 977 participants in internet-delivered treatment conditions and 1008 participants in control conditions across 21 comparisons. Random-effects models detected a significant small effect for anxiety symptoms (across 20 comparisons; Hedges g=−0.25, 95% CI −0.38 to −0.12; P<.001) and a small but not significant effect for depression (across 13 comparisons; Hedges g=−0.27, 95% CI −0.55 to 0.01; P=.06) in favor of internet-delivered interventions compared with control groups. Regarding secondary outcomes, there was a small effect of treatment across 9 comparisons for impaired functioning (Hedges g=0.52, 95% CI 0.24-0.80; P<.001), and 5 comparisons of quality of life showed no effect (Hedges g=−0.01, 95% CI −0.23 to 0.21; P=.94). Conclusions: The results show that the potential of internet-delivered interventions for young people with symptoms of anxiety or depression has not been tapped into to date. This review highlights an opportunity for the development of population-specific interventions and their research to expand our current knowledge and build an empirical base for digital interventions for CYP. Trial Registration: PROSPERO CRD42020220171; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=220171 %M 35551071 %R 10.2196/33551 %U https://pediatrics.jmir.org/2022/2/e33551 %U https://doi.org/10.2196/33551 %U http://www.ncbi.nlm.nih.gov/pubmed/35551071 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e34655 %T Acceptability of Web-Based Mental Health Interventions in the Workplace: Systematic Review %A Scheutzow,Johanna %A Attoe,Chris %A Harwood,Joshua %+ Department of Psychosis, Institute of Psychiatry, Psychology and Neuroscience, School of Academic Psychiatry, King’s College London, 16 De Crespigny Park, London, SE5 8AB, United Kingdom, 44 020 7848 0002, johanna.scheutzow2512@gmail.com %K acceptability %K e-mental health %K online mental health interventions %K occupational online interventions %K employees %K mobile phone %D 2022 %7 11.5.2022 %9 Review %J JMIR Ment Health %G English %X Background: Web-based interventions have proven to be effective not only in clinical populations but also in the occupational setting. Recent studies conducted in the work environment have focused on the effectiveness of these interventions. However, the role of employees’ acceptability of web-based interventions and programs has not yet enjoyed a similar level of attention. Objective: The objective of this systematic review was to conduct the first comprehensive study on employees’ level of acceptability of web-based mental health interventions based on direct and indirect measures, outline the utility of different types of web-based interventions for work-related mental health issues, and build a research base in the field. Methods: The search was conducted between October 2018 and July 2019 and allowed for any study design. The studies used either qualitative or quantitative data sources. The web-based interventions were generally aimed at supporting employees with their mental health issues. The study characteristics were outlined in a table as well as graded based on their quality using a traffic light schema. The level of acceptability was individually rated using commonly applied methods, including percentile quartiles ranging from low to very high. Results: A total of 1303 studies were identified through multiple database searches and additional resources, from which 28 (2%) were rated as eligible for the synthesis. The results of employees’ acceptability levels were mixed, and the studies were very heterogeneous in design, intervention characteristics, and population. Approximately 79% (22/28) of the studies outlined acceptability measures from high to very high, and 54% (15/28) of the studies reported acceptability levels from low to moderate (overlap when studies reported both quantitative and qualitative results). Qualitative studies also provided insights into barriers and preferences, including simple and tailored application tools as well as the preference for nonstigmatized language. However, there were multiple flaws in the methodology of the studies, such as the blinding of participants and personnel. Conclusions: The results outline the need for further research with more homogeneous acceptability studies to draw a final conclusion. However, the underlying results show that there is a tendency toward general acceptability of web-based interventions in the workplace, with findings of general applicability to the use of web-based mental health interventions. %M 35544305 %R 10.2196/34655 %U https://mental.jmir.org/2022/5/e34655 %U https://doi.org/10.2196/34655 %U http://www.ncbi.nlm.nih.gov/pubmed/35544305 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e35224 %T Virtual Reality Intervention for Managing Apathy in People With Cognitive Impairment: Systematic Review %A Ho,Ka Ying %A Cheung,Po Mang %A Cheng,Tap Wing %A Suen,Wing Yin %A Ho,Hiu Ying %A Cheung,Daphne Sze Ki %+ School of Nursing, The Hong Kong Polytechinc University, Room GH526, Hung Hom, Kowloon, Hong Kong, Hong Kong, 852 27664534, daphne.cheung@polyu.edu.hk %K virtual reality %K apathy %K cognitive impairment %K dementia %K systematic review %D 2022 %7 11.5.2022 %9 Review %J JMIR Aging %G English %X Background: Apathy is common in people with cognitive impairment. It leads to different consequences, such as more severe cognitive deficits, rapid functional decline, and decreased quality of life. Virtual reality (VR) interventions are increasingly being used to manage apathy in individuals with cognitive impairment. However, reports of VR interventions are scattered across studies, which has hindered the development and use of the interventions. Objective: This study aimed to systematically review existing evidence on the use of VR interventions for managing apathy in people with cognitive impairment with regard to the effectiveness, contents, and implementation of the interventions. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. The PubMed, Embase, CINAHL, and PsycINFO databases were systematically searched for experimental studies published up to March 13, 2022, that reported the effects of VR interventions on apathy in older adults with cognitive impairment. Hand searching and citation chasing were conducted. The results of the included studies were synthesized by using a narrative synthesis. Their quality was appraised by using the Effective Public Health Practice Project quality assessment tool. However, because the VR interventions varied in duration, content, and implementation across studies, a meta-analysis was not conducted. Results: A total of 22 studies were identified from the databases, of which 6 (27%) met the inclusion criteria. Of these 6 studies, 2 (33%) were randomized controlled trials, 1 (17%) was a controlled clinical trial, and 3 (50%) were quasi-experimental studies. Individual studies showed significant improvement in apathy and yielded within-group medium to large effect sizes. The level of immersion ranged from low to high. Minor adverse effects were reported. The VR content mostly included natural scenes, followed by city views and game-based activities. A background soundtrack was often used with natural scenes. Most (5/6, 83%) of the studies were conducted in a residential care setting and were implemented by health care professionals or researchers. Safety precautions were taken in most (5/6, 83%) of the studies. Conclusions: Although preliminary evidence shows that VR interventions may be effective and feasible for alleviating apathy in people with cognitive impairment, the methodological limitations in the included studies make it difficult to reach a firm conclusion on these points. The implementation of the interventions was highlighted and discussed. More rigorous studies are encouraged. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021268289; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021268289 %M 35544317 %R 10.2196/35224 %U https://aging.jmir.org/2022/2/e35224 %U https://doi.org/10.2196/35224 %U http://www.ncbi.nlm.nih.gov/pubmed/35544317 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34769 %T The Effect of Dissemination Pathways on Uptake and Relative Costs for a Transdiagnostic, Self-guided Internet Intervention for Reducing Depression, Anxiety, and Suicidal Ideation: Comparative Implementation Study %A Batterham,Philip J %A Gulliver,Amelia %A Kurz,Ella %A Farrer,Louise M %A Vis,Christiaan %A Schuurmans,Josien %A Calear,Alison L %+ Centre for Mental Health Research, The Australian National University, 63 Eggleston Rd, Canberra, 2601, Australia, 61 261251031, philip.batterham@anu.edu.au %K implementation %K mental health %K adherence %K uptake %K internet %D 2022 %7 6.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-guided web-based programs are effective; however, inadequate implementation of these programs limits their potential to provide effective and low-cost treatment for common mental health problems at scale. There is a lack of research examining optimal methods for the dissemination of web-based programs in the community. Objective: This study aimed to compare the uptake, reach, relative costs, and adherence associated with 3 community-based pathways for delivering a low-intensity web-based transdiagnostic mental health program. The 3 dissemination pathways were social media advertising, advertising in general practice, and advertising in pharmacies. Methods: Participants were recruited on the web, from general practices, or from community pharmacies; completed a screener for psychological distress; and were offered the 4-week FitMindKit program—a 12-module psychotherapeutic intervention. Uptake was defined as the number of participants who enrolled in the web-based program; reach was defined as the rate of uptake per exposure; and costs were calculated based on staff time, equipment, and advertising. Adherence was assessed as the number of modules of FitMindKit completed by the participants. Results: Uptake comprised 1014 participants who were recruited through the 3 dissemination pathways: on the web (991/1014, 97.73%), in general practice (16/1014, 1.58%), and in pharmacy (7/1014, 0.69%). Reach was highest for social media: 1 in every 50 people exposed to web-based advertising took up the intervention compared with 1 in every 441 in general practitioner clinics and 1 in every 1708 in pharmacies. The dissemination cost was US $4.87 per user on social media, US $557 per user for general practitioner clinics, and US $1272 per user for pharmacy dissemination. No significant differences in adherence were observed between the conditions, whereas all pathways showed an underrepresentation of men and linguistic diversity. Conclusions: The web-based dissemination pathway was the most efficient and cost-effective for delivering a self-guided internet-based mental health program to people in the community. More research is needed to identify how best to engage men and those with culturally diverse backgrounds in web-based interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001688279; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=376113 %M 35522458 %R 10.2196/34769 %U https://www.jmir.org/2022/5/e34769 %U https://doi.org/10.2196/34769 %U http://www.ncbi.nlm.nih.gov/pubmed/35522458 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e27707 %T The Role of Emotion Regulation and Loss-Related Coping Self-efficacy in an Internet Intervention for Grief: Mediation Analysis %A Brodbeck,Jeannette %A Berger,Thomas %A Biesold,Nicola %A Rockstroh,Franziska %A Schmidt,Stefanie J %A Znoj,Hansjoerg %+ Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 316843805, jeannette.brodbeck@unibe.ch %K grief %K divorce %K separation %K bereavement %K internet intervention %K emotion regulation %K coping self-efficacy %K mediation %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet interventions for mental disorders and psychological problems such as prolonged grief have established their efficacy. However, little is known about how internet interventions work and the mechanisms through which they are linked to the outcomes. Objective: As a first step in identifying mechanisms of change, this study aimed to examine emotion regulation and loss-related coping self-efficacy as putative mediators in a randomized controlled trial of a guided internet intervention for prolonged grief symptoms after spousal bereavement or separation or divorce. Methods: The sample comprised older adults who reported prolonged grief or adaptation problems after bereavement, separation, or divorce and sought help from a guided internet intervention. They were recruited mainly via newspaper articles. The outcome variables were grief symptoms assessed using the Texas Revised Inventory of Grief and psychopathology symptoms assessed using the Brief Symptom Inventory. A total of 6 module-related items assessed loss-focused emotion regulation and loss-related coping self-efficacy. In the first step, path models were used to examine emotion regulation and loss-related coping self-efficacy as single mediators for improvements in grief and psychopathology symptoms. Subsequently, exploratory path models with the simultaneous inclusion of emotion regulation and self-efficacy were used to investigate the specificity and relative strength of these variables as parallel mediators. Results: A total of 100 participants took part in the guided internet intervention. The average age was 51.11 (SD 13.60) years; 80% (80/100) were separated or divorced, 69% (69/100) were female, and 76% (76/100) were of Swiss origin. The internet intervention increased emotion regulation skills (β=.33; P=.001) and loss-related coping self-efficacy (β=.30; P=.002), both of which correlated with improvements in grief and psychopathology symptoms. Path models suggested that emotion regulation and loss-related coping self-efficacy were mediators for improvement in grief. Emotion regulation showed a significant indirect effect (β=.13; P=.009), whereas coping self-efficacy showed a trend (β=.07; P=.06). Both were confirmed as mediators for psychopathology (β=.12, P=.02; β=.10; P=.02, respectively). The path from the intervention to the improvement in grief remained significant when including the mediators (β=.26, P=.004; β=.32, P≤.001, respectively) in contrast to the path from the intervention to improvements in psychopathology (β=.15, P=.13; β=.16, P=.10, respectively). Conclusions: Emotion regulation and loss-related coping self-efficacy are promising therapeutic targets for optimizing internet interventions for grief. Both should be further examined as transdiagnostic or disorder-specific putative mediators in internet interventions for other disorders. Trial Registration: ClinicalTrials.gov NCT02900534; https://clinicaltrials.gov/ct2/show/NCT02900534 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1759-5 %M 35522459 %R 10.2196/27707 %U https://mental.jmir.org/2022/5/e27707 %U https://doi.org/10.2196/27707 %U http://www.ncbi.nlm.nih.gov/pubmed/35522459 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e35526 %T Virtual Reality Behavioral Activation for Adults With Major Depressive Disorder: Feasibility Randomized Controlled Trial %A Paul,Margot %A Bullock,Kim %A Bailenson,Jeremy %+ PGSP-Stanford PsyD Consortium, Palo Alto University, 1791 Arastradero Rd, Palo Alto, CA, 94304, United States, 1 800 818 6136, mdpaul@stanford.edu %K virtual reality %K major depressive disorder %K behavioral activation %K depression %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Major depressive disorder (MDD) is a global crisis with increasing incidence and prevalence. There are many established evidence-based psychotherapies (EBPs) for depression, but numerous barriers still exist; most notably, access and dissemination. Virtual reality (VR) may offer some solutions to existing constraints of EBPs for MDD. Objective: We aimed to examine the feasibility, acceptability, and tolerability of using VR as a method of delivering behavioral activation (BA) for adults diagnosed with MDD during a global pandemic and to explore for signs of clinical efficacy by comparing VR-enhanced BA (VR BA) to a standard BA treatment and a treatment as usual control group for individuals diagnosed with MDD. Methods: A feasibility trial using a 3-armed, unblinded, randomized controlled pilot design was conducted. The study took place remotely via Zoom telehealth visits between April 8, 2020, and January 15, 2021. This study used a 3-week, 4-session protocol in which VR BA participants used a VR headset to complete their BA homework. Feasibility was measured using dropout rates, serious adverse events, completion of homework, an adapted telepresence scale, the Simulator Sickness Questionnaire, the Brief Agitation Measure, and an adapted Technology Acceptance Model. Efficacy was assessed using the Patient Health Questionnaire–9. Results: Of the 35 participants assessed for eligibility, 13 (37%) were randomized into VR BA (n=5, 38%), traditional BA (n=4, 31%), or a treatment as usual control (n=4, 31%). The mean age of the 13 participants (5/13, 38% male; 7/13, 54% female; and 1/13, 8% nonbinary or third gender) was 35.4 (SD 12.3) years. This study demonstrated VR BA feasibility in participants with MDD through documented high levels of acceptability and tolerability while engaging in VR-induced pleasurable activities in conjunction with a brief BA protocol. No adverse events were reported. This study also illustrated that VR BA may have potential clinical utility for treating MDD, as the average VR BA participant’s clinical severity decreased by 5.67 points, signifying a clinically meaningful change in severity from a moderate to a mild level of depression as per the Patient Health Questionnaire–9 score. Conclusions: The findings of this study demonstrate that VR BA is safe and feasible to explore for the treatment of MDD. This study documented evidence that VR BA may be efficacious and justifies further examination in an adequately powered randomized controlled trial. This pilot study highlights the potential utility that VR technology may offer patients with MDD, especially those who have difficulty accessing real-world pleasant activities. In addition, for those having difficulty accessing care, VR BA could be adapted as a first step to help people improve their mood and increase their motivation while waiting to connect with a health care professional for other EBPs. Trial Registration: ClinicalTrials.gov NCT04268316; https://clinicaltrials.gov/ct2/show/NCT04268316 International Registered Report Identifier (IRRID): RR2-10.2196/24331 %M 35404830 %R 10.2196/35526 %U https://mental.jmir.org/2022/5/e35526 %U https://doi.org/10.2196/35526 %U http://www.ncbi.nlm.nih.gov/pubmed/35404830 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e37292 %T A Group-Facilitated, Internet-Based Intervention to Promote Mental Health and Well-Being in a Vulnerable Population of University Students: Randomized Controlled Trial of the Be Well Plan Program %A Fassnacht,Daniel B %A Ali,Kathina %A van Agteren,Joep %A Iasiello,Matthew %A Mavrangelos,Teri %A Furber,Gareth %A Kyrios,Michael %+ College of Education, Psychology and Social Work, Flinders University, Sturt Road, Bedford Park, Adelaide, 5042, Australia, 61 8 8201 2621, dan.fassnacht@flinders.edu.au %K COVID-19 %K mental health %K well-being %K depression %K anxiety %K online %K digital %K intervention %K Be Well Plan %K health outcome %K online health %K digital health %K health intervention %K primary outcome %K cognition %K randomized control trial %K resilience %K participant satisfaction %K student %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: A growing literature supports the use of internet-based interventions to improve mental health outcomes. However, most programs target specific symptoms or participant groups and are not tailored to facilitate improvements in mental health and well-being or do not allow for needs and preferences of individual participants. The Be Well Plan, a 5-week group-facilitated, internet-based mental health and well-being group intervention addresses these gaps, allowing participants to select a range of activities that they can tailor to their specific characteristics, needs, and preferences. Objective: This study aims to test whether the Be Well Plan program was effective in improving primary outcomes of mental well-being, resilience, anxiety, and depression compared to a waitlist control group during the COVID-19 pandemic; secondary outcomes included self-efficacy, a sense of control, and cognitive flexibility. The study further seeks to examine participants’ engagement and satisfaction with the program. Methods: A randomized controlled trial (RCT) was conducted with 2 parallel arms, an intervention and a waitlist control group. The intervention involved 5 weekly 2-hour sessions, which were facilitated in group format using Zoom videoconferencing software. University students were recruited via social media posts, lectures, emails, flyers, and posters. Results: Using an intentional randomization 2:1 allocation strategy, we recruited 215 participants to the trial (n=126, 58.6%, intervention group; n=89, 41.4%, waitlist control group). Of the 126 participants assigned to the intervention group, 75 (59.5%) commenced the program and were included in modified intention-to-treat (mITT) analyses. mITT intervention participants attended, on average, 3.41 sessions (SD 1.56, median 4); 55 (73.3%) attended at least 4 sessions, and 25 (33.3%) attended all 5 sessions. Of the 49 intervention group participants who completed the postintervention assessment, 47 (95.9%) were either very satisfied (n=31, 66%) or satisfied (n=16, 34%). The mITT analysis for well-being (F1,162=9.65, P=.002, Cohen d=0.48) and resilience (F1,162=7.85, P=.006, Cohen d=0.44) showed significant time × group interaction effects, suggesting that both groups improved over time, but the Be Well Plan (intervention) group showed significantly greater improvement compared to the waitlist control group. A similar pattern of results was observed for depression and anxiety (Cohen d=0.32 and 0.37, respectively), as well as the secondary outcomes (self-efficacy, Cohen d=0.50; sense of control, Cohen d=0.42; cognitive flexibility, Cohen d=0.65). Larger effect sizes were observed in the completer analyses. Reliable change analysis showed that the majority of mITT participants (58/75, 77.3%) demonstrated a significant reliable improvement in at least 1 of the primary outcomes. Conclusions: The Be Well Plan program was effective in improving mental health and well-being, including mental well-being, resilience, depression, and anxiety. Participant satisfaction scores and attendance indicated a high degree of engagement and satisfaction with the program. Trial Registration: Australian New Zealand Clinical Trial Registry ACTRN12621000180819; https://tinyurl.com/2p8da5sk %M 35471196 %R 10.2196/37292 %U https://mental.jmir.org/2022/5/e37292 %U https://doi.org/10.2196/37292 %U http://www.ncbi.nlm.nih.gov/pubmed/35471196 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e34222 %T A Web-Based Escape Room to Raise Awareness About Severe Mental Illness Among University Students: Randomized Controlled Trial %A Rodriguez-Ferrer,Jose M %A Manzano-León,Ana %A Cangas,Adolfo J %A Aguilar-Parra,Jose M %+ Faculty of Psychology, University of Almeria, Carretera Sacramento s/n, La Cañada de San Urbano, Almería, 04120, Spain, 34 950 01 55 50, aml570@ual.es %K escape room %K severe mental disorder %K higher education %K nursing education %K mental health %K mental disorder %K serious games %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: People with severe mental illness (SMI) face discriminatory situations because of prejudice toward them, even among health care personnel. Escape rooms can be a novel educational strategy for learning about and empathizing with SMI, thus reducing stigma among health care students. Objective: This study aimed to examine the effect of the Without Memories escape room on nursing students’ stigma against SMI. Methods: A pre- and postintervention study was conducted with a control group and an experimental group. A total of 306 students from 2 Andalusian universities participated in the study. Data were collected through a pre-post study questionnaire, consisting of an adapted version of the Attributional Style Questionnaire and a questionnaire on motivation for cooperative playful learning strategies. The control group carried out an escape room scenario without sensitizing content, whereas the experimental group carried out an escape room scenario on SMI, with both escape rooms being carried out in a 1-hour session of subjects related to mental health. To answer the research questions, a 2-way analysis of variance with repeated measures, a linear regression, and a 2-way analysis of variance were performed. Results: After the intervention, a significant reduction (P<.001) was observed in the experimental group in stigmatizing attitudes compared with the control group, in which no statistically significant changes (P>.05) were observed. In contrast, the linear regression (t195=−22.15; P<.001) showed that there was an inverse relationship between flow and the level of reduced stigma. When controlling for having or not having a close relative, the intervention was also shown to be effective (P<.001) in reducing the stigma displayed, both for people with affected and unaffected relatives. Conclusions: Our findings suggest that the Without Memories escape room can be used as an effective tool to educate and raise awareness about stigmatizing attitudes toward SMI in university students studying health care. Future testing of the effectiveness of educational escape rooms should be designed with new programs through playful strategies of longer duration to evaluate whether they can achieve a greater impact on motivation, acquisition of knowledge, and awareness. In addition, the feasibility of implementing the Without Memories escape room in other careers related to health and community should be investigated. %M 35511232 %R 10.2196/34222 %U https://games.jmir.org/2022/2/e34222 %U https://doi.org/10.2196/34222 %U http://www.ncbi.nlm.nih.gov/pubmed/35511232 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e35549 %T Smartphone Sensor Data for Identifying and Monitoring Symptoms of Mood Disorders: A Longitudinal Observational Study %A Braund,Taylor A %A Zin,May The %A Boonstra,Tjeerd W %A Wong,Quincy J J %A Larsen,Mark E %A Christensen,Helen %A Tillman,Gabriel %A O’Dea,Bridianne %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 2 9065 9255, t.braund@blackdog.org.au %K depression %K bipolar disorder %K sensors %K mobile app %K circadian rhythm %K mobile phone %D 2022 %7 4.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mood disorders are burdensome illnesses that often go undetected and untreated. Sensor technologies within smartphones may provide an opportunity for identifying the early changes in circadian rhythm and social support/connectedness that signify the onset of a depressive or manic episode. Objective: Using smartphone sensor data, this study investigated the relationship between circadian rhythm, which was determined by GPS data, and symptoms of mental health among a clinical sample of adults diagnosed with major depressive disorder or bipolar disorder. Methods: A total of 121 participants were recruited from a clinical setting to take part in a 10-week observational study. Self-report questionnaires for mental health outcomes, social support, social connectedness, and quality of life were assessed at 6 time points throughout the study period. Participants consented to passively sharing their smartphone GPS data for the duration of the study. Circadian rhythm (ie, regularity of location changes in a 24-hour rhythm) was extracted from GPS mobility patterns at baseline. Results: Although we found no association between circadian rhythm and mental health functioning at baseline, there was a positive association between circadian rhythm and the size of participants’ social support networks at baseline (r=0.22; P=.03; R2=0.049). In participants with bipolar disorder, circadian rhythm was associated with a change in anxiety from baseline; a higher circadian rhythm was associated with an increase in anxiety and a lower circadian rhythm was associated with a decrease in anxiety at time point 5. Conclusions: Circadian rhythm, which was extracted from smartphone GPS data, was associated with social support and predicted changes in anxiety in a clinical sample of adults with mood disorders. Larger studies are required for further validations. However, smartphone sensing may have the potential to monitor early symptoms of mood disorders. %M 35507385 %R 10.2196/35549 %U https://mental.jmir.org/2022/5/e35549 %U https://doi.org/10.2196/35549 %U http://www.ncbi.nlm.nih.gov/pubmed/35507385 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36203 %T Digital Mental Health Intervention Plus Usual Care Compared With Usual Care Only and Usual Care Plus In-Person Psychological Counseling for Orthopedic Patients With Symptoms of Depression or Anxiety: Cohort Study %A Leo,Ashwin J %A Schuelke,Matthew J %A Hunt,Devyani M %A Miller,J Philip %A Areán,Patricia A %A Cheng,Abby L %+ Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Washington University in St Louis School of Medicine, Box MSC 8233-0004-05, 660S S Euclid Ave, St Louis, MO, 63110, United States, 1 3147472823, ChengAL@wustl.edu %K digital health %K mental health %K depression %K anxiety %K chronic pain %K musculoskeletal %K orthopedic %D 2022 %7 4.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression and anxiety frequently coexist with chronic musculoskeletal pain and can negatively impact patients’ responses to standard orthopedic treatments. Nevertheless, mental health is not routinely addressed in the orthopedic care setting. If effective, a digital mental health intervention may be a feasible and scalable method of addressing mental health in an orthopedic setting. Objective: We aimed to compare 2-month changes in mental and physical health between orthopedic patients who received a digital mental health intervention in addition to usual orthopedic care, those who received usual orthopedic care only (without a specific mental health intervention), and those who received in-person care with a psychologist as part of their orthopedic treatment plan. Methods: In this single-center retrospective cohort study involving ancillary analysis of a pilot feasibility study, 2-month self-reported health changes were compared between a cohort of orthopedic patients who received access to a digital mental health intervention (Wysa) and 2 convenience sample comparison cohorts (patients who received usual orthopedic care without a specific mental health intervention and patients who received in-person care with a psychologist as part of their orthopedic treatment plan). All patients were 18 years or older and reported elevated symptoms of depression or anxiety at an orthopedic clinic visit (Patient-Reported Outcomes Measurement Information System [PROMIS] Depression or Anxiety score ≥55). The digital intervention was a multi-component mobile app that used chatbot technology and text-based access to human counselors to provide cognitive behavioral therapy, mindfulness training, and sleep tools, among other features, with an emphasis on behavioral activation and pain acceptance. Outcomes of interest were between-cohort differences in the 2-month longitudinal changes in PROMIS Depression and Anxiety scores (primary outcomes) and PROMIS Pain Interference and Physical Function scores (secondary outcomes). Results: Among 153 patients (mean age 55, SD 15 years; 128 [83.7%] female; 51 patients per cohort), patients who received the digital mental health intervention showed clinically meaningful improvements at the 2-month follow-up for all PROMIS measures (mean longitudinal improvement 2.8-3.7 points; P≤.02). After controlling for age and BMI, the improvements in PROMIS Depression, Pain Interference, and Physical Function were meaningfully greater than longitudinal changes shown by patients who received usual orthopedic care (mean between-group difference 2.6-4.8 points; P≤.04). Improvements in PROMIS Physical Function were also meaningfully greater than longitudinal changes shown by patients who received in-person psychological counseling (mean between-group difference 2.4 points; P=.04). Conclusions: Patients who received a digital mental health intervention as part of orthopedic care reported greater 2-month mean improvements in depression, pain interference, and physical function than patients who received usual orthopedic care. They also reported a greater mean improvement in physical function and comparable improvements in depression, anxiety, and pain interference compared with orthopedic patients who received in-person psychological counseling. %M 35507387 %R 10.2196/36203 %U https://formative.jmir.org/2022/5/e36203 %U https://doi.org/10.2196/36203 %U http://www.ncbi.nlm.nih.gov/pubmed/35507387 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e36775 %T Therapeutic Alliance in Online and Face-to-face Psychological Treatment: Comparative Study %A Mercadal Rotger,Josep %A Cabré,Victor %+ Institut Universitari de Salut Mental Vidal i Barraquer, Universitat Ramon Llull, C/ Sant Gervasi de Cassoles 88-90, Barcelona, 08022, Spain, 34 660221557, jmercadal@fvb.cat %K online psychological intervention %K therapeutic alliance %K digital health %K mental health %K mental health education %K mental health treatment %K health interventions %K health professional %K online health %K web-based health %K intervention modality %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Since the COVID-19 pandemic, the number of online mental health treatments have grown exponentially. Additionally, it seems inevitable that this technical resource is here to stay at health centers. However, there is still very little scholarly literature published on this topic, and therefore, the impact of the changes that have had to be dealt with in this regard has not been studied. Objective: This study aims to evaluate the differences in the establishment of the therapeutic alliance (TA) based on the intervention modality (online or face-to-face), the type of attachment, and diagnosis. Methods: A total of 291 subjects participated in the study, 149 (51.2%) of whom were men and 142 were (48.8%) women between the ages of 18 and 30 years. The instruments used were sociodemographic data, SOFTA-o (System for Observing Family Therapeutic Alliances—observational), and Relationship Questionnaire. Results: The results show that the treatments conducted face-to-face obtain significantly better scores in the creation of the TA than those conducted online (t=–42.045, df=289, P<.001). The same holds true with attachment, in that users with secure attachment show a better TA than those with insecure attachment (t=6.068, P<.001,), although there were no significant differences with the diagnosis (F=4.566, P=.44), age (r=0.02, P=.70), and sex (t=0.217, P=.33). Conclusions: We believe that professionals are not yet prepared to conduct remote treatment with a degree of efficacy similar to that of face-to-face. It is essential for professionals to receive training in this new technical resource and to understand and incorporate the variants it entails into their daily practice. %M 35499910 %R 10.2196/36775 %U https://mental.jmir.org/2022/5/e36775 %U https://doi.org/10.2196/36775 %U http://www.ncbi.nlm.nih.gov/pubmed/35499910 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 5 %P e35048 %T Engagement, Predictors, and Outcomes of a Trauma Recovery Digital Mental Health Intervention: Longitudinal Study %A Yeager,Carolyn M %A Benight,Charles C %+ Lyda Hill Institute for Human Resilience, University of Colorado Colorado Springs, Fourth Floor, 4863 North Nevada Avenue, Colorado Springs, CO, 80918, United States, 1 (719) 413 8075, cyeager@uccs.edu %K engagement %K digital health %K digital mental health intervention %K social cognitive theory %K SCT %K self-efficacy %K outcome expectations %K trauma %K posttraumatic stress disorder %K PTSD %D 2022 %7 2.5.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Worldwide, exposure to potentially traumatic events is extremely common, and many individuals develop posttraumatic stress disorder (PTSD) along with other disorders. Unfortunately, considerable barriers to treatment exist. A promising approach to overcoming treatment barriers is a digital mental health intervention (DMHI). However, engagement with DMHIs is a concern, and theoretically based research in this area is sparse and often inconclusive. Objective: The focus of this study is on the complex issue of DMHI engagement. On the basis of the social cognitive theory framework, the conceptualization of engagement and a theoretically based model of predictors and outcomes were investigated using a DMHI for trauma recovery. Methods: A 6-week longitudinal study with a national sample of survivors of trauma was conducted to measure engagement, predictors of engagement, and mediational pathways to symptom reduction while using a trauma recovery DMHI (time 1: N=915; time 2: N=350; time 3: N=168; and time 4: N=101). Results: Confirmatory factor analysis of the engagement latent constructs of duration, frequency, interest, attention, and affect produced an acceptable model fit (χ22=8.3; P=.02; comparative fit index 0.973; root mean square error of approximation 0.059; 90% CI 0.022-0.103). Using the latent construct, the longitudinal theoretical model demonstrated adequate model fit (comparative fit index 0.929; root mean square error of approximation 0.052; 90% CI 0.040-0.064), indicating that engagement self-efficacy (β=.35; P<.001) and outcome expectations (β=.37; P<.001) were significant predictors of engagement (R2=39%). The overall indirect effect between engagement and PTSD symptom reduction was significant (β=–.065; P<.001; 90% CI –0.071 to –0.058). This relationship was serially mediated by both skill activation self-efficacy (β=.80; P<.001) and trauma coping self-efficacy (β=.40; P<.001), which predicted a reduction in PTSD symptoms (β=−.20; P=.02). Conclusions: The results of this study may provide a solid foundation for formalizing the nascent science of engagement. Engagement conceptualization comprised general measures of attention, interest, affect, and use that could be applied to other applications. The longitudinal research model supported 2 theoretically based predictors of engagement: engagement self-efficacy and outcome expectancies. A total of 2 task-specific self-efficacies—skill activation and trauma coping—proved to be significant mediators between engagement and symptom reduction. Taken together, this model can be applied to other DMHIs to understand engagement, as well as predictors and mechanisms of action. Ultimately, this could help improve the design and development of engaging and effective trauma recovery DMHIs. %M 35499857 %R 10.2196/35048 %U https://mental.jmir.org/2022/5/e35048 %U https://doi.org/10.2196/35048 %U http://www.ncbi.nlm.nih.gov/pubmed/35499857 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29258 %T Internet-Delivered Cognitive Behavioral Therapy for Insomnia Comorbid With Chronic Pain: Randomized Controlled Trial %A Wiklund,Tobias %A Molander,Peter %A Lindner,Philip %A Andersson,Gerhard %A Gerdle,Björn %A Dragioti,Elena %+ Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Brigadgatan 22, Linkoping, 581 85, Sweden, 46 763251361, elena.dragioti@liu.se %K insomnia %K chronic pain %K comorbid %K CBT-i %K RCT %K web-based CBT %K pain %K online health %K online treatment %K digital health %K mental health %K rehabilitation %D 2022 %7 29.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with chronic pain often experience insomnia symptoms. Pain initiates, maintains, and exacerbates insomnia symptoms, and vice versa, indicating a complex situation with an additional burden for these patients. Hence, the evaluation of insomnia-related interventions for patients with chronic pain is important. Objective: This randomized controlled trial examined the effectiveness of internet-based cognitive behavioral therapy for insomnia (ICBT-i) for reducing insomnia severity and other sleep- and pain-related parameters in patients with chronic pain. Participants were recruited from the Swedish Quality Registry for Pain Rehabilitation. Methods: We included 54 patients (mean age 49.3, SD 12.3 years) who were randomly assigned to the ICBT-i condition and 24 to an active control condition (applied relaxation). Both treatment conditions were delivered via the internet. The Insomnia Severity Index (ISI), a sleep diary, and a battery of anxiety, depression, and pain-related parameter measurements were assessed at baseline, after treatment, and at a 6-month follow-up (only ISI, anxiety, depression, and pain-related parameters). For the ISI and sleep diary, we also recorded weekly measurements during the 5-week treatment. Negative effects were also monitored and reported. Results: Results showed a significant immediate interaction effect (time by treatment) on the ISI and other sleep parameters, namely, sleep efficiency, sleep onset latency, early morning awakenings, and wake time after sleep onset. Participants in the applied relaxation group reported no significant immediate improvements, but both groups exhibited a time effect for anxiety and depression at the 6-month follow-up. No significant improvements on pain-related parameters were found. At the 6-month follow-up, both the ICBT-i and applied relaxation groups had similar sleep parameters. For both treatment arms, increased stress was the most frequently reported negative effect. Conclusions: In patients with chronic pain, brief ICBT-i leads to a more rapid decline in insomnia symptoms than does applied relaxation. As these results are unique, further research is needed to investigate the effect of ICBT-i on a larger sample size of people with chronic pain. Using both treatments might lead to an even better outcome in patients with comorbid insomnia and chronic pain. Trial Registration: ClinicalTrials.gov NCT03425942; https://clinicaltrials.gov/ct2/show/NCT03425942 %M 35486418 %R 10.2196/29258 %U https://www.jmir.org/2022/4/e29258 %U https://doi.org/10.2196/29258 %U http://www.ncbi.nlm.nih.gov/pubmed/35486418 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e25249 %T Data Visualization for Chronic Neurological and Mental Health Condition Self-management: Systematic Review of User Perspectives %A Polhemus,Ashley %A Novak,Jan %A Majid,Shazmin %A Simblett,Sara %A Morris,Daniel %A Bruce,Stuart %A Burke,Patrick %A Dockendorf,Marissa F %A Temesi,Gergely %A Wykes,Til %+ Merck Research Labs, Information Technology, Merck, Sharpe, & Dohme, The Circle 66, Zurich, 8058, Switzerland, 41 764922388, ashley.polhemus@uzh.ch %K digital health %K remote measurement technology %K neurology %K mental health %K data visualization %K user-centered design %D 2022 %7 28.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: Remote measurement technologies (RMT) such as mobile health devices and apps are increasingly used by those living with chronic neurological and mental health conditions. RMT enables real-world data collection and regular feedback, providing users with insights about their own conditions. Data visualizations are an integral part of RMT, although little is known about visualization design preferences from the perspectives of those living with chronic conditions. Objective: The aim of this review was to explore the experiences and preferences of individuals with chronic neurological and mental health conditions on data visualizations derived from RMT to manage health. Methods: In this systematic review, we searched peer-reviewed literature and conference proceedings (PubMed, IEEE Xplore, EMBASE, Web of Science, Association for Computing Machinery Computer-Human Interface proceedings, and the Cochrane Library) for original papers published between January 2007 and September 2021 that reported perspectives on data visualization of people living with chronic neurological and mental health conditions. Two reviewers independently screened each abstract and full-text article, with disagreements resolved through discussion. Studies were critically appraised, and extracted data underwent thematic synthesis. Results: We identified 35 eligible publications from 31 studies representing 12 conditions. Coded data coalesced into 3 themes: desire for data visualization, impact of visualizations on condition management, and visualization design considerations. Data visualizations were viewed as an integral part of users’ experiences with RMT, impacting satisfaction and engagement. However, user preferences were diverse and often conflicting both between and within conditions. Conclusions: When used effectively, data visualizations are valuable, engaging components of RMT. They can provide structure and insight, allowing individuals to manage their own health more effectively. However, visualizations are not “one-size-fits-all,” and it is important to engage with potential users during visualization design to understand when, how, and with whom the visualizations will be used to manage health. %M 35482368 %R 10.2196/25249 %U https://mental.jmir.org/2022/4/e25249 %U https://doi.org/10.2196/25249 %U http://www.ncbi.nlm.nih.gov/pubmed/35482368 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e33080 %T Comparing the Ratio of Therapist Support to Internet Sessions in a Blended Therapy Delivered to Trauma-Exposed Veterans: Quasi-experimental Comparison Study %A Cloitre,Marylene %A Amspoker,Amber Bush %A Fletcher,Terri L %A Hogan,Julianna B %A Jackson,Christie %A Jacobs,Adam %A Shammet,Rayan %A Speicher,Sarah %A Wassef,Miryam %A Lindsay,Jan %+ National Center for PTSD Dissemination and Training Division, Veterans Administration Palo Alto Health Care System, 795 Willow Road, Palo Alto, CA, 94025, United States, 1 415 603 8093, marylene.cloitre@gmail.com %K PTSD %K depression %K veterans %K blended therapy %K iCBT %K web-based %K webSTAIR %K noninferiority %K mental health %K digital health %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Blended models of therapy, which incorporate elements of both internet and face-to-face methods, have been shown to be effective, but therapists and patients have expressed concerns that fewer face-to-face therapy sessions than self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates, and poorer outcomes. Objective: A multisite quasi-experimental comparison study with a noninferiority design implemented in routine clinical care was used to assess webSTAIR, a 10-module blended therapy derived from STAIR (skills training in affective and interpersonal regulation) for trauma-exposed individuals delivered with 10 weekly therapist sessions (termed Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be as good as Coach10 in a range of outcomes. Methods: A total of 202 veterans were enrolled in the study with 101 assigned to Coach5 and 101 to Coach10. Posttraumatic stress disorder (PTSD) symptoms, depression, emotion regulation, interpersonal problems, and social functioning measures were collected pre-, mid-, and posttreatment, and at a 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons were made of continuous and categorical measures regarding participant and therapist activities. Results: Participants reported moderate to severe levels of baseline PTSD, depression, or both. Significant reductions were obtained in all symptom measures posttreatment and at the 3-month follow up. Coach5 was not inferior to Coach10 in any outcome. Therapeutic alliance was at an equivalently high level across the 2 treatment conditions; completion rates and web usage were similar. Total session time was substantially less for the Coach5 therapists than the Coach10 therapists. Both programs were associated with a low, but equal number of therapist activities related to scheduling and crisis or motivational sessions. Conclusions: A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions in individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes with high versus low doses of therapist support will help create flexible, technology-based intervention programming. %M 35475777 %R 10.2196/33080 %U https://mental.jmir.org/2022/4/e33080 %U https://doi.org/10.2196/33080 %U http://www.ncbi.nlm.nih.gov/pubmed/35475777 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35671 %T Understanding People With Chronic Pain Who Use a Cognitive Behavioral Therapy–Based Artificial Intelligence Mental Health App (Wysa): Mixed Methods Retrospective Observational Study %A Meheli,Saha %A Sinha,Chaitali %A Kadaba,Madhura %+ Wysa Inc, 131 Dartmouth St, Boston, MA, United States, 1 916 753 7824, chaitali@wysa.io %K chronic pain %K digital mental health %K mobile health %K mHealth %K pain management %K artificial intelligence %K cognitive behavioral therapy %K conversational agent %K software agent %K pain conditions %K depression %K anxiety %D 2022 %7 27.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital health interventions can bridge barriers in access to treatment among individuals with chronic pain. Objective: This study aimed to evaluate the perceived needs, engagement, and effectiveness of the mental health app Wysa with regard to mental health outcomes among real-world users who reported chronic pain and engaged with the app for support. Methods: Real-world data from users (N=2194) who reported chronic pain and associated health conditions in their conversations with the mental health app were examined using a mixed methods retrospective observational study. An inductive thematic analysis was used to analyze the conversational data of users with chronic pain to assess perceived needs, along with comparative macro-analyses of conversational flows to capture engagement within the app. Additionally, the scores from a subset of users who completed a set of pre-post assessment questionnaires, namely Patient Health Questionnaire-9 (PHQ-9) (n=69) and Generalized Anxiety Disorder Assessment-7 (GAD-7) (n=57), were examined to evaluate the effectiveness of Wysa in providing support for mental health concerns among those managing chronic pain. Results: The themes emerging from the conversations of users with chronic pain included health concerns, socioeconomic concerns, and pain management concerns. Findings from the quantitative analysis indicated that users with chronic pain showed significantly greater app engagement (P<.001) than users without chronic pain, with a large effect size (Vargha and Delaney A=0.76-0.80). Furthermore, users with pre-post assessments during the study period were found to have significant improvements in group means for both PHQ-9 and GAD-7 symptom scores, with a medium effect size (Cohen d=0.60-0.61). Conclusions: The findings indicate that users look for tools that can help them address their concerns related to mental health, pain management, and sleep issues. The study findings also indicate the breadth of the needs of users with chronic pain and the lack of support structures, and suggest that Wysa can provide effective support to bridge the gap. %M 35314422 %R 10.2196/35671 %U https://humanfactors.jmir.org/2022/2/e35671 %U https://doi.org/10.2196/35671 %U http://www.ncbi.nlm.nih.gov/pubmed/35314422 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e32146 %T Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating %A Vega,Julio %A Bell,Beth T %A Taylor,Caitlin %A Xie,Jue %A Ng,Heidi %A Honary,Mahsa %A McNaney,Roisin %+ Department of Human Centred Computing, Monash University, Wellington Rd, Clayton, VIC 3800, Australia, 61 3 9902 6000, roisin.mcnaney@monash.edu %K eating disorder %K binge eating %K mental health %K mobile sensing %K context-aware computing %K NAP %K EMA %K mobile phone %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting). Objective: The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions. Methods: This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38% binge eating and n=5, 63% comparisons) consented. Results: The findings showed unique differences in the types of sensor data that were triangulated with the individuals’ episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants’ awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet. Conclusions: This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population. %M 35086064 %R 10.2196/32146 %U https://mental.jmir.org/2022/4/e32146 %U https://doi.org/10.2196/32146 %U http://www.ncbi.nlm.nih.gov/pubmed/35086064 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e30680 %T An E–Mental Health Solution to Prevent and Manage Posttraumatic Stress Injuries Among First Responders in Alberta: Protocol for the Implementation and Evaluation of Text Messaging Services (Text4PTSI and Text4Wellbeing) %A Obuobi-Donkor,Gloria %A Eboreime,Ejemai %A Bond,Jennifer %A Phung,Natalie %A Eyben,Scarlett %A Hayward,Jake %A Zhang,Yanbo %A MacMaster,Frank %A Clelland,Steven %A Greiner,Russell %A Jones,Chelsea %A Cao,Bo %A Brémault-Phillips,Suzette %A Wells,Kristopher %A Li,Xin-Min %A Hilario,Carla %A Greenshaw,Andrew J %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans Memorial Lane, 8th Floor Abbie J Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, B3H 2E2, Canada, 1 7802157771, vn602367@dal.ca %K posttraumatic stress injury %K first responders %K messaging %K mobile phone %K text-based intervention %K Text4PTSI %K Text4Wellbeing %D 2022 %7 25.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: First responders are confronted with traumatic events in their work that has a substantial toll on their psychological health and may contribute to or result in posttraumatic stress injuries (PTSIs) for many responders. Persons with a PTSI usually seek management therapies. Evidence indicates that digital delivery of these therapies is an innovative, efficient, and effective way to improve PTSI symptoms as an adjunct to in-person delivery. Objective: This project aims to implement and provide accessible, convenient, and economical SMS text messaging services, known as Text4PTSI and Text4Wellbeing, to first responders in Alberta, Canada; to prevent and improve the symptoms of PTSI among first responders; and to improve their overall quality of life. We will evaluate posttraumatic symptoms and the impact of Text4PTSI and Text4Wellbeing on stress, anxiety, and depression in relation to the correspondents’ demographic backgrounds. Methods: First responders who subscribe to Text4PTSI or Text4Wellbeing receive daily supportive and psychoeducational SMS text messages for 6 months. The SMS text messages are preprogrammed into an online software program that delivers messages to subscribers. Baseline and follow-up data are collected through online questionnaires using validated scales at enrollment, 6 weeks, 12 weeks, and 24 weeks (end point). In-depth interviews will be conducted to assess satisfaction with the text-based intervention. Results: We hypothesize that participants who enroll in this program will have improved PTSI symptoms; increased or improved quality of life; and significant reduction in associated stress, depression, and anxiety symptoms, among other psychological concerns. Improvement will be determined in comparison to established baseline parameters. Conclusions: This research will be beneficial for practitioners and will inform policy-making and decision-making regarding psychological interventions for PTSI. Lessons from this study will inform the scale-up of the intervention, a cost-effective, zero contact therapeutic option to manage PTSI. International Registered Report Identifier (IRRID): PRR1-10.2196/30680 %M 35468094 %R 10.2196/30680 %U https://www.researchprotocols.org/2022/4/e30680 %U https://doi.org/10.2196/30680 %U http://www.ncbi.nlm.nih.gov/pubmed/35468094 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e17761 %T Blended Treatment for Alcohol Use Disorder (Blend-A): Explorative Mixed Methods Pilot and Feasibility Study %A Tarp,Kristine %A Rasmussen,Johan %A Mejldal,Anna %A Folker,Marie Paldam %A Nielsen,Anette Søgaard %+ Centre for Telepsychiatry, Mental Health Services, Region of Southern Denmark, Heden 11, Odense, 5000, Denmark, 45 24661404, kristine.tarp@rsyd.dk %K alcohol use disorder %K blended treatment %K usability %K patient perceptions %K therapist perspectives %K mobile phone %D 2022 %7 25.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In Denmark, approximately 150,000 people have alcohol use disorder (AUD). However, only approximately 10% seek AUD treatment, preferably outside conventional health care settings and opening hours. The AUD treatment area experiences low adherence to treatment, as well as high numbers of no-show and premature dropouts. Objective: The purpose of the Blend-A (Blended Treatment for Alcohol Use Disorder) feasibility and pilot study was to describe the process of translating and adapting the Dutch treatment protocol into Danish and Danish culture with a high amount of user involvement and to report how patients and therapists perceived the adapted version, when trying it out. Methods: The settings were 3 Danish public municipal outpatient alcohol clinics. Study participants were patients and therapists from the 3 settings. Data consisted of survey data from the System Usability Scale, individual patient interviews, and therapist group interviews. Statistical analyses were conducted using the Stata software and Excel. Qualitative analysis was conducted using a theoretical thematic analysis. Results: The usability of the treatment platform was rated above average. The patients chose to use the blended treatment format because it ensured anonymity and had a flexible design. Platform use formed the basis of face-to-face sessions. The use of the self-determined platform resulted in a more thorough process. Patient involvement qualified development of a feasible system. Managerial support for time use was essential. Guidance from an experienced peer was useful. Conclusions: This study indicates that, during the processes of translating, adapting, and implementing blended, guided, internet-based, and face-to-face AUD treatment, it is relevant to focus on patient involvement, managerial support, and guidance from experienced peers. Owing to the discrete and flexible design of the blended offer, it appears that it may reach patient groups who would not otherwise have sought treatment. Therefore, blended treatment may increase access to treatment and contribute to reaching people affected by excessive alcohol use, who would not otherwise have sought treatment. In addition, it seems that the blended offer may enhance the participants’ perceived satisfaction and the effect of the treatment course. Thus, it appears that Blend-A may be able to contribute to existing treatment offers. Such findings highlight the need to determine the actual effect of the Blend-A offer; therefore, an effectiveness study with a controlled design is warranted. %M 35468082 %R 10.2196/17761 %U https://formative.jmir.org/2022/4/e17761 %U https://doi.org/10.2196/17761 %U http://www.ncbi.nlm.nih.gov/pubmed/35468082 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e30218 %T Conditions for the Successful Integration of an eHealth Tool "StopBlues" Into Community-Based Interventions in France: Results From a Multiple Correspondence Analysis %A Turmaine,Kathleen %A Dumas,Agnès %A Chevreul,Karine %A , %+ Université Paris Cité, ECEVE, UMR 1123, Inserm, 10 avenue de Verdun, Paris, 75010, France, 33 1 57 27 86 89, kathleen.turmaine@inserm.fr %K eHealth %K internet-based intervention %K community participation %K health promotion %K prevention %K mental health %D 2022 %7 22.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: For over a decade, digital health has held promise for enabling broader access to health information, education, and services for the general population at a lower cost. However, recent studies have shown mixed results leading to a certain disappointment regarding the benefits of eHealth technologies. In this context, community-based health promotion represents an interesting and efficient conceptual framework that could help increase the adoption of digital health solutions and facilitate their evaluation. Objective: To understand how the local implementation of the promotion of an eHealth tool, StopBlues (SB), aimed at preventing psychological distress and suicide, varied according to local contexts and if the implementation was related to the use of the tool. Methods: The study was nested within a cluster-randomized controlled trial that was conducted to evaluate the effectiveness of the promotion, with before and after observation (NCT03565562). Data from questionnaires, observations, and institutional sources were collected in 27 localities where SB was implemented. A multiple correspondence analysis was performed to assess the relations between context, type of implementation and promotion, and use of the tool. Results: Three distinct promotion patterns emerged according to the profiles of the localities that were associated with specific SB utilization rates. From highest to lowest utilization rates, they are listed as follows: the privileged urban localities, investing in health that implemented a high-intensity and digital promotion, demonstrating a greater capacity to take ownership of the project; the urban, but less privileged localities that, in spite of having relatively little experience in health policy implementation, managed to implement a traditional and high-intensity promotion; and the rural localities, with little experience in addressing health issues, that implemented low-intensity promotion but could not overcome the challenges associated with their local context. Conclusions: These findings indicate the substantial influence of local context on the reception of digital tools. The urban and socioeconomic status profiles of the localities, along with their investment and pre-existing experience in health, appear to be critical for shaping the promotion and implementation of eHealth tools in terms of intensity and use of digital communication. The more digital channels used, the higher the utilization rates, ultimately leading to the overall success of the intervention. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04464-2 %M 35451977 %R 10.2196/30218 %U https://www.jmir.org/2022/4/e30218 %U https://doi.org/10.2196/30218 %U http://www.ncbi.nlm.nih.gov/pubmed/35451977 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e35928 %T Natural Language Processing Methods and Bipolar Disorder: Scoping Review %A Harvey,Daisy %A Lobban,Fiona %A Rayson,Paul %A Warner,Aaron %A Jones,Steven %+ Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4YG, United Kingdom, 44 152465201, d.harvey4@lancaster.ac.uk %K bipolar disorder %K mental health %K mental illness %K natural language processing %K computational linguistics %D 2022 %7 22.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: Health researchers are increasingly using natural language processing (NLP) to study various mental health conditions using both social media and electronic health records (EHRs). There is currently no published synthesis that relates specifically to the use of NLP methods for bipolar disorder, and this scoping review was conducted to synthesize valuable insights that have been presented in the literature. Objective: This scoping review explored how NLP methods have been used in research to better understand bipolar disorder and identify opportunities for further use of these methods. Methods: A systematic, computerized search of index and free-text terms related to bipolar disorder and NLP was conducted using 5 databases and 1 anthology: MEDLINE, PsycINFO, Academic Search Ultimate, Scopus, Web of Science Core Collection, and the ACL Anthology. Results: Of 507 identified studies, a total of 35 (6.9%) studies met the inclusion criteria. A narrative synthesis was used to describe the data, and the studies were grouped into four objectives: prediction and classification (n=25), characterization of the language of bipolar disorder (n=13), use of EHRs to measure health outcomes (n=3), and use of EHRs for phenotyping (n=2). Ethical considerations were reported in 60% (21/35) of the studies. Conclusions: The current literature demonstrates how language analysis can be used to assist in and improve the provision of care for people living with bipolar disorder. Individuals with bipolar disorder and the medical community could benefit from research that uses NLP to investigate risk-taking, web-based services, social and occupational functioning, and the representation of gender in bipolar disorder populations on the web. Future research that implements NLP methods to study bipolar disorder should be governed by ethical principles, and any decisions regarding the collection and sharing of data sets should ultimately be made on a case-by-case basis, considering the risk to the data participants and whether their privacy can be ensured. %M 35451984 %R 10.2196/35928 %U https://mental.jmir.org/2022/4/e35928 %U https://doi.org/10.2196/35928 %U http://www.ncbi.nlm.nih.gov/pubmed/35451984 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e29077 %T Associations Between Addictive Behaviors, Individual Characteristics, and the Use of Gambling Services Within the World of Gaming: Cross-sectional Survey Study %A Kisch,Mark %A Håkansson,Anders %+ Division of Psychiatry, Department of Clinical Sciences, Lund University, Baravägen 1, Lund, 22100, Sweden, 46 070 3135677, anders_c.hakansson@med.lu.se %K gambling disorder %K gaming disorder %K behavioral addiction %K mental health %K gambling %K gaming %K addiction %K behavior %K cross-sectional %K online survey %K age %K gender %D 2022 %7 22.4.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: Gambling within the world of gaming is an emerging phenomenon that may share common conceptual characteristics with traditional forms of gambling. The current literature suggests a higher degree of problematic behaviors in this gambling pattern, but studies are few, prompting for further research regarding individual characteristics and comorbid conditions associated with this activity. Objective: The aim of the study is to investigate correlations between the use of gambling services within the world of gaming and individual characteristics and addictive behaviors including problem gambling. Methods: A cross-sectional web survey was distributed to an existing panel of online respondents in Sweden. A total of 2001 respondents were included. Chi-square and Mann-Whitney U tests, followed by a logistic regression, were used in order to determine independent variables associated with gambling in the context of gaming. Results: A total of 2.9% (58/1984) of respondents reported past-year gambling within gaming. Significant associations were found with male sex, younger age, history of treatment-seeking for alcohol problems, and higher Gaming Addiction Scale scores. Conclusions: The demonstrated findings strengthen previously found associations between gambling in gaming and younger age, male sex, and problematic gaming behaviors. Additionally, the association with a history of treatment needs for alcohol problems adds to the previous impression of increased problem severity and comorbidity in within-gaming gamblers. %M 35451974 %R 10.2196/29077 %U https://games.jmir.org/2022/2/e29077 %U https://doi.org/10.2196/29077 %U http://www.ncbi.nlm.nih.gov/pubmed/35451974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e35940 %T Unguided Computer-Assisted Self-Help Interventions Without Human Contact in Patients With Obsessive-Compulsive Disorder: Systematic Review and Meta-analysis %A Imai,Hissei %A Tajika,Aran %A Narita,Hisashi %A Yoshinaga,Naoki %A Kimura,Kenichi %A Nakamura,Hideki %A Takeshima,Nozomi %A Hayasaka,Yu %A Ogawa,Yusuke %A Furukawa,Toshi %+ Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan, 81 75 753 9491, ihits@hotmail.com %K randomized controlled trial %K RCT %K information technology %K psychotherapy %K treatment adherence %K anxiety disorder %K anxiety %K OCD %K obsessive-compulsive disorder %K systematic review %K meta-analysis %K mental health %K computer-assisted %K therapy %K efficacy %K acceptability %K eHealth %K mental illness %D 2022 %7 21.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Computer-assisted treatment may reduce therapist contact and costs and promote client participation. This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy in patients with obsessive-compulsive disorder (OCD) compared with a waiting list or attention placebo. Objective: This study aimed to evaluate the effectiveness and adherence of computer-assisted self-help treatment without human contact in patients with OCD using a systematic review and meta-analysis approach. Methods: Randomized controlled trials with participants primarily diagnosed with OCD by health professionals with clinically significant OCD symptoms as measured with validated scales were included. The interventions included self-help treatment through the internet, computers, and smartphones. We excluded interventions that used human contact. We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov, as well as the reference lists of the included studies. The risk of bias was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason. Results: We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference −0.47, 95% CI −0.73 to −0.22). Unguided computer-assisted self-help therapy had more dropouts for any reason than waiting list or psychological placebo (risk ratio 1.98, 95% CI 1.21 to 3.23). However, the quality of evidence was very low because of the risk of bias and inconsistent results among the included studies. The subgroup analysis showed that exposure response and prevention and an intervention duration of more than 4 weeks strengthen the efficacy without worsening acceptability. Only a few studies have examined the interaction between participants and systems, and no study has used gamification. Most researchers only used text-based interventions, and no study has used a mobile device. The overall risk of bias of the included studies was high and the heterogeneity of results was moderate to considerable. Conclusions: Unguided computer-assisted self-help therapy for OCD is effective compared with waiting lists or psychological placebo. An exposure response and prevention component and intervention duration of more than 4 weeks may strengthen the efficacy without worsening the acceptability of the therapy. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42021264644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=264644 %M 35451993 %R 10.2196/35940 %U https://www.jmir.org/2022/4/e35940 %U https://doi.org/10.2196/35940 %U http://www.ncbi.nlm.nih.gov/pubmed/35451993 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e34005 %T A Web-Based Well-being Program for Health Care Workers (Thrive): Protocol for a Randomized Controlled Trial %A Egan,Luke A %A Mulcahy,Mary %A Tuqiri,Karen %A Gatt,Justine M %+ Neuroscience Research Australia, Margarete Ainsworth Building, Barker St, Randwick, 2031, Australia, 61 2 9399 1812, j.gatt@neura.edu.au %K well-being %K Composure, Own-worth, Mastery, Positivity, Achievement, and Satisfaction for Wellbeing %K COMPAS-W %K mental health %K resilience %K health care %K hospital %K brain %K neuroscience %K online %K randomized controlled trial %K RCT %D 2022 %7 21.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health has come to be understood as not merely the absence of mental illness but also the presence of mental well-being, and recent interventions have sought to increase well-being in various populations. A population that deserves particular attention is that of health care workers, whose occupations entail high levels of stress, especially given the ongoing COVID-19 pandemic. A neuroscience-based web-based well-being program for health care workers—the Thrive program—has been newly developed to promote habits and activities that contribute to brain health and overall mental well-being. Objective: This paper describes the protocol for a randomized controlled trial whose objective is to evaluate the Thrive program in comparison with an active control condition to measure whether the program is effective at increasing well-being and decreasing symptoms of psychological distress in health care workers at a designated Australian hospital. Methods: The trial will comprise two groups (intervention vs active control) and 4 measurement occasions over a 12-week period. A survey will be administered in each of weeks 0, 4, 8, and 12, and the well-being program will be delivered in weeks 1-7 (via web-based video presentations or digital pamphlets). Each of the 4 surveys will comprise a range of questionnaires to measure well-being, psychological distress, and other key variables. The planned analyses will estimate group-by-time interaction effects to test the hypothesis that mental health will increase over time in the intervention condition relative to the active control condition. Results: The Thrive program was delivered to a small number of wards at the hospital between February 2021 and July 2021, and it will be delivered to the remaining wards from October 2021 to December 2021. A power calculation has recommended a sample size of at least 200 participants in total. A linear mixed model will be used to estimate the interaction effects. Conclusions: This trial seeks to evaluate a new web-based well-being program for health care workers at a major public hospital. It will contribute to the growing body of research on mental well-being and ways to promote it. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000027819; https://tinyurl.com/58wwjut9 International Registered Report Identifier (IRRID): DERR1-10.2196/34005 %M 35451973 %R 10.2196/34005 %U https://www.researchprotocols.org/2022/4/e34005 %U https://doi.org/10.2196/34005 %U http://www.ncbi.nlm.nih.gov/pubmed/35451973 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e34105 %T Assessment of Population Well-being With the Mental Health Quotient: Validation Study %A Newson,Jennifer Jane %A Pastukh,Vladyslav %A Thiagarajan,Tara C %+ Sapien Labs, 1201 Wilson Blvd, 27th floor, Arlington, VA, 22209, United States, 1 7039976657, jennifer@sapienlabs.org %K psychiatry %K public health %K methods %K mental health %K population health %K social determinants of health %K global health %K behavioral symptoms %K diagnosis %K symptom assessment %K psychopathology %K mental disorders %K mHealth %K depression %K anxiety %K attention deficit disorder with hyperactivity %K autistic disorder %K internet %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The Mental Health Quotient (MHQ) is an anonymous web-based assessment of mental health and well-being that comprehensively covers symptoms across 10 major psychiatric disorders, as well as positive elements of mental function. It uses a novel life impact scale and provides a score to the individual that places them on a spectrum from Distressed to Thriving along with a personal report that offers self-care recommendations. Since April 2020, the MHQ has been freely deployed as part of the Mental Health Million Project. Objective: This paper demonstrates the reliability and validity of the MHQ, including the construct validity of the life impact scale, sample and test-retest reliability of the assessment, and criterion validation of the MHQ with respect to clinical burden and productivity loss. Methods: Data were taken from the Mental Health Million open-access database (N=179,238) and included responses from English-speaking adults (aged≥18 years) from the United States, Canada, the United Kingdom, Ireland, Australia, New Zealand, South Africa, Singapore, India, and Nigeria collected during 2021. To assess sample reliability, random demographically matched samples (each 11,033/179,238, 6.16%) were compared within the same 6-month period. Test-retest reliability was determined using the subset of individuals who had taken the assessment twice ≥3 days apart (1907/179,238, 1.06%). To assess the construct validity of the life impact scale, additional questions were asked about the frequency and severity of an example symptom (feelings of sadness, distress, or hopelessness; 4247/179,238, 2.37%). To assess criterion validity, elements rated as having a highly negative life impact by a respondent (equivalent to experiencing the symptom ≥5 days a week) were mapped to clinical diagnostic criteria to calculate the clinical burden (174,618/179,238, 97.42%). In addition, MHQ scores were compared with the number of workdays missed or with reduced productivity in the past month (7625/179,238, 4.25%). Results: Distinct samples collected during the same period had indistinguishable MHQ distributions and MHQ scores were correlated with r=0.84 between retakes within an 8- to 120-day period. Life impact ratings were correlated with frequency and severity of symptoms, with a clear linear relationship (R2>0.99). Furthermore, the aggregate MHQ scores were systematically related to both clinical burden and productivity. At one end of the scale, 89.08% (8986/10,087) of those in the Distressed category mapped to one or more disorders and had an average productivity loss of 15.2 (SD 11.2; SEM [standard error of measurement] 0.5) days per month. In contrast, at the other end of the scale, 0% (1/24,365) of those in the Thriving category mapped to any of the 10 disorders and had an average productivity loss of 1.3 (SD 3.6; SEM 0.1) days per month. Conclusions: The MHQ is a valid and reliable assessment of mental health and well-being when delivered anonymously on the web. %M 35442210 %R 10.2196/34105 %U https://mental.jmir.org/2022/4/e34105 %U https://doi.org/10.2196/34105 %U http://www.ncbi.nlm.nih.gov/pubmed/35442210 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e33628 %T Residual Effect of Texting to Promote Medication Adherence for Villagers with Schizophrenia in China: 18-Month Follow-up Survey After the Randomized Controlled Trial Discontinuation %A Cai,Yiyuan %A Gong,Wenjie %A He,Wenjun %A He,Hua %A Hughes,James P %A Simoni,Jane %A Xiao,Shuiyuan %A Gloyd,Stephen %A Lin,Meijuan %A Deng,Xinlei %A Liang,Zichao %A Dai,Bofeng %A Liao,Jing %A Hao,Yuantao %A Xu,Dong Roman %+ Center for World Health Organization (WHO) Studies and Department of Health Management, School of Health Management of Southern Medical University, 1023 South Shatai Road, Guangzhou, 510515, China, 86 02061647194, romanxu@i.smu.edu.cn %K medication adherence %K mobile texting %K lay health worker %K resource-poor community %K primary health care %K quality of care %K mHealth %K schizophrenia %K maintenance %K residual effect %K mental health %K patient outcomes %D 2022 %7 19.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Reducing the treatment gap for mental health in low- and middle-income countries is a high priority. Even with treatment, adherence to antipsychotics is rather low. Our integrated intervention package significantly improved medication adherence within 6 months for villagers with schizophrenia in resource-poor communities in rural China. However, considering the resource constraint, we need to test whether the effect of those behavior-shaping interventions may be maintained even after the suspension of the intervention. Objective: The aim of this study is to explore the primary outcome of adherence and other outcomes at an 18-month follow-up after the intervention had been suspended. Methods: In a 6-month randomized trial, 277 villagers with schizophrenia were randomized to receive either a government community mental health program (686 Program) or the 686 Program plus Lay health supporters, e-platform, award, and integration (LEAN), which included health supporters for medication or care supervision, e-platform access for sending mobile SMS text messaging reminders and education message, a token gift for positive behavior changes (eg, continuing taking medicine), and integrating the e-platform with the existing 686 Program. After the 6-month intervention, both groups received only the 686 Program for 18 months (phase 2). Outcomes at both phases included antipsychotic medication adherence, functioning, symptoms, number of rehospitalization, suicide, and violent behaviors. The adherence and functioning were assessed at the home visit by trained assessors. We calculated the adherence in the past 30 days by counting the percentage of dosages taken from November to December 2018 by unannounced home-based pill counts. The functioning was assessed using the World Health Organization Disability Assessment Schedule 2.0. The symptoms were evaluated using the Clinical Global Impression–Schizophrenia during their visits to the 686 Program psychiatrists. Other outcomes were routinely collected in the 686 Program system. We used intention-to-treat analysis, and missing data were dealt with using multiple imputation. The generalized estimating equation model was used to assess program effects on adherence, functioning, and symptoms. Results: In phase 1, antipsychotic adherence and rehospitalization incidence improved significantly. However, in phase 2, the difference of the mean of antipsychotic adherence (adjusted mean difference 0.05, 95% CI −0.06 to 0.16; P=.41; Cohen d effect size=0.11) and rehospitalization incidence (relative risk 0.65, 95% CI 0.32-1.33; P=.24; number needed to treat 21.83, 95% CI 8.30-34.69) was no longer statistically significant, and there was no improvement in other outcomes in either phase (P≥.05). Conclusions: The simple community-based LEAN intervention could not continually improve adherence and reduce the rehospitalization of people with schizophrenia. Our study inclined to suggest that prompts for medication may be necessary to maintain medication adherence for people with schizophrenia, although we cannot definitively exclude other alternative interpretations. %M 35438649 %R 10.2196/33628 %U https://mhealth.jmir.org/2022/4/e33628 %U https://doi.org/10.2196/33628 %U http://www.ncbi.nlm.nih.gov/pubmed/35438649 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e36094 %T Social Robot Interventions in Mental Health Care and Their Outcomes, Barriers, and Facilitators: Scoping Review %A Guemghar,Imane %A Pires de Oliveira Padilha,Paula %A Abdel-Baki,Amal %A Jutras-Aswad,Didier %A Paquette,Jesseca %A Pomey,Marie-Pascale %+ Centre de Recherche du Centre Hospitalier de l’Université de Montréal, 850 rue Saint-Denis, Montreal, QC, H2X 0A9, Canada, 1 514 343 6111 ext 1364, marie-pascale.pomey@umontreal.ca %K social robots %K socially assistive robots %K SARs %K mental health %K mental health services %K dementia %K autism spectrum disorder %K schizophrenia %K depression %K scoping review %D 2022 %7 19.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: The use of social robots as innovative therapeutic tools has been increasingly explored in recent years in an effort to address the growing need for alternative intervention modalities in mental health care. Objective: The aim of this scoping review was to identify and describe social robot interventions in mental health facilities and to highlight their outcomes as well as the barriers and facilitators to their implementation. Methods: A scoping review of the literature published since 2015 was conducted using the Arksey and O’Malley’s framework. The MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and PsycINFO databases were searched, and 2239 papers were retrieved. The papers included were primary empirical studies published in peer-reviewed literature. Eligible studies were set in mental health facilities and they included participants with a known mental health disorder. The methodological quality of the included papers was also assessed using the Mixed Methods Appraisal Tool. Results: A total of 30 papers met the eligibility criteria for this review. Studies involved participants with dementia, cognitive impairment, schizophrenia, depression, autism spectrum disorder, attention-deficit hyperactivity disorder, and an intellectual disability. The outcomes studied included engagement, social interaction, emotional state, agitation, behavior, and quality of life. Conclusions: The methodological weaknesses of the studies conducted this far and the lack of diversity in the conditions studied limit the generalizability of the results. However, despite the presence of certain barriers to their implementation (eg, technical problems, unsuitable environment, staff resistance), social robot interventions generally show positive effects on patients with mental health disorders. Studies of stronger methodological quality are needed to further understand the benefits and the place of social robots in mental health care. %M 35438639 %R 10.2196/36094 %U https://mental.jmir.org/2022/4/e36094 %U https://doi.org/10.2196/36094 %U http://www.ncbi.nlm.nih.gov/pubmed/35438639 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e32492 %T Telehealth-Based Psychoeducation for Caregivers: The Family Intervention in Recent-Onset Schizophrenia Treatment Study %A Mueser,Kim T %A Achtyes,Eric D %A Gogate,Jagadish %A Mancevski,Branislav %A Kim,Edward %A Starr,H Lynn %+ Janssen Scientific Affairs, LLC, 1125 Trenton-Harbourton Road, Titusville, NJ, 08560, United States, 1 609 730 3115, bmancevs@its.jnj.com %K schizophrenia %K family psychoeducation %K caregiver burden %K recent-onset schizophrenia %K telehealth %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Schizophrenia is a lifelong illness that requires long-term treatment and caregiving. Family psychoeducation (FP) has been shown to lessen caregiver burden, improve caregiver functioning, and improve outcomes in patients. However, the impact of FP delivered specifically to caregivers on patient outcomes has not been well explored, particularly for early schizophrenia. Furthermore, there is a lack of research examining the benefits of telehealth-based psychoeducation for caregivers on either patient or caregiver outcomes. Objective: The Family Intervention in Recent-Onset Schizophrenia Treatment (FIRST) study is a randomized controlled trial of patients with schizophrenia spectrum disorders and their caregivers, which is designed to evaluate the effect of telehealth-based, caregiver-focused, study-provided psychoeducation versus usual care (UC) on patient treatment failure (TF). The impact of study-provided psychoeducation on caregiver burden is also investigated. Methods: Eligible patients and their designated caregivers were randomly assigned to either the study-provided psychoeducation (≤16 sessions of telehealth-based psychoeducation over 6 months) or UC group, stratified by antipsychotic treatment (paliperidone palmitate or oral antipsychotic). The major TF events (ie, psychiatric hospitalization or intervention, arrest or incarceration, and suicide attempts) were assessed at 3, 6, and 12 months after baseline. A proportional means model using mean cumulative function was used to assess between-group differences in the mean cumulative number of TF events over 12 months. Caregiver burden was assessed using the Involvement Evaluation Questionnaire and 12-item Short Form Health Survey. Results: A total of 148 pairs of participants were enrolled in the study, of whom 96 (64.9%) patients and 94 (63.5%) caregivers completed the 12-month follow-up. The mean number of sessions in the study-provided psychoeducation group was 7.7 (SD 5.9). No differences were observed between the study-provided psychoeducation and UC groups in patient outcomes (rates of TF: 70% vs 67%; P=.90) or measures of caregiver burden (assessment of caregiver distress and physical and mental health). However, post hoc analyses revealed lower relapse rates in patients who received paliperidone palmitate than in those who received oral antipsychotics at all time points. Although the FIRST study did not meet the primary end point, several key lessons were identified to inform future caregiver-focused, telehealth-based FP interventions. Lack of study-provided psychoeducation, focus on caregiver-only intervention, difficulties with enrollment, and caregiver–treatment team coordination may have affected the outcomes of the FIRST study. Conclusions: Key insights from the FIRST study suggest the potential importance of supporting sufficient caregiver engagement; communication between clinicians, patients, and family members regarding treatment plans; and solidifying the relationship between clinicians providing psychoeducation to the caregiver and patient treatment team. Trial Registration: ClinicalTrials.gov NCT02600741; http://clinicaltrials.gov/ct2/show/NCT02600741 %M 35436231 %R 10.2196/32492 %U https://mental.jmir.org/2022/4/e32492 %U https://doi.org/10.2196/32492 %U http://www.ncbi.nlm.nih.gov/pubmed/35436231 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e33450 %T Problematic Social Media Use in Adolescents and Young Adults: Systematic Review and Meta-analysis %A Shannon,Holly %A Bush,Katie %A Villeneuve,Paul J %A Hellemans,Kim GC %A Guimond,Synthia %+ Department of Psychiatry, The Royal's Institute of Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada, 1 6135708402, synthia.guimond@theroyal.ca %K problematic social media use %K depression %K anxiety %K stress %D 2022 %7 14.4.2022 %9 Review %J JMIR Ment Health %G English %X Background: Technology is ever evolving, with more and more diverse activities becoming possible on screen-based devices. However, participating in a heavy screen-based lifestyle may come at a cost. Our hypothesis was that problematic social media use increased the prevalence of mental health outcomes. Objective: This study seeks to systematically examine problematic social media use in youth and its association with symptoms of depression, anxiety, and stress. Methods: A systematic search was conducted to identify studies in adolescents and young adults, using the databases Engineering Village, Psycinfo, Pubmed, and Web of Science. A total of 18 studies were identified, with a total of 9269 participants in our review and included in the meta-analysis. Results: Our metaregression shows moderate but statistically significant correlations between problematic social media use and depression (r=0.273, P<.001), anxiety (r=0.348, P<.001), and stress (r=0.313, P<.001). We did not find evidence of heterogeneity of these summary correlations by age, gender, or year of publication. Conclusions: This study provides further evidence of the association between problematic social media use and negative mental health among adolescents and young adults and supports future research to focus on the underlying mechanisms of problematic use of social media. Trial Registration: PROSPERO CRD42021222309; https://tinyurl.com/2p9y4bjx %M 35436240 %R 10.2196/33450 %U https://mental.jmir.org/2022/4/e33450 %U https://doi.org/10.2196/33450 %U http://www.ncbi.nlm.nih.gov/pubmed/35436240 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e35196 %T App-Based Mindfulness Meditation for People of Color Who Experience Race-Related Stress: Protocol for a Randomized Controlled Trial %A Ramos,Giovanni %A Aguilera,Adrian %A Montoya,Amanda %A Lau,Anna %A Wen,Chu Yin %A Cruz Torres,Victor %A Chavira,Denise %+ Department of Psychology, University of California, Los Angeles, 502 Portola Plaza, Los Angeles, CA, 90095, United States, 1 786 564 2448, gioramos@ucla.edu %K race-related stress %K discrimination %K mindfulness %K meditation %K mental health %K app %K digital mental health intervention %K racial and ethnic minority %K people of color %K BIPOC %D 2022 %7 14.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation may be especially well suited to help POC cope, given its emphasis on gaining awareness and acceptance of emotions associated with discriminatory treatment. However, mindfulness meditation rarely reaches POC, and digital approaches could reduce this treatment gap by addressing traditional barriers to care. Objective: This study will test the effectiveness of a self-directed app-based mindfulness meditation program among POC who experience elevated levels of race-related stress. Implementation outcomes such as treatment acceptability, adherence, and satisfaction will be examined. Methods: Participants (n=80) will be recruited online by posting recruitment materials on social media and sending emails to relevant groups. In-person recruitment will consist of posting flyers in communities with significant POC representation. Eligible participants will be block randomized to either the intervention group (n=40) that will complete a self-directed 4-week mindfulness meditation program or a wait-list control condition (n=40) that will receive access to the app after study completion. All participants will complete measures at baseline, midtreatment, and posttreatment. Primary outcomes include changes in stress, anxiety, and depression, and secondary outcomes constitute changes in mindfulness, self-compassion, rumination, emotion suppression, and experiential avoidance. Exploratory analyses will examine whether changes in the secondary outcomes mediate changes in primary outcomes. Finally, treatment acceptability, adherence, and satisfaction will be examined descriptively. Results: Recruitment began in October 2021. Data will be analyzed using multilevel modeling, a statistical methodology that accounts for the dependence among repeated observations. Considering attrition issues in self-directed digital interventions and their potential effects on statistical significance and treatment effect sizes, we will examine data using both intention-to-treat and per-protocol analyses. Conclusions: To our knowledge, this will be the first study to provide data on the effectiveness of a self-directed app-based mindfulness meditation program for POC recruited based on elevated race-related stress, a high-risk population. Similarly, meaningful clinical targets for POC affected by stressors related to race will be examined. Findings will provide important information regarding whether this type of intervention is an acceptable treatment among these marginalized groups. Trial Registration: ClinicalTrials.gov NCT05027113; https://clinicaltrials.gov/ct2/show/NCT05027113 International Registered Report Identifier (IRRID): DERR1-10.2196/35196 %M 35436228 %R 10.2196/35196 %U https://www.researchprotocols.org/2022/4/e35196 %U https://doi.org/10.2196/35196 %U http://www.ncbi.nlm.nih.gov/pubmed/35436228 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35668 %T Evaluating User Feedback for an Artificial Intelligence–Enabled, Cognitive Behavioral Therapy–Based Mental Health App (Wysa): Qualitative Thematic Analysis %A Malik,Tanya %A Ambrose,Adrian Jacques %A Sinha,Chaitali %+ Wysa Inc, 131 Dartmouth St, Boston, MA, United States, 1 9874803442, tanya@wysa.io %K digital mental health %K artificial intelligence %K user reviews %K cognitive behavioral therapy %K CBT %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital mental health apps are rapidly becoming a common source of accessible support across the world, but their effectiveness is often influenced by limited helpfulness and engagement. Objective: This study’s primary objective was to analyze feedback content to understand users’ experiences with engaging with a digital mental health app. As a secondary objective, an exploratory analysis captured the types of mental health app users. Methods: This study utilized a user-led approach to understanding factors for engagement and helpfulness in digital mental health by analyzing feedback (n=7929) reported on Google Play Store about Wysa, a mental health app (1-year period). The analysis of keywords in the user feedback categorized and evaluated the reported user experience into the core domains of acceptability, usability, usefulness, and integration. The study also captured key deficits and strengths of the app and explored salient characteristics of the types of users who benefit from accessible digital mental health support. Results: The analysis of user feedback found the app to be overwhelmingly positively reviewed (6700/7929, 84.50% 5-star rating). The themes of engaging exercises, interactive interface, and artificial intelligence (AI) conversational ability indicated the acceptability of the app, while the nonjudgmentality and ease of conversation highlighted its usability. The app’s usefulness was portrayed by themes such as improvement in mental health, convenient access, and cognitive restructuring exercises. Themes of privacy and confidentiality underscored users’ preference for the integrated aspects of the app. Further analysis revealed 4 predominant types of individuals who shared app feedback on the store. Conclusions: Users reported therapeutic elements of a comfortable, safe, and supportive environment through using the digital mental health app. Digital mental health apps may expand mental health access to those unable to access traditional forms of mental health support and treatments. %M 35249886 %R 10.2196/35668 %U https://humanfactors.jmir.org/2022/2/e35668 %U https://doi.org/10.2196/35668 %U http://www.ncbi.nlm.nih.gov/pubmed/35249886 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e33473 %T Web-Based Single Session Intervention for Perceived Control Over Anxiety During COVID-19: Randomized Controlled Trial %A Mullarkey,Michael %A Dobias,Mallory %A Sung,Jenna %A Ahuvia,Isaac %A Shumake,Jason %A Beevers,Christopher %A Schleider,Jessica %+ Department of Psychology, Stony Brook University, 100 Nicolls Rd, Stony Brook, NY, 11794, United States, 1 6316326000, Michael.Mullarkey@stonybrook.edu %K anxiety %K COVID-19 %K single-session intervention %K SSI %K perceived control %K intervention %K mental health %K control %K online intervention %K telemedicine %K telehealth %K scalable %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety is rising across the United States during the COVID-19 pandemic, and social distancing mandates preclude in-person mental health care. Greater perceived control over anxiety has predicted decreased anxiety pathology, including adaptive responses to uncontrollable stressors. Evidence suggests that no-therapist, single-session interventions can strengthen perceived control over emotions like anxiety; similar programs, if designed for the COVID-19 context, could hold substantial public health value. Objective: Our registered report evaluated a no-therapist, single-session, online intervention targeting perceived control over anxiety in the COVID-19 context against a placebo intervention encouraging handwashing. We tested whether the intervention could (1) decrease generalized anxiety and increase perceived control over anxiety and (2) achieve this without decreasing social-distancing intentions. Methods: We tested these questions using a between-subjects design in a weighted-probability sample of US adults recruited via a closed online platform (ie, Prolific). All outcomes were indexed via online self-report questionnaires. Results: Of 522 randomized individuals, 500 (95.8%) completed the baseline survey and intervention. Intent-to-treat analyses using all randomized participants (N=522) found no support for therapeutic or iatrogenic effects; effects on generalized anxiety were d=–0.06 (95% CI –0.27 to 0.15; P=.48), effects on perceived control were d=0.04 (95% CI –0.08 to 0.16; P=.48), and effects on social-distancing intentions were d=–0.02 (95% CI –0.23 to 0.19; P=.83). Conclusions: Strengths of this study included a large, nationally representative sample and adherence to open science practices. Implications for scalable interventions, including the challenge of targeting perceived control over anxiety, are discussed. Trial Registration: ClinicalTrials.gov NCT04459455; https://clinicaltrials.gov/show/NCT04459455 %M 35230962 %R 10.2196/33473 %U https://mental.jmir.org/2022/4/e33473 %U https://doi.org/10.2196/33473 %U http://www.ncbi.nlm.nih.gov/pubmed/35230962 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29842 %T Computerized Cognitive Behavioral Therapy for Treatment of Depression and Anxiety in Adolescents: Systematic Review and Meta-analysis %A Wickersham,Alice %A Barack,Tamara %A Cross,Lauren %A Downs,Johnny %+ Institute of Psychiatry, Psychology & Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 (0)20 7848 0002, alice.wickersham@kcl.ac.uk %K adolescent %K anxiety %K depression %K meta-analysis %D 2022 %7 11.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Depression and anxiety are major public health concerns among adolescents. Computerized cognitive behavioral therapy (cCBT) has emerged as a potential intervention, but its efficacy in adolescents remains unestablished. Objective: This review aimed to systematically review and meta-analyze findings on the efficacy of cCBT for the treatment of adolescent depression and anxiety. Methods: Embase, PsycINFO, and Ovid MEDLINE were systematically searched for randomized controlled trials in English, which investigated the efficacy of cCBT for reducing self-reported depression or anxiety in adolescents aged 11 to 19 years. Titles, abstracts, and full texts were screened for eligibility by 2 independent researchers (TB and LC). A random-effects meta-analysis was conducted to pool the effects of cCBT on depression and anxiety symptom scores compared with the control groups. Study quality was assessed using the Cochrane Collaboration Risk of Bias tool. Results: A total of 16 randomized controlled trials were eligible for inclusion in this review, of which 13 (81%) were included in the meta-analysis. The quality of the studies was mixed, with 5 (31%) studies rated as good overall, 2 (13%) rated as fair, and 9 (56%) rated as poor. Small but statistically significant effects of cCBT were detected, with cCBT conditions showing lower symptom scores at follow-up compared with control conditions for both anxiety (standardized mean difference −0.21, 95% CI −0.33 to −0.09; I2=36.2%) and depression (standardized mean difference −0.23, 95% CI −0.39 to −0.07; I2=59.5%). Secondary analyses suggested that cCBT may be comparable with alternative, active interventions (such as face-to-face therapy or treatment as usual). Conclusions: This meta-analysis reinforces the efficacy of cCBT for the treatment of anxiety and depression and is the first to examine this exclusively in adolescents. Future research could aim to identify the active components of these interventions toward optimizing their development and increasing the feasibility and acceptability of cCBT in this age group. Trial Registration: PROSPERO CRD42019141941; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=141941 %M 35404263 %R 10.2196/29842 %U https://www.jmir.org/2022/4/e29842 %U https://doi.org/10.2196/29842 %U http://www.ncbi.nlm.nih.gov/pubmed/35404263 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33307 %T Human Support in App-Based Cognitive Behavioral Therapies for Emotional Disorders: Scoping Review %A Bernstein,Emily E %A Weingarden,Hilary %A Wolfe,Emma C %A Hall,Margaret D %A Snorrason,Ivar %A Wilhelm,Sabine %+ Massachusetts General Hospital, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, United States, 1 6177246032, eebernstein@mgh.harvard.edu %K digital health %K mental health %K cognitive behavioral therapy %K coaching %K guided %K mobile app %K emotional disorder %K mobile phone %D 2022 %7 8.4.2022 %9 Review %J J Med Internet Res %G English %X Background: Smartphone app–based therapies offer clear promise for reducing the gap in available mental health care for people at risk for or people with mental illness. To this end, as smartphone ownership has become widespread, app-based therapies have become increasingly common. However, the research on app-based therapies is lagging behind. In particular, although experts suggest that human support may be critical for increasing engagement and effectiveness, we have little systematic knowledge about the role that human support plays in app-based therapy. It is critical to address these open questions to optimally design and scale these interventions. Objective: The purpose of this study is to provide a scoping review of the use of human support or coaching in app-based cognitive behavioral therapy for emotional disorders, identify critical knowledge gaps, and offer recommendations for future research. Cognitive behavioral therapy is the most well-researched treatment for a wide range of concerns and is understood to be particularly well suited to digital implementations, given its structured, skill-based approach. Methods: We conducted systematic searches of 3 databases (PubMed, PsycINFO, and Embase). Broadly, eligible articles described a cognitive behavioral intervention delivered via smartphone app whose primary target was an emotional disorder or problem and included some level of human involvement or support (coaching). All records were reviewed by 2 authors. Information regarding the qualifications and training of coaches, stated purpose and content of the coaching, method and frequency of communication with users, and relationship between coaching and outcomes was recorded. Results: Of the 2940 titles returned by the searches, 64 (2.18%) were eligible for inclusion. This review found significant heterogeneity across all of the dimensions of coaching considered as well as considerable missing information in the published articles. Moreover, few studies had qualitatively or quantitatively evaluated how the level of coaching impacts treatment engagement or outcomes. Although users tend to self-report that coaching improves their engagement and outcomes, there is limited and mixed supporting quantitative evidence at present. Conclusions: Digital mental health is a young but rapidly expanding field with great potential to improve the reach of evidence-based care. Researchers across the reviewed articles offered numerous approaches to encouraging and guiding users. However, with the relative infancy of these treatment approaches, this review found that the field has yet to develop standards or consensus for implementing coaching protocols, let alone those for measuring and reporting on the impact. We conclude that coaching remains a significant hole in the growing digital mental health literature and lay out recommendations for future data collection, reporting, experimentation, and analysis. %M 35394434 %R 10.2196/33307 %U https://www.jmir.org/2022/4/e33307 %U https://doi.org/10.2196/33307 %U http://www.ncbi.nlm.nih.gov/pubmed/35394434 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e36489 %T Stigmatizing Attitudes Across Cybersuicides and Offline Suicides: Content Analysis of Sina Weibo %A Li,Ang %A Jiao,Dongdong %A Zhu,Tingshao %+ Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, Hexie Building, No 16 Lincui Rd, Beijing, 100101, China, 86 150 1096 5509, tszhu@psych.ac.cn %K stigma %K cybersuicide %K livestreamed suicide %K linguistic analysis %K social media %D 2022 %7 8.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The new reality of cybersuicide raises challenges to ideologies about the traditional form of suicide that does not involve the internet (offline suicide), which may lead to changes in audience’s attitudes. However, knowledge on whether stigmatizing attitudes differ between cybersuicides and offline suicides remains limited. Objective: This study aims to consider livestreamed suicide as a typical representative of cybersuicide and use social media data (Sina Weibo) to investigate the differences in stigmatizing attitudes across cybersuicides and offline suicides in terms of attitude types and linguistic characteristics. Methods: A total of 4393 cybersuicide-related and 2843 offline suicide-related Weibo posts were collected and analyzed. First, human coders were recruited and trained to perform a content analysis on the collected posts to determine whether each of them reflected stigma. Second, a text analysis tool was used to automatically extract a number of psycholinguistic features from each post. Subsequently, based on the selected features, a series of classification models were constructed for different purposes: differentiating the general stigma of cybersuicide from that of offline suicide and differentiating the negative stereotypes of cybersuicide from that of offline suicide. Results: In terms of attitude types, cybersuicide was observed to carry more stigma than offline suicide (χ21=179.8; P<.001). Between cybersuicides and offline suicides, there were significant differences in the proportion of posts associated with five different negative stereotypes, including stupid and shallow (χ21=28.9; P<.001), false representation (χ21=144.4; P<.001), weak and pathetic (χ21=20.4; P<.001), glorified and normalized (χ21=177.6; P<.001), and immoral (χ21=11.8; P=.001). Similar results were also found for different genders and regions. In terms of linguistic characteristics, the F-measure values of the classification models ranged from 0.81 to 0.85. Conclusions: The way people perceive cybersuicide differs from how they perceive offline suicide. The results of this study have implications for reducing the stigma against suicide. %M 35394437 %R 10.2196/36489 %U https://www.jmir.org/2022/4/e36489 %U https://doi.org/10.2196/36489 %U http://www.ncbi.nlm.nih.gov/pubmed/35394437 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e29211 %T Characterizing Use of a Multicomponent Digital Intervention to Predict Treatment Outcomes in First-Episode Psychosis: Cluster Analysis %A O'Sullivan,Shaunagh %A Schmaal,Lianne %A D'Alfonso,Simon %A Toenders,Yara Jo %A Valentine,Lee %A McEnery,Carla %A Bendall,Sarah %A Nelson,Barnaby %A Gleeson,John F %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Road, Parkville, 3052, Australia, 61 428 282 470, shaunagh.osullivan@orygen.org.au %K digital intervention %K digital health %K youth mental health %K psychotic disorders %K clustering %K usage metrics %K log data %K social networking %D 2022 %7 7.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Multicomponent digital interventions offer the potential for tailored and flexible interventions that aim to address high attrition rates and increase engagement, an area of concern in digital mental health. However, increased flexibility in use makes it difficult to determine which components lead to improved treatment outcomes. Objective: This study aims to identify user profiles on Horyzons, an 18-month digital relapse prevention intervention for first-episode psychosis that incorporates therapeutic content and social networking, along with clinical, vocational, and peer support, and to examine the predictive value of these user profiles for treatment outcomes. A secondary objective is to compare each user profile with young people receiving treatment as usual (TAU). Methods: Participants comprised 82 young people (aged 16-27 years) with access to Horyzons and 84 receiving TAU, recovering from first-episode psychosis. In addition, 6-month use data from the therapy and social networking components of Horyzons were used as features for K-means clustering for joint trajectories to identify user profiles. Social functioning, psychotic symptoms, depression, and anxiety were assessed at baseline and 6-month follow-up. General linear mixed models were used to examine the predictive value of user profiles for treatment outcomes and between each user profile with TAU. Results: A total of 3 user profiles were identified based on the following system use metrics: low use, maintained use of social components, and maintained use of both therapy and social components. The maintained therapy and social group showed improvements in social functioning (F2,51=3.58; P=.04), negative symptoms (F2,51=4.45; P=.02), and overall psychiatric symptom severity (F2,50=3.23; P=.048) compared with the other user profiles. This group also showed improvements in social functioning (F1,62=4.68; P=.03), negative symptoms (F1,62=14.61; P<.001), and overall psychiatric symptom severity (F1,63=5.66; P=.02) compared with the TAU group. Conversely, the maintained social group showed increases in anxiety compared with the TAU group (F1,57=7.65; P=.008). No differences were found between the low use group and the TAU group on treatment outcomes. Conclusions: Continued engagement with both therapy and social components might be key in achieving long-term recovery. Maintained social use and low use outcomes were broadly comparable with TAU, emphasizing the importance of maintaining engagement for improved treatment outcomes. Although the social network may be a key ingredient to increase sustained engagement, as users engaged with this more consistently, it should be leveraged as a tool to engage young people with therapeutic content to bring about social and clinical benefits. %M 35389351 %R 10.2196/29211 %U https://mental.jmir.org/2022/4/e29211 %U https://doi.org/10.2196/29211 %U http://www.ncbi.nlm.nih.gov/pubmed/35389351 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e33526 %T A Serious Game for Young People With First Episode Psychosis (OnTrack>The Game): Qualitative Findings of a Randomized Controlled Trial %A Jankowski,Samantha %A Ferreira,Kathleen %A Mascayano,Franco %A Donovan,Effy %A Rahim,Reanne %A Birnbaum,Michael L %A Yum-Chan,Sabrina %A Medoff,Deborah %A Marcogliese,Bethany %A Fang,Lijuan %A Nicholson,Terriann %A Dixon,Lisa %+ Department of Psychiatry, New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032, United States, 1 212 326 8441, Lisa.Dixon@nyspi.columbia.edu %K video gaming %K internet %K recovery %K schizophrenia %K psychosis %K clinicians %K mobile phone %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Several studies have shown the benefits of coordinated specialty care (CSC) for individuals with first episode psychosis; however, pathways to care are marred by lack of knowledge, stigma, and difficulties with treatment engagement. Serious games or video interventions may provide a way to address these factors. Objective: This study focuses on qualitative results of a randomized controlled trial comparing OnTrack>The Game (OTG) with recovery videos (RVs) on engagement, stigma, empowerment, hope, recovery, and understanding of psychosis in clients receiving CSC. Clinicians are also interviewed regarding their perceptions of the interventions and suggestions for improvement. Methods: A total of 16 clients aged 16-30 years, with first episode psychosis attending a CSC program in New York State, and 9 clinicians participated in the qualitative interviews. Interviews were analyzed using the rapid identification of themes from audio recordings method. Results: For clients, themes included relatability of game content, an increased sense of hope and the possibility of recovery, decreased self-stigma and public stigma, increased understanding of the importance of social support, and increased empowerment in the OTG group. Clinicians had a preference for RV and provided suggestions for dissemination and implementation. Conclusions: Themes that may help inform future research in this area, particularly regarding dissemination and implementation of OTG and RV, emerged. Trial Registration: ClinicalTrials.gov NCT03390491; https://clinicaltrials.gov/ct2/show/NCT03390491 %M 35384847 %R 10.2196/33526 %U https://mental.jmir.org/2022/4/e33526 %U https://doi.org/10.2196/33526 %U http://www.ncbi.nlm.nih.gov/pubmed/35384847 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e36217 %T Predicting Uptake of the COVID Coach App Among US Military Veterans: Funnel Analysis Using a Probability-Based Panel %A Jaworski,Beth K %A Taylor,Katherine %A Ramsey,Kelly M %A Heinz,Adrienne J %A Steinmetz,Sarah %A Owen,Jason E %A Tsai,Jack %A Pietrzak,Robert H %+ National Center for Posttraumatic Stress Disorder, Dissemination & Training Division, US Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 18312781567, beth.jaworski@nih.gov %K COVID-19 %K coronavirus %K mobile app %K mHealth %K digital health %K mental health %K public mental health %K stress %K coping %K older adults %K veterans %D 2022 %7 5.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although the COVID-19 pandemic has not led to a uniform increase of mental health concerns among older adults, there is evidence to suggest that some older veterans did experience an exacerbation of preexisting mental health conditions, and that mental health difficulties were associated with a lack of social support and increasing numbers of pandemic-related stressors. Mobile mental health apps are scalable, may be a helpful resource for managing stress during the pandemic and beyond, and could potentially provide services that are not accessible due to the pandemic. However, overall comfort with mobile devices and factors influencing the uptake and usage of mobile apps during the pandemic among older veterans are not well known. COVID Coach is a free, evidence-informed mobile app designed for pandemic-related stress. Public usage data have been evaluated; however, the uptake and usage of the app among older veterans have not been explored. Objective: The purpose of this study was to characterize smartphone ownership rates among US veterans, identify veteran characteristics associated with downloading and use of COVID Coach, and characterize key content usage within the app. Methods: Data were analyzed from the 2019-2020 National Health and Resilience in Veterans Study (NHRVS), which surveyed a nationally representative, prospective cohort of 3078 US military veterans before and 1 year into the pandemic. The NHRVS sample was drawn from KnowledgePanel, a research panel of more than 50,000 households maintained by Ipsos, Inc. The median time to complete the survey was nearly 32 minutes. The research version of COVID Coach was offered to all veterans who completed the peripandemic follow-up assessment on a mobile device (n=814; weighted 34.2% of total sample). App usage data from all respondents who downloaded the app (n=34; weighted 3.3% of the mobile completers sample) were collected between November 14, 2020, and November 7, 2021. Results: We found that most US veterans (81.5%) own smartphones, and that veterans with higher education, greater number of adverse childhood experiences, higher extraversion, and greater severity of pandemic-related posttraumatic stress disorder symptoms were more likely to download COVID Coach. Although uptake and usage of COVID Coach were relatively low (3.3% of eligible participants, n=34), 50% of the participants returned to the app for more than 1 day of use. The interactive tools for managing stress were used most frequently. Conclusions: The COVID-19 pandemic has increased the need for and creation of digital mental health tools. However, these resources may require tailoring for older veteran populations. Future research is needed to better understand how to optimize digital mental health tools such as apps to ensure uptake and usage among older adults, particularly those who have experienced traumas across the lifespan. %M 35245204 %R 10.2196/36217 %U https://mental.jmir.org/2022/4/e36217 %U https://doi.org/10.2196/36217 %U http://www.ncbi.nlm.nih.gov/pubmed/35245204 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 4 %P e34002 %T Brief Digital Interventions to Support the Psychological Well-being of NHS Staff During the COVID-19 Pandemic: 3-Arm Pilot Randomized Controlled Trial %A De Kock,Johannes H %A Latham,Helen Ann %A Cowden,Richard G %A Cullen,Breda %A Narzisi,Katia %A Jerdan,Shaun %A Munoz,Sarah-Anne %A Leslie,Stephen J %A Stamatis,Andreas %A Eze,Jude %+ Division of Rural Health and Wellbeing, Institute of Health Research and Innovation, School of Health, University of the Highlands and Islands, 12b Ness Walk, Inverness, IV3 5SQ, United Kingdom, 44 01463 255000, Hannes.De@nhs.scot %K eHealth %K public health %K depression %K anxiety %K well-being %K mobile health %K intervention studies %K staff %K occupational health %K NHS %K intervention %K support %K COVID-19 %K randomized controlled trial %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Health and social care staff are at high risk of experiencing adverse mental health (MH) outcomes during the COVID-19 pandemic. Hence, there is a need to prioritize and identify ways to effectively support their psychological well-being (PWB). Compared to traditional psychological interventions, digital psychological interventions are cost-effective treatment options that allow for large-scale dissemination and transcend social distancing, overcome rurality, and minimize clinician time. Objective: This study reports MH outcomes of a Consolidated Standards of Reporting Trials (CONSORT)-compliant parallel-arm pilot randomized controlled trial (RCT) examining the potential usefulness of an existing and a novel digital psychological intervention aimed at supporting psychological health among National Health Service (NHS) staff working through the COVID-19 pandemic. Methods: NHS Highland (NHSH) frontline staff volunteers (N=169) were randomly assigned to the newly developed NHSH Staff Wellbeing Project (NHSWBP), an established digital intervention (My Possible Self [MPS]), or a waitlist (WL) group for 4 weeks. Attempts were made to blind participants to which digital intervention they were allocated. The interventions were fully automated, without any human input or guidance. We measured 5 self-reported psychological outcomes over 3 time points: before (baseline), in the middle of (after 2 weeks), and after treatment (4 weeks). The primary outcomes were anxiety (7-item General Anxiety Disorder), depression (Patient Health Questionnaire), and mental well-being (Warwick-Edinburgh Mental Well-being Scale). The secondary outcomes included mental toughness (Mental Toughness Index) and gratitude (Gratitude Questionnaire-6). Results: Retention rates mid- and postintervention were 77% (n=130) and 63.3% (n=107), respectively. Postintervention, small differences were noted between the WL and the 2 treatment groups on anxiety (vs MPS: Cohen d=0.07, 95% CI –0.20 to 0.33; vs NHSWBP: Cohen d=0.06, 95% CI –0.19 to 0.31), depression (vs MPS: Cohen d=0.37, 95% CI 0.07-0.66; vs NHSWBP: Cohen d=0.18, 95% CI –0.11 to 0.46), and mental well-being (vs MPS: Cohen d=–0.04, 95% CI –0.62 to –0.08; vs NHSWBP: Cohen d=–0.15, 95% CI –0.41 to 0.10). A similar pattern of between-group differences was found for the secondary outcomes. The NHSWBP group generally had larger within-group effects than the other groups and displayed a greater rate of change compared to the other groups on all outcomes, except for gratitude, where the rate of change was greatest for the MPS group. Conclusions: Our analyses provided encouraging results for the use of brief digital psychological interventions in improving PWB among health and social care workers. Future multisite RCTs, with power to reliably detect differences, are needed to determine the efficacy of contextualized interventions relative to existing digital treatments. Trial Registration: ISRCTN Registry (ISRCTN) ISRCTN18107122; https://www.isrctn.com/ISRCTN18107122 %M 35044927 %R 10.2196/34002 %U https://mental.jmir.org/2022/4/e34002 %U https://doi.org/10.2196/34002 %U http://www.ncbi.nlm.nih.gov/pubmed/35044927 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e34330 %T Efficacy of a Web-Based Intervention for Depressive Disorders: Three-Arm Randomized Controlled Trial Comparing Guided and Unguided Self-Help With Waitlist Control %A Krämer,Rico %A Köhne-Volland,Lea %A Schumacher,Anna %A Köhler,Stephan %+ Department of Psychiatry and Neuroscience, Charité – Universitätsmedizin Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 15152515774, stephan.koehler@charite.de %K major depressive disorder %K online intervention %K blended treatment %K public health %K routine practice %K randomized controlled trial %K depression %K disorder %K intervention %K treatment %K efficacy %K self-help %K guidance %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health apps are efficacious treatment options for mild-to-moderate depressive disorders. However, the extent to which psychological guidance increases the efficacy of these apps is controversial. Objective: We evaluated the efficacy of a web-based intervention, called Selfapy, for unipolar depression. We also investigated differences between psychotherapist-guided and unguided versions. Methods: Selfapy is a cognitive behavioral therapy–based intervention for depressive disorders. Participants with mild-to-severe depressive disorders were assigned randomly to participate in either guided (weekly 25-minute duration telephone calls) intervention, unguided version, or waiting list (control group) for 12 weeks. We assessed depressive symptoms at the start of the study, midway through the intervention (6 weeks), at the end of the intervention (12 weeks), and at follow-up (6 months). The main outcome was difference in the Beck Depression Inventory score between the start of the study and the end of the intervention. Secondary outcomes were the Quick Inventory of Depressive Symptomatology—Self Report, the Hamilton Rating Depression Scale, and the Beck Anxiety Inventory. Results: Of 401 participants, 301 participants (75.1%) completed the intervention. Changes in the Beck Depression Inventory from baseline differed significantly between groups at the postintervention (F2,398=37.20, P<.001). The reductions in scores for both guided and unguided intervention groups were greater than that for the control group, with large between-group effect sizes (guided vs control: d=1.63, 95% CI 1.37 to 1.93; unguided vs control: d=1.47, 95% CI 1.22 to 1.73) at postintervention. No significant differences were found between guided and unguided intervention groups (P=.18). At follow-up (6 months), treatment effects on the primary outcome were maintained for both intervention groups (guided: F1,194=0.62, P>.999; unguided: F1,176=0.13, P>.999). Conclusions: Both guided and unguided versions of the intervention were highly effective in reducing depressive symptoms. Follow-up data suggest that these effects could be maintained. The guided version was not superior to the unguided version. Trial Registration: German Clinical Trials Register DRKS00017191; https://tinyurl.com/2p9h5hnx International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05218-4 %M 35105536 %R 10.2196/34330 %U https://formative.jmir.org/2022/4/e34330 %U https://doi.org/10.2196/34330 %U http://www.ncbi.nlm.nih.gov/pubmed/35105536 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e29566 %T Satisfaction and Acceptability Ratings of a Web-Based Self-help Intervention for Depression: Retrospective Cross-sectional Study From a Resource-Limited Country %A Lara,Ma. Asunción %A Patiño,Pamela %A Tiburcio,Marcela %A Navarrete,Laura %+ Department of Psychosocial Studies in Specific Population, Division of Epidemiological and Psychosocial Research, Ramón de la Fuente Muñiz National Institute of Psychiatry, Calz. Mexico-Xochimilco 101, Col. San Lorenzo Huipulco, Del. Tlalpan, Mexico City, 14370, Mexico, 52 55 4160 5170, laracan@imp.edu.mx %K depression %K web-based intervention %K unguided intervention %K acceptability %K satisfaction %K resource-limited country %D 2022 %7 4.4.2022 %9 Early Reports %J JMIR Form Res %G English %X Background: Web-based interventions are at an early stage in non–English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version. Objective: The aim of this study is to explore participants’ satisfaction and acceptability for the second version of HDep. Methods: A retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]). Results: In all groups, users experienced high levels of depressive symptoms (189/191, 98.9%; Center for Epidemiological Studies Scale-Depression >16). Moderate levels of satisfaction (HPUs: mean 21.9, SD 6.7; PUs: mean 21.1, SD 5.8; range: 8-32) and acceptability (HPUs: mean 13.8, SD 3.9; PUs: mean 13.9, SD 3.2; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (odds ratio [OR] 3.4, 95% CI 1.1-10.0), whereas among PUs, older respondents (OR 1.04, 95% CI 1.01-1.08), those with paid work (OR 3.1, 95% CI 2.4-7.6), those who had not been in therapy (OR 2.42, 95% CI 1.09-5.98), and those who had not attempted suicide (OR 3.4, 95% CI 1.1-11.1) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work (OR 2.5, 95% CI 1.1-5.5), those who had not been in therapy (OR 3.1, 95% CI 1.3-7.3), those without disability (OR 2.9, 95% CI 1.3-6.6), and those who had not attempted suicide (OR 2.6, 95% CI 1.0-6.6) showed higher acceptability. Conclusions: HDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative–quantitative study from a low- to middle-income, non–English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence. %M 35377324 %R 10.2196/29566 %U https://formative.jmir.org/2022/4/e29566 %U https://doi.org/10.2196/29566 %U http://www.ncbi.nlm.nih.gov/pubmed/35377324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e31839 %T The Impact of Web-Based Physical Activity Interventions on Depression and Anxiety Among College Students: Randomized Experimental Trial %A Murray,Andy %A Marenus,Michele %A Cahuas,Ana %A Friedman,Kathryn %A Ottensoser,Haley %A Kumaravel,Varun %A Sanowski,Julia %A Chen,Weiyun %+ Physical Activity and Health Laboratory, School of Kinesiology, University of Michigan, SKB 4250, 830 N University Ave, Ann Arbor, MI, 48109, United States, 1 (734) 615 0376, chenwy@umich.edu %K depression %K anxiety %K college students %K mindfulness %K aerobic exercise %K resistance training %K web-based intervention %D 2022 %7 1.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression and anxiety are growing issues for college students, with both aerobic resistance training and mindfulness yoga exercises known to be effective in reducing symptoms and severity. However, no known research is available comparing these 2 depression and anxiety interventions simultaneously and in a web-based environment. Objective: This study aims to determine the effects of a web-based aerobic resistance exercise intervention (WeActive) and a web-based yoga mindfulness exercise intervention (WeMindful) on depression and anxiety symptoms in college students. Methods: The participants were 77 college students who anonymously completed a Qualtrics survey, including the Generalized Anxiety Disorder Scale and the Major Depression Inventory at baseline and after the intervention. Participants were randomly assigned to either the WeActive or WeMindful group and underwent two 30-minute web-based aerobic resistance exercise lessons or yoga mindfulness lessons per week for 8 weeks. Results: The results of analysis of covariance with repeated measures indicated that although not statistically significant, both groups showed a notable decrease in anxiety with a marginally significant main effect of time (F1=3.485; P=.07; η2=0.047) but no significant main effect of group and no significant interaction effect of time with group. The 2 intervention groups experienced a significant decrease in depression with the main effect of time (F=3.892; P=.05; η2=0.052). There was no significant main effect of group or interaction effect of time with group for depression. Conclusions: College students in both WeActive and WeMindful groups experienced a significant decrease in depression symptoms and a decrease, although not significant, in anxiety as well. The study suggests that web-based WeActive and WeMindful interventions are effective approaches to managing US college students’ depression and anxiety during a pandemic. %M 35363151 %R 10.2196/31839 %U https://formative.jmir.org/2022/4/e31839 %U https://doi.org/10.2196/31839 %U http://www.ncbi.nlm.nih.gov/pubmed/35363151 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e35253 %T Utilizing Big Data From Google Trends to Map Population Depression in the United States: Exploratory Infodemiology Study %A Wang,Alex %A McCarron,Robert %A Azzam,Daniel %A Stehli,Annamarie %A Xiong,Glen %A DeMartini,Jeremy %+ Department of Psychiatry and Human Behavior, University of California, Irvine, 101 The City Dr S, Orange, CA, 92868, United States, 1 8584059768, wangaj3@uci.edu %K depression %K epidemiology %K internet %K google trends %K big data %K mental health %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The epidemiology of mental health disorders has important theoretical and practical implications for health care service and planning. The recent increase in big data storage and subsequent development of analytical tools suggest that mining search databases may yield important trends on mental health, which can be used to support existing population health studies. Objective: This study aimed to map depression search intent in the United States based on internet-based mental health queries. Methods: Weekly data on mental health searches were extracted from Google Trends for an 11-year period (2010-2021) and separated by US state for the following terms: “feeling sad,” “depressed,” “depression,” “empty,” “insomnia,” “fatigue,” “guilty,” “feeling guilty,” and “suicide.” Multivariable regression models were created based on geographic and environmental factors and normalized to the following control terms: “sports,” “news,” “google,” “youtube,” “facebook,” and “netflix.” Heat maps of population depression were generated based on search intent. Results: Depression search intent grew 67% from January 2010 to March 2021. Depression search intent showed significant seasonal patterns with peak intensity during winter (adjusted P<.001) and early spring months (adjusted P<.001), relative to summer months. Geographic location correlated with depression search intent with states in the Northeast (adjusted P=.01) having higher search intent than states in the South. Conclusions: The trends extrapolated from Google Trends successfully correlate with known risk factors for depression, such as seasonality and increasing latitude. These findings suggest that Google Trends may be a valid novel epidemiological tool to map depression prevalence in the United States. %M 35357320 %R 10.2196/35253 %U https://mental.jmir.org/2022/3/e35253 %U https://doi.org/10.2196/35253 %U http://www.ncbi.nlm.nih.gov/pubmed/35357320 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e27402 %T A Web-Based App for Emotional Management During the COVID-19 Pandemic: Platform Development and Retrospective Analysis of its Use Throughout Two Waves of the Outbreak in Spain %A Fidel Kinori,Sara Guila %A Carot-Sans,Gerard %A Cuartero,Andrés %A Valero-Bover,Damià %A Roma Monfa,Rosa %A Garcia,Elisabet %A Pérez Sust,Pol %A Blanch,Jordi %A Piera-Jiménez,Jordi %A Ramos-Quiroga,Josep Antoni %+ Information Systems Directorate, Servei Català de la Salut, Barcelona, Spain, 34 651041515, jpieraj@uoc.edu %K web-based app %K emotional management %K lockdown %K COVID-19 %K posttraumatic stress disorder %K anxiety %K quarantine %K PTSD %K app %K emotion %K development %K platform %K retrospective %K usage %K utilization %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Quarantines and nationwide lockdowns implemented for containing the spread of the COVID-19 pandemic may lead to distress and increase the frequency of anxiety and depression symptoms among the general population. During the nationwide lockdown of the first wave of the COVID-19 outbreak in Spain, we developed and launched a web-based app to promote emotional self-care in the general population and facilitate contact with health care professionals. Objective: This study aimed to describe a web-based app and analyze its utilization pattern throughout 2 successive waves of the COVID-19 outbreak in Spain. Methods: Our web-based app targeted all individuals aged 18 years or more and was designed by adapting the contents of a mobile app for adjuvant treatment of posttraumatic stress disorder (ie, the PTSD Coach app) to the general population and the pandemic or lockdown scenario. We retrospectively assessed the utilization pattern of the web-based app using data systematically retrieved from Google Analytics. Data were grouped into 3 time periods, defined using Joinpoint regression analysis of COVID-19 incidence in our area: first wave, between-wave period, and second wave. Results: The resulting web-based app, named gesioemocional.cat, maintains the navigation structure of the PTSD Coach app, with three main modules: tools for emotional self-care, a self-assessment test, and professional resources for on-demand contact. The self-assessment test combines the Patient Health Questionnaire-2 and the 7-item Generalized Anxiety Disorder scale and offers professional contact in the advent of a high level of depression and anxiety; contact is prioritized in accordance with a screening questionnaire administered at the time of obtaining individual consent to be contacted. The tools for emotional self-care can be accessed either on-demand or symptom-driven. The utilization analysis showed a high number of weekly accesses during the first wave. In this period, press releases regarding critical events of the pandemic progression and government decisions on containment measures were followed by a utilization peak, irrespective of the sense (ie, positive or negative) of the information. Positive information pieces (eg, relaxation of containment measures due to a reduction of COVID-19 cases) resulted in a sharp increase in utilization immediately after information release, followed by a successive decline in utilization. The second wave was characterized by a lower and less responsive utilization of the web-based app. Conclusions: mHealth tools may help the general population cope with stressful conditions associated with the pandemic scenario. Future studies shall investigate the effectiveness of these tools among the general population—including individuals without diagnosed mental illnesses—and strategies to reach as many people as possible. %M 35142638 %R 10.2196/27402 %U https://formative.jmir.org/2022/3/e27402 %U https://doi.org/10.2196/27402 %U http://www.ncbi.nlm.nih.gov/pubmed/35142638 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e33423 %T Effectiveness of a Mindfulness-Based Mobile Application for the Treatment of Depression in Ambulatory Care: Protocol for a Randomized Controlled Trial %A Sarlon,Jan %A Doll,Jessica P K %A Schmassmann,Aline %A Brand,Serge %A Ferreira,Naomi %A Muehlhauser,Markus %A Urech-Meyer,Stefanie %A Schweinfurth,Nina %A Lang,Undine Emmi %A Bruehl,Annette Beatrix %+ University Psychiatric Clinics, University of Basel, Wilhelm Klein-Strasse 27, Basel, 4002, Switzerland, 41 613255097, jan.sarlon@upk.ch %K depression %K mindfulness %K mhealth %K ehealth %K stress level %D 2022 %7 31.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with major depressive disorder (MDD) often experience relapses despite regular treatment with pharmacotherapy and psychotherapy. Further, long waiting lists and more demand than treatment capacity characterize ambulatory settings. Mindfulness-based interventions proved to be effective in relapse prevention in MDD. Next, mindfulness-based interventions in the form of free mobile applications can be an effective augmentation of the treatment as usual and can fill a gap in ambulatory care. Objective: Given this background, the aim of this randomized controlled study is to assess the effectiveness of additional MBI via a mobile app on the symptom severity and stress levels, compared to treatment as usual. Methods: A total of 140 individuals with MDD will be randomly allocated to the intervention or control condition. The intervention consists of the daily use of the mindfulness mobile application Headspace for thirty days (up to 10 minutes a day). The control condition will be treatment as usual. At baseline and four weeks later, the following key outcome dimensions will be assessed: self-rated (Beck Depression Inventory) and experts’ rated symptoms of MDD (Hamilton Depression Rating Scale); secondary outcome variables will be blood pressure, heart rate, and respiratory rate and changes in tobacco and alcohol consumption and medication as a proxy of perceived stress. Results: This study was funded in February 2021 and approved by the institutional review board on April 15, 2021, and it started in May 2021. As of December 2021, we enrolled 30 participants. The findings are expected to be published in spring 2023. Conclusions: We hypothesize that compared to the control conditions, individuals with MDD of the mobile app-condition will have both lower self- and experts’ rated symptoms of MDD and more favorable stress-related levels. While the risk for medical events is low, the immediate benefit for participants could be a decrease in symptom severity and reduction of the stress level. Trial Registration: Clinical Trials.gov NCT05060393; https://clinicaltrials.gov/ct2/show/NCT05060393. International Registered Report Identifier (IRRID): DERR1-10.2196/33423 %M 35357325 %R 10.2196/33423 %U https://www.researchprotocols.org/2022/3/e33423 %U https://doi.org/10.2196/33423 %U http://www.ncbi.nlm.nih.gov/pubmed/35357325 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e33685 %T Quantifying Changes in the Language Used Around Mental Health on Twitter Over 10 Years: Observational Study %A Stupinski,Anne Marie %A Alshaabi,Thayer %A Arnold,Michael V %A Adams,Jane Lydia %A Minot,Joshua R %A Price,Matthew %A Dodds,Peter Sheridan %A Danforth,Christopher M %+ Department of Mathematics and Statistics, University of Vermont, Innovation Hall E220, 82 University Place, Burlington, VT, 05405, United States, 1 802 656 3032, chris.danforth@uvm.edu %K mental health %K stigma %K natural language processing %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health challenges are thought to affect approximately 10% of the global population each year, with many of those affected going untreated because of the stigma and limited access to services. As social media lowers the barrier for joining difficult conversations and finding supportive groups, Twitter is an open source of language data describing the changing experience of a stigmatized group. Objective: By measuring changes in the conversation around mental health on Twitter, we aim to quantify the hypothesized increase in discussions and awareness of the topic as well as the corresponding reduction in stigma around mental health. Methods: We explored trends in words and phrases related to mental health through a collection of 1-, 2-, and 3-grams parsed from a data stream of approximately 10% of all English tweets from 2010 to 2021. We examined temporal dynamics of mental health language and measured levels of positivity of the messages. Finally, we used the ratio of original tweets to retweets to quantify the fraction of appearances of mental health language that was due to social amplification. Results: We found that the popularity of the phrase mental health increased by nearly two orders of magnitude between 2012 and 2018. We observed that mentions of mental health spiked annually and reliably because of mental health awareness campaigns as well as unpredictably in response to mass shootings, celebrities dying by suicide, and popular fictional television stories portraying suicide. We found that the level of positivity of messages containing mental health, while stable through the growth period, has declined recently. Finally, we observed that since 2015, mentions of mental health have become increasingly due to retweets, suggesting that the stigma associated with the discussion of mental health on Twitter has diminished with time. Conclusions: These results provide useful texture regarding the growing conversation around mental health on Twitter and suggest that more awareness and acceptance has been brought to the topic compared with past years. %M 35353049 %R 10.2196/33685 %U https://mental.jmir.org/2022/3/e33685 %U https://doi.org/10.2196/33685 %U http://www.ncbi.nlm.nih.gov/pubmed/35353049 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e32824 %T The Current State and Validity of Digital Assessment Tools for Psychiatry: Systematic Review %A Martin-Key,Nayra A %A Spadaro,Benedetta %A Funnell,Erin %A Barker,Eleanor Jane %A Schei,Thea Sofie %A Tomasik,Jakub %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K diagnostic accuracy %K digital mental health %K digital questionnaire %K psychiatry %K systematic review %D 2022 %7 30.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: Given the role digital technologies are likely to play in the future of mental health care, there is a need for a comprehensive appraisal of the current state and validity (ie, screening or diagnostic accuracy) of digital mental health assessments. Objective: The aim of this review is to explore the current state and validity of question-and-answer–based digital tools for diagnosing and screening psychiatric conditions in adults. Methods: This systematic review was based on the Population, Intervention, Comparison, and Outcome framework and was carried out in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. MEDLINE, Embase, Cochrane Library, ASSIA, Web of Science Core Collection, CINAHL, and PsycINFO were systematically searched for articles published between 2005 and 2021. A descriptive evaluation of the study characteristics and digital solutions and a quantitative appraisal of the screening or diagnostic accuracy of the included tools were conducted. Risk of bias and applicability were assessed using the revised tool for the Quality Assessment of Diagnostic Accuracy Studies 2. Results: A total of 28 studies met the inclusion criteria, with the most frequently evaluated conditions encompassing generalized anxiety disorder, major depressive disorder, and any depressive disorder. Most of the studies used digitized versions of existing pen-and-paper questionnaires, with findings revealing poor to excellent screening or diagnostic accuracy (sensitivity=0.32-1.00, specificity=0.37-1.00, area under the receiver operating characteristic curve=0.57-0.98) and a high risk of bias for most of the included studies. Conclusions: The field of digital mental health tools is in its early stages, and high-quality evidence is lacking. International Registered Report Identifier (IRRID): RR2-10.2196/25382 %M 35353053 %R 10.2196/32824 %U https://mental.jmir.org/2022/3/e32824 %U https://doi.org/10.2196/32824 %U http://www.ncbi.nlm.nih.gov/pubmed/35353053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34301 %T Barriers and Considerations in the Design and Implementation of Digital Behavioral Interventions: Qualitative Analysis %A Marcu,Gabriela %A Ondersma,Steven J %A Spiller,Allison N %A Broderick,Brianna M %A Kadri,Reema %A Buis,Lorraine R %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, United States, 1 734 998 7120, buisl@umich.edu %K computers %K mobile apps %K screening %K brief interventions %K diagnosis %K computer-assisted/methods %K surveys and questionnaires %K motivational interviewing %K therapy %K implementation %K qualitative %K mobile phone %D 2022 %7 30.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital behavioral interventions have become increasingly popular for their ability to support patient diagnosis and treatment, chronic disease self-management, behavior change, and adherence to recommended care. However, digital intervention development is impeded by challenges such as limited technical skills, limited access to developers, and cost. The purpose of this study is to elicit in-depth qualitative feedback from intervention developers who have interest in digital behavioral interventions but lack programming skills regarding the barriers they experience and key considerations in the design and implementation of digital interventions. Objective: This study aims to understand barriers in the design and implementation of digital behavioral interventions, as well as to identify key considerations for researchers who are developing these interventions. Methods: We conducted semistructured qualitative interviews with 18 researchers who had experience either designing (but not coding) digital behavioral interventions or running research studies with them. Participants were a convenience sample of users of the Computerized Intervention Authoring System platform, an existing no-code development platform for building digital intervention content, and were recruited through either direct email solicitation or snowball sampling. All interviews were conducted and recorded over videoconference between February and April 2020. Recordings from interviews were transcribed and thematically analyzed by multiple coders. Results: Interviews were completed with 18 participants and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project/study staff. Three key barriers in the development of digital behavior interventions were identified during interviews: lack of cross-disciplinary understanding; variability in recipients’ technology access, infrastructure, and literacy; and the idea that evidence-based in-person interactions do not translate directly to digital interactions. Interviewees identified several key considerations that interventionists learned to prioritize, which have the potential to overcome these barriers and lead to successful interventions. Conclusions: Barriers in the development of digital behavioral interventions are often created by a lack of cross-disciplinary understanding, which can lead to difficulties conceptualizing interventions, unrealistic expectations in terms of cost, and confusion about the development process. Moreover, concerns about research study participant characteristics and access to technology, as well as the translation of in-person interventions to digital, are apparent. Appropriate training in how to work with software development teams may help future digital behavior intervention creators overcome these barriers and may lead to new, exciting innovations in this space. %M 35353043 %R 10.2196/34301 %U https://www.jmir.org/2022/3/e34301 %U https://doi.org/10.2196/34301 %U http://www.ncbi.nlm.nih.gov/pubmed/35353043 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34300 %T The Perceived Benefits of Digital Interventions for Behavioral Health: Qualitative Interview Study %A Marcu,Gabriela %A Ondersma,Steven J %A Spiller,Allison N %A Broderick,Brianna M %A Kadri,Reema %A Buis,Lorraine R %+ Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI, 48104-1213, United States, 1 734 998 7120, buisl@umich.edu %K computers %K mobile apps %K screening %K brief interventions %K diagnosis %K computer-assisted/methods %K surveys and questionnaires %K motivational interviewing %K therapy %K computer-assisted/methods %K implementation %K qualitative %K mobile phone %D 2022 %7 30.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital interventions have gained momentum in terms of behavioral health. However, owing to lacking standard approaches or tools for creating digital behavioral interventions, clinical researchers follow widely varying conceptions of how best to go about digital intervention development. Researchers also face significant cost-, time-, and expertise-related challenges in digital intervention development. Improving the availability of tools and guidance for researchers will require a thorough understanding of the motivations and needs of researchers seeking to create digital interventions. Objective: This study aims to understand the perceptions of behavioral researchers toward digital interventions, and inform the use of these interventions, by documenting the reasons why researchers are increasingly focusing their efforts on digital interventions and their perspectives on the perceived benefits that digital approaches can provide for researchers and intervention recipients. Methods: We conducted semistructured qualitative interviews with 18 researchers who had experience designing digital behavioral interventions or running studies with them. A convenience sample of interviewees was recruited from among users of the Computerized Intervention Authoring System platform, a web-based tool that facilitates the process of creating and deploying digital interventions in behavioral research. Interviews were conducted over teleconference between February and April 2020. Recordings from the interviews were transcribed and thematically analyzed by multiple coders. Results: Interviews were completed with 18 individuals and lasted between 24 and 65 (mean 46.9, SD 11.3) minutes. Interviewees were predominantly female (17/18, 94%) and represented different job roles, ranging from researcher to project or study staff. Four major themes came out of the interviews concerning the benefits of digital interventions for behavioral health: convenience and flexibility for interventionists and recipients, support for implementing evidence-based interventions with fidelity, scaling and improving access to interventions, and getting a foot in the door despite stigma and disenfranchisement. Conclusions: Interviewees described a number of important potential benefits of digital interventions, particularly with respect to scientific rigor, scalability, and overcoming barriers to reaching more people. There are complex considerations with regard to translating behavior change strategies into digital forms of delivery, and interventionists make individual, sometimes unexpected, choices with minimal evidence of their relative effectiveness. Future research should investigate how behavioral researchers can be supported in making these choices toward usability, ease of access, and approachability of digital interventions. Our study underscores the need for authoring platforms that can facilitate the process of creating and deploying digital interventions to reach their full potential for interventionists and recipients alike. %M 35353045 %R 10.2196/34300 %U https://www.jmir.org/2022/3/e34300 %U https://doi.org/10.2196/34300 %U http://www.ncbi.nlm.nih.gov/pubmed/35353045 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e34760 %T Development of a Framework for the Implementation of Synchronous Digital Mental Health: Realist Synthesis of Systematic Reviews %A Villarreal-Zegarra,David %A Alarcon-Ruiz,Christoper A %A Melendez-Torres,GJ %A Torres-Puente,Roberto %A Navarro-Flores,Alba %A Cavero,Victoria %A Ambrosio-Melgarejo,Juan %A Rojas-Vargas,Jefferson %A Almeida,Guillermo %A Albitres-Flores,Leonardo %A Romero-Cabrera,Alejandra B %A Huarcaya-Victoria,Jeff %+ Unidad de Psiquiatría de Enlace, Departamento de Psiquiatría, Hospital Nacional Guillermo Almenara Irigoyen, Av Grau 800, Lima, 15001, Peru, 51 987382101, jeff.huarcaya@upsjb.edu.pe %K telemedicine %K digital health %K internet-based intervention %K mental health %K mental disorders %K systematic reviews %K qualitative research %K realist review %K mHealth %K eHealth %K telehealth %D 2022 %7 29.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. Objective: The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. Methods: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. Results: A total of 21 systematic reviews were included in the study. Among these, 90% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. Conclusions: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203811 International Registered Report Identifier (IRRID): RR2-10.12688/f1000research.27150.2 %M 35348469 %R 10.2196/34760 %U https://mental.jmir.org/2022/3/e34760 %U https://doi.org/10.2196/34760 %U http://www.ncbi.nlm.nih.gov/pubmed/35348469 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e34744 %T PTSD Coach Version 3.1: A Closer Look at the Reach, Use, and Potential Impact of This Updated Mobile Health App in the General Public %A Hallenbeck,Haijing Wu %A Jaworski,Beth K %A Wielgosz,Joseph %A Kuhn,Eric %A Ramsey,Kelly M %A Taylor,Katherine %A Juhasz,Katherine %A McGee-Vincent,Pearl %A Mackintosh,Margaret-Anne %A Owen,Jason E %+ Dissemination and Training Division, National Center for Posttraumatic Stress Disorder, Veterans Affairs Palo Alto Health Care System, 795 Willow Rd, Menlo Park, CA, 94025, United States, 1 650 493 5000, haijing.hallenbeck@stanford.edu %K posttraumatic stress disorder %K trauma %K mental health %K mHealth %K mobile app %K public health %K self-management %K mobile phone %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: With widespread smartphone ownership, mobile health apps (mHealth) can expand access to evidence-based interventions for mental health conditions, including posttraumatic stress disorder (PTSD). Research to evaluate new features and capabilities in these apps is critical but lags behind app development. The initial release of PTSD Coach, a free self-management app developed by the US Departments of Veterans Affairs and Defense, was found to have a positive public health impact. However, major stakeholder-driven updates to the app have yet to be evaluated. Objective: We aimed to characterize the reach, use, and potential impact of PTSD Coach Version 3.1 in the general public. As part of characterizing use, we investigated the use of specific app features, which extended previous work on PTSD Coach. Methods: We examined the naturalistic use of PTSD Coach during a 1-year observation period between April 20, 2020, and April 19, 2021, using anonymous in-app event data to generate summary metrics for users. Results: During the observation period, PTSD Coach was broadly disseminated to the public, reaching approximately 150,000 total users and 20,000 users per month. On average, users used the app 3 times across 3 separate days for 18 minutes in total, with steep drop-offs in use over time; a subset of users, however, demonstrated high or sustained engagement. More than half of users (79,099/128,691, 61.46%) accessed one or more main content areas of the app (ie, Manage Symptoms, Track Progress, Learn, or Get Support). Among content areas, features under Manage Symptoms (including coping tools) were accessed most frequently, by over 40% of users (53,314/128,691, 41.43% to 56,971/128,691, 44.27%, depending on the feature). Users who provided initial distress ratings (56,971/128,691, 44.27%) reported relatively high momentary distress (mean 6.03, SD 2.52, on a scale of 0-10), and the use of a coping tool modestly improved momentary distress (mean −1.38, SD 1.70). Among users who completed at least one PTSD Checklist for DSM-5 (PCL-5) assessment (17,589/128,691, 13.67%), PTSD symptoms were largely above the clinical threshold (mean 49.80, SD 16.36). Among users who completed at least two PCL-5 assessments (4989/128,691, 3.88%), PTSD symptoms decreased from the first to last assessment (mean −4.35, SD 15.29), with approximately one-third (1585/4989, 31.77%) of these users experiencing clinically significant improvements. Conclusions: PTSD Coach continues to fulfill its mission as a public health resource. Version 3.1 compares favorably with version 1 on most metrics related to reach, use, and potential impact. Although benefits appear modest on an individual basis, the app provides these benefits to a large population. For mHealth apps to reach their full potential in supporting trauma recovery, future research should aim to understand the utility of individual app features and identify strategies to maximize overall effectiveness and engagement. %M 35348458 %R 10.2196/34744 %U https://mental.jmir.org/2022/3/e34744 %U https://doi.org/10.2196/34744 %U http://www.ncbi.nlm.nih.gov/pubmed/35348458 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e30754 %T Measuring Adherence Within a Self-Guided Online Intervention for Depression and Anxiety: Secondary Analyses of a Randomized Controlled Trial %A Hanano,Maria %A Rith-Najarian,Leslie %A Boyd,Meredith %A Chavira,Denise %+ Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Box 951563, Los Angeles, CA, 90095, United States, 1 9493501523, mariahanano@g.ucla.edu %K self-guided %K adherence %K depression %K anxiety %K online intervention %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Self-guided online interventions offer users the ability to participate in an intervention at their own pace and address some traditional service barriers (eg, attending in-person appointments, cost). However, these interventions suffer from high dropout rates, and current literature provides little guidance for defining and measuring online intervention adherence as it relates to clinical outcomes. Objective: This study aims to develop and test multiple measures of adherence to a specific self-guided online intervention, as guided by best practices from the literature. Methods: We conducted secondary analyses on data from a randomized controlled trial of an 8-week online cognitive behavioral program that targets depression and anxiety in college students. We defined multiple behavioral and attitudinal adherence measures at varying levels of effort (ie, low, moderate, and high). Linear regressions were run with adherence terms predicting improvement in the primary outcome measure, the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Results: Of the 947 participants, 747 initiated any activity and 449 provided posttest data. Results from the intent-to-treat sample indicated that high level of effort for behavioral adherence significantly predicted symptom change (F4,746=17.18, P<.001; and β=–.26, P=.04). Moderate level of effort for attitudinal adherence also significantly predicted symptom change (F4,746=17.25, P<.001; and β=–.36, P=.03). Results differed in the initiators-only sample, such that none of the adherence measures significantly predicted symptom change (P=.09-.27). Conclusions: Our findings highlight the differential results of dose-response models testing adherence measures in predicting clinical outcomes. We summarize recommendations that might provide helpful guidance to future researchers and intervention developers aiming to investigate online intervention adherence. Trial Registration: ClinicalTrials.gov NCT04361045; https://clinicaltrials.gov/ct2/show/NCT04361045 %M 35343901 %R 10.2196/30754 %U https://mental.jmir.org/2022/3/e30754 %U https://doi.org/10.2196/30754 %U http://www.ncbi.nlm.nih.gov/pubmed/35343901 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33073 %T Patient- and Provider-Reported Experiences of a Mobile Novel Digital Therapeutic in People With Opioid Use Disorder (reSET-O): Feasibility and Acceptability Study %A Kawasaki,Sarah %A Mills-Huffnagle,Sara %A Aydinoglo,Nicole %A Maxin,Halley %A Nunes,Edward %+ Department of Psychiatry and Behavioral Health, Penn State Health, 500 University Drive, Box H073, Hershey, PA, 17033, United States, 1 7177826844, skawasaki@pennstatehealth.psu.edu %K reSET-O %K digital therapeutic %K opioid use disorder %K prescription digital therapeutic %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Medications for the treatment of opioid use disorder, such as buprenorphine, are effective and essential for addressing the opioid epidemic. However, high dropout rates from medication remain a challenge. Behavioral treatment with contingency management and cognitive behavioral counseling has shown promise for improving the outcomes of buprenorphine treatment but is complicated to deliver. The delivery of behavioral treatment through technology-based platforms has the potential to make it more feasible for widespread dissemination. Objective: reSET-O is a prescription digital therapeutic and a commercial adaptation of the Therapeutic Education System, an internet-based program with a Community Reinforcement Approach to cognitive behavioral therapy. It delivers cognitive behavioral therapy modules and contingency management rewards upon completion of modules and negative urine drug screens. This pilot study aims to assess the feasibility and acceptability of reSET-O in a community-based opioid treatment program with a Hub and Spoke model of care as part of a larger strategy to maintain individuals in treatment. Objective and qualitative results, as well as acceptability and likeability of reSET-O, were obtained from 15 individuals. Methods: English-speaking individuals aged ≥18 years with a diagnosis of current opioid use disorder were recruited after being on buprenorphine for at least 1 week of treatment. Two 12-week prescriptions for reSET-O were written for the 24-week study. Patient reports of drug use and likeability scales of reSET-O were conducted at weeks 4, 8, 12, and 24 of the study. Qualitative interviews were also conducted. A total of 4 providers were recruited and provided feedback on the acceptability and feasibility of reSET-O. Results: Of the 15 participants who participated in this pilot study, 7 (47%) completed 24 weeks, and 8 (53%) were unable to complete because of dropout after enrollment, attrition in treatment, or incarceration. An average of US $96 in contingency management rewards were earned by participants for the completion of modules for the duration of the pilot study. Participants’ subjective feedback revealed that reSET-O was easy to use, enjoyable, and helped provide a safe space to admit recurring substance use. Conclusions: reSET-O was well accepted based on patient and provider feedback in this pilot study; however, adherence and retention in treatment remain areas for improvement. Randomized control trials are needed to assess whether retention of community-based buprenorphine treatment is enhanced through the use of technology-based behavioral interventions such as reSET-O. %M 35333189 %R 10.2196/33073 %U https://formative.jmir.org/2022/3/e33073 %U https://doi.org/10.2196/33073 %U http://www.ncbi.nlm.nih.gov/pubmed/35333189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32940 %T Adapting an Evidence-Based e-Learning Cognitive Behavioral Therapy Program Into a Mobile App for People Experiencing Gambling-Related Problems: Formative Study %A Humphrey,Gayl %A Chu,Joanna Ting %A Ruwhiu-Collins,Rebecca %A Erick-Peleti,Stephanie %A Dowling,Nicki %A Merkouris,Stephanie %A Newcombe,David %A Rodda,Simone %A Ho,Elsie %A Nosa,Vili %A Parag,Varsha %A Bullen,Christopher %+ National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland, 1145, New Zealand, 64 21 1100901, g.humphrey@auckland.ac.nz %K gambling %K CBT %K mHealth %K co-design %K smartphone %K self-directed %K behavior change %K engagement %K mobile phone %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people who experience harm and problems from gambling do not seek treatment from gambling treatment services because of personal and resource barriers. Mobile health (mHealth) interventions are widely used across diverse health care areas and populations. However, there are few in the gambling harm field, despite their potential as an additional modality for delivering treatment and support. Objective: This study aims to understand the needs, preferences, and priorities of people experiencing gambling harms and who are potential end users of a cognitive behavioral therapy mHealth intervention to inform design, features, and functions. Methods: Drawing on a mixed methods approach, we used creators and domain experts to review the GAMBLINGLESS web-based program and convert it into an mHealth prototype. Each module was reviewed against the original evidence base to maintain its intended fidelity and conceptual integrity. Early wireframes, design ideas (look, feel, and function), and content examples were developed to initiate discussions with end users. Using a cocreation process with a young adult, a Māori, and a Pasifika peoples group, all with experiences of problem or harmful gambling, we undertook 6 focus groups: 2 cycles per group. In each focus group, participants identified preferences, features, and functions for inclusion in the final design and content of the mHealth intervention. Results: Over 3 months, the GAMBLINGLESS web-based intervention was reviewed and remapped from 4 modules to 6. This revised program is based on the principles underpinning the transtheoretical model, in which it is recognized that some end users will be more ready to change than others. Change is a process that unfolds over time, and a nonlinear progression is common. Different intervention pathways were identified to reflect the end users’ stage of change. In all, 2 cycles of focus groups were then conducted, with 30 unique participants (13 Māori, 9 Pasifika, and 8 young adults) in the first session and 18 participants (7 Māori, 6 Pasifika, and 5 young adults) in the second session. Prototype examples demonstrably reflected the focus group discussions and ideas, and the features, functions, and designs of the Manaaki app were finalized. Attributes such as personalization, cultural relevance, and positive framing were identified as the key. Congruence of the final app attributes with the conceptual frameworks of the original program was also confirmed. Conclusions: Those who experience gambling harms may not seek help. Developing and demonstrating the effectiveness of new modalities to provide treatment and support are required. mHealth has the potential to deliver interventions directly to the end user. Weaving the underpinning theory and existing evidence of effective treatment with end-user input into the design and development of mHealth interventions does not guarantee success. However, it provides a foundation for framing the intervention’s mechanism, context, and content, and arguably provides a greater chance of demonstrating effectiveness. %M 35108213 %R 10.2196/32940 %U https://formative.jmir.org/2022/3/e32940 %U https://doi.org/10.2196/32940 %U http://www.ncbi.nlm.nih.gov/pubmed/35108213 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e29384 %T Internet-Delivered Cognitive Behavioral Therapy for Generalized Anxiety Disorder in Nationwide Routine Care: Effectiveness Study %A Ritola,Ville %A Lipsanen,Jari Olavi %A Pihlaja,Satu %A Gummerus,Eero-Matti %A Stenberg,Jan-Henry %A Saarni,Suoma %A Joffe,Grigori %+ Department of Psychiatry, Helsinki University Hospital and University of Helsinki, P.O. Box 100, Helsinki, 00029 HUS, Finland, 358 405136500, grigori.joffe@hus.fi %K CBT %K iCBT %K cognitive behavioral therapy %K routine care %K generalized anxiety disorder %K internet %K web-based %K digital health %K mental health %D 2022 %7 24.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Therapist-supported, internet-delivered cognitive behavioral therapy (iCBT) is efficacious for generalized anxiety disorder (GAD), but few studies are yet to report its effectiveness in routine care. Objective: In this study, we aim to examine whether a new 12-session iCBT program for GAD is effective in nationwide routine care. Methods: We administered a specialized, clinic-delivered, therapist-supported iCBT for GAD in 1099 physician-referred patients. The program was free of charge for patients, and the completion time was not predetermined. We measured symptoms with web-based questionnaires. The primary measure of anxiety was the GAD 7-item scale (GAD-7); secondary measures were, for pathological worry, the Penn State Worry Questionnaire and, for anxiety and impairment, the Overall Anxiety Severity and Impairment Scale. Results: Patients completed a mean 7.8 (SD 4.2; 65.1%) of 12 sessions, and 44.1% (485/1099) of patients completed all sessions. The effect size in the whole sample for GAD-7 was large (Cohen d=0.97, 95% CI 0.88-1.06). For completers, effect sizes were very large (Cohen d=1.34, 95% CI 1.25-1.53 for GAD-7; Cohen d=1.14, 95% CI 1.00-1.27 for Penn State Worry Questionnaire; and Cohen d=1.23, 95% CI 1.09-1.37 for Overall Anxiety Severity and Impairment Scale). Noncompleters also benefited from the treatment. Greater symptomatic GAD-7–measured relief was associated with more completed sessions, older age, and being referred from private or occupational care. Of the 894 patients with a baseline GAD-7 score ≥10, approximately 421 (47.1%) achieved reliable recovery. Conclusions: This nationwide, free-of-charge, therapist-supported HUS Helsinki University Hospital–iCBT for GAD was effective in routine care, but further research must establish effectiveness against other treatments and optimize the design of iCBT for GAD for different patient groups and individual patients. %M 35323119 %R 10.2196/29384 %U https://www.jmir.org/2022/3/e29384 %U https://doi.org/10.2196/29384 %U http://www.ncbi.nlm.nih.gov/pubmed/35323119 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e29114 %T Process and Outcome Evaluations of Smartphone Apps for Bipolar Disorder: Scoping Review %A Tatham,Iona %A Clarke,Ellisiv %A Grieve,Kelly Ann %A Kaushal,Pulkit %A Smeddinck,Jan %A Millar,Evelyn Barron %A Sharma,Aditya Narain %+ Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University, Academic Psychiatry, Wolfson Research Centre, Campus for Ageing and Vitality, Newcastle upon Tyne, NE4 5PL, United Kingdom, 44 1912875262, aditya.sharma@ncl.ac.uk %K child and adolescent mental health %K scoping review %K bipolar disorder %K mental health %D 2022 %7 23.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Mental health apps (MHAs) provide opportunities for accessible, immediate, and innovative approaches to better understand and support the treatment of mental health disorders, especially those with a high burden, such as bipolar disorder (BD). Many MHAs have been developed, but few have had their effectiveness evaluated. Objective: This systematic scoping review explores current process and outcome measures of MHAs for BD with the aim to provide a comprehensive overview of current research. This will identify the best practice for evaluating MHAs for BD and inform future studies. Methods: A systematic literature search of the health science databases PsycINFO, MEDLINE, Embase, EBSCO, Scopus, and Web of Science was undertaken up to January 2021 (with no start date) to narratively assess how studies had evaluated MHAs for BD. Results: Of 4051 original search results, 12 articles were included. These 12 studies included 435 participants, and of these, 343 had BD type I or II. Moreover, 11 of the 12 studies provided the ages (mean 37 years) of the participants. One study did not report age data. The male to female ratio of the 343 participants was 137:206. The most widely employed validated outcome measure was the Young Mania Rating Scale, being used 8 times. The Hamilton Depression Rating Scale-17/Hamilton Depression Rating Scale was used thrice; the Altman Self-Rating Mania Scale, Quick Inventory of Depressive Symptomatology, and Functional Assessment Staging Test were used twice; and the Coping Inventory for Stressful Situations, EuroQoL 5-Dimension Health Questionnaire, Generalized Anxiety Disorder Scale-7, Inventory of Depressive Symptomatology, Mindfulness Attention Awareness Scale, Major Depression Index, Morisky-Green 8-item, Perceived Stress Scale, and World Health Organization Quality of Life-BREF were used once. Self-report measures were captured in 9 different studies, 6 of which used MONARCA. Mood and energy levels were the most commonly used self-report measures, being used 4 times each. Furthermore, 11 of the 12 studies discussed the various confounding factors and barriers to the use of MHAs for BD. Conclusions: Reported low adherence rates, usability challenges, and privacy concerns act as barriers to the use of MHAs for BD. Moreover, as MHA evaluation is itself developing, guidance for clinicians in how to aid patient choices in mobile health needs to develop. These obstacles could be ameliorated by incorporating co-production and co-design using participatory patient approaches during the development and evaluation stages of MHAs for BD. Further, including qualitative aspects in trials that examine patient experience of both mental ill health and the MHA itself could result in a more patient-friendly fit-for-purpose MHA for BD. %M 35319470 %R 10.2196/29114 %U https://www.jmir.org/2022/3/e29114 %U https://doi.org/10.2196/29114 %U http://www.ncbi.nlm.nih.gov/pubmed/35319470 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e30231 %T Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis %A Jensen,Esben Skov %A Ladegaard,Nicolai %A Mellentin,Angelina Isabella %A Ebert,David Daniel %A Titzler,Ingrid %A Araya,Ricardo %A Cerga Pashoja,Arlinda %A Hazo,Jean-Baptiste %A Holtzmann,Jérôme %A Cieslak,Roman %A Smoktunowicz,Ewelina %A Baños,Rosa %A Herrero,Rocio %A García-Palacios,Azucena %A Botella,Cristina %A Berger,Thomas %A Krieger,Tobias %A Holmberg,Trine Theresa %A Topooco,Naira %A Andersson,Gerhard %A van Straten,Annemieke %A Kemmeren,Lise %A Kleiboer,Annet %A Riper,Heleen %A Mathiasen,Kim %+ Centre for Telepsychiatry, Mental Health Services of Southern Denmark, Odense, Denmark, 1 61677747, kmathiasen@health.sdu.dk %K blended care %K bCBT %K cognitive behavioral therapy %K digital intervention %K major depressive disorder %K sleep disturbance %K sleep disorder %K mental health %K digital health %K mobile phone %D 2022 %7 21.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Sleep disturbance symptoms are common in major depressive disorder (MDD) and have been found to hamper the treatment effect of conventional face-to-face psychological treatments such as cognitive behavioral therapy. To increase the dissemination of evidence-based treatment, blended cognitive behavioral therapy (bCBT) consisting of web-based and face-to-face treatment is on the rise for patients with MDD. To date, no study has examined whether sleep disturbance symptoms have an impact on bCBT treatment outcomes and whether it affects bCBT and treatment-as-usual (TAU) equally. Objective: The objectives of this study are to investigate whether baseline sleep disturbance symptoms have an impact on treatment outcomes independent of treatment modality and whether sleep disturbance symptoms impact bCBT and TAU in routine care equally. Methods: The study was based on data from the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment Versus Treatment-as-Usual) study, a 2-arm, multisite, parallel randomized controlled, noninferiority trial. A total of 943 outpatients with MDD were randomized to either bCBT (476/943, 50.5%) or TAU consisting of routine clinical MDD treatment (467/943, 49.5%). The primary outcome of this study was the change in depression symptom severity at the 12-month follow-up. The secondary outcomes were the change in depression symptom severity at the 3- and 6-month follow-up and MDD diagnoses at the 12-month follow-up, assessed using the Patient Health Questionnaire-9 and Mini-International Neuropsychiatric Interview, respectively. Mixed effects models were used to examine the association of sleep disturbance symptoms with treatment outcome and treatment modality over time. Results: Of the 943 patients recruited for the study, 558 (59.2%) completed the 12-month follow-up assessment. In the total sample, baseline sleep disturbance symptoms did not significantly affect change in depressive symptom severity at the 12-month follow-up (β=.16, 95% CI –0.04 to 0.36). However, baseline sleep disturbance symptoms were negatively associated with treatment outcome for bCBT (β=.49, 95% CI 0.22-0.76) but not for TAU (β=–.23, 95% CI −0.50 to 0.05) at the 12-month follow-up, even when adjusting for baseline depression symptom severity. The same result was seen for the effect of sleep disturbance symptoms on the presence of depression measured with Mini-International Neuropsychiatric Interview at the 12-month follow-up. However, for both treatment formats, baseline sleep disturbance symptoms were not associated with depression symptom severity at either the 3- (β=.06, 95% CI −0.11 to 0.23) or 6-month (β=.09, 95% CI −0.10 to 0.28) follow-up. Conclusions: Baseline sleep disturbance symptoms may have a negative impact on long-term treatment outcomes in bCBT for MDD. This effect was not observed for TAU. These findings suggest that special attention to sleep disturbance symptoms might be warranted when MDD is treated with bCBT. Future studies should investigate the effect of implementing modules specifically targeting sleep disturbance symptoms in bCBT for MDD to improve long-term prognosis. %M 35311687 %R 10.2196/30231 %U https://www.jmir.org/2022/3/e30231 %U https://doi.org/10.2196/30231 %U http://www.ncbi.nlm.nih.gov/pubmed/35311687 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e33092 %T Treatment Interruptions and Telemedicine Utilization in Serious Mental Illness: Retrospective Longitudinal Claims Analysis %A Ainslie,Marcy %A Brunette,Mary F %A Capozzoli,Michelle %+ Department of Nursing, University of New Hampshire, 4 library way, hewitt hall, Durham, NH, 03824, United States, 1 603 562 8833, marcy.ainslie@unh.edu %K telemedicine %K mental health %K serious mental illness %K retention %K mental illness %K telehealth %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Avoiding interruptions and dropout in outpatient care can prevent mental illness symptom exacerbation and costly crisis services, such as emergency room visits and inpatient psychiatric hospitalization. During the COVID-19 pandemic, to attempt to maintain care continuity, telemedicine services were increasingly utilized, despite the lack of data on efficacy in patients with serious mental illness. Patients with serious mental illness are challenging to enroll and sustain in randomized controlled trials over time due to fluctuations in disease exacerbation. However, capturing and examining utilization and efficacy data in community mental health center (CMHC) patients with serious mental illness during the pandemic is a unique opportunity to inform future clinical and policy decision-making. Objective: We aimed to identify and describe the characteristics of CMHC patients with serious mental illness who experienced treatment interruptions and who utilized telemedicine during the pandemic. Methods: We conducted a retrospective observational study of treatment interruptions and telemedicine use during the period from December 2019 to June 2020 (compared to the period from December 2018 to June 2019) in New Hampshire CMHC patients. The study population included all Medicaid beneficiaries with serious mental illness engaged in treatment 3 months prior to the declaration of a state of emergency in response to the COVID-19 pandemic. We used chi-square tests of independence and logistic regression to explore associations between treatment interruptions and variables (gender, age, rurality, and diagnosis). Telemedicine utilization was categorized as low (<25%), medium (25%-75%), or high (>75%) use. Results: A total of 16,030 patients were identified. New Hampshire CMHCs demonstrated only a 4.9% increase in treatment interruptions compared with the year prior. Patients who were male (odds ratio [OR] 1.27, 95% CI 1.17-1.38; P<.001), under the age of 18 years (ages 0-12 years: OR 1.37, 95% CI 0.62-0.86, P<.001; aged 13-17 years: OR 1.49, 95% CI 0.57-0.79, P<.001), or among milder diagnostic categories, such as anxiety disorders (OR 3.77, 95% CI 3.04-4.68; P<.001) and posttraumatic stress disorder (OR 3.69, 95% CI 2.96-4.61; P<.001), were most likely to experience treatment interruptions. Patients who were female (OR 0.89, CI 0.65-0.74), 18 to 34 years old (OR 0.74, CI 0.70-0.79), or among milder diagnostic categories, such as anxiety disorder (OR 0.69, CI 0.65-0.74) or posttraumatic stress disorder (OR 0.77, CI 0.72-0.83), and with major depressive disorder (OR 0.73, CI 0.68-0.78) were less likely to be in the low telemedicine utilization group. Conclusions: The integration of telemedicine supported care continuity for most CMHC patients; yet, retention varied by subpopulation, as did telemedicine utilization. The development of policies and clinical practice guidelines requires empirical evidence on the effectiveness and limitations of telemedicine in patients with serious mental illness. %M 35311673 %R 10.2196/33092 %U https://mental.jmir.org/2022/3/e33092 %U https://doi.org/10.2196/33092 %U http://www.ncbi.nlm.nih.gov/pubmed/35311673 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30829 %T The Use of Telehealth for Psychological Counselling of Vulnerable Adult Patients With Rheumatic Diseases or Diabetes: Explorative Study Inspired by Participatory Design %A Rothmann,Mette Juel %A Mouritsen,Julie Drotner %A Ladefoged,Nanna Skov %A Jeppesen,Marie Nedergaard %A Lillevang,Anna Sofie %A Laustrup,Helle %A Ellingsen,Torkell %+ Steno Diabetes Center Odense, Odense University Hospital, J.B. Winsløws Vej 4, Odense, 5000, Denmark, 45 22346388, mette.rothmann@rsyd.dk %K telehealth %K videoconferencing %K app %K co-production %K co-creation %K psychologist %K psychology %K rheumatic diseases %K diabetes %K mobile phone %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Video consultation is increasingly used in different health care settings to reach patients. However, little is known about telehealth in psychological counselling for vulnerable patients with somatic and chronic conditions such as rheumatoid arthritis and diabetes. Objective: This study aimed to develop and pilot test a telepsychology module for inclusion in the app My Hospital (Mit Sygehus) to provide remote psychological counselling to vulnerable adults with either rheumatic diseases or diabetes. Methods: With inspiration from participatory design, the content of the telepsychology module was developed through user involvement and evaluated by individual interviews with patients and psychologists as well as questionnaires. Results: We developed a module with our patient partners that targeted patients with rheumatic diseases and diabetes in relation to the psychological challenges of living with chronic diseases. The module included information, tools, exercises, and videoconferencing. In total, 16 patients and 3 psychologists participated in the pilot test. Psychological counselling was described by 4 themes: “The good relation despite physical distance,” “The comfort of being at home,” “The pros of saving time on transport and energy,” and “A therapeutic alliance at a distance.” Conclusions: Psychological counselling in relation to somatic care can be provided by videoconferencing supported by web-based or mobile delivery of tailored information, tools, and exercises without compromising on the quality of care. To ensure a good alliance between the patient and psychologist, a first face-to-face meeting is important. The home location provided patients with a safe environment and increased accessibility and reduced travel time to the hospital. %M 35311690 %R 10.2196/30829 %U https://humanfactors.jmir.org/2022/1/e30829 %U https://doi.org/10.2196/30829 %U http://www.ncbi.nlm.nih.gov/pubmed/35311690 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e32123 %T The Effectiveness of a Nonguided Mindfulness App on Perceived Stress in a Nonclinical Dutch Population: Randomized Controlled Trial %A Kranenburg,Leonieke W %A Gillis,Jamie %A Mayer,Birgit %A Hoogendijk,Witte J G %+ Section of Medical Psychology, Department of Psychiatry, Erasmus University Medical Center, PO Box 2040, Rotterdam, 3000 CA, Netherlands, 31 10 7040139, l.kranenburg@erasmusmc.nl %K mHealth %K mindfulness %K stress %K burnout %K non-clinical population %K nonclinical %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mindfulness has become increasingly popular, and positive outcomes have been reported for mindfulness-based interventions (MBIs) in reducing stress. These findings make room for innovative perspectives on how MBIs could be applied, for instance through mobile health (mHealth). Objective: The aim of this study is to investigate whether a nonguided mindfulness mobile app can decrease perceived stress in a nonclinical Dutch population over the course of 8 weeks, with follow-up at 6 months. Methods: A randomized controlled trial was performed to compare an experimental group that made use of a structured 8-week mHealth mindfulness program and a control group after 8 weeks, with follow-up after 6 months. Participants were recruited via a national television program. The primary outcome measure was perceived stress as measured by the Perceived Stress Scale, secondary outcomes were symptoms of burnout (measured using the visual analog scale [VAS]) and psychological symptoms (measured using the Four-Dimensional Symptom Questionnaire [4DSQ] at follow-up). Outcomes were analyzed using a multilevel regression model. Results: At baseline, 587 respondents were included. Results showed no postintervention differences between groups for the level of perceived stress. With regard to the secondary outcome measures, the VAS for emotional exhaustion and physical exhaustion showed significantly lower scores for the experimental group after 8 weeks (P=.04 and P=.01, respectively), but not at follow-up. There were no differences between groups for psychological symptoms measured using the 4DSQ. Conclusions: These findings do not support our hypothesis that using the mindfulness app would reduce stress levels. However, our findings related to diminished exhaustion at 8 weeks are encouraging and require further investigation. Trial Registration: ClinicalTrials.gov NCT05246800; https://clinicaltrials.gov/show/NCT05246800 %M 35302504 %R 10.2196/32123 %U https://mental.jmir.org/2022/3/e32123 %U https://doi.org/10.2196/32123 %U http://www.ncbi.nlm.nih.gov/pubmed/35302504 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31229 %T Predicting Acceptance of e–Mental Health Interventions in Patients With Obesity by Using an Extended Unified Theory of Acceptance Model: Cross-sectional Study %A Rentrop,Vanessa %A Damerau,Mirjam %A Schweda,Adam %A Steinbach,Jasmin %A Schüren,Lynik Chantal %A Niedergethmann,Marco %A Skoda,Eva-Maria %A Teufel,Martin %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Virchowstraße 174, Essen, 45147, Germany, 49 201438755101, vanessa.rentrop@uni-due.de %K e–mental health %K UTAUT %K obesity %K acceptance %K mobile phone %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The rapid increase in the number of people who are overweight and obese is a worldwide health problem. Obesity is often associated with physiological and mental health burdens. Owing to several barriers to face-to-face psychotherapy, a promising approach is to exploit recent developments and implement innovative e–mental health interventions that offer various benefits to patients with obesity and to the health care system. Objective: This study aims to assess the acceptance of e–mental health interventions in patients with obesity and explore its influencing predictors. In addition, the well-established Unified Theory of Acceptance and Use of Technology (UTAUT) model is compared with an extended UTAUT model in terms of variance explanation of acceptance. Methods: A cross-sectional web-based survey study was conducted from July 2020 to January 2021 in Germany. Eligibility requirements were adult age (≥18 years), internet access, good command of the German language, and BMI >30 kg/m2 (obesity). A total of 448 patients with obesity (grades I, II, and III) were recruited via specialized social media platforms. The impact of various sociodemographic, medical, and mental health characteristics was assessed. eHealth-related data and acceptance of e–mental health interventions were examined using a modified questionnaire based on the UTAUT. Results: Overall, the acceptance of e–mental health interventions in patients with obesity was moderate (mean 3.18, SD 1.11). Significant differences in the acceptance of e–mental health interventions among patients with obesity exist, depending on the grade of obesity, age, sex, occupational status, and mental health status. In an extended UTAUT regression model, acceptance was significantly predicted by the depression score (Patient Health Questionnaire-8; β=.07; P=.03), stress owing to constant availability via mobile phone or email (β=.06; P=.02), and confidence in using digital media (β=−0.058; P=.04) and by the UTAUT core predictors performance expectancy (β=.45; P<.001), effort expectancy (β=.22; P<.001), and social influence (β=.27; P<.001). The comparison between an extended UTAUT model (16 predictors) and the restrictive UTAUT model (performance expectancy, effort expectancy, and social influence) revealed a significant difference in explained variance (F13,431=2.366; P=.005). Conclusions: The UTAUT model has proven to be a valuable instrument to predict the acceptance of e–mental health interventions in patients with obesity. The extended UTAUT model explained a significantly high percentage of variance in acceptance (in total 73.6%). On the basis of the strong association between acceptance and future use, new interventions should focus on these UTAUT predictors to promote the establishment of effective e–mental health interventions for patients with obesity who experience mental health burdens. %M 35297769 %R 10.2196/31229 %U https://formative.jmir.org/2022/3/e31229 %U https://doi.org/10.2196/31229 %U http://www.ncbi.nlm.nih.gov/pubmed/35297769 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e25441 %T Usage Intensity of a Relapse Prevention Program and Its Relation to Symptom Severity in Remitted Patients With Anxiety and Depression: Pre-Post Study %A Krijnen-de Bruin,Esther %A Muntingh,Anna DT %A Bourguignon,Evelien M %A Hoogendoorn,Adriaan %A Maarsingh,Otto R %A van Balkom,Anton JLM %A Batelaan,Neeltje M %A van Straten,Annemieke %A van Meijel,Berno %+ Department of Health, Sports and Welfare, Research Group Mental Health Nursing, Inholland University of Applied Sciences, De Boelelaan 1109, Amsterdam, 1081 HV, Netherlands, 31 20 495 1111, esther.krijnendebruin@inholland.nl %K relapse prevention %K anxiety disorder %K depressive disorder %K eHealth %K primary care practice %K usage intensity %K self-management %K mobile phone %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given that relapse is common in patients in remission from anxiety and depressive disorders, relapse prevention is needed in the maintenance phase. Although existing psychological relapse prevention interventions have proven to be effective, they are not explicitly based on patients’ preferences. Hence, we developed a blended relapse prevention program based on patients’ preferences, which was delivered in primary care practices by mental health professionals (MHPs). This program comprises contact with MHPs, completion of core and optional online modules (including a relapse prevention plan), and keeping a mood and anxiety diary in which patients can monitor their symptoms. Objective: The aims of this study were to provide insight into (1) usage intensity of the program (over time), (2) the course of symptoms during the 9 months of the study, and (3) the association between usage intensity and the course of symptoms. Methods: The Guided E-healTh for RElapse prevention in Anxiety and Depression (GET READY) program was guided by 54 MHPs working in primary care practices. Patients in remission from anxiety and depressive disorders were included. Demographic and clinical characteristics, including anxiety and depressive symptoms, were collected via questionnaires at baseline and after 3, 6, and 9 months. Log data were collected to assess the usage intensity of the program. Results: A total of 113 patients participated in the study. Twenty-seven patients (23.9%) met the criteria for the minimal usage intensity measure. The core modules were used by ≥70% of the patients, while the optional modules were used by <40% of the patients. Usage decreased quickly over time. Anxiety and depressive symptoms remained stable across the total sample; a minority of 15% (12/79) of patients experienced a relapse in their anxiety symptoms, while 10% (8/79) experienced a relapse in their depressive symptoms. Generalized estimating equations analysis indicated a significant association between more frequent face-to-face contact with the MHPs and an increase in both anxiety symptoms (β=.84, 95% CI .39-1.29) and depressive symptoms (β=1.12, 95% CI 0.45-1.79). Diary entries and the number of completed modules were not significantly associated with the course of symptoms. Conclusions: Although the core modules of the GET READY program were used by most of the patients and all patients saw an MHP at least once, usage decreased quickly over time. Most patients remained stable while participating in the study. The significant association between the frequency of contact and the course of symptoms most likely indicates that those who received more support had more symptoms, and thus, it is questionable whether the support offered by the program was sufficient to prevent these patients from relapsing. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-019-2034-6 %M 35293876 %R 10.2196/25441 %U https://mental.jmir.org/2022/3/e25441 %U https://doi.org/10.2196/25441 %U http://www.ncbi.nlm.nih.gov/pubmed/35293876 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e30966 %T Effects of a Person-Centered eHealth Intervention for Patients on Sick Leave Due to Common Mental Disorders (PROMISE Study): Open Randomized Controlled Trial %A Cederberg,Matilda %A Alsén,Sara %A Ali,Lilas %A Ekman,Inger %A Glise,Kristina %A Jonsdottir,Ingibjörg H %A Gyllensten,Hanna %A Swedberg,Karl %A Fors,Andreas %+ Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Box 457, Gothenburg, 40530, Sweden, 46 766182014, matilda.cederberg@gu.se %K depression %K anxiety %K stress %K patient-centered care %K person-centered care %K telehealth %K mHealth %K sickness absence %K intervention %K randomized controlled trial %K mobile phone %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Sick leave due to common mental disorders (CMDs) is a public health problem in several countries, including Sweden. Given that symptom relief does not necessarily correspond to return to work, health care interventions focusing on factors that have proven important to influence the return to work process, such as self-efficacy, are warranted. Self-efficacy is also a central concept in person-centered care. Objective: The aim of this study is to evaluate the effects of a person-centered eHealth intervention for patients on sick leave due to CMDs. Methods: A randomized controlled trial of 209 patients allocated to either a control group (107/209, 51.2%) or an intervention group (102/209, 48.8%) was conducted. The control group received usual care, whereas the intervention group received usual care with the addition of a person-centered eHealth intervention. The intervention was built on person-centered care principles and consisted of telephone support and a web-based platform. The primary outcome was a composite score of changes in general self-efficacy (GSE) and level of sick leave at the 6-month follow-up. An intention-to-treat analysis included all participants, and a per-protocol analysis consisted of those using both the telephone support and the web-based platform. Results: At the 3-month follow-up, in the intention-to-treat analysis, more patients in the intervention group improved on the composite score than those in the control group (20/102, 19.6%, vs 10/107, 9.3%; odds ratio [OR] 2.37, 95% CI 1.05-5.34; P=.04). At the 6-month follow-up, the difference was no longer significant between the groups (31/100, 31%, vs 25/107, 23.4%; OR 1.47, 95% CI 0.80-2.73; P=.22). In the per-protocol analysis, a significant difference was observed between the intervention and control groups at the 3-month follow-up (18/85, 21.2%, vs 10/107, 9.3%; OR 2.6, 95% CI 1.13-6.00; P=.02) but not at 6 months (30/84, 35.7%, vs 25/107, 23.4%; OR 1.8, 95% CI 0.97-3.43; P=.06). Changes in GSE drove the effects in the composite score, but the intervention did not affect the level of sick leave. Conclusions: A person-centered eHealth intervention for patients on sick leave due to CMDs improved GSE but did not affect the level of sick leave. Trial Registration: ClinicalTrials.gov NCT03404583; https://clinicaltrials.gov/ct2/show/NCT03404583 %M 35289756 %R 10.2196/30966 %U https://mental.jmir.org/2022/3/e30966 %U https://doi.org/10.2196/30966 %U http://www.ncbi.nlm.nih.gov/pubmed/35289756 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e36263 %T Telehealth Services for Substance Use Disorders During the COVID-19 Pandemic: Longitudinal Assessment of Intensive Outpatient Programming and Data Collection Practices %A Gliske,Kate %A Welsh,Justine W %A Braughton,Jacqueline E %A Waller,Lance A %A Ngo,Quyen M %+ Butler Center for Research, Hazelden Betty Ford Foundation, 15251 Pleasant Valley Road, BC4, Center City, MN, 55012, United States, 1 6512134347, KGLISKE@hazeldenbettyford.org %K telehealth %K substance use disorder %K COVID-19 %K substance use treatment %K feasibility study %K routine outcome monitoring data %K mental health %K addiction %K digital health %K telemedicine %K outpatient program %K virtual health %K addiction treatment %K virtual care %K patient outcomes %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The onset of the COVID-19 pandemic necessitated the rapid transition of many types of substance use disorder (SUD) treatments to telehealth formats, despite limited information about what makes treatment effective in this novel format. Objective: This study aims to examine the feasibility and effectiveness of virtual intensive outpatient programming (IOP) treatment for SUD in the context of a global pandemic, while considering the unique challenges posed to data collection during an unprecedented public health crisis. Methods: The study is based on a longitudinal study with a baseline sample of 3642 patients who enrolled in intensive outpatient addiction treatment (in-person, hybrid, or virtual care) from January 2020 to March 2021 at a large substance use treatment center in the United States. The analytical sample consisted of patients who completed the 3-month postdischarge outcome survey as part of routine outcome monitoring (n=1060, 29.1% response rate). Results: No significant differences were detected by delivery format in continuous abstinence (χ22=0.4, P=.81), overall quality of life (F2,826=2.06, P=.13), financial well-being (F2,767=2.30, P=.10), psychological well-being (F2,918=0.72, P=.49), and confidence in one’s ability to stay sober (F2,941=0.21, P=.81). Individuals in hybrid programming were more likely to report a higher level of general health than those in virtual IOP (F2,917=4.19, P=.01). Conclusions: Virtual outpatient care for the treatment of SUD is a feasible alternative to in-person-only programming, leading to similar self-reported outcomes at 3 months postdischarge. Given the many obstacles presented throughout data collection during a pandemic, further research is needed to better understand under what conditions telehealth is an acceptable alternative to in-person care. %M 35285807 %R 10.2196/36263 %U https://mental.jmir.org/2022/3/e36263 %U https://doi.org/10.2196/36263 %U http://www.ncbi.nlm.nih.gov/pubmed/35285807 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e34898 %T Longitudinal Relationships Between Depressive Symptom Severity and Phone-Measured Mobility: Dynamic Structural Equation Modeling Study %A Zhang,Yuezhou %A Folarin,Amos A %A Sun,Shaoxiong %A Cummins,Nicholas %A Vairavan,Srinivasan %A Bendayan,Rebecca %A Ranjan,Yatharth %A Rashid,Zulqarnain %A Conde,Pauline %A Stewart,Callum %A Laiou,Petroula %A Sankesara,Heet %A Matcham,Faith %A White,Katie M %A Oetzmann,Carolin %A Ivan,Alina %A Lamers,Femke %A Siddi,Sara %A Vilella,Elisabet %A Simblett,Sara %A Rintala,Aki %A Bruce,Stuart %A Mohr,David C %A Myin-Germeys,Inez %A Wykes,Til %A Haro,Josep Maria %A Penninx,Brenda WJH %A Narayan,Vaibhav A %A Annas,Peter %A Hotopf,Matthew %A Dobson,Richard JB %A , %+ Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, London, SE5 8AF, United Kingdom, 44 20 7848 0473, richard.j.dobson@kcl.ac.uk %K depression %K mobile health %K location data %K mobility %K dynamic structural equation modeling %K mHealth %K mental health %K medical informatics %K modeling %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The mobility of an individual measured by phone-collected location data has been found to be associated with depression; however, the longitudinal relationships (the temporal direction of relationships) between depressive symptom severity and phone-measured mobility have yet to be fully explored. Objective: We aimed to explore the relationships and the direction of the relationships between depressive symptom severity and phone-measured mobility over time. Methods: Data used in this paper came from a major EU program, called the Remote Assessment of Disease and Relapse–Major Depressive Disorder, which was conducted in 3 European countries. Depressive symptom severity was measured with the 8-item Patient Health Questionnaire (PHQ-8) through mobile phones every 2 weeks. Participants’ location data were recorded by GPS and network sensors in mobile phones every 10 minutes, and 11 mobility features were extracted from location data for the 2 weeks prior to the PHQ-8 assessment. Dynamic structural equation modeling was used to explore the longitudinal relationships between depressive symptom severity and phone-measured mobility. Results: This study included 2341 PHQ-8 records and corresponding phone-collected location data from 290 participants (age: median 50.0 IQR 34.0, 59.0) years; of whom 215 (74.1%) were female, and 149 (51.4%) were employed. Significant negative correlations were found between depressive symptom severity and phone-measured mobility, and these correlations were more significant at the within-individual level than the between-individual level. For the direction of relationships over time, Homestay (time at home) (φ=0.09, P=.01), Location Entropy (time distribution on different locations) (φ=−0.04, P=.02), and Residential Location Count (reflecting traveling) (φ=0.05, P=.02) were significantly correlated with the subsequent changes in the PHQ-8 score, while changes in the PHQ-8 score significantly affected (φ=−0.07, P<.001) the subsequent periodicity of mobility. Conclusions: Several phone-derived mobility features have the potential to predict future depression, which may provide support for future clinical applications, relapse prevention, and remote mental health monitoring practices in real-world settings. %M 35275087 %R 10.2196/34898 %U https://mental.jmir.org/2022/3/e34898 %U https://doi.org/10.2196/34898 %U http://www.ncbi.nlm.nih.gov/pubmed/35275087 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e31780 %T Telehealth Versus Face-to-face Psychotherapy for Less Common Mental Health Conditions: Systematic Review and Meta-analysis of Randomized Controlled Trials %A Greenwood,Hannah %A Krzyzaniak,Natalia %A Peiris,Ruwani %A Clark,Justin %A Scott,Anna Mae %A Cardona,Magnolia %A Griffith,Rebecca %A Glasziou,Paul %+ Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, 4226, Australia, 61 755955816 ext 55816, hgreenwo@bond.edu.au %K telemedicine %K psychology %K mental health %K psychotherapy %K primary health care %K behavioral sciences %K systematic review %D 2022 %7 11.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: Mental disorders are a leading cause of distress and disability worldwide. To meet patient demand, there is a need for increased access to high-quality, evidence-based mental health care. Telehealth has become well established in the treatment of illnesses, including mental health conditions. Objective: This study aims to conduct a robust evidence synthesis to assess whether there is evidence of differences between telehealth and face-to-face care for the management of less common mental and physical health conditions requiring psychotherapy. Methods: In this systematic review, we included randomized controlled trials comparing telehealth (telephone, video, or both) versus the face-to-face delivery of psychotherapy for less common mental health conditions and physical health conditions requiring psychotherapy. The psychotherapy delivered had to be comparable between the telehealth and face-to-face groups, and it had to be delivered by general practitioners, primary care nurses, or allied health staff (such as psychologists and counselors). Patient (symptom severity, overall improvement in psychological symptoms, and function), process (working alliance and client satisfaction), and financial (cost) outcomes were included. Results: A total of 12 randomized controlled trials were included, with 931 patients in aggregate; therapies included cognitive behavioral and family therapies delivered in populations encompassing addiction disorders, eating disorders, childhood mental health problems, and chronic conditions. Telehealth was delivered by video in 7 trials, by telephone in 3 trials, and by both in 1 trial, and the delivery mode was unclear in 1 trial. The risk of bias for the 12 trials was low or unclear for most domains, except for the lack of the blinding of participants, owing to the nature of the comparison. There were no significant differences in symptom severity between telehealth and face-to-face therapy immediately after treatment (standardized mean difference [SMD] 0.05, 95% CI −0.17 to 0.27) or at any other follow-up time point. Similarly, there were no significant differences immediately after treatment between telehealth and face-to-face care delivery on any of the other outcomes meta-analyzed, including overall improvement (SMD 0.00, 95% CI −0.40 to 0.39), function (SMD 0.13, 95% CI −0.16 to 0.42), working alliance client (SMD 0.11, 95% CI −0.34 to 0.57), working alliance therapist (SMD −0.16, 95% CI −0.91 to 0.59), and client satisfaction (SMD 0.12, 95% CI −0.30 to 0.53), or at any other time point (3, 6, and 12 months). Conclusions: With regard to effectively treating less common mental health conditions and physical conditions requiring psychological support, there is insufficient evidence of a difference between psychotherapy delivered via telehealth and the same therapy delivered face-to-face. However, there was no includable evidence in this review for some serious mental health conditions, such as schizophrenia and bipolar disorders, and further high-quality research is needed to determine whether telehealth is a viable, equivalent treatment option for these conditions. %M 35275081 %R 10.2196/31780 %U https://mental.jmir.org/2022/3/e31780 %U https://doi.org/10.2196/31780 %U http://www.ncbi.nlm.nih.gov/pubmed/35275081 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e37440 %T Authors’ Reply to: Toward a Better Understanding of Quality Social Connections. Comment on “Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis” %A Dewa,Lindsay H %A Roberts,Lily %A Lawrance,Emma %A Ashrafian,Hutan %+ Institute of Global Health Innovation, Imperial College London, Reynolds Building, 3rd Floor, London, W6 8RP, United Kingdom, 44 02075940815, l.dewa@imperial.ac.uk %K mental health %K digital interventions %K young people %K quality social connection %K depression %K anxiety %K systematic review %K meta-analysis %K patient and public involvement %K mobile phone %D 2022 %7 11.3.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35275072 %R 10.2196/37440 %U https://www.jmir.org/2022/3/e37440 %U https://doi.org/10.2196/37440 %U http://www.ncbi.nlm.nih.gov/pubmed/35275072 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e36739 %T Toward a Better Understanding of Quality Social Connections. Comment on “Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis” %A Deng,Huachu %A Qin,Xingan %+ Department of Gastrointestinal and Gland Surgery, First Affiliated Hospital of Guangxi Medical University, 6 Shuangyong Road, Qingxiu District, Nanning, 530000, China, 86 15277114948, drqinxingan@126.com %K mental health %K digital interventions %K young people %K quality social connection %K depression %K anxiety %K systematic review %K meta-analysis %K patient and public involvement %K mobile phone %D 2022 %7 11.3.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35275073 %R 10.2196/36739 %U https://www.jmir.org/2022/3/e36739 %U https://doi.org/10.2196/36739 %U http://www.ncbi.nlm.nih.gov/pubmed/35275073 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e27791 %T Implementation of Cognitive Behavioral Therapy in e–Mental Health Apps: Literature Review %A Denecke,Kerstin %A Schmid,Nicole %A Nüssli,Stephan %+ Institute for Medical Informatics, Bern University of Applied Sciences, Quellgasse 21, Biel, 2501, Switzerland, 41 32 321 67 94, kerstin.denecke@bfh.ch %K cognitive behavioral therapy %K mHealth %K e–mental health %K chatbot %K mobile phone %D 2022 %7 10.3.2022 %9 Review %J J Med Internet Res %G English %X Background: To address the matter of limited resources for treating individuals with mental disorders, e–mental health has gained interest in recent years. More specifically, mobile health (mHealth) apps have been suggested as electronic mental health interventions accompanied by cognitive behavioral therapy (CBT). Objective: This study aims to identify the therapeutic aspects of CBT that have been implemented in existing mHealth apps and the technologies used. From these, we aim to derive research gaps that should be addressed in the future. Methods: Three databases were screened for studies on mHealth apps in the context of mental disorders that implement techniques of CBT: PubMed, IEEE Xplore, and ACM Digital Library. The studies were independently selected by 2 reviewers, who then extracted data from the included studies. Data on CBT techniques and their technical implementation in mHealth apps were synthesized narratively. Results: Of the 530 retrieved citations, 34 (6.4%) studies were included in this review. mHealth apps for CBT exploit two groups of technologies: technologies that implement CBT techniques for cognitive restructuring, behavioral activation, and problem solving (exposure is not yet realized in mHealth apps) and technologies that aim to increase user experience, adherence, and engagement. The synergy of these technologies enables patients to self-manage and self-monitor their mental state and access relevant information on their mental illness, which helps them cope with mental health problems and allows self-treatment. Conclusions: There are CBT techniques that can be implemented in mHealth apps. Additional research is needed on the efficacy of the mHealth interventions and their side effects, including inequalities because of the digital divide, addictive internet behavior, lack of trust in mHealth, anonymity issues, risks and biases for user groups and social contexts, and ethical implications. Further research is also required to integrate and test psychological theories to improve the impact of mHealth and adherence to the e–mental health interventions. %M 35266875 %R 10.2196/27791 %U https://www.jmir.org/2022/3/e27791 %U https://doi.org/10.2196/27791 %U http://www.ncbi.nlm.nih.gov/pubmed/35266875 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e28942 %T Education on Depression in Mental Health Apps: Systematic Assessment of Characteristics and Adherence to Evidence-Based Guidelines %A Martinengo,Laura %A Stona,Anne-Claire %A Tudor Car,Lorainne %A Lee,Jimmy %A Griva,Konstadina %A Car,Josip %+ Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Rd, Clinical Sciences Building Level 18, Singapore, 308232, Singapore, 65 69047017, josip.car@ntu.edu.sg %K health literacy %K mental health literacy %K depression %K mobile apps %K apps %K telemedicine %K mHealth %K self-management %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Suboptimal understanding of depression and mental health disorders by the general population is an important contributor to the wide treatment gap in depression. Mental health literacy encompasses knowledge and beliefs about mental disorders and supports their recognition, management, and prevention. Besides knowledge improvement, psychoeducational interventions reduce symptoms of depression, enhance help-seeking behavior, and decrease stigma. Mental health apps often offer educational content, but the trustworthiness of the included information is unclear. Objective: The aim of this study is to systematically evaluate adherence to clinical guidelines on depression of the information offered by mental health apps available in major commercial app stores. Methods: A systematic assessment of the educational content regarding depression in the apps available in the Apple App Store and Google Play was conducted in July 2020. A systematic search for apps published or updated since January 2019 was performed using 42matters. Apps meeting the inclusion criteria were downloaded and assessed using two smartphones: an iPhone 7 (iOS version 14.0.1) and a Sony XPERIA XZs (Android version 8.0.0). The 156-question assessment checklist comprised general characteristics of apps, appraisal of 38 educational topics and their adherence to evidence-based clinical guidelines, as well as technical aspects and quality assurance. The results were tabulated and reported as a narrative review, using descriptive statistics. Results: The app search retrieved 2218 apps, of which 58 were included in the analysis (Android apps: n=29, 50%; iOS apps: n=29, 50%). Of the 58 included apps, 37 (64%) apps offered educational content within a more comprehensive depression or mental health management app. Moreover, 21% (12/58) of apps provided non–evidence-based information. Furthermore, 88% (51/58) of apps included up to 20 of the educational topics, the common ones being listing the symptoms of depression (52/58, 90%) and available treatments (48/58, 83%), particularly psychotherapy. Depression-associated stigma was mentioned by 38% (22/58) of the apps, whereas suicide risk was mentioned by 71% (41/58), generally as an item in a list of symptoms. Of the 58 included apps, 44 (76%) highlighted the importance of help seeking, 29 (50%) emphasized the importance of involving the user’s support network. In addition, 52% (30/58) of apps referenced their content, and 17% (10/58) included advertisements. Conclusions: Information in mental health and depression apps is often brief and incomplete, with 1 in 5 apps providing non–evidence-based information. Given the unmet needs and stigma associated with the disease, it is imperative that apps seize the opportunity to offer quality, evidence-based education or point the users to relevant resources. A multistakeholder consensus on a more stringent development and publication process for mental health apps is essential. %M 35262489 %R 10.2196/28942 %U https://www.jmir.org/2022/3/e28942 %U https://doi.org/10.2196/28942 %U http://www.ncbi.nlm.nih.gov/pubmed/35262489 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e33060 %T Informing the Future of Integrated Digital and Clinical Mental Health Care: Synthesis of the Outcomes From Project Synergy %A LaMonica,Haley M %A Iorfino,Frank %A Lee,Grace Yeeun %A Piper,Sarah %A Occhipinti,Jo-An %A Davenport,Tracey A %A Cross,Shane %A Milton,Alyssa %A Ospina-Pinillos,Laura %A Whittle,Lisa %A Rowe,Shelley C %A Dowling,Mitchell %A Stewart,Elizabeth %A Ottavio,Antonia %A Hockey,Samuel %A Cheng,Vanessa Wan Sze %A Burns,Jane %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 426955658, haley.lamonica@sydney.edu.au %K mental health %K technology %K co-design %K participatory research %K health care reform %K stakeholder participation %K mobile phone %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Globally, there are fundamental shortcomings in mental health care systems, including restricted access, siloed services, interventions that are poorly matched to service users’ needs, underuse of personal outcome monitoring to track progress, exclusion of family and carers, and suboptimal experiences of care. Health information technologies (HITs) hold great potential to improve these aspects that underpin the enhanced quality of mental health care. Objective: Project Synergy aimed to co-design, implement, and evaluate novel HITs, as exemplified by the InnoWell Platform, to work with standard health care organizations. The goals were to deliver improved outcomes for specific populations under focus and support organizations to enact significant system-level reforms. Methods: Participating health care organizations included the following: Open Arms–Veterans & Families Counselling (in Sydney and Lismore, New South Wales [NSW]); NSW North Coast headspace centers for youth (Port Macquarie, Coffs Harbour, Grafton, Lismore, and Tweed Heads); the Butterfly Foundation’s National Helpline for eating disorders; Kildare Road Medical Centre for enhanced primary care; and Connect to Wellbeing North Coast NSW (administered by Neami National), for population-based intake and assessment. Service users, families and carers, health professionals, and administrators of services across Australia were actively engaged in the configuration of the InnoWell Platform to meet service needs, identify barriers to and facilitators of quality mental health care, and highlight potentially the best points in the service pathway to integrate the InnoWell Platform. The locally configured InnoWell Platform was then implemented within the respective services. A mixed methods approach, including surveys, semistructured interviews, and workshops, was used to evaluate the impact of the InnoWell Platform. A participatory systems modeling approach involving co-design with local stakeholders was also undertaken to simulate the likely impact of the platform in combination with other services being considered for implementation within the North Coast Primary Health Network to explore resulting impacts on mental health outcomes, including suicide prevention. Results: Despite overwhelming support for integrating digital health solutions into mental health service settings and promising impacts of the platform simulated under idealized implementation conditions, our results emphasized that successful implementation is dependent on health professional and service readiness for change, leadership at the local service level, the appropriateness and responsiveness of the technology for the target end users, and, critically, funding models being available to support implementation. The key places of interoperability of digital solutions and a willingness to use technology to coordinate health care system use were also highlighted. Conclusions: Although the COVID-19 pandemic has resulted in the widespread acceptance of very basic digital health solutions, Project Synergy highlights the critical need to support equity of access to HITs, provide funding for digital infrastructure and digital mental health care, and actively promote the use of technology-enabled, coordinated systems of care. %M 34974414 %R 10.2196/33060 %U https://mental.jmir.org/2022/3/e33060 %U https://doi.org/10.2196/33060 %U http://www.ncbi.nlm.nih.gov/pubmed/34974414 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34601 %T The Essential Network (TEN): Protocol for an Implementation Study of a Digital-First Mental Health Solution for Australian Health Care Workers During COVID-19 %A Coleshill,Matthew James %A Baldwin,Peter %A Black,Melissa %A Newby,Jill %A Shrestha,Tanya %A Haffar,Sam %A Mills,Llewellyn %A Stensel,Andrew %A Cockayne,Nicole %A Tennant,Jon %A Harvey,Samuel %A Christensen,Helen %+ Black Dog Institute, Hospital Road, Randwick, New South Wales, Sydney, 2031, Australia, 61 02 9065 9149, m.coleshill@blackdog.org.au %K blended care %K mental health %K burnout %K health care workers %K COVID-19 %K health care service %K health service %D 2022 %7 9.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has placed health care workers (HCWs) under severe stress, compounded by barriers to seeking mental health support among HCWs. The Essential Network (TEN) is a blend of digital and person-to-person (blended care) mental health support services for HCWs, funded by the Australian Federal Department of Health as part of their national COVID-19 response strategy. TEN is designed as both a preventative measure and treatment for common mental health problems faced by HCWs. New blended services need to demonstrate improvements in mental health symptoms and test acceptability in their target audience, as well as review implementation strategies to improve engagement. Objective: The primary objective of this implementation study is to design and test an implementation strategy to improve uptake of TEN. The secondary objectives are examining the acceptability of TEN among HCWs, changes in mental health outcomes associated with the use of TEN, and reductions in mental health stigma among HCWs following the use of TEN. Methods: The implementation study contains 3 components: (1) a consultation study with up to 39 stakeholders or researchers with implementation experience to design an implementation strategy, (1) a longitudinal observational study of at least 105 HCWs to examine the acceptability of TEN and the effectiveness of TEN at 1 and 6 months in improving mental health (as assessed by the Distress Questionnaire [DQ-5], Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder [GAD-7], Oldenburg Burnout Inventory [OBI-16], and Work and Social Adjustment Scale [WSAS]) and reducing mental health stigma (the Endorsed and Anticipated Stigma Inventory [EASI]), and (3) an implementation study where TEN service uptake analytics will be examined for 3 months before and after the introduction of the implementation strategy. Results: The implementation strategy, designed with input from the consultation and observational studies, is expected to lead to an increased number of unique visits to the TEN website in the 3 months following the introduction of the implementation strategy. The observational study is expected to observe high service acceptability. Moderate improvements to general mental health (DQ-5, WSAS) and a reduction in workplace- and treatment-related mental health stigma (EASI) between the baseline and 1-month time points are expected. Conclusions: TEN is a first-of-a-kind blended mental health service available to Australian HCWs. The results of this project have the potential to inform the implementation and development of blended care mental health services, as well as how such services can be effectively implemented during a crisis. International Registered Report Identifier (IRRID): DERR1-10.2196/34601 %M 35148269 %R 10.2196/34601 %U https://www.researchprotocols.org/2022/3/e34601 %U https://doi.org/10.2196/34601 %U http://www.ncbi.nlm.nih.gov/pubmed/35148269 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33066 %T Effects of a National Preventive Intervention Against Potential COVID-19–Related Gambling Problems in Online Gamblers: Self-Report Survey Study %A Håkansson,Anders %A Sundvall,Andreas %A Lyckberg,Axel %+ Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Baravägen 1, Lund, 22100, Sweden, 46 46175596, anders_c.hakansson@med.lu.se %K gambling disorder %K problem gambling %K COVID-19 %K harm reduction %K behavioral addiction %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has been suspected to increase gambling problems in the population. Several governments introduced COVID-19–specific interventions early with the aim to prevent gambling problems, but their effects have not been evaluated. Objective: This study aimed to evaluate a Swedish COVID-19–related temporary legislation imposing an automated weekly deposit limit for online casino gambling. Methods: The study was an anonymous survey sent by a state-owned gambling operator to online gamblers (N=619), among whom 54.0% (n=334) were moderate-risk/problem gamblers who reached the weekly limit on online gambling during the summer of 2020. Results: Overall, 60.1% (372/619) were aware of having been limited by the COVID-19–related deposit limit, and a minority (145/619, 23.4%) perceived the intervention as fairly bad or very bad. Among those aware of the intervention, 38.7% (144/372) believed the intervention decreased their overall gambling, whereas 7.8% (29/372) believed it rather increased it. However, 82.5% (307/372) reported having gambled at more than one operator after the limit, and the most common gambling type reported to have increased at another operator was online casino (42% among moderate-risk/problem gamblers and 19% among others; P<.001). An increase in gambling following the intervention was associated with being a moderate-risk/problem gambler and having negative attitudes toward the intervention. Conclusions: The weekly deposit limit had relatively high acceptability, but the study highlights the limitations of a single-operator deposit limit, given the high number of gamblers also reporting gambling at other operators and the lower effect in clients with gambling problems. %M 34678751 %R 10.2196/33066 %U https://formative.jmir.org/2022/3/e33066 %U https://doi.org/10.2196/33066 %U http://www.ncbi.nlm.nih.gov/pubmed/34678751 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e28301 %T Coaching to Support Mental Health Apps: Exploratory Narrative Review %A Meyer,Ashley %A Wisniewski,Hannah %A Torous,John %+ Division of Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02115, United States, 1 6176676700, jtorous@bidmc.harvard.edu %K smartphone %K apps %K mental health %K coaching %K engagement %D 2022 %7 8.3.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The therapeutic alliance is crucial for the success of face-to-face therapies. Little is known about how coaching functions and fosters the therapeutic alliance in asynchronous treatment modalities such as smartphone apps. Objective: The aim of this paper was to assess how coaching functions and fosters the therapeutic alliance in asynchronous treatment modalities. Methods: We conducted a selected review to gather preliminary data about the role of coaching in mobile technology use for mental health care. We identified 26 trials using a 2019 review by Tønning et al and a 2021 scoping review by Tokgöz et al to assess how coaching is currently being used across different studies. Results: Our results showed a high level of heterogeneity as studies used varying types of coaching methods but provided little information about coaching protocols and training. Coaching was feasible by clinicians and nonclinicians, scheduled and on demand, and across all technologies ranging from phone calls to social media. Conclusions: Further research is required to better understand the effects of coaching in mobile mental health treatments, but examples offered from reviewed papers suggest several options to implement coaching today. Coaching based on replicable protocols that are verifiable for fidelity will enable the scaling of this model and a better exploration of the digital therapeutic alliance. %M 35258468 %R 10.2196/28301 %U https://humanfactors.jmir.org/2022/1/e28301 %U https://doi.org/10.2196/28301 %U http://www.ncbi.nlm.nih.gov/pubmed/35258468 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e34221 %T Customized Information and Communication Technology for Reducing Social Isolation and Loneliness Among Older Adults: Scoping Review %A Thangavel,Gomathi %A Memedi,Mevludin %A Hedström,Karin %+ Centre for Empirical Research on Information Systems, Örebro University School of Business, Fakultetsgatan 1, Örebro, 70281, Sweden, 46 19 302471, gomathi.thangavel@oru.se %K social isolation %K loneliness %K review %K ICT %K older adults %K customization %K mobile phone %D 2022 %7 7.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: Advancements in science and various technologies have resulted in people having access to better health care, a good quality of life, and better economic situations, enabling humans to live longer than ever before. Research shows that the problems of loneliness and social isolation are common among older adults, affecting psychological and physical health. Information and communication technology (ICT) plays an important role in alleviating social isolation and loneliness. Objective: The aim of this review is to explore ICT solutions for reducing social isolation or loneliness among older adults, the purpose of ICT solutions, and the evaluation focus of these solutions. This study particularly focuses on customized ICT solutions that either are designed from scratch or are modifications of existing off-the-shelf products that cater to the needs of older adults. Methods: A scoping literature review was conducted. A search across 7 databases, including ScienceDirect, Association for Computing Machinery, PubMed, IEEE Xplore, PsycINFO, Scopus, and Web of Science, was performed, targeting ICT solutions for reducing and managing social isolation and loneliness among older adults. Articles published in English from 2010 to 2020 were extracted and analyzed. Results: From the review of 39 articles, we identified 5 different purposes of customized ICT solutions focusing on reducing social isolation and loneliness. These were social communication, social participation, a sense of belonging, companionship, and feelings of being seen. The mapping of purposes of ICT solutions with problems found among older adults indicates that increasing social communication and social participation can help reduce social isolation problems, whereas fulfilling emotional relationships and feeling valued can reduce feelings of loneliness. In terms of customized ICT solution types, we found the following seven different categories: social network, messaging services, video chat, virtual spaces or classrooms with messaging capabilities, robotics, games, and content creation and management. Most of the included studies (30/39, 77%) evaluated the usability and acceptance aspects, and few studies (11/39, 28%) focused on loneliness or social isolation outcomes. Conclusions: This review highlights the importance of discussing and managing social isolation and loneliness as different but related concepts and emphasizes the need for future research to use suitable outcome measures for evaluating ICT solutions based on the problem. Even though a wide range of customized ICT solutions have been developed, future studies need to explore the recent emerging technologies, such as the Internet of Things and augmented or virtual reality, to tackle social isolation and loneliness among older adults. Furthermore, future studies should consider evaluating social isolation or loneliness while developing customized ICT solutions to provide more robust data on the effectiveness of the solutions. %M 35254273 %R 10.2196/34221 %U https://mental.jmir.org/2022/3/e34221 %U https://doi.org/10.2196/34221 %U http://www.ncbi.nlm.nih.gov/pubmed/35254273 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e32758 %T Social Media–Driven Routes to Positive Mental Health Among Youth: Qualitative Enquiry and Concept Mapping Study %A Vaingankar,Janhavi Ajit %A van Dam,Rob M %A Samari,Ellaisha %A Chang,Sherilyn %A Seow,Esmond %A Chua,Yi Chian %A Luo,Nan %A Verma,Swapna %A Subramaniam,Mythily %+ Research Division, Institute of Mental Health, 10, Buangkok View, Singapore, 539747, Singapore, 65 63892794, janhavi_vaingankar@imh.com.sg %K teens %K young adults %K concept mapping %K mental well-being %K digital media %K social media %K mental health %K social support %K mental health promotion %K self-expression %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Social media influence almost every aspect of our lives by facilitating instant many-to-many communication and self-expression. Recent research suggests strong negative and positive impacts of social media exposure on youth mental health; however, there has been more emphasis on harmful relationships. Objective: Given the limited research on the benefits of social media for mental health, this qualitative study explored the lived experiences of youth to understand how social media use can contribute to positive mental health among youth. Methods: Using an interpretivist epistemological approach, 25 semistructured interviews and 11 focus group discussions were conducted with male and female youth of different ethnicities (aged 15 to 24 years) residing in Singapore, who were recruited through purposive sampling from the community. We conducted inductive thematic analysis and concept mapping to address the research aims. Results: We found that youth engaged in a wide range of activities on social media from connecting with family and friends to participating in global movements, and these served as avenues for building positive mental health. Based on participants’ narratives, our analysis suggested that positive mental health among youth could be influenced by 3 features of social media consumption (connection with friends and their global community, engagement with social media content, and the value of social media as an outlet for expression). Through these, pathways leading to the following 5 positive mental health components were identified: (1) positive relationships and social capital, (2) self-concept, (3) coping, (4) happiness, and (5) other relevant aspects of mental health (for example, positivity and personal growth). Conclusions: The study results highlight the integral role of social media in the lives of today’s youth and indicate that they can offer opportunities for positive influence, personal expression, and social support, thus contributing to positive mental health among youth. The findings of our research can be applied to optimize engagement with youth through social media and enhance the digital modes of mental health promotion. %M 35254285 %R 10.2196/32758 %U https://pediatrics.jmir.org/2022/1/e32758 %U https://doi.org/10.2196/32758 %U http://www.ncbi.nlm.nih.gov/pubmed/35254285 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e29250 %T Community Mental Health Clinicians’ Perspectives on Telehealth During the COVID-19 Pandemic: Mixed Methods Study %A Schriger,Simone H %A Klein,Melanie R %A Last,Briana S %A Fernandez-Marcote,Sara %A Dallard,Natalie %A Jones,Bryanna %A Beidas,Rinad S %+ Department of Psychology, University of Pennsylvania, 425 S University Ave, Stephen A Levin Building, Philadelphia, PA, 19104-6241, United States, 1 215 898 7300, schriger@sas.upenn.edu %K telehealth %K COVID-19 %K evidence-based practice %K community mental health %K trauma-focused cognitive behavioral therapy %K implementation science %K youth mental health %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In March 2020, a rapid shift to telehealth occurred in community mental health settings in response to the need for physical distancing to decrease transmission of the virus causing COVID-19. Whereas treatment delivered over telehealth was previously utilized sparingly in community settings, it quickly became the primary mode of treatment delivery for the vast majority of clinicians, many of whom had little time to prepare for this shift and limited to no experience using telehealth. Little is known about community mental health clinicians’ experiences using telehealth. Although telehealth may make mental health treatment more accessible for some clients, it may create additional barriers for others given the high rates of poverty among individuals seeking treatment from community mental health centers. Objective: We examined community mental health clinicians’ perspectives on using telehealth to deliver trauma-focused cognitive behavioral therapy to youth. We sought to better understand the acceptability of using telehealth, as well as barriers and facilitators to usage. Methods: We surveyed 45 clinicians across 15 community clinics in Philadelphia. Clinicians rated their satisfaction with telehealth using a quantitative scale and shared their perspectives on telehealth in response to open-ended questions. Therapists’ responses were coded using an open-coding approach wherein coders generated domains, themes, and subthemes. Results: Clinicians rated telehealth relatively positively on the quantitative survey, expressing overall satisfaction with their current use of telehealth during the pandemic, and endorsing telehealth as a helpful mode of connecting with clients. Responses to open-ended questions fell into five domains. Clinicians noted that (1) telehealth affects the content (ie, what is discussed) and process (ie, how it is discussed) of therapy; (2) telehealth alters engagement, retention, and attendance; (3) technology is a crucial component of utilizing telehealth; (4) training, resources, and support are needed to facilitate telehealth usage; and (5) the barriers, facilitators, and level of acceptability of telehealth differ across individual clinicians and clients. Conclusions: First, telehealth is likely a better fit for some clients and clinicians than others, and attention should be given to better understanding who is most likely to succeed using this modality. Second, although telehealth increased convenience and accessibility of treatment, clinicians noted that across the board, it was difficult to engage clients (eg, young clients were easily distracted), and further work is needed to identify better telehealth engagement strategies. Third, for many clients, the telehealth modality may actually create an additional barrier to care, as children from families living in poverty may not have the requisite devices or quality broadband connection to make telehealth workable. Better strategies to address disparities in access to and quality of digital technologies are needed to render telehealth an equitable option for all youth seeking mental health services. %M 35023839 %R 10.2196/29250 %U https://pediatrics.jmir.org/2022/1/e29250 %U https://doi.org/10.2196/29250 %U http://www.ncbi.nlm.nih.gov/pubmed/35023839 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 3 %P e27244 %T Detecting and Measuring Depression on Social Media Using a Machine Learning Approach: Systematic Review %A Liu,Danxia %A Feng,Xing Lin %A Ahmed,Farooq %A Shahid,Muhammad %A Guo,Jing %+ Department of Health Policy and Management, School of Public Health, Peking University, 38 Xueyuan Road, Beijing, 100191, China, 86 18086471505, jing624218@bjmu.edu.cn %K depression %K machine learning %K social media %D 2022 %7 1.3.2022 %9 Review %J JMIR Ment Health %G English %X Background: Detection of depression gained prominence soon after this troublesome disease emerged as a serious public health concern worldwide. Objective: This systematic review aims to summarize the findings of previous studies concerning applying machine learning (ML) methods to text data from social media to detect depressive symptoms and to suggest directions for future research in this area. Methods: A bibliographic search was conducted for the period of January 1990 to December 2020 in Google Scholar, PubMed, Medline, ERIC, PsycINFO, and BioMed. Two reviewers retrieved and independently assessed the 418 studies consisting of 322 articles identified through database searching and 96 articles identified through other sources; 17 of the studies met the criteria for inclusion. Results: Of the 17 studies, 10 had identified depression based on researcher-inferred mental status, 5 had identified it based on users’ own descriptions of their mental status, and 2 were identified based on community membership. The ML approaches of 13 of the 17 studies were supervised learning approaches, while 3 used unsupervised learning approaches; the remaining 1 study did not describe its ML approach. Challenges in areas such as sampling, optimization of approaches to prediction and their features, generalizability, privacy, and other ethical issues call for further research. Conclusions: ML approaches applied to text data from users on social media can work effectively in depression detection and could serve as complementary tools in public mental health practice. %M 35230252 %R 10.2196/27244 %U https://mental.jmir.org/2022/3/e27244 %U https://doi.org/10.2196/27244 %U http://www.ncbi.nlm.nih.gov/pubmed/35230252 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e33058 %T Methods and Applications of Social Media Monitoring of Mental Health During Disasters: Scoping Review %A Teague,Samantha J %A Shatte,Adrian B R %A Weller,Emmelyn %A Fuller-Tyszkiewicz,Matthew %A Hutchinson,Delyse M %+ Centre for Social and Early Emotional Development, School of Psychology, Deakin University, 1 Gheringhap St, Geelong, 3220, Australia, 61 3 924 68440, sam.teague@deakin.edu.au %K social media %K SNS %K mental health %K disaster %K big data %K digital psychiatry %D 2022 %7 28.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: With the increasing frequency and magnitude of disasters internationally, there is growing research and clinical interest in the application of social media sites for disaster mental health surveillance. However, important questions remain regarding the extent to which unstructured social media data can be harnessed for clinically meaningful decision-making. Objective: This comprehensive scoping review synthesizes interdisciplinary literature with a particular focus on research methods and applications. Methods: A total of 6 health and computer science databases were searched for studies published before April 20, 2021, resulting in the identification of 47 studies. Included studies were published in peer-reviewed outlets and examined mental health during disasters or crises by using social media data. Results: Applications across 31 mental health issues were identified, which were grouped into the following three broader themes: estimating mental health burden, planning or evaluating interventions and policies, and knowledge discovery. Mental health assessments were completed by primarily using lexical dictionaries and human annotations. The analyses included a range of supervised and unsupervised machine learning, statistical modeling, and qualitative techniques. The overall reporting quality was poor, with key details such as the total number of users and data features often not being reported. Further, biases in sample selection and related limitations in generalizability were often overlooked. Conclusions: The application of social media monitoring has considerable potential for measuring mental health impacts on populations during disasters. Studies have primarily conceptualized mental health in broad terms, such as distress or negative affect, but greater focus is required on validating mental health assessments. There was little evidence for the clinical integration of social media–based disaster mental health monitoring, such as combining surveillance with social media–based interventions or developing and testing real-world disaster management tools. To address issues with study quality, a structured set of reporting guidelines is recommended to improve the methodological quality, replicability, and clinical relevance of future research on the social media monitoring of mental health during disasters. %M 35225815 %R 10.2196/33058 %U https://mental.jmir.org/2022/2/e33058 %U https://doi.org/10.2196/33058 %U http://www.ncbi.nlm.nih.gov/pubmed/35225815 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e26479 %T A Web-Based Cognitive Behavioral Therapy, Mindfulness Meditation, and Yoga Intervention for Posttraumatic Stress Disorder: Single-Arm Experimental Clinical Trial %A Kirk,Megan A %A Taha,Bilal %A Dang,Kevin %A McCague,Hugh %A Hatzinakos,Dimitrios %A Katz,Joel %A Ritvo,Paul %+ Yale Center for Emotional Intelligence, Yale School of Medicine, Yale University, 350 George Street, 3rd Floor, New Haven, CT, 06511, United States, 1 203 432 4326 ext 24326, megan.kirkchang@yale.edu %K posttraumatic stress disorder %K cognitive therapy %K internet delivery %K pupillometry %K psychophysiology %K PTSD %K therapy %K cognitive behavioral therapy %K mindfulness %K intervention %D 2022 %7 28.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Posttraumatic stress disorder (PTSD) is a debilitating, undertreated condition. The web-based delivery of cognitive behavioral therapy supplemented with mindfulness meditation and yoga is a viable treatment that emphasizes self-directed daily practice. Objective: This study aims to examine the effectiveness of a web-based cognitive behavioral therapy, mindfulness, and yoga (CBT-MY) program designed for daily use. Methods: We conducted an 8-week, single-arm, experimental, registered clinical trial on adults reporting PTSD symptoms (n=22; aged 18-35 years). Each participant received web-based CBT-MY content and an hour of web-based counseling each week. Pre-post outcomes included self-reported PTSD symptom severity, depression, anxiety, chronic pain, and mindfulness. Pre-post psychophysiological outcomes included peak pupil dilation (PPD) and heart rate variability (HRV). HRV and PPD were also compared with cross-sectional data from a non-PTSD comparison group without a history of clinical mental health diagnoses and CBT-MY exposure (n=46). Results: Pre-post intention-to-treat analyses revealed substantial improvements in PTSD severity (d=1.60), depression (d=0.83), anxiety (d=0.99), and mindfulness (d=0.88). Linear multilevel mixed models demonstrated a significant pre-post reduction in PPD (B=−0.06; SE=0.01; P<.001; d=0.90) but no significant pre-post change in HRV (P=.87). Overall, participants spent an average of 11.53 (SD 22.76) min/day on self-directed mindfulness practice. Conclusions: Web-based CBT-MY was associated with clinically significant symptom reductions and significant PPD changes, suggesting healthier autonomic functioning. Future randomized controlled trials are needed to further examine the gains apparent in this single-arm study. Trial Registration: ClinicalTrials.gov NCT03684473; https://clinicaltrials.gov/ct2/show/NCT03684473 %M 34499613 %R 10.2196/26479 %U https://mental.jmir.org/2022/2/e26479 %U https://doi.org/10.2196/26479 %U http://www.ncbi.nlm.nih.gov/pubmed/34499613 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e35776 %T A Brief, Daily, Online Mental Health and Well-being Intervention for University Staff During the COVID-19 Pandemic: Program Description and Outcomes Using a Mixed Methods Design %A Parker,Alexandra %A Dash,Sarah %A Bourke,Matthew %A Patten,Rhiannon %A Craike,Melinda %A Baldwin,Peter %A Hosking,Warwick %A Levinger,Itamar %A Apostolopoulos,Vasso %A de Courten,Maximilian %A Sharples,Jenny %A Naslund,Monika %A Stavropoulos,Vasileios %A Woessner,Mary %A Sonn,Christopher %A Stansen,Caroline %A Pascoe,Michaela %+ Institute for Health and Sport, Victoria University, Ballarat Road, Melbourne, 3011, Australia, 61 399195874, alex.parker@vu.edu.au %K workplace mental health %K well-being %K mental health promotion %K online intervention %K telehealth %K COVID-19 pandemic %K COVID-19 %K pandemic %K health promotion %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The unprecedented changes and isolation measures to contain COVID-19 have had multiple psychological and social impacts, with implications for professional and personal functioning. Evidence-informed interventions that can be rapidly implemented under pandemic conditions to support mental health during such times are urgently needed. Objective: The aim of this study was to determine the acceptability and preliminary outcomes of a daily online mental health promotion program for tertiary education staff during the COVID-19 pandemic. Methods: The “Victoria University (VU) Elevenses” program was delivered as an uncontrolled intervention at Victoria University (VU) in the western metropolitan region of Melbourne, Australia. In April 2020, an email invitation was sent to all academic and professional staff inviting them to: (1) participate in the program and (2) opt-in to the research component. The “VU Elevenses” program provided 10-15–minute microinterventions comprising lifestyle and well-being strategies to promote mental health via an online meeting platform at 11 AM each weekday. A mixed methods approach was used to evaluate the program, combining structured questionnaires with semistructured interviews to investigate the experiences of staff who participated in the program. Results: Between 16 and 90 participants provided weekly program feedback. A total of 106 university staff opted into the longitudinal research component and 10 staff participated in the interviews. Participants reported high levels of satisfaction with sessions and perceived benefits for mental health. Approximately one quarter of participants reported moderate to severe symptoms of depression, anxiety, and stress at baseline, with significant reductions in these symptoms in the first 7 weeks of the program, corresponding with easing in mandatory isolation (“lockdown”) restrictions. Symptoms of depression, anxiety, and stress all increased when lockdown measures were reintroduced, but not to the same levels as found during the initial lockdown period. Overall changes in depression and anxiety from baseline to the end of the program were explained by changes in COVID-19–related distress, whereas changes in self-compassion explained changes in stress. Conclusions: We show that it is feasible and acceptable to develop and deliver a program of brief interventions in a timely manner, using a simple and accessible online platform. Although participation in the program was initially associated with reduced symptoms of depression, anxiety, and stress, participants’ mental health worsened with the reintroduction of a “lockdown” period. However, as symptoms of depression, anxiety, and stress did not return to levels observed at the start of the VU Elevenses program, participation in the uncontrolled intervention may have offered a protective benefit against the impact of the second significant lockdown period. %M 35044304 %R 10.2196/35776 %U https://formative.jmir.org/2022/2/e35776 %U https://doi.org/10.2196/35776 %U http://www.ncbi.nlm.nih.gov/pubmed/35044304 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e33337 %T Digitalized Cognitive Behavioral Interventions for Depressive Symptoms During Pregnancy: Systematic Review %A Wan Mohd Yunus,Wan Mohd Azam %A Matinolli,Hanna-Maria %A Waris,Otto %A Upadhyaya,Subina %A Vuori,Miika %A Korpilahti-Leino,Tarja %A Ristkari,Terja %A Koffert,Tarja %A Sourander,Andre %+ Research Centre for Child Psychiatry, University of Turku, Lemminkäisenkatu 3/Teutori 3. floor, Turku, 20014, Finland, 358 503653447, andsou@utu.fi %K pregnancy %K antenatal depression %K systematic review %K cognitive behavior therapy %K digital interventions %K COVID-19 %D 2022 %7 23.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Studies have shown a high prevalence of depression during pregnancy, and there is also evidence that cognitive behavioral therapy (CBT) is one of the most effective psychosocial interventions. Emerging evidence from randomized controlled trials (RCTs) has shown that technology has been successfully harnessed to provide CBT interventions for other populations. However, very few studies have focused on their use during pregnancy. This approach has become increasingly important in many clinical areas due to the COVID-19 pandemic, and our study aimed to expand the knowledge in this particular clinical area. Objective: Our systematic review aimed to bring together the available research-based evidence on digitalized CBT interventions for depression symptoms during pregnancy. Methods: A systematic review of the Web of Science, Cochrane Central Register of Controlled Trials, CINAHL, MEDLINE, Embase, PsycINFO, Scopus, ClinicalTrials.gov, and EBSCO Open Dissertations databases was carried out from the earliest available evidence to October 27, 2021. Only RCT studies published in English were considered. The PRISMA (Preferred Reporting Items of Systematic Reviews and Meta-analyses) guidelines were followed, and the protocol was registered on the Prospective Register of Systematic Reviews. The risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials. Results: The review identified 7 studies from 5 countries (the United States, China, Australia, Norway, and Sweden) published from 2015 to 2021. The sample sizes ranged from 25 to 1342 participants. The interventions used various technological elements, including text, images, videos, games, interactive features, and peer group discussions. They comprised 2 guided and 5 unguided approaches. Using digitalized CBT interventions for depression during pregnancy showed promising efficacy, with guided intervention showing higher effect sizes (Hedges g=1.21) than the unguided interventions (Hedges g=0.14-0.99). The acceptability of the digitalized CBT interventions was highly encouraging, based on user feedback. Attrition rates were low for the guided intervention (4.5%) but high for the unguided interventions (22.1%-46.5%). A high overall risk of bias was present for 6 of the 7 studies. Conclusions: Our search only identified a small number of digitalized CBT interventions for pregnant women, despite the potential of this approach. These showed promising evidence when it came to efficacy and positive outcomes for depression symptoms, and user feedback was positive. However, the overall risk of bias suggests that the efficacy of the interventions needs to be interpreted with caution. Future studies need to consider how to mitigate these sources of biases. Digitalized CBT interventions can provide prompt, effective, evidence-based interventions for pregnant women. This review increases our understanding of the importance of digitalized interventions during pregnancy, including during the COVID-19 pandemic. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020216159; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=216159 %M 35195532 %R 10.2196/33337 %U https://www.jmir.org/2022/2/e33337 %U https://doi.org/10.2196/33337 %U http://www.ncbi.nlm.nih.gov/pubmed/35195532 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30598 %T The Impact of COVID-19 Confinement on Cognition and Mental Health and Technology Use Among Socially Vulnerable Older People: Retrospective Cohort Study %A Dura-Perez,Elena %A Goodman-Casanova,Jessica Marian %A Vega-Nuñez,Amanda %A Guerrero-Pertiñez,Gloria %A Varela-Moreno,Esperanza %A Garolera,Maite %A Quintana,Maria %A Cuesta-Vargas,Antonio I %A Barnestein-Fonseca,Pilar %A Gómez Sánchez-Lafuente,Carlos %A Mayoral-Cleries,Fermin %A Guzman-Parra,Jose %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital, s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K COVID-19 %K cognition %K quality of life %K social isolation %K mental health %K social support %K technology %K physical distancing %K leisure activities %K nursing %D 2022 %7 22.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 forced the implementation of restrictive measures in Spain, such as lockdown, home confinement, social distancing, and isolation. It is necessary to study whether limited access to basic services and decreased family and social support could have deleterious effects on cognition, quality of life, and mental health in vulnerable older people. Objective: This study aims to explore the impact of the COVID-19 outbreak on cognition in older adults with mild cognitive impairment or dementia as the main outcome and the quality of life, perceived health status, and depression as secondary outcomes and to analyze the association of living alone and a change in living arrangements with those outcomes and other variables related with the use of technology and health services. Likewise, this study aims to analyze the association of high and low technophilia with those variables, to explore the access and use of health care and social support services, and, finally, to explore the informative-, cognitive-, entertainment-, and socialization-related uses of information and communications technologies (ICTs) during the COVID-19 outbreak. Methods: This cohort study was conducted in Málaga (Spain). In total, 151 participants with mild cognitive impairment or mild dementia, from the SMART4MD (n=75, 49.7%) and TV-AssistDem (n=76, 50.3%) randomized clinical trials, were interviewed by telephone between May 11 and June 26, 2020. All participants had undergone 1-3 assessments (in 6-month intervals) on cognition, quality of life, and mood prior to the COVID-19 breakout. Results: The outbreak did not significantly impact the cognition, quality of life, and mood of our study population when making comparisons with baseline assessments prior to the outbreak. Perceived stress was reported as moderate during the outbreak. After correction for multiple comparisons, living alone, a change in living arrangements, and technophilia were not associated with negative mental health outcomes. However, being alone was nominally associated with self-perceived fear and depression, and higher technophilia with better quality of life, less boredom, perceived stress and depression, and also less calmness. Overall, health care and social support service access and utilization were high. The most used ICTs during the COVID-19 outbreak were the television for informative, cognitive, and entertainment-related uses and the smartphone for socialization. Conclusions: Our findings show that the first months of the outbreak did not significantly impact the cognition, quality of life, perceived health status, and depression of our study population when making comparisons with baseline assessments prior to the outbreak. Living alone and low technophilia require further research to establish whether they are risk factors of mental health problems during lockdowns in vulnerable populations. Moreover, although ICTs have proven to be useful for informative-, cognitive-, entertainment-, and socialization-related uses during the pandemic, more evidence is needed to support these interventions. Trial Registration: ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797 International Registered Report Identifier (IRRID): RR2-10.2196/26431 %M 35049505 %R 10.2196/30598 %U https://www.jmir.org/2022/2/e30598 %U https://doi.org/10.2196/30598 %U http://www.ncbi.nlm.nih.gov/pubmed/35049505 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e25238 %T International Technologies on Prevention and Treatment of Neurological and Psychiatric Diseases: Bibliometric Analysis of Patents %A Zheng,Fuhao %A Wang,Ling %A Zeng,Zhaonan %A Wu,Siying %+ Public Health School of Fujian Medical University, Number 1, Xueyuan Road, Fuzhou, 350108, China, 86 591 228 6202 ext 5, fmuwsy@163.com %K neurological diseases %K psychiatric diseases %K patent %K bibliometric analysis %K prevention %K treatment %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Neurological and psychiatric disorders are serious and expensive global public health problems. Therefore, exploring effective intervention technologies plays an important role in improving patients’ clinical symptoms and social functions, as well as reducing medical burden. Objective: The aim of this study is to analyze and summarize the key new technologies and innovative development trends witnessed globally for neurological illness and psychiatric disorders by mining the relevant patent data. Methods: A bibliometric analysis was conducted on patent applications, priority countries, main patentees, hot technologies, and other patent information on neurological and psychiatric disorders, revealing the current situation along with the trend of technology development in this field. Results: In recent years, inventions and innovations related to neurological and psychiatric diseases have become very active, with China being the largest patent priority country. Of the top patent holders, Visicu (headquartered in the United States) is the leader. The distribution of patent holders in China remains relatively scattered, with no monopoly organization at present. Global technologies on neurological illness and psychiatric disorders are mainly concentrated around A61B (diagnosis, surgery, and identification). Conclusions: This paper analyzed and summarized the key new technologies and global innovative development trends of neurological and psychiatric diseases by mining the relevant patent data, and provides practical references and research perspectives for the prevention and treatment of the aforesaid diseases. %M 35191849 %R 10.2196/25238 %U https://mental.jmir.org/2022/2/e25238 %U https://doi.org/10.2196/25238 %U http://www.ncbi.nlm.nih.gov/pubmed/35191849 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e31116 %T eHealth Interventions for Treatment and Prevention of Depression, Anxiety, and Insomnia During Pregnancy: Systematic Review and Meta-analysis %A Silang,Katherine A %A Sohal,Pooja R %A Bright,Katherine S %A Leason,Jennifer %A Roos,Leslie %A Lebel,Catherine %A Giesbrecht,Gerald F %A Tomfohr-Madsen,Lianne M %+ Department of Psychology, University of Calgary, 2500 University Drive, NW, Calgary, AB, T2N 1N4, Canada, 1 403 220 2243, ltomfohr@ucalgary.ca %K eHealth %K pregnancy %K depression %K anxiety %K insomnia %K mobile phone %D 2022 %7 21.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: Pregnancy is associated with an increased risk for depression, anxiety, and insomnia. eHealth interventions provide a promising and accessible treatment alternative to face-to-face interventions. Objective: The objective of this systematic review and meta-analysis is to determine the effectiveness of eHealth interventions in preventing and treating depression, anxiety, and insomnia during pregnancy. Secondary aims are to identify demographic and intervention moderators of effectiveness. Methods: A total of 5 databases (PsycINFO, Medline, CINAHL, Embase, and Cochrane) were searched from inception to May 2021. Terms related to eHealth, pregnancy, randomized controlled trials (RCTs), depression, anxiety, and insomnia were included. RCTs and pilot RCTs were included if they reported an eHealth intervention for the prevention or treatment of depression, anxiety, or insomnia in pregnant women. Study screening, data extractions, and quality assessment were conducted independently by 2 reviewers from an 8-member research team (KAS, PRS, Hangsel Sanguino, Roshni Sohail, Jasleen Kaur, Songyang (Mark) Jin, Makayla Freeman, and Beatrice Valmana). Random-effects meta-analyses of pooled effect sizes were conducted to determine the effect of eHealth interventions on prenatal mental health. Meta-regression analyses were conducted to identify potential moderators. Results: In total, 17 studies were included in this review that assessed changes in depression (11/17, 65%), anxiety (10/17, 59%), and insomnia (3/17, 18%). Several studies included both depression and anxiety symptoms as outcomes (7/17, 41%). The results indicated that during pregnancy, eHealth interventions showed small effect sizes for preventing and treating symptoms of anxiety and depression and a moderate effect size for treating symptoms of insomnia. With the exception of intervention type for the outcome of depressive symptoms, where mindfulness interventions outperformed other intervention types, no significant moderators were detected. Conclusions: eHealth interventions are an accessible and promising resource for treating symptoms of anxiety, depression, and insomnia during pregnancy. However, more research is necessary to identify ways to increase the efficacy of eHealth interventions for this population. Trial Registration: PROSPERO (International Prospective Register of Systematic Reviews) CRD42020205954; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=205954 %M 35188471 %R 10.2196/31116 %U https://mental.jmir.org/2022/2/e31116 %U https://doi.org/10.2196/31116 %U http://www.ncbi.nlm.nih.gov/pubmed/35188471 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e30710 %T A Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder (LiveWell): Empirical and Theoretical Framework, Intervention Design, and Study Protocol for a Randomized Controlled Trial %A Goulding,Evan H %A Dopke,Cynthia A %A Rossom,Rebecca C %A Michaels,Tania %A Martin,Clair R %A Ryan,Chloe %A Jonathan,Geneva %A McBride,Alyssa %A Babington,Pamela %A Bernstein,Mary %A Bank,Andrew %A Garborg,C Spencer %A Dinh,Jennifer M %A Begale,Mark %A Kwasny,Mary J %A Mohr,David C %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave., Chicago, IL, 60611, United States, 1 3125031189, e-goulding@fsm.northwestern.edu %K bipolar disorder %K self-management %K mHealth %K eHealth %K smartphone %K mobile phone %K mental health %K mobile health %D 2022 %7 21.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Bipolar disorder is a severe mental illness with high morbidity and mortality rates. Even with pharmacological treatment, frequent recurrence of episodes, long episode durations, and persistent interepisode symptoms are common and disruptive. Combining psychotherapy with pharmacotherapy improves outcomes; however, many individuals with bipolar disorder do not receive psychotherapy. Mental health technologies can increase access to self-management strategies derived from empirically supported bipolar disorder psychotherapies while also enhancing treatment by delivering real-time assessments, personalized feedback, and provider alerts. In addition, mental health technologies provide a platform for self-report, app use, and behavioral data collection to advance understanding of the longitudinal course of bipolar disorder, which can then be used to support ongoing improvement of treatment. Objective: A description of the theoretical and empirically supported framework, design, and protocol for a randomized controlled trial (RCT) of LiveWell, a smartphone-based self-management intervention for individuals with bipolar disorder, is provided to facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar disorder. The goal of the trial is to determine the effectiveness of LiveWell for reducing relapse risk and symptom burden as well as improving quality of life (QOL) while simultaneously clarifying behavioral targets involved in staying well and better characterizing the course of bipolar disorder and treatment response. Methods: The study is a single-blind RCT (n=205; 2:3 ratio of usual care vs usual care plus LiveWell). The primary outcome is the time to relapse. Secondary outcomes are percentage time symptomatic, symptom severity, and QOL. Longitudinal changes in target behaviors proposed to mediate the primary and secondary outcomes will also be determined, and their relationships with the outcomes will be assessed. A database of clinical status, symptom severity, real-time self-report, behavioral sensor, app use, and personalized content will be created to better predict treatment response and relapse risk. Results: Recruitment and screening began in March 2017 and ended in April 2019. Follow-up ended in April 2020. The results of this study are expected to be published in 2022. Conclusions: This study will examine whether LiveWell reduces relapse risk and symptom burden and improves QOL for individuals with bipolar disorder by increasing access to empirically supported self-management strategies. The role of selected target behaviors (medication adherence, sleep duration, routine, and management of signs and symptoms) in these outcomes will also be examined. Simultaneously, a database will be created to initiate the development of algorithms to personalize and improve treatment for bipolar disorder. In addition, we hope that this description of the theoretical and empirically supported framework, intervention design, and study protocol for the RCT of LiveWell will facilitate the ability to replicate, improve, implement, and disseminate effective interventions for bipolar and other mental health disorders. Trial Registration: ClinicalTrials.gov NCT03088462; https://www.clinicaltrials.gov/ct2/show/NCT03088462 International Registered Report Identifier (IRRID): DERR1-10.2196/30710 %M 35188473 %R 10.2196/30710 %U https://www.researchprotocols.org/2022/2/e30710 %U https://doi.org/10.2196/30710 %U http://www.ncbi.nlm.nih.gov/pubmed/35188473 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e28502 %T Feasibility and Efficacy of Virtual Reality Interventions to Improve Psychosocial Functioning in Psychosis: Systematic Review %A Schroeder,Alexandra H %A Bogie,Bryce J M %A Rahman,Tabassum T %A Thérond,Alexandra %A Matheson,Hannah %A Guimond,Synthia %+ The Royal’s Institute of Mental Health Research, University of Ottawa, 1145 Carling Avenue, Ottawa, ON, K1Z 7K4, Canada, 1 (613) 722 6521 ext 6586, synthia.guimond@uqo.ca %K auditory verbal hallucinations %K cognitive remediation %K functional outcomes %K neurocognition %K paranoia %K psychosis %K schizophrenia %K social skills %K virtual reality (VR) %K vocational skills %D 2022 %7 18.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: Functional recovery in psychosis remains a challenge despite current evidence-based treatment approaches. To address this problem, innovative interventions using virtual reality (VR) have recently been developed. VR technologies have enabled the development of realistic environments in which individuals with psychosis can receive psychosocial treatment interventions in more ecological settings than traditional clinics. These interventions may therefore increase the transfer of learned psychosocial skills to real-world environments, thereby promoting long-term functional recovery. However, the overall feasibility and efficacy of such interventions within the psychosis population remain unclear. Objective: This systematic review aims to investigate whether VR-based psychosocial interventions are feasible and enjoyable for individuals with psychosis, synthesize current evidence on the efficacy of VR-based psychosocial interventions for psychosis, and identify the limitations in the current literature to guide future research. Methods: This research followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Literature searches were conducted in PubMed and PsycINFO in May 2021. We searched for peer-reviewed English articles that used a psychosocial intervention with a VR component. Participants in the included studies were diagnosed with schizophrenia, schizoaffective disorder, or another psychotic disorder. The included studies were divided into four categories as follows: cognitive remediation interventions, social skills interventions, vocational skills interventions, and auditory verbal hallucinations and paranoia interventions. The risk of bias assessment was performed for each study. Results: A total of 18 studies were included in this systematic review. Of these 18 studies, 4 (22%) studies used a cognitive remediation intervention, 4 (22%) studies used a social skills intervention, 3 (17%) studies used a vocational skills intervention, and 7 (39%) studies implemented an intervention aimed at improving auditory verbal hallucinations or paranoia. A total of 745 individuals with psychosis were included in the study. All the studies that evaluated feasibility showed that VR-based psychosocial interventions were feasible and enjoyable for individuals with psychosis. The preliminary evidence on efficacy included in this review suggests that VR-based psychosocial interventions can improve cognitive, social, and vocational skills in individuals with psychosis. VR-based interventions may also improve the symptoms of auditory verbal hallucinations and paranoia. The skills that participants learned through these interventions were durable, transferred into real-world environments, and led to improved functional outcomes, such as autonomy, managing housework, and work performance. Conclusions: VR-based interventions may represent a novel and efficacious approach for improving psychosocial functioning in psychosis. Therefore, VR-based psychosocial interventions represent a promising adjunctive therapy for the treatment of psychosis, which may be used to improve psychosocial skills, community functioning, and quality of life. %M 35179501 %R 10.2196/28502 %U https://mental.jmir.org/2022/2/e28502 %U https://doi.org/10.2196/28502 %U http://www.ncbi.nlm.nih.gov/pubmed/35179501 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e23700 %T The Associations Between Gaming Motivation and Internet Gaming Disorder: Systematic Review and Meta-analysis %A Wang,Hsin-Yi %A Cheng,Cecilia %+ Department of Psychology, The University of Hong Kong, Pokfulam, Hong Kong, Hong Kong, 852 39174224, ceci-cheng@hku.hk %K gaming motivation %K problematic gaming %K gaming disorder %K video gaming %K online gaming %K compulsive gaming %K escapism %K culture %K cross-cultural comparison, cultural individualism %D 2022 %7 17.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: There has been a surge in interest in examining internet gaming disorder (IGD) and its associations with gaming motivation. Three broad components of gaming motivation have been proposed: achievement, immersion, and social. Achievement-oriented players are motivated by gaining in-game rewards, immersion-oriented players are motivated by the experience of immersion in the virtual world, and social-oriented players are motivated by the need to socialize with other players through gaming. Objective: This study aimed to (1) quantitatively synthesize the growing body of literature to systematically examine the discrepancies in the magnitude of associations between various components of gaming motivation and IGD and (2) examine the moderating role of cultural dimension on the association between escapism gaming motivation and IGD. Methods: We conducted a systematic search of multiple databases between 2002 and 2020. Studies were included if they (1) included quantitative data, (2) used measures assessing both gaming motivation and IGD, and (3) contained sufficient information for effect size calculation. Results: The findings revealed IGD to have a stronger association with achievement motivation (r=0.32) than with immersion (r=0.22) or social motivation (r=0.20), but the strongest such association was found to be with escapism motivation (r=0.40), a subcomponent of immersion motivation. Our cross-cultural comparison further showed a stronger association between escapism motivation and IGD in studies conducted in individualistic (vs collectivistic) regions. Conclusions: This meta-analysis highlights the importance of acknowledging the discrepancies among different components of gaming motivation with respect to their role in the development of IGD, as well as the potential cultural variations in the strength of such associations. %M 35175204 %R 10.2196/23700 %U https://mental.jmir.org/2022/2/e23700 %U https://doi.org/10.2196/23700 %U http://www.ncbi.nlm.nih.gov/pubmed/35175204 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e30489 %T Online Cognitive Behavioral Therapy (CBT) Life Skills Program for Depression: Pilot Randomized Controlled Trial %A Williams,Christopher %A McClay,Carrie-Anne %A Martinez,Rebeca %A Morrison,Jill %A Haig,Caroline %A Jones,Ray %A Farrand,Paul %+ Institute of Health and Wellbeing, University of Glasgow, Mental Health and Wellbeing, Gartnavel Royal Hospital, Administration building, 1st floor, General Office, Glasgow, G12 0XH, United Kingdom, 44 141 330 3299, chris.williams@glasgow.ac.uk %K pilot study %K depression %K low mood %K iCBT %K guided self-help %K online %K psychotherapy %K LLTTF %K RCT %K treatment gap %K bibliotherapy %K life skills %K anxiety %D 2022 %7 17.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression is a common mental health problem with significant personal and social consequences. Studies have suggested that cognitive behavioral therapy (CBT) is an effective treatment for depression and anxiety when delivered one-to-one by an expert practitioner, but access to this talking therapy is often limited, and waiting lists can be long. However, a range of low-intensity interventions that can increase access to services are available including guided CBT self-help materials delivered via books, classes, and online packages. Objective: This project aimed to pilot a randomized controlled trial (RCT) of an online CBT-based life skills course with community-based individuals experiencing depression. Methods: Individuals with symptoms of depression were recruited directly from the community via newspaper advertisements. Participants were remotely randomized to receive either immediate access (IA) or delayed access (DA) to a research version of the Living Life to the Full online CBT-based life skills package (3rd edition) with telephone support provided by nonspecialist, charity-based workers while they used the online intervention. The primary end point was at 3 months postrandomization, at which point, the DA group were offered the intervention. Levels of depression, anxiety, social functioning, and satisfaction were assessed. Results: There were effective recruitment, randomization, and uptake, with 19 IA and 17 DA control participants entering the pilot study via newspaper advertisements and 13 of the 19 participants taking up the intervention. Overall, 72% (26/36) were not currently under the care of their general practitioner. The online package was acceptable to participants; the mean satisfaction score on the Client Satisfaction Questionnaire was 21 out of 32 (SD 8.89). At 3 months, data collection was achieved from 78% (28/36) of the participants. The efficacy and retention data were used for a power calculation indicating that 72 participants in total will be required for a future substantive RCT. Conclusions: The research design successfully tested the recruitment, data collection, and intervention delivery. The pilot study has provided data for the required sample size for the full RCT. Trial Registration: ISRCTN registry ISRCTN12890709; https://doi.org/10.1186/ISRCTN12890709 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-016-1336-y %M 35175203 %R 10.2196/30489 %U https://formative.jmir.org/2022/2/e30489 %U https://doi.org/10.2196/30489 %U http://www.ncbi.nlm.nih.gov/pubmed/35175203 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e30810 %T Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review %A Moon,Khatiya %A Sobolev,Michael %A Kane,John M %+ Zucker Hillside Hospital, Northwell Health, 75-59 263rd Street, Glen Oaks, NY, 11004, United States, 1 718 470 4597, KMoon2@northwell.edu %K collaborative care %K integrated care %K augmented care %K digital health %K mobile health %K behavioral health %K review %D 2022 %7 16.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. Objective: This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. Methods: This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. Results: A total of 3982 nonduplicate reports were identified, of which 20 (0.5%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35%), there were no differences between groups, or the differences were modest. Conclusions: The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials. %M 35171105 %R 10.2196/30810 %U https://mental.jmir.org/2022/2/e30810 %U https://doi.org/10.2196/30810 %U http://www.ncbi.nlm.nih.gov/pubmed/35171105 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28093 %T Remotely Delivered Interventions to Support Women With Symptoms of Anxiety in Pregnancy: Mixed Methods Systematic Review and Meta-analysis %A Evans,Kerry %A Rennick-Egglestone,Stefan %A Cox,Serena %A Kuipers,Yvonne %A Spiby,Helen %+ School of Health Sciences, University of Nottingham, Queen's Medical Centre, Derby Rd, Lenton, Nottingham, NG7 2HA, United Kingdom, 44 7596783920, kerry.evans1@nottingham.ac.uk %K anxiety %K pregnancy %K antenatal %K systematic review %K digital interventions %K eHealth %K remote interventions %K electronic health %K parenting %K remote delivery %K therapy %K CBT %K fear %K distress %K mobile phone %D 2022 %7 15.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Symptoms of anxiety are common in pregnancy, with severe symptoms associated with negative outcomes for women and babies. Low-level psychological therapy is recommended for women with mild to moderate anxiety, with the aim of preventing an escalation of symptoms and providing coping strategies. Remotely delivered interventions have been suggested to improve access to treatment and support and provide a cost-effective, flexible, and timely solution. Objective: This study identifies and evaluates remotely delivered, digital, or web-based interventions to support women with symptoms of anxiety during pregnancy. Methods: This mixed methods systematic review followed a convergent segregated approach to synthesize qualitative and quantitative data. The ACM Digital Library, Allied and Complementary Medicine Database, Applied Social Sciences Index and Abstracts, Centre for Reviews and Dissemination database, the Cochrane Central Register of Controlled Trials, the Cochrane Library, CINAHL, Embase, Health Technology Assessment Library, IEEE Xplore, Joanna Briggs Institute, Maternity and Infant Care, MEDLINE, PsycINFO, and the Social Science Citation Index were searched in October 2020. Quantitative or qualitative primary research that included pregnant women and evaluated remotely delivered interventions reporting measures of anxiety, fear, stress, distress, women’s views, and opinions were included. Results: Overall, 3 qualitative studies and 14 quantitative studies were included. Populations included a general antenatal population and pregnant women having anxiety and depression, fear of childbirth, insomnia, and preterm labor. Interventions included cognitive behavioral therapy, problem solving, mindfulness, and educational designs. Most interventions were delivered via web-based platforms, and 62% (8/13) included direct contact from trained therapists or coaches. A meta-analysis of the quantitative data found internet-based cognitive behavioral therapy and facilitated interventions showed a beneficial effect in relation to the reduction of anxiety scores (standardized mean difference −0.49, 95% CI −0.75 to −0.22; standardized mean difference −0.48, 95% CI −0.75 to −0.22). Due to limitations in the amount of available data and study quality, the findings should be interpreted with caution. Synthesized findings found some evidence to suggest that interventions are more effective when women maintain regular participation which may be enhanced by providing regular contact with therapists or peer support, appropriate targeting of interventions involving components of relaxation and cognitive-based skills, and providing sufficient sessions to develop new skills without being too time consuming. Conclusions: There is limited evidence to suggest that women who are pregnant may benefit from remotely delivered interventions. Components of interventions that may improve the effectiveness and acceptability of remotely delivered interventions included providing web-based contact with a therapist, health care professional, or peer community. Women may be more motivated to complete interventions that are perceived as relevant or tailored to their needs. Remote interventions may also provide women with greater anonymity to help them feel more confident in disclosing their symptoms. %M 35166688 %R 10.2196/28093 %U https://www.jmir.org/2022/2/e28093 %U https://doi.org/10.2196/28093 %U http://www.ncbi.nlm.nih.gov/pubmed/35166688 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27584 %T Internet-Based Audiologist-Guided Cognitive Behavioral Therapy for Tinnitus: Randomized Controlled Trial %A W Beukes,Eldré %A Andersson,Gerhard %A Fagelson,Marc %A Manchaiah,Vinaya %+ Vision and Hearing Research Centre, Anglia Ruskin University, East Road, Cambridge, CB1 1TP, United Kingdom, 44 07951113157, eldre.beukes@aru.co.uk %K tinnitus %K cognitive behavioral therapy %K internet intervention %K web-based intervention %K randomized controlled trial %K telehealth %K teleaudiology %K eHealth %D 2022 %7 14.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Tinnitus is a symptom that can be very distressing owing to hearing sounds not related to any external sound source. Managing tinnitus is notoriously difficult, and access to evidence-based care is limited. Cognitive behavioral therapy (CBT) is a tinnitus management strategy with the most evidence of effectiveness but is rarely offered to those distressed by tinnitus. The provision of internet-based CBT for tinnitus overcomes accessibility barriers; however, it is not currently readily available in the United States. Objective: The aim of this study is to investigate the efficacy of internet-based CBT compared with that of weekly monitoring for the management of tinnitus in reducing tinnitus distress; reducing tinnitus-related comorbidities, including tinnitus cognitions, insomnia, anxiety, and depression; and assessing the stability of the intervention effects 2 months after the intervention. Methods: A 2-arm randomized clinical trial comparing audiologist-guided internet-based CBT (n=79) to a weekly monitoring group (n=79) with a 2-month follow-up assessed the efficacy of internet-based CBT. Eligible participants included adults seeking help for tinnitus. Recruitment was conducted on the web using an open-access website. Participants were randomized via 1:1 allocation, but blinding was not possible. The study was undertaken by English or Spanish speakers on the web. The primary outcome was a change in tinnitus distress as measured using the Tinnitus Functional Index. Secondary outcome measures included anxiety, depression, insomnia, tinnitus cognition, hearing-related difficulties, and quality of life. Results: Internet-based CBT led to a greater reduction in tinnitus distress (mean 36.57, SD 22) compared with that in weekly monitoring (mean 46.31, SD 20.63; effect size: Cohen d=0.46, 95% CI 0.14-0.77) using an intention-to-treat analysis. For the secondary outcomes, there was a greater reduction in negative tinnitus cognition and insomnia. The results remained stable over the 2-month follow-up period. No important adverse events were observed. Further, 16% (10/158) of participants withdrew, with low overall compliance rates for questionnaire completion of 72.3% (107/148) at T1, 61% (91/148) at T2, and 42% (62/148) at T3. Conclusions: This study is the first to evaluate and indicate the efficacy of audiologist-delivered internet-based CBT in reducing tinnitus distress in a US population. It was also the first study to offer internet-based CBT in Spanish to accommodate the large Hispanic population in the United States. The results have been encouraging, and further work is indicated in view of making such an intervention applicable to a wider population. Further work is required to improve compliance and attract more Spanish speakers. Trial Registration: ClinicalTrials.gov NCT04004260; https://clinicaltrials.gov/ct2/show/NCT04004260 %M 35156936 %R 10.2196/27584 %U https://www.jmir.org/2022/2/e27584 %U https://doi.org/10.2196/27584 %U http://www.ncbi.nlm.nih.gov/pubmed/35156936 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e29137 %T The Effectiveness of Serious Games in Alleviating Anxiety: Systematic Review and Meta-analysis %A Abd-alrazaq,Alaa %A Alajlani,Mohannad %A Alhuwail,Dari %A Schneider,Jens %A Akhu-Zaheya,Laila %A Ahmed,Arfan %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar, 974 55708566, mhouseh@hbku.edu.qa %K serious games %K exergames %K anxiety %K computerized cognitive behavioral therapy games %K biofeedback games %K systematic reviews %K meta-analysis %K mobile phone %D 2022 %7 14.2.2022 %9 Review %J JMIR Serious Games %G English %X Background: Anxiety is a mental disorder characterized by apprehension, tension, uneasiness, and other related behavioral disturbances. One of the nonpharmacological treatments used for reducing anxiety is serious games, which are games that have a purpose other than entertainment. The effectiveness of serious games in alleviating anxiety has been investigated by several systematic reviews; however, they were limited by design and methodological weaknesses. Objective: This study aims to assess the effectiveness of serious games in alleviating anxiety by summarizing the results of previous studies and providing an up-to-date review. Methods: We conducted a systematic review of randomized controlled trials (RCTs). The following seven databases were searched: MEDLINE, CINAHL, PsycINFO, ACM Digital Library, IEEE Xplore, Scopus, and Google Scholar. We also conducted backward and forward reference list checking for the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. We used a narrative and statistical approach, as appropriate, to synthesize the results of the included studies. Results: Of the 935 citations retrieved, 33 studies were included in this review. Of these, 22 RCTs were eventually included in the meta-analysis. Very low–quality evidence from 9 RCTs and 5 RCTs showed no statistically significant effect of exergames (games entailing physical exercises) on anxiety levels when compared with conventional exercises (P=.70) and no intervention (P=.27), respectively. Although 6 RCTs demonstrated a statistically and clinically significant effect of computerized cognitive behavioral therapy games on anxiety levels when compared with no intervention (P=.01), the quality of the evidence reported was low. Similarly, low-quality evidence from 3 RCTs showed a statistically and clinically significant effect of biofeedback games on anxiety levels when compared with conventional video games (P=.03). Conclusions: This review shows that exergames can be as effective as conventional exercises in alleviating anxiety; computerized cognitive behavioral therapy games and exergames can be more effective than no intervention, and biofeedback games can be more effective than conventional video games. However, our findings remain inconclusive, mainly because there was a high risk of bias in the individual studies included, the quality of meta-analyzed evidence was low, few studies were included in some meta-analyses, patients without anxiety were recruited in most studies, and purpose-shifted serious games were used in most studies. Therefore, serious games should be considered complementary to existing interventions. Researchers should use serious games that are designed specifically to alleviate depression, deliver other therapeutic modalities, and recruit a diverse population of patients with anxiety. %M 35156932 %R 10.2196/29137 %U https://games.jmir.org/2022/1/e29137 %U https://doi.org/10.2196/29137 %U http://www.ncbi.nlm.nih.gov/pubmed/35156932 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e30838 %T Attentional Harms and Digital Inequalities %A Hartford,Anna %A Stein,Dan J %+ Brain-Behaviour Unit, University of Cape Town, J-Block, Groote Schuur Hospital, Cape Town, 7935, South Africa, 27 214042174, annahartford@gmail.com %K digital inequalities %K attentional harms %K excessive internet use %K persuasive technologies %K internet ethics %K attention economies %D 2022 %7 11.2.2022 %9 Viewpoint %J JMIR Ment Health %G English %X Recent years have seen growing public concern about the effects of persuasive digital technologies on public mental health and well-being. As the draws on our attention reach such staggering scales and as our ability to focus our attention on our own considered ends erodes ever further, the need to understand and articulate what is at stake has become pressing. In this ethical viewpoint, we explore the concept of attentional harms and emphasize their potential seriousness. We further argue that the acknowledgment of these harms has relevance for evolving debates on digital inequalities. An underdiscussed aspect of web-based inequality concerns the persuasions, and even the manipulations, that help to generate sustained attentional loss. These inequalities are poised to grow, and as they do, so will concerns about justice with regard to the psychological and self-regulatory burdens of web-based participation for different internet users. In line with calls for multidimensional approaches to digital inequalities, it is important to recognize these potential harms as well as to empower internet users against them even while expanding high-quality access. %M 35147504 %R 10.2196/30838 %U https://mental.jmir.org/2022/2/e30838 %U https://doi.org/10.2196/30838 %U http://www.ncbi.nlm.nih.gov/pubmed/35147504 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28771 %T The Effect of Digital Health Interventions on Parents’ Mental Health Literacy and Help Seeking for Their Child’s Mental Health Problem: Systematic Review %A Peyton,Daniel %A Goods,Marquelle %A Hiscock,Harriet %+ Murdoch Children's Research Institute, 50 Flemington Road, Parkville, 3052, Australia, 61 93456910, harriet.hiscock@rch.org.au %K child %K mental health %K systematic review %K caregiver %K health literacy %K digital health %D 2022 %7 10.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Many children with mental health problems do not receive professional help. Despite the frequent use of digital health interventions (DHIs) such as websites or web-based service navigation platforms, their effects on parents’ mental health literacy, help seeking, or uptake of professional services are unclear. Objective: This study aims to provide a systematic review and narrative synthesis to describe whether DHIs improve the aforementioned parental outcomes. Methods: Databases, including CINAHL, Embase, MEDLINE OVID, PsycINFO, and PubMed (2000-2020), were accessed. Studies were included if they evaluated quantitative changes in mental health literacy, help seeking, or the uptake of services by parents of children with mental health problems. Theoretical frameworks, sample sizes, participant demographics, recruitment, interventions, DHI use, results, and health economic measures were used for data extraction. Results: Of the 11,379 search results, 5 (0.04%) studies met the inclusion criteria. One randomized controlled trial found the reduced uptake of services after using a DHI coupled with a telephone coach for a child’s behavioral problem. Of 3 studies, 2 (66.7%) found statistically significant improvement in mental health literacy for attention-deficit/hyperactivity disorder but had no control group. One study found nonsignificant improvement in mental health literacy and help-seeking attitudes toward anxiety and depression compared with those in active controls. All studies were rated as having a high or serious risk of bias. Search results were affected because of a single reviewer screening articles, overall low-quality studies, and a lack of consistent nomenclature. Conclusions: There is no high-quality evidence that DHIs can improve parents’ mental health literacy, help seeking, or uptake of services. More research is needed to evaluate DHIs by using rigorous study designs and consistent measures. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020130074; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020130074 %M 35142623 %R 10.2196/28771 %U https://www.jmir.org/2022/2/e28771 %U https://doi.org/10.2196/28771 %U http://www.ncbi.nlm.nih.gov/pubmed/35142623 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e28233 %T Web-Based Cognitive Testing in Psychiatric Research: Validation and Usability Study %A Lynham,Amy Joanne %A Jones,Ian R %A Walters,James T R %+ Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Division of Psychiatry and Clinical Neurosciences, School of Medicine, Cardiff University, Cardiff, CF24 4HQ, United Kingdom, 44 29206 88434, waltersjt@cardiff.ac.uk %K cognition %K mental health %K online %K digital %K assessment %K validation %K memory %K attention %K mobile phone %D 2022 %7 10.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive impairments are features of many psychiatric disorders and affect functioning. A barrier to cognitive research on psychiatric disorders is the lack of large cross-disorder data sets. However, the collection of cognitive data can be logistically challenging and expensive. Web-based collection may be an alternative; however, little is known about who does and does not complete web-based cognitive assessments for psychiatric research. Objective: The aims of this study are to develop a web-based cognitive battery for use in psychiatric research, validate the battery against the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery, and compare the characteristics of the participants who chose to take part with those of the individuals who did not participate. Methods: Tasks were developed by The Many Brains Project and selected to measure the domains specified by the MATRICS initiative. We undertook a cross-validation study of 65 participants with schizophrenia, bipolar disorder, depression, or no history of psychiatric disorders to compare the web-based tasks with the MATRICS Consensus Cognitive Battery. Following validation, we invited participants from 2 large ongoing genetic studies, which recruited participants with psychiatric disorders to complete the battery and evaluated the demographic and clinical characteristics of those who took part. Results: Correlations between web-based and MATRICS tasks ranged between 0.26 and 0.73. Of the 961 participants, 887 (92.3%) completed at least one web-based task, and 644 (67%) completed all tasks, indicating adequate completion rates. Predictors of web-based participation included being female (odds ratio [OR] 1.3, 95% CI 1.07-1.58), ethnicity other than White European (OR 0.66, 95% CI 0.46-0.96), higher levels of education (OR 1.19, 95% CI 1.11-1.29), diagnosis of an eating disorder (OR 2.17, 95% CI 1.17-4) or depression and anxiety (OR 5.12, 95% CI 3.38-7.83), and absence of a diagnosis of schizophrenia (OR 0.59, 95% CI 0.35-0.94). Lower performance on the battery was associated with poorer functioning (B=−1.76, SE 0.26; P<.001). Conclusions: Our findings offer valuable insights into the advantages and disadvantages of testing cognitive function remotely for mental health research. %M 35142640 %R 10.2196/28233 %U https://www.jmir.org/2022/2/e28233 %U https://doi.org/10.2196/28233 %U http://www.ncbi.nlm.nih.gov/pubmed/35142640 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e26736 %T The Effectiveness of Virtual Reality Exposure–Based Cognitive Behavioral Therapy for Severe Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder: Meta-analysis %A van Loenen,Inge %A Scholten,Willemijn %A Muntingh,Anna %A Smit,Johannes %A Batelaan,Neeltje %+ GGZ inGeest Specialized Mental Health Care, Oldenaller 1, Amsterdam, 1081HJ, Netherlands, 31 207884666, w.scholten@ggzingeest.nl %K anxiety disorders %K virtual reality %K virtual reality exposure therapy %K cognitive behavioral therapy %K meta-analysis %K mobile phone %D 2022 %7 10.2.2022 %9 Review %J J Med Internet Res %G English %X Background: In recent years, virtual reality exposure–based cognitive behavioral therapy (VRE-CBT) has shown good treatment results in (subclinical) anxiety disorders and seems to be a good alternative to exposure in vivo in regular cognitive behavioral therapy (CBT). However, previous meta-analyses on the efficacy of VRE-CBT on anxiety disorders have included studies on specific phobias and subthreshold anxiety; therefore, these results may not be generalizable to patients with more severe and disabling anxiety disorders. Objective: The objective of our study is to determine the efficacy of VRE-CBT on more severe anxiety disorders, excluding specific phobias and subthreshold anxiety disorders. Meta-analyses will be conducted to examine the efficacy of VRE-CBT versus waitlist and regular CBT. Our secondary objectives are to examine whether the efficacy differs according to the type of anxiety disorder, type of recruitment, and type of VRE-CBT (virtual reality exposure either with or without regular CBT). Furthermore, attrition in VRE-CBT and CBT will be compared. Methods: Studies published until August 20, 2020, were retrieved through systematic literature searches in PubMed, PsycINFO, and Embase. We calculated the effect sizes (Hedges g) for the difference between the conditions and their 95% CIs for posttest and follow-up measurements in a random effects model. A separate meta-analysis was performed to compare attrition between the VRE-CBT and CBT conditions. Results: A total of 16 trials with 817 participants were included. We identified 10 comparisons between VRE-CBT and a waitlist condition and 13 comparisons between VRE-CBT and a CBT condition. With regard to risk of bias, information on random sequence generation, allocation concealment, and risk of bias for selective outcome reporting was often absent or unclear. The mean effect size of VRE-CBT compared with waitlist (nco=10) was medium and significant, favoring VRE-CBT (Hedges g=−0.490, 95% CI −0.82 to −0.16; P=.003). The mean effect size of VRE-CBT compared with CBT (nco=13) was small and nonsignificant, favoring CBT (Hedges g=0.083, 95% CI −0.13 to 0.30; P=.45). The dropout rates between VRE-CBT and CBT (nco=10) showed no significant difference (odds ratio 0.79, 95% CI 0.49-1.27; P=.32). There were no indications of small study effects or publication bias. Conclusions: The results of our study show that VRE-CBT is more effective than waitlist and as effective as CBT in the treatment of more severe anxiety disorders. Therefore, VRE-CBT may be considered a promising alternative to CBT for patients with more severe anxiety disorders. Higher-quality randomized controlled trials are needed to verify the robustness of these findings. %M 35142632 %R 10.2196/26736 %U https://www.jmir.org/2022/2/e26736 %U https://doi.org/10.2196/26736 %U http://www.ncbi.nlm.nih.gov/pubmed/35142632 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e31018 %T Web-Based Interventions to Help Australian Adults Address Depression, Anxiety, Suicidal Ideation, and General Mental Well-being: Scoping Review %A Skaczkowski,Gemma %A van der Kruk,Shannen %A Loxton,Sophie %A Hughes-Barton,Donna %A Howell,Cate %A Turnbull,Deborah %A Jensen,Neil %A Smout,Matthew %A Gunn,Kate %+ Department of Rural Health, Allied Health and Human Performance, University of South Australia, North Terrace, Adelaide, 5001, Australia, 61 417852537, kate.gunn@unisa.edu.au %K web-based interventions %K depression %K anxiety %K suicide %K well-being %K mental health %K technology %K access to health care %D 2022 %7 8.2.2022 %9 Review %J JMIR Ment Health %G English %X Background: A large number of Australians experience mental health challenges at some point in their lives. However, in many parts of Australia, the wait times to see general practitioners and mental health professionals can be lengthy. With increasing internet use across Australia, web-based interventions may help increase access to timely mental health care. As a result, this is an area of increasing research interest, and the number of publicly available web-based interventions is growing. However, it can be confusing for clinicians and consumers to know the resources that are evidence-based and best meet their needs. Objective: This study aims to scope out the range of web-based mental health interventions that address depression, anxiety, suicidal ideation, or general mental well-being and are freely available to Australian adults, along with their impact, acceptability, therapeutic approach, and key features. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews (PRISMA-ScR [PRISMA extension for Scoping Reviews]) guided the review process. Keywords for the search were depression, anxiety, suicide, and well-being. The search was conducted using Google as well as the key intervention databases Beacon, Head to Health, and e-Mental Health in Practice. Interventions were deemed eligible if they targeted depression, anxiety, suicidal ideation, or general mental well-being (eg, resilience) in adults; and were web-based, written in English, interactive, free, and publicly available. They also had to be guided by an evidence-based therapeutic approach. Results: Overall, 52 eligible programs were identified, of which 9 (17%) addressed depression, 15 (29%) addressed anxiety, 13 (25%) addressed general mental well-being, and 13 (25%) addressed multiple issues. Only 4% (2/52) addressed distress in the form of suicidal ideation. The most common therapeutic approach was cognitive behavioral therapy. Half of the programs guided users through exercises in a set sequence, and most programs enabled users to log in and complete the activities on their own without professional support. Just over half of the programs had been evaluated for their effectiveness in reducing symptoms, and 11% (6/52) were being evaluated at the time of writing. Program evaluation scores ranged from 44% to 100%, with a total average score of 85%. Conclusions: There are numerous web-based programs for depression, anxiety, suicidal ideation, and general well-being, which are freely and publicly available in Australia. However, identified gaps include a lack of available web-based interventions for culturally and linguistically diverse populations and programs that use newer therapeutic approaches such as acceptance and commitment therapy and dialectical behavior therapy. Despite most programs included in this review being of good quality, clinicians and consumers should pay careful attention when selecting which program to recommend and use, as variations in the levels of acceptability and impact of publicly available programs do exist. %M 35133281 %R 10.2196/31018 %U https://mental.jmir.org/2022/2/e31018 %U https://doi.org/10.2196/31018 %U http://www.ncbi.nlm.nih.gov/pubmed/35133281 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e27642 %T Therapist-Assisted Web-Based Intervention for Prolonged Grief Disorder After Cancer Bereavement: Randomized Controlled Trial %A Kaiser,Julia %A Nagl,Michaela %A Hoffmann,Rahel %A Linde,Katja %A Kersting,Anette %+ Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Semmelweisstraße 10, Leipzig, 04103, Germany, 49 34197 ext 18943, julia.kaiser@medizin.uni-leipzig.de %K digital interventions %K grief %K traumatic loss %K treatment effectiveness evaluation %K cognitive behavioral therapy %K neoplasms %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Bereavement due to cancer increases the risk of prolonged grief disorder. However, specialized treatment options for prolonged grief after a loss due to illness are still scarce. Objective: The aim of this study is to extend previous findings by evaluating a web-based cognitive behavioral intervention with asynchronous therapist support, consisting of structured writing tasks adapted specifically for prolonged grief after cancer bereavement. Methods: The intervention was evaluated in a purely web-based randomized waitlist-controlled trial. Open-access recruitment of participants was conducted on the web. Prolonged grief (Inventory of Complicated Grief), depression, anxiety, posttraumatic stress, posttraumatic growth, somatization, sleep quality, and mental and physical health were assessed on the web via validated self-report measures. Results: A total of 87 participants were randomized into the intervention group (IG; 44/87, 51%) or the waitlist control group (43/87, 49%). Of the participants, 7% (6/87) dropped out of the study (5/44, 11%, in the IG). Of the 39 completers in the IG, 37 (95%) completed all intervention tasks. The intervention reduced symptoms of prolonged grief (intention-to-treat: P<.001; η2=0.34; Cohen d=0.80) to a clinically significant extent. It had favorable effects on depression, anxiety, posttraumatic stress, posttraumatic growth, and overall mental health but not on somatization, sleep quality, or physical health. Conclusions: The web-based intervention for prolonged grief after cancer bereavement is effective in reducing symptoms of prolonged grief disorder and accompanying syndromes in a timely, easily realizable manner and addresses specific challenges of bereavement to illness. Considering web-based approaches in future mental health care policy and practice can reduce health care gaps for those who are bereaved to cancer. Trial Registration: German Clinical Trial Register U1111–1186-6255; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00011001 %M 35133286 %R 10.2196/27642 %U https://mental.jmir.org/2022/2/e27642 %U https://doi.org/10.2196/27642 %U http://www.ncbi.nlm.nih.gov/pubmed/35133286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27388 %T Characteristics of Mobile Health Platforms for Depression and Anxiety: Content Analysis Through a Systematic Review of the Literature and Systematic Search of Two App Stores %A Leong,Qiao Ying %A Sridhar,Shreya %A Blasiak,Agata %A Tadeo,Xavier %A Yeo,GeckHong %A Remus,Alexandria %A Ho,Dean %+ N.1 Institute for Health, National University of Singapore, 28 Medical Drive, Singapore, 117456, Singapore, 65 86118796, bieamr@nus.edu.sg %K mHealth %K digital medicine %K anxiety %K depression %K systematic review %K mental health conditions %K mobile phone %D 2022 %7 4.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Mobile health (mHealth) platforms show promise in the management of mental health conditions such as anxiety and depression. This has resulted in an abundance of mHealth platforms available for research or commercial use. Objective: The objective of this review is to characterize the current state of mHealth platforms designed for anxiety or depression that are available for research, commercial use, or both. Methods: A systematic review was conducted using a two-pronged approach: searching relevant literature with prespecified search terms to identify platforms in published research and simultaneously searching 2 major app stores—Google Play Store and Apple App Store—to identify commercially available platforms. Key characteristics of the mHealth platforms were synthesized, such as platform name, targeted condition, targeted group, purpose, technology type, intervention type, commercial availability, and regulatory information. Results: The literature and app store searches yielded 169 and 179 mHealth platforms, respectively. Most platforms developed for research purposes were designed for depression (116/169, 68.6%), whereas the app store search reported a higher number of platforms developed for anxiety (Android: 58/179, 32.4%; iOS: 27/179, 15.1%). The most common purpose of platforms in both searches was treatment (literature search: 122/169, 72.2%; app store search: 129/179, 72.1%). With regard to the types of intervention, cognitive behavioral therapy and referral to care or counseling emerged as the most popular options offered by the platforms identified in the literature and app store searches, respectively. Most platforms from both searches did not have a specific target age group. In addition, most platforms found in app stores lacked clinical and real-world evidence, and a small number of platforms found in the published research were available commercially. Conclusions: A considerable number of mHealth platforms designed for anxiety or depression are available for research, commercial use, or both. The characteristics of these mHealth platforms greatly vary. Future efforts should focus on assessing the quality—utility, safety, and effectiveness—of the existing platforms and providing developers, from both commercial and research sectors, a reporting guideline for their platform description and a regulatory framework to facilitate the development, validation, and deployment of effective mHealth platforms. %M 35119370 %R 10.2196/27388 %U https://www.jmir.org/2022/2/e27388 %U https://doi.org/10.2196/27388 %U http://www.ncbi.nlm.nih.gov/pubmed/35119370 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30359 %T Opportunities and Challenges for Professionals in Psychiatry and Mental Health Care Using Digital Technologies During the COVID-19 Pandemic: Systematic Review %A Kane,Hélène %A Gourret Baumgart,Jade %A El-Hage,Wissam %A Deloyer,Jocelyn %A Maes,Christine %A Lebas,Marie-Clotilde %A Marazziti,Donatella %A Thome,Johannes %A Fond-Harmant,Laurence %A Denis,Frédéric %+ Laboratoire Éducation, Éthique, Santé, Université de Tours, Boulevard Tonnellé, Tours, 37032, France, 33 279060019, helene.kane@gmail.com %K COVID-19 %K e–mental health %K professional practices %K quality of care %K telepsychiatry %K videoconferencing %D 2022 %7 4.2.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has required psychiatric and mental health professionals to change their practices to reduce the risk of transmission of SARS-CoV-2, in particular by favoring remote monitoring and assessment via digital technologies. Objective: As part of a research project that was cofunded by the French National Research Agency (ARN) and the Centre-Val de Loire Region, the aim of this systematic literature review was to investigate how such uses of digital technologies have been developing. Methods: This systematic review was conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The search was carried out in the MEDLINE (ie, PubMed) and Cairn databases, as well as in a platform specializing in mental health, Ascodocpsy. The search yielded 558 results for the year 2020. After applying inclusion and exclusion criteria, first on titles and abstracts and then on full texts, 61 articles were included. Results: The analysis of the literature revealed a heterogeneous integration of digital technologies, not only depending on countries, contexts, and local regulations, but also depending on the modalities of care. Notwithstanding these variations, the use of videoconferencing has developed significantly, affecting working conditions and therapeutic relationships. For many psychiatric and mental health professionals, the pandemic has been an opportunity to build up their experience of remote care and, thus, better identify the possibilities and limits of these digital technologies. Conclusions: New uses of such technologies essentially consist of a transition from the classic consultation model toward teleconsultation and make less use of the specific potential of artificial intelligence. As professionals were not prepared for these uses, they were confronted with practical difficulties and ethical questions, such as the place of digital technology in care, confidentiality and protection of personal data, and equity in access to care. The COVID-19 health crisis questions how the organization of health care integrates the possibilities offered by digital technology, in particular to promote the autonomy and empowerment of mental health service users. %M 34736224 %R 10.2196/30359 %U https://humanfactors.jmir.org/2022/1/e30359 %U https://doi.org/10.2196/30359 %U http://www.ncbi.nlm.nih.gov/pubmed/34736224 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e32992 %T Assessing the Efficacy of an Individualized Psychological Flexibility Skills Training Intervention App for Medical Student Burnout and Well-being: Protocol for a Randomized Controlled Trial %A Ditton,Elizabeth %A Knott,Brendon %A Hodyl,Nicolette %A Horton,Graeme %A Walker,Frederick Rohan %A Nilsson,Michael %+ Centre for Rehab Innovations, University of Newcastle, University Drive, Callaghan, 2308, Australia, 61 2 404 ext 20738, elizabeth.ditton@newcastle.edu.au %K burnout %K psychological %K burnout interventions %K psychological flexibility %K digital intervention %K individualized intervention %K acceptance and commitment therapy %K medical students %K well-being %K mobile phone %D 2022 %7 4.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Medical student burnout is a prevalent problem with adverse long-term outcomes. Incorporating psychological resource-building interventions into comprehensive burnout prevention approaches during medical training is an identified priority among educators. These interventions could reduce burnout risk by buffering students against nonmodifiable career stressors. However, there is a need for rigorous investigation into optimal intervention targets and methods. Psychological flexibility (PF) is an adaptive behavioral skill set that has demonstrated relationships with medical student burnout and well-being. More broadly, there is evidence that PF mediates burnout and well-being outcomes and may be a protective factor. Efficacy studies assessing the benefits of interventions targeting PF among medical students are needed. Research also supports the need to establish optimal methods for increasing intervention efficacy in the context of individual differences in burnout and PF by using individualized approaches. Objective: This study aims to assess whether an app-delivered PF intervention (Acceptance and Commitment Training) reduces burnout and improves well-being among medical students. We will examine whether changes in burnout and well-being are mediated by changes in PF. The potential benefits of an individualized version of the app versus those of a nonindividualized version will also be evaluated. Methods: In this 3-arm, parallel, randomized controlled study, a sample of medical students will be randomly allocated to 1 of 3 intervention arms (individualized, nonindividualized, and waiting list) by using a 1:1:1 allocation ratio. Participants in the individualized and nonindividualized intervention arms will have 5 weeks to access the app, which includes a PF concepts training session (stage 1) and access to short PF skill activities on demand (stage 2). Stage 2 will be either individualized to meet participants’ identified PF training needs at each log-in or nonindividualized. Results: Burnout, well-being, and PF will be assessed at baseline and after the intervention. Quantitative analyses will include descriptive and inferential statistics. We hypothesize that the Acceptance and Commitment Training intervention app will be effective in improving burnout and well-being and that changes in these outcomes will be mediated by changes in PF. We further hypothesize that participants in the individualized intervention group will demonstrate greater improvements in burnout and well-being outcomes than those in the nonindividualized group. Conclusions: The findings of this study could guide the development of burnout prevention and well-being initiatives for medical students. Identifying PF as a mediating process would provide support for the delivery of preventive intervention programs that train individuals to strengthen this psychological resource before burnout symptoms emerge. This would be an important step in addressing and potentially offsetting the significant costs of burnout among medical students and physicians. Demonstrating the superiority of an individualized version of the app over a nonindividualized version would have implications for enhancing intervention precision and efficacy by using scalable interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ANZCTR 12621000911897; https://www.anzctr.org.au/ACTRN12621000911897.aspx International Registered Report Identifier (IRRID): PRR1-10.2196/32992 %M 35119378 %R 10.2196/32992 %U https://www.researchprotocols.org/2022/2/e32992 %U https://doi.org/10.2196/32992 %U http://www.ncbi.nlm.nih.gov/pubmed/35119378 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31565 %T Real-world Implementation of a Smartphone-Based Psychoeducation Program for Bipolar Disorder: Observational Ecological Study %A García-Estela,Aitana %A Cantillo,Jordi %A Angarita-Osorio,Natalia %A Mur-Milà,Estanislao %A Anmella,Gerard %A Pérez,Víctor %A Vieta,Eduard %A Hidalgo-Mazzei,Diego %A Colom,Francesc %+ Mental Health Research Group, Hospital del Mar Medical Research Institute (IMIM), Office 202, PRBB Building, Doctor Aiguader, 88, Barcelona, 08003, Spain, 34 933160400 ext 1493, fcolom@imim.es %K bipolar disorder %K psychoeducation %K smartphone %K app %K SIMPLe %K Intervention %K mobile phone %D 2022 %7 2.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: SIMPLe is an internet‐delivered self‐management mobile app for bipolar disorder (BD) designed to combine technology with evidence-based interventions and facilitate access to psychoeducational content. The SIMPLe app was launched to the real world to make it available worldwide within the context of BD treatment. Objective: The main aims of this study are as follows: to describe app use, engagement, and retention rates based on server data; to identify patterns of user retention over the first 6-month follow-up of use; and to explore potential factors contributing to discontinuation of app use. Methods: This was an observational ecological study in which we pooled available data from a real-world implementation of the SIMPLe app. Participation was open on the project website, and the data-collection sources were a web-based questionnaire on clinical data and treatment history administered at inclusion and at 6 months, subjective data gathered through continuous app use, and the use patterns captured by the app server. Characteristics and engagement of regular users, occasional users, and no users were compared using 2-tailed t tests or analysis of variance or their nonparametric equivalent. Survival analysis and risk functions were applied to regular users’ data to examine and compare use and user retention. In addition, a user evaluation analysis was performed based on satisfaction, perceived usefulness, and reasons to discontinue app use. Results: We included 503 participants with data collected between 2016 and 2018, of whom 77.5% (n=390) used the app. Among the app users, 44.4% (173/390) completed the follow-up assessment, and data from these participants were used in our analyses. Engagement declined gradually over the first 6 months of use. The probability of retention of the regular users after 1 month of app use was 67.4% (263/390; 95% CI 62.7%-72.4%). Age (P=.002), time passed since illness onset (P<.001), and years since diagnosis of BD (P=.048) correlate with retention duration. In addition, participants who had been diagnosed with BD for longer used the app on more days (mean 97.73, SD 69.15 days; P=.002) than those who had had a more recent onset (mean 66.49, SD 66.18 days; P=.002) or those who had been diagnosed more recently (mean 73.45, SD 66 days; P=.01). Conclusions: The user retention rate of the app decreased rapidly after each month until reaching only one-third of the users at 6 months. There exists a strong association between age and app engagement of individuals with BD. Other variables such as years lived with BD, diagnosis of an anxiety disorder, and taking antipsychotics seem relevant as well. Understanding these associations can help in the definition of the most suitable user profiles for predicting trends of engagement, optimization of app prescription, and management. %M 35107440 %R 10.2196/31565 %U https://www.jmir.org/2022/2/e31565 %U https://doi.org/10.2196/31565 %U http://www.ncbi.nlm.nih.gov/pubmed/35107440 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27781 %T Perceived Acceptability and Experiences of a Digital Psychoeducation and Peer Support Intervention (COPe-support): Interview Study With Carers Supporting Individuals With Psychosis %A Batchelor,Rachel %A Gulshan,Sarah %A Shritharan,Halpana %A Williams,Elen %A Henderson,Claire %A Gillard,Steve %A Woodham,Luke A %A Cornelius,Victoria %A Elkes,Jack %A Sin,Jacqueline %+ School of Health Sciences, City, University of London, Myddelton Street Building, 1 Myddelton Street, London, EC1R 1UW, United Kingdom, 44 07817027035, jacqueline.sin@city.ac.uk %K eHealth %K family carers %K qualitative research %K psychosis %K peer support %K web-based psychoeducation %K mobile phone %D 2022 %7 2.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based mental health interventions offer a novel, accessible, and self-paced approach to care delivery to family carers (ie, relatives and close friends who support a loved one with psychosis). We coproduced COPe-support (Carers fOr People with Psychosis e-support), a psychoeducational intervention delivered via an enriched web-based learning environment with network support from professionals and peers. In addition to the rigorous investigation of the effectiveness of COPe-support on the well-being of carers and mental health outcomes, it is imperative to understand the experiences of using the web-based intervention by carers and its associated web-based implementation and facilitation strategies. Objective: This study aims to explore the experiences of carers and perceived acceptability of COPe-support and its different components, how carers found engagement with COPe-support affected their own well-being and caregiving, and the ideas of carers for improving COPe-support and its delivery to inform any future wider implementation. Methods: We conducted a qualitative study, individually interviewing 35 carers, following their use of COPe-support for 8 months through a web-based, randomized controlled trial across England. A semistructured guide with open-ended questions was used to explore the experiences of carers and perceived acceptability of the intervention and their ideas to improve the provision. All interviews were conducted remotely through mobile phones or internet communication media, audio recorded and transcribed verbatim. We used a thematic analysis framework to analyze the data. Results: Three key themes were identified: remote, flexible, and personalized support; impacts on well-being and outlook on caregiving; and future implementation and integration with existing services. Overall, carers found COPe-support a flexible source of knowledge and support from professionals and peers that they could personalize to suit their own needs and convenience. Participants described gaining self-confidence, hope, and a sense of connectivity with others in a similar situation, which helped ameliorate isolation and perceived stigma. Most importantly, COPe-support promoted self-care among the carers themselves. Participants’ experiences, use, and activity on COPe-support varied greatly and differed among carers of various ages and levels of computer literacy. Conclusions: Nearly all participants had a positive experience with COPe-support and supported its wider implementation as a beneficial adjunctive support resource for carers in the future. Any future scale-up of such an intervention needs to consider feedback from carers and suggestions for further improvement. These included having more graphics and audiovisual content materials, improving the navigation, and building in more interactional and customization options to suit various user styles, such as emoji reactions, live web-based chat, opting in and out of updates, and choosing the frequency of reminders. To ensure successful implementation, we should also consider factors pertinent to reaching more carers and integrating the web-based resources with other conventional services. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 89563420; https://www.isrctn.com/ISRCTN89563420 International Registered Report Identifier (IRRID): RR2-10.1186/s12888-020-02528-w %M 35107439 %R 10.2196/27781 %U https://www.jmir.org/2022/2/e27781 %U https://doi.org/10.2196/27781 %U http://www.ncbi.nlm.nih.gov/pubmed/35107439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e33374 %T An Internet-Based Cognitive Behavioral Therapy Program for Anxiety and Depression (Tranquility): Adaptation Co-design and Fidelity Evaluation Study %A Patterson,Victoria C %A Rossi,Meghan A %A Pencer,Alissa %A Wozney,Lori %+ Department of Psychology and Neuroscience, Dalhousie University, P.O. Box 15000, Halifax, NS, B3H 4R2, Canada, 1 9024944466, alissa.pencer@dal.ca %K cognitive behavioral therapy %K anxiety %K depression %K fidelity %K usability %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) is a necessary step toward increasing the accessibility of mental health services. Yet, few iCBT programs have been evaluated for their fidelity to the therapeutic principles of cognitive behavioral therapy (CBT) or usability standards. In addition, many existing iCBT programs do not include treatments targeting both anxiety and depression, which are commonly co-occurring conditions. Objective: This study aims to evaluate the usability of Tranquility—a novel iCBT program for anxiety—and its fidelity to CBT principles. This study also aims to engage in a co-design process to adapt Tranquility to include treatment elements for depression. Methods: CBT experts (n=6) and mental health–informed peers (n=6) reviewed the iCBT program Tranquility. CBT experts assessed Tranquility’s fidelity to CBT principles and were asked to identify necessary interventions for depression by using 2 simulated client case examples. Mental health–informed peers engaged in 2 co-design focus groups to discuss adaptations to the existing anxiety program and the integration of interventions for depression. Both groups completed web-based surveys assessing the usability of Tranquility and the likelihood that they would recommend the program. Results: The CBT experts’ mean rating of Tranquility’s fidelity to CBT principles was 91%, indicating a high fidelity to CBT. Further, 5 out of 6 CBT experts and all mental health–informed peers (all participants: 11/12, 88%) rated Tranquility as satisfactory, indicating that they may recommend Tranquility to others, and they rated its usability highly (mean 76.56, SD 14.07). Mental health–informed peers provided suggestions on how to leverage engagement with Tranquility (eg, adding incentives and notification control). Conclusions: This preliminary study demonstrated the strong fidelity of Tranquility to CBT and usability standards. The results highlight the importance of involving stakeholders in the co-design process and future opportunities to increase engagement. %M 34910660 %R 10.2196/33374 %U https://formative.jmir.org/2022/2/e33374 %U https://doi.org/10.2196/33374 %U http://www.ncbi.nlm.nih.gov/pubmed/34910660 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e31036 %T Promoting Resilience and Well-being Through Co-design (The PRIDE Project): Protocol for the Development and Preliminary Evaluation of a Prototype Resilience-Based Intervention for Sexual and Gender Minority Youth %A Lucassen,Mathijs F G %A Samra,Rajvinder %A Rimes,Katharine A %A Brown,Katherine E %A Wallace,Louise M %+ Department of Health and Social Care, The Open University, Walton Hall, School of Health, Wellbeing and Social Care, Milton Keynes, MK7 6AA, United Kingdom, 44 01908652987, mathijs.lucassen@open.ac.uk %K LGBT %K e-therapy %K depression %K adolescent %K youth %K online %K sexuality %K gender %K resilience %K public health %D 2022 %7 1.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual and gender minority youth (SGMY) are at an increased risk of a range of mental health problems. However, few evidence-informed interventions have been developed specifically to support their mental well-being. Interventions that are evidence-informed for the general population and are fine-tuned specifically with SGMY in mind proffer considerable potential. A particular opportunity lies in the delivery of engaging interventions on the web, where the focus is on enhancing the coping skills and building the resilience of SGMY, in a way that is directly relevant to their experiences. On the basis of earlier work related to an intervention called Rainbow SPARX (Smart, Positive, Active, Realistic, X-factor thoughts), we seek to create a new resource, especially for SGMY in the United Kingdom. Objective: This project has 3 main objectives. First, together with SGMY as well as key adult experts, we aim to co-design a media-rich evidence-informed web-based SGMY well-being prototype toolkit aimed at those aged between 13 and 19 years. Second, we will explore how the web-based toolkit can be used within public health systems in the United Kingdom by SGMY and potentially other relevant stakeholders. Third, we aim to conduct a preliminary evaluation of the toolkit, which will inform the design of a future effectiveness study. Methods: The first objective will be met by conducting the following: approximately 10 interviews with SGMY and 15 interviews with adult experts, a scoping review of studies focused on psychosocial coping strategies for SGMY, and co-design workshops with approximately 20 SGMY, which will inform the creation of the prototype toolkit. The second objective will be met by carrying out interviews with approximately 5 selected adult experts and 10 SGMY to explore how the toolkit can be best used and to determine the parameters and user-generated standards for a future effectiveness trial. The final objective will be met with a small-scale process evaluation, using the think out loud methodology, conducted with approximately 10 SGMY. Results: The study commenced on September 1, 2021, and data gathering for phase 1 began in October 2021. Conclusions: A considerable body of work has described the issues faced by the SGMY. However, there is a dearth of research seeking to develop interventions for SGMY so that they can thrive. This project aims to co-design such an intervention. Trial Registration: Research Registry Reference researchregistry6815; https://www.researchregistry.com/browse-the-registry#home/registrationdetails/609e81bda4a706001c94b63a/ International Registered Report Identifier (IRRID): PRR1-10.2196/31036 %M 35103613 %R 10.2196/31036 %U https://www.researchprotocols.org/2022/2/e31036 %U https://doi.org/10.2196/31036 %U http://www.ncbi.nlm.nih.gov/pubmed/35103613 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e32832 %T Diagnostic Performance of an App-Based Symptom Checker in Mental Disorders: Comparative Study in Psychotherapy Outpatients %A Hennemann,Severin %A Kuhn,Sebastian %A Witthöft,Michael %A Jungmann,Stefanie M %+ Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, University of Mainz, Wallstr 3, Mainz, 55122, Germany, 49 61313939215, s.hennemann@uni-mainz.de %K mHealth %K symptom checker %K diagnostics %K mental disorders %K psychotherapy %K mobile phone %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital technologies have become a common starting point for health-related information-seeking. Web- or app-based symptom checkers aim to provide rapid and accurate condition suggestions and triage advice but have not yet been investigated for mental disorders in routine health care settings. Objective: This study aims to test the diagnostic performance of a widely available symptom checker in the context of formal diagnosis of mental disorders when compared with therapists’ diagnoses based on structured clinical interviews. Methods: Adult patients from an outpatient psychotherapy clinic used the app-based symptom checker Ada–check your health (ADA; Ada Health GmbH) at intake. Accuracy was assessed as the agreement of the first and 1 of the first 5 condition suggestions of ADA with at least one of the interview-based therapist diagnoses. In addition, sensitivity, specificity, and interrater reliabilities (Gwet first-order agreement coefficient [AC1]) were calculated for the 3 most prevalent disorder categories. Self-reported usability (assessed using the System Usability Scale) and acceptance of ADA (assessed using an adapted feedback questionnaire) were evaluated. Results: A total of 49 patients (30/49, 61% women; mean age 33.41, SD 12.79 years) were included in this study. Across all patients, the interview-based diagnoses matched ADA’s first condition suggestion in 51% (25/49; 95% CI 37.5-64.4) of cases and 1 of the first 5 condition suggestions in 69% (34/49; 95% CI 55.4-80.6) of cases. Within the main disorder categories, the accuracy of ADA’s first condition suggestion was 0.82 for somatoform and associated disorders, 0.65 for affective disorders, and 0.53 for anxiety disorders. Interrater reliabilities ranged from low (AC1=0.15 for anxiety disorders) to good (AC1=0.76 for somatoform and associated disorders). The usability of ADA was rated as high in the System Usability Scale (mean 81.51, SD 11.82, score range 0-100). Approximately 71% (35/49) of participants would have preferred a face-to-face over an app-based diagnostic. Conclusions: Overall, our findings suggest that a widely available symptom checker used in the formal diagnosis of mental disorders could provide clinicians with a list of condition suggestions with moderate-to-good accuracy. However, diagnostic performance was heterogeneous between disorder categories and included low interrater reliability. Although symptom checkers have some potential to complement the diagnostic process as a screening tool, the diagnostic performance should be tested in larger samples and in comparison with further diagnostic instruments. %M 35099395 %R 10.2196/32832 %U https://mental.jmir.org/2022/1/e32832 %U https://doi.org/10.2196/32832 %U http://www.ncbi.nlm.nih.gov/pubmed/35099395 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30766 %T User Experience, Engagement, and Popularity in Mental Health Apps: Secondary Analysis of App Analytics and Expert App Reviews %A Kaveladze,Benjamin T %A Wasil,Akash R %A Bunyi,John B %A Ramirez,Veronica %A Schueller,Stephen M %+ Department of Psychological Science, University of California, 4201 Social & Behavioral Sciences Gateway, Irvine, CA, 92697-7085, United States, 1 310 984 9318, bkavelad@uci.edu %K mental health apps %K engagement %K user experience %K digital mental health %K user retention %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: User experience and engagement are critical elements of mental health apps’ abilities to support users. However, work examining the relationships among user experience, engagement, and popularity has been limited. Understanding how user experience relates to engagement with and popularity of mental health apps can demonstrate the relationship between subjective and objective measures of app use. In turn, this may inform efforts to develop more effective and appealing mental health apps and ensure that they reach wide audiences. Objective: We aimed to examine the relationship among subjective measures of user experience, objective measures of popularity, and engagement in mental health apps. Methods: We conducted a preregistered secondary data analysis in a sample of 56 mental health apps. To measure user experience, we used expert ratings on the Mobile App Rating Scale (MARS) and consumer ratings from the Apple App Store and Google Play. To measure engagement, we acquired estimates of monthly active users (MAU) and user retention. To measure app popularity, we used download count, total app revenue, and MAU again. Results: MARS total score was moderately positively correlated with app-level revenue (Kendall rank [T]=0.30, P=.002), MAU (T=0.39, P<.001), and downloads (T=0.41, P<.001). However, the MARS total score and each of its subscales (Engagement, Functionality, Aesthetics, and Information) showed extremely small correlations with user retention 1, 7, and 30 days after downloading. Furthermore, the total MARS score only correlated with app store rating at T=0.12, which, at P=.20, did not meet our threshold for significance. Conclusions: More popular mental health apps receive better ratings of user experience than less popular ones. However, user experience does not predict sustained engagement with mental health apps. Thus, mental health app developers and evaluators need to better understand user experience and engagement, as well as to define sustained engagement, what leads to it, and how to create products that achieve it. This understanding might be supported by better collaboration between industry and academic teams to advance a science of engagement. %M 35099398 %R 10.2196/30766 %U https://humanfactors.jmir.org/2022/1/e30766 %U https://doi.org/10.2196/30766 %U http://www.ncbi.nlm.nih.gov/pubmed/35099398 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32552 %T The Impact of the COVID-19 Infodemic on Depression and Sleep Disorders: Focusing on Uncertainty Reduction Strategies and Level of Interpretation Theory %A Jung,Soyoung %A Jung,Sooin %+ The School of Journalism and Communication, Renmin University of China, 59 Zhongguancun Street, Haidian District, Room 502, Mingde Building, Beijing, 100872, China, 86 10 62514835, soyoungjungs@gmail.com %K COVID-19 %K social media %K infodemic %K construal level theory %K uncertainty reduction strategy %K depression %K sleep disorder %K preventive actions, affective reaction %K infodemiology %K misinformation %K uncertainty %K strategy %K mental health %K sleep %K prevention %K survey %K usage %K behavior %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, information diffusion about the COVID-19 has attracted public attention through social media. The World Health Organization declared an infodemic of COVID-19 on February 15, 2020. Misinformation and disinformation, including overwhelming amounts of information about COVID-19 on social media, could promote adverse psychological effects. Objective: This study used the Psychological Distance and Level of Construal theory (CLT) to predict peoples’ negative psychological symptoms from social media usage. In this study, the CLT intended to show peoples’ psychological proximity to objects and events with respect to the COVID-19 pandemic. Furthermore, this study links the uncertainty reduction strategy (URS) and CLT for COVID-19–related preventive behaviors and affective reactions to assess their effects on mental health problems. Methods: A path model was tested (N=297) with data from a web-based survey to examine how social media usage behaviors are associated with URS and psychological distance with COVID-19 (based on the CLT), leading to preventive behaviors and affective reactions. Finally, the path model was used to examine how preventive behaviors and affective reactions are associated with mental health problems including anxiety and sleep disorder. Results: After measuring participants’ social media usage behavior, we found that an increase in general social media usage led to higher use of the URS and lower construal level on COVID-19. The URS is associated with preventive behaviors, but the CLT did not show any association with preventive behaviors; however, it increases affective reactions. Moreover, increased preventive behavior showed negative associations with symptoms of mental health problems; that is, depression and sleep disorder. However, the affective reaction tends to be positively associated with depression and sleep disorder. Owing to the infodemic of COVID-19, the psychological perception of the pandemic negatively influenced users’ mental health problems. Conclusions: Our results imply that the information from social media usage heightened concerns and had a lower construal level; this does not facilitate taking preventive actions but rather reinforces the negative emotional reaction and mental health problems. Thus, higher URS usage is desirable. %M 34870609 %R 10.2196/32552 %U https://formative.jmir.org/2022/1/e32552 %U https://doi.org/10.2196/32552 %U http://www.ncbi.nlm.nih.gov/pubmed/34870609 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31674 %T The Effect of Internet-Delivered Cognitive Behavioral Therapy Versus Psychoeducation Only on Psychological Distress in Patients With Noncardiac Chest Pain: Randomized Controlled Trial %A Mourad,Ghassan %A Eriksson-Liebon,Magda %A Karlström,Patric %A Johansson,Peter %+ Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden, 46 +46736209582, ghassan.mourad@liu.se %K cardiac anxiety %K cognitive behavioral therapy %K health-related quality of life %K internet delivered %K noncardiac chest pain %K psychological distress %D 2022 %7 28.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with recurrent episodes of noncardiac chest pain (NCCP) experience cardiac anxiety as they misinterpret the pain to be cardiac related and avoid physical activity that they think could threaten their lives. Psychological interventions, such as internet-delivered cognitive behavioral therapy (iCBT), targeting anxiety can be a feasible solution by supporting patients to learn how to perceive and handle their chest pain. Objective: This study aims to evaluate the effects of a nurse-led iCBT program on cardiac anxiety and other patient-reported outcomes in patients with NCCP. Methods: Patients with at least two health care consultations because of NCCP during the past 6 months, and who were experiencing cardiac anxiety (Cardiac Anxiety Questionnaire score ≥24), were randomized into 5 weeks of iCBT (n=54) or psychoeducation (n=55). Patients were aged 54 (SD 17) years versus 57 (SD 16) years and were mainly women (32/54, 59% vs 35/55, 64%). The iCBT program comprised psychoeducation, mindfulness, and exposure to physical activity, with weekly homework assignments. The primary outcome was cardiac anxiety. The secondary outcomes were fear of bodily sensations, depressive symptoms, health-related quality of life, and chest pain frequency. Intention-to-treat analysis was applied, and the patients were followed up for 3 months. Mixed model analysis was used to determine between-group differences in primary and secondary outcomes. Results: No significant differences were found between the iCBT and psychoeducation groups regarding cardiac anxiety or any of the secondary outcomes in terms of the interaction effect of time and group over the 3-month follow-up. iCBT demonstrated a small effect size on cardiac anxiety (Cohen d=0.31). In the iCBT group, 36% (16/44) of patients reported a positive reliable change score (≥11 points on the Cardiac Anxiety Questionnaire), and thus an improvement in cardiac anxiety, compared with 27% of (13/48) patients in the psychoeducation group. Within-group analysis showed further significant improvement in cardiac anxiety (P=.04) at the 3-month follow-up compared with the 5-week follow-up in the iCBT group but not in the psychoeducation group. Conclusions: iCBT was not superior to psychoeducation in decreasing cardiac anxiety in patients with NCCP. However, iCBT tends to have better long-term effects on psychological distress, including cardiac anxiety, health-related quality of life, and NCCP frequency than psychoeducation. The effects need to be followed up to draw more reliable conclusions. Trial Registration: ClinicalTrials.gov NCT03336112; https://www.clinicaltrials.gov/ct2/show/NCT03336112 %M 35089153 %R 10.2196/31674 %U https://www.jmir.org/2022/1/e31674 %U https://doi.org/10.2196/31674 %U http://www.ncbi.nlm.nih.gov/pubmed/35089153 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e28095 %T The Association Between Home Stay and Symptom Severity in Major Depressive Disorder: Preliminary Findings From a Multicenter Observational Study Using Geolocation Data From Smartphones %A Laiou,Petroula %A Kaliukhovich,Dzmitry A %A Folarin,Amos A %A Ranjan,Yatharth %A Rashid,Zulqarnain %A Conde,Pauline %A Stewart,Callum %A Sun,Shaoxiong %A Zhang,Yuezhou %A Matcham,Faith %A Ivan,Alina %A Lavelle,Grace %A Siddi,Sara %A Lamers,Femke %A Penninx,Brenda WJH %A Haro,Josep Maria %A Annas,Peter %A Cummins,Nicholas %A Vairavan,Srinivasan %A Manyakov,Nikolay V %A Narayan,Vaibhav A %A Dobson,Richard JB %A Hotopf,Matthew %A , %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Memory Lane, London, SE5 8AF, United Kingdom, 44 20 7848 0002, petroula.laiou@kcl.ac.uk %K major depressive disorder %K PHQ-8 %K smartphone %K GPS %K home stay %K mobile phone %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most smartphones and wearables are currently equipped with location sensing (using GPS and mobile network information), which enables continuous location tracking of their users. Several studies have reported that various mobility metrics, as well as home stay, that is, the amount of time an individual spends at home in a day, are associated with symptom severity in people with major depressive disorder (MDD). Owing to the use of small and homogeneous cohorts of participants, it is uncertain whether the findings reported in those studies generalize to a broader population of individuals with MDD symptoms. Objective: The objective of this study is to examine the relationship between the overall severity of depressive symptoms, as assessed by the 8-item Patient Health Questionnaire, and median daily home stay over the 2 weeks preceding the completion of a questionnaire in individuals with MDD. Methods: We used questionnaire and geolocation data of 164 participants with MDD collected in the observational Remote Assessment of Disease and Relapse–Major Depressive Disorder study. The participants were recruited from three study sites: King’s College London in the United Kingdom (109/164, 66.5%); Vrije Universiteit Medisch Centrum in Amsterdam, the Netherlands (17/164, 10.4%); and Centro de Investigación Biomédica en Red in Barcelona, Spain (38/164, 23.2%). We used a linear regression model and a resampling technique (n=100 draws) to investigate the relationship between home stay and the overall severity of MDD symptoms. Participant age at enrollment, gender, occupational status, and geolocation data quality metrics were included in the model as additional explanatory variables. The 95% 2-sided CIs were used to evaluate the significance of model variables. Results: Participant age and severity of MDD symptoms were found to be significantly related to home stay, with older (95% CI 0.161-0.325) and more severely affected individuals (95% CI 0.015-0.184) spending more time at home. The association between home stay and symptoms severity appeared to be stronger on weekdays (95% CI 0.023-0.178, median 0.098; home stay: 25th-75th percentiles 17.8-22.8, median 20.9 hours a day) than on weekends (95% CI −0.079 to 0.149, median 0.052; home stay: 25th-75th percentiles 19.7-23.5, median 22.3 hours a day). Furthermore, we found a significant modulation of home stay by occupational status, with employment reducing home stay (employed participants: 25th-75th percentiles 16.1-22.1, median 19.7 hours a day; unemployed participants: 25th-75th percentiles 20.4-23.5, median 22.6 hours a day). Conclusions: Our findings suggest that home stay is associated with symptom severity in MDD and demonstrate the importance of accounting for confounding factors in future studies. In addition, they illustrate that passive sensing of individuals with depression is feasible and could provide clinically relevant information to monitor the course of illness in patients with MDD. %M 35089148 %R 10.2196/28095 %U https://mhealth.jmir.org/2022/1/e28095 %U https://doi.org/10.2196/28095 %U http://www.ncbi.nlm.nih.gov/pubmed/35089148 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e26049 %T FOCUS mHealth Intervention for Veterans With Serious Mental Illness in an Outpatient Department of Veterans Affairs Setting: Feasibility, Acceptability, and Usability Study %A Buck,Benjamin %A Nguyen,Janelle %A Porter,Shelan %A Ben-Zeev,Dror %A Reger,Greg M %+ Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 221 8518, buckbe@uw.edu %K mHealth %K veterans %K schizophrenia %K serious mental illness %K mobile phone %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Veterans with serious mental illnesses (SMIs) face barriers to accessing in-person evidence-based interventions that improve illness management. Mobile health (mHealth) has been demonstrated to be feasible, acceptable, effective, and engaging among individuals with SMIs in community mental health settings. mHealth for SMIs has not been tested within the Department of Veterans Affairs (VA). Objective: This study examines the feasibility, acceptability, and preliminary effectiveness of an mHealth intervention for SMI in the context of VA outpatient care. Methods: A total of 17 veterans with SMIs were enrolled in a 1-month pilot trial of FOCUS, a smartphone-based self-management intervention for SMI. At baseline and posttest, they completed measures examining symptoms and functional recovery. The participants provided qualitative feedback related to the usability and acceptability of the intervention. Results: Veterans completed on an average of 85.0 (SD 96.1) interactions with FOCUS over the 1-month intervention period. They reported high satisfaction, usability, and acceptability, with nearly all participants (16/17, 94%) reporting that they would recommend the intervention to a fellow veteran. Clinicians consistently reported finding mHealth-related updates useful for informing their care. Qualitative feedback indicated that veterans thought mHealth complemented their existing VA services well and described potential opportunities to adapt FOCUS to specific subpopulations (eg, combat veterans) as well as specific delivery modalities (eg, groups). In the 1-month period, the participants experienced small improvements in self-assessed recovery, auditory hallucinations, and quality of life. Conclusions: The FOCUS mHealth intervention is feasible, acceptable, and usable among veterans. Future work should develop and examine VA-specific implementation approaches of FOCUS for this population. %M 35089151 %R 10.2196/26049 %U https://mental.jmir.org/2022/1/e26049 %U https://doi.org/10.2196/26049 %U http://www.ncbi.nlm.nih.gov/pubmed/35089151 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e33114 %T Problematic Internet Use Before and During the COVID-19 Pandemic in Youth in Outpatient Mental Health Treatment: App-Based Ecological Momentary Assessment Study %A Gansner,Meredith %A Nisenson,Melanie %A Lin,Vanessa %A Pong,Sovannarath %A Torous,John %A Carson,Nicholas %+ Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, 02139, United States, 1 617 575 5498, meredith.gansner@gmail.com %K COVID-19 %K problematic internet use %K ecological momentary assessment %K internet %K app %K youth %K young adult %K teenager %K outpatient %K mental health %K treatment %K pilot %K cohort %K change %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Youth with existing psychiatric illness are more apt to use the internet as a coping skill. Because many “in-person” coping skills were not easily accessible during the COVID-19 pandemic, youth in outpatient mental health treatment may have been particularly vulnerable to the development of problematic internet use (PIU). The identification of a pandemic-associated worsening of PIU in this population is critical in order to guide clinical care; if these youth have become dependent upon the internet to regulate their negative emotions, PIU must be addressed as part of mental health treatment. However, many existing studies of youth digital media use in the pandemic do not include youth in psychiatric treatment or are reliant upon cross-sectional methodology and self-report measures of digital media use. Objective: This is a retrospective cohort study that used data collected from an app-based ecological momentary assessment protocol to examine potential pandemic-associated changes in digital media youth in outpatient mental health treatment. Secondary analyses assessed for differences in digital media use dependent upon personal and familial COVID-19 exposure and familial hospitalization, as well as factors associated with PIU in this population. Methods: The participants were aged 12-23 years and were receiving mental health treatment in an outpatient community hospital setting. All participants completed a 6-week daily ecological momentary assessment protocol on their personal smartphones. Questions were asked about depression (PHQ-8 [8-item Patient Health Questionnaire]), anxiety (GAD-7 [7-item General Anxiety Disorder]), PIU (PIU-SF-6 [Problematic Internet Use Short Form 6]), digital media use based on Apple’s daily screen time reports, and personal and familial COVID-19 exposure. The analyses compared screen time, psychiatric symptoms, and PIU between cohorts, as well as between youth with personal or familial COVID-19 exposures and those without. The analyses also assessed for demographic and psychiatric factors associated with clinically significant PIU-SF-6 scores. Results: A total of 69 participants completed the study. The participants recruited during the pandemic were significantly more likely to meet the criteria for PIU based on their average PIU-SF-6 score (P=.02) and to spend more time using social media each day (P=.049). The overall amount of daily screen time did not differ between cohorts. Secondary analyses revealed a significant increase in average daily screen time among subjects who were exposed to COVID-19 (P=.01). Youth with clinically significant PIU-SF-6 scores were younger and more likely to have higher PHQ-8 (P=.003) and GAD-7 (P=.003) scores. No differences in scale scores or media use were found between subjects based on familial COVID-19 exposure or hospitalization. Conclusions: Our findings support our hypothesis that PIU may have worsened for youth in mental health treatment during the pandemic, particularly the problematic use of social media. Mental health clinicians should incorporate screening for PIU into routine clinical care in order to prevent potential familial conflict and subsequent psychiatric crises that might stem from unrecognized PIU. %M 35089157 %R 10.2196/33114 %U https://mental.jmir.org/2022/1/e33114 %U https://doi.org/10.2196/33114 %U http://www.ncbi.nlm.nih.gov/pubmed/35089157 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e30204 %T Patient Satisfaction and Recommendations for Delivering a Group-Based Intensive Outpatient Program via Telemental Health During the COVID-19 Pandemic: Cross-sectional Cohort Study %A Skime,Michelle K %A Puspitasari,Ajeng J %A Gentry,Melanie T %A Heredia Jr,Dagoberto %A Sawchuk,Craig N %A Moore,Wendy R %A Taylor-Desir,Monica J %A Schak,Kathryn M %+ Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55902, United States, 1 507 255 0501, skime.michelle@mayo.edu %K COVID-19 %K telemental health %K teletherapy %K telepsychiatry %K telemedicine %K intensive outpatient %K patient satisfaction %D 2022 %7 28.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although group-based intensive outpatient programs (IOPs) are a level of care commonly utilized by adults with serious mental illness, few studies have examined the acceptability of group-based IOPs that required rapid transition to a telemental health (TMH) format during the COVID-19 pandemic. Objective: The aim of this study was to evaluate patient satisfaction and future recommendations for a group-based IOP that was transitioned to a TMH format during the COVID-19 pandemic. Methods: A 17-item patient satisfaction questionnaire was completed by patients at discharge and covered 3 areas: IOP TMH satisfaction, future recommendations, and video technology challenges. Descriptive and content analyses were conducted for the quantitative and open-ended questions, respectively. Results: A total of 76 patients completed the program in 2020. A subset of patients (n=40, 53%) responded to the survey at program discharge. The results indicated that the patients were satisfied overall with the TMH program format; 50% (n=20) of the patients preferred the program continue offering the TMH format, and the rest preferred returning to in-person formats after the pandemic. The patients indicated the elements of the program that they found most valuable and provided recommendations for future program improvement. Conclusions: Overall, adults with serious mental illness reported high satisfaction with the group-based IOP delivered via TMH. Health care systems may want to consider offering both TMH and in-person formats regardless of the state of the pandemic. Patients’ feedback on future improvements should be considered to help ensure long-term success. %M 34878999 %R 10.2196/30204 %U https://mental.jmir.org/2022/1/e30204 %U https://doi.org/10.2196/30204 %U http://www.ncbi.nlm.nih.gov/pubmed/34878999 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e33596 %T A Novel, Scalable Social Media–Based Intervention (“Warna-Warni Waktu”) to Reduce Body Dissatisfaction Among Young Indonesian Women: Protocol for a Parallel Randomized Controlled Trial %A Garbett,Kirsty May %A Craddock,Nadia %A Haywood,Sharon %A Nasution,Kholisah %A White,Paul %A Saraswati,L Ayu %A Medise,Bernie Endyarni %A , %A , %A Diedrichs,Phillippa C %A Williamson,Heidi %+ Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 1173282911, Kirsty.garbett@uwe.ac.uk %K body image %K body dissatisfaction %K Indonesia %K adolescent %K mental health %K randomized controlled trial %K study protocol %K eHealth intervention %K Southeast Asia %K young adult %K teenager %K women %K social media %K intervention %K image %K protocol %K mood %K satisfaction %D 2022 %7 28.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Despite the prevalence of body dissatisfaction among young Indonesian women and its consequential negative impacts, there are currently no evidence-based, culturally appropriate interventions to tackle this issue. Therefore, there is a need to develop scalable, cost-effective, and accessible interventions to improve body image among this population. Objective: This paper describes the study protocol of a parallel randomized controlled trial to evaluate the effectiveness of Warna-Warni Waktu, a social media–based intervention that aims to reduce state and trait body dissatisfaction and improve mood among young Indonesian women aged 15-19 years. Methods: The trial will take place online. Approximately 1800 young women from 10 cities in Indonesia, evenly split across the ages of 15-19 years, will be recruited via a local research agency’s established research panel. Participants will be randomly allocated to the intervention condition or a waitlist control condition. The intervention consists of six 5-minute videos, with each video supplemented with up to five brief interactive activities. The videos (and associated activities) will be delivered at a rate of one per day across 6 days. All participants will complete three self-report assessments: at baseline (Day 1), 1 day following the intervention (Day 9), and 1 month following the intervention (Day 36). The primary outcome will be change in trait body dissatisfaction. Secondary outcomes include change in internalization of appearance ideals, trait mood, and skin shade satisfaction. Intervention effectiveness on these outcomes will be analyzed using linear mixed models by a statistician blinded to the randomized condition. Intervention participants will also complete state measures of body satisfaction and mood before and after watching each video to assess the immediate impact of each video. This secondary analysis of state measures will be conducted at the within-group level. Results: Recruitment began in October 2021, with baseline assessments underway shortly thereafter. The results of the study will be submitted for publication in 2022. Conclusions: This is the first study to evaluate an eHealth intervention aimed at reducing body dissatisfaction among young Indonesian women. If effective, the intervention will be disseminated to over half a million young women in Indonesia via Facebook, Instagram, and YouTube. Trial Registration: ClinicalTrials.gov NCT05023213; https://clinicaltrials.gov/ct2/show/NCT05023213 International Registered Report Identifier (IRRID): PRR1-10.2196/33596 %M 35089154 %R 10.2196/33596 %U https://www.researchprotocols.org/2022/1/e33596 %U https://doi.org/10.2196/33596 %U http://www.ncbi.nlm.nih.gov/pubmed/35089154 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e32430 %T A Novel Peer-to-Peer Coaching Program to Support Digital Mental Health: Design and Implementation %A Rosenberg,Benjamin M %A Kodish,Tamar %A Cohen,Zachary D %A Gong-Guy,Elizabeth %A Craske,Michelle G %+ Department of Psychology, University of California, Los Angeles, 1285 Franz Hall, Los Angeles, CA, 95030, United States, 1 4083068603, benrosenberg@g.ucla.edu %K peer support %K digital mental health %K university students %K college students %K training and supervision %K scalable psychological interventions %D 2022 %7 26.1.2022 %9 Viewpoint %J JMIR Ment Health %G English %X Many individuals in need of mental health services do not currently receive care. Scalable programs are needed to reduce the burden of mental illness among those without access to existing providers. Digital interventions present an avenue for increasing the reach of mental health services. These interventions often rely on paraprofessionals, or coaches, to support the treatment. Although existing programs hold immense promise, providers must ensure that treatments are delivered with high fidelity and adherence to the treatment model. In this paper, we first highlight the tension between the scalability and fidelity of mental health services. We then describe the design and implementation of a peer-to-peer coach training program to support a digital mental health intervention for undergraduate students within a university setting. We specifically note strategies for emphasizing fidelity within our scalable framework, including principles of learning theory and competency-based supervision. Finally, we discuss future applications of this work, including the potential adaptability of our model for use within other contexts. %M 35080504 %R 10.2196/32430 %U https://mental.jmir.org/2022/1/e32430 %U https://doi.org/10.2196/32430 %U http://www.ncbi.nlm.nih.gov/pubmed/35080504 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34033 %T Randomized Waitlist-Control Trial of a Web-Based Stress-Management and Resiliency Program for Adolescent and Young Adult Cancer Survivors: Protocol for the Bounce Back Study %A Mizrach,Helen %A Goshe,Brett %A Park,Elyse R %A Recklitis,Christopher %A Greer,Joseph A %A Chang,Yuchiao %A Frederick,Natasha %A Abrams,Annah %A Tower,Mary D %A Walsh,Emily A %A Huang,Mary %A Kenney,Lisa %A Homans,Alan %A Miller,Karen %A Denninger,John %A Usmani,Ghazala Naheed %A Peppercorn,Jeffrey %A Perez,Giselle K %+ Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, United States, 1 9084992113, hmizrach@mgh.harvard.edu %K cancer survivorship %K adolescent and young adult (AYA) %K resiliency %K stress management %K coping %D 2022 %7 26.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The emotional health of adolescent and young adult (AYA) cancer survivors is compromised both during and after cancer treatment. Targeted programs designed to support AYAs’ ability to cope with stress in the years following treatment completion are lacking. Mind-body programs may ameliorate the negative psychological and emotional effects of stress and assist AYAs with managing the psychosocial challenges of early survivorship. Objective: Our randomized waitlist-control trial aims to assess the feasibility, acceptability, and preliminary efficacy of a virtual group program (Bounce Back) to promote stress management and resiliency among posttreatment AYAs. Methods: Bounce Back is a stress management and resiliency program delivered via videoconference by a trained mental health clinician. Sessions were adapted from an evidence-based mind-body program (Stress Management and Resiliency Training - Relaxation Response Resiliency Program [SMART-3RP]) grounded in relaxation response elicitation, mindfulness, cognitive behavioral therapy, and positive psychology. Seventy-two AYAs (diagnosed with cancer between ages 14 years and 29 years and had completed cancer treatment within the last 5 years) were randomly assigned to the Bounce Back program or waitlist-control group and completed assessments at baseline, 3 months postbaseline, and 6 months postbaseline. The primary aim of the study is to determine the feasibility and acceptability of the Bounce Back program. Descriptive statistics, including means, frequencies, and ranges supplemented by qualitative exit interview feedback will be used to characterize the sample and to summarize feasibility and acceptability. The exploratory aims are to evaluate the preliminary effects of the program on stress coping and psychosocial outcome measures (ie, anxiety, depression) collected across the 3 time points. Results: This study was funded by the National Cancer Institute in July 2017. Study procedures were approved by the Dana-Farber Harvard Cancer Center Institutional Review Board in October 2018 (Protocol 18-428). The randomized trial was conducted from July 2019 to March 2021. Quantitative data collection is complete, and qualitative exit interview data collection is ongoing. Results are expected to be published in peer-reviewed journals and presented at local, national, or international meetings in the coming years. Conclusions: Few evidence-based programs exist that tackle the key transitional issues faced by AYA cancer survivors. Future analyses will help us determine the feasibility and acceptability of the Bounce Back program and its impact on AYA stress coping and psychological well-being. Trial Registration: ClinicalTrials.gov NCT03768336; https://clinicaltrials.gov/ct2/show/NCT03768336 International Registered Report Identifier (IRRID): DERR1-10.2196/34033 %M 35080500 %R 10.2196/34033 %U https://www.researchprotocols.org/2022/1/e34033 %U https://doi.org/10.2196/34033 %U http://www.ncbi.nlm.nih.gov/pubmed/35080500 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e32759 %T Patient Engagement With a Game-Based Digital Therapeutic for the Treatment of Opioid Use Disorder: Protocol for a Randomized Controlled Open-Label, Decentralized Trial %A Luderer,Hilary %A Chiodo,Lisa %A Wilson,Amanda %A Brezing,Christina %A Martinez,Suky %A Xiong,Xiaorui %A Gerwien,Robert %A Imbert,Bruce %A Deeg,Mark %A Maricich,Yuri %A Campbell,Aimee %+ Pear Therapeutics, Inc, 200 State St., Boston, MA, 02109, United States, 1 (617) 932 7504, hilary.luderer@peartherapeutics.com %K decentralized trial %K game-based %K gamification %K prescription digital therapeutic %K digital therapeutics %K opioid use disorder %K reSET-O %K virtual trial %K trial %K game %K therapy %K opioid %K drug %K engagement %K treatment %K disorder %K addiction %K randomized controlled trial %K mental health %K symptom %D 2022 %7 26.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Prescription digital therapeutics are software-based disease treatments that are regulated by the US Food and Drug Administration; the reSET-O prescription digital therapeutic was authorized in 2018 and delivers behavioral treatment for individuals receiving buprenorphine for opioid use disorder. Although reSET-O improves outcomes for individuals with opioid use disorder, most of the therapeutic content is delivered as narrative text. PEAR-008 is an investigational device based on reSET-O that uses an interactive, game-based platform to deliver similar therapeutic content designed to enhance patient engagement, which may further improve treatment outcomes. Objective: We aim to investigate how participants interact with the prescription digital therapeutic’s new content delivery format. Secondary objectives include evaluating treatment success, symptoms of co-occurring mental health disorders, recovery capital, and skill development. Methods: Due to the COVID-19 pandemic, this study was redesigned using a decentralized model because it was not possible to conduct medication initiation and study visits in person, as initially intended. A decentralized, randomized controlled trial design will be utilized to compare patient engagement with PEAR-008 and that with reSET-O using both subjective and objective assessments. The study population will consist of approximately 130 individuals with opioid use disorder (based on Diagnostic and Statistical Manual of Mental Disorders 5 criteria) who have recently started buprenorphine treatment for opioid use disorder. Participants will be virtually recruited and randomly assigned to receive either PEAR-008 or reSET-O. All study sessions will be virtual, and the duration of the study is 12 weeks. The primary outcome measure of engagement is operationalized as the number of active sessions per week with either PEAR-008 or reSET-O. (An active session is any session that contains some active participation in the app, such as navigating to a different screen, engaging with a learning module, or responding to a notification.) Subjective dimensions of engagement will be assessed with participant surveys. The hypothesis is that PEAR-008 will have significantly greater participant engagement than reSET-O. Results: As of February 2021, participant enrollment is ongoing. Conclusions: This randomized controlled trial will investigate if changing the delivery format and enhancing the content of a prescription digital therapeutic for opioid use disorder will affect how participants use and interact with the prescription digital therapeutic. The study design may serve as a useful model for conducting decentralized studies in this patient population. Trial Registration: ClinicalTrials.gov NCT04542642; https://clinicaltrials.gov/ct2/show/NCT04542642 International Registered Report Identifier (IRRID): DERR1-10.2196/32759 %M 35080499 %R 10.2196/32759 %U https://www.researchprotocols.org/2022/1/e32759 %U https://doi.org/10.2196/32759 %U http://www.ncbi.nlm.nih.gov/pubmed/35080499 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e24699 %T Acoustic and Facial Features From Clinical Interviews for Machine Learning–Based Psychiatric Diagnosis: Algorithm Development %A Birnbaum,Michael L %A Abrami,Avner %A Heisig,Stephen %A Ali,Asra %A Arenare,Elizabeth %A Agurto,Carla %A Lu,Nathaniel %A Kane,John M %A Cecchi,Guillermo %+ Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, 75-59 263rd St, Glen Oaks, NY, 11004, United States, 1 7184708305, mbirnbaum@northwell.edu %K audiovisual patterns %K speech analysis %K facial analysis %K psychiatry %K schizophrenia spectrum disorders %K bipolar disorder %K symptom prediction %K diagnostic prediction %K machine learning %K audiovisual %K speech %K schizophrenia %K spectrum disorders %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: In contrast to all other areas of medicine, psychiatry is still nearly entirely reliant on subjective assessments such as patient self-report and clinical observation. The lack of objective information on which to base clinical decisions can contribute to reduced quality of care. Behavioral health clinicians need objective and reliable patient data to support effective targeted interventions. Objective: We aimed to investigate whether reliable inferences—psychiatric signs, symptoms, and diagnoses—can be extracted from audiovisual patterns in recorded evaluation interviews of participants with schizophrenia spectrum disorders and bipolar disorder. Methods: We obtained audiovisual data from 89 participants (mean age 25.3 years; male: 48/89, 53.9%; female: 41/89, 46.1%): individuals with schizophrenia spectrum disorders (n=41), individuals with bipolar disorder (n=21), and healthy volunteers (n=27). We developed machine learning models based on acoustic and facial movement features extracted from participant interviews to predict diagnoses and detect clinician-coded neuropsychiatric symptoms, and we assessed model performance using area under the receiver operating characteristic curve (AUROC) in 5-fold cross-validation. Results: The model successfully differentiated between schizophrenia spectrum disorders and bipolar disorder (AUROC 0.73) when aggregating face and voice features. Facial action units including cheek-raising muscle (AUROC 0.64) and chin-raising muscle (AUROC 0.74) provided the strongest signal for men. Vocal features, such as energy in the frequency band 1 to 4 kHz (AUROC 0.80) and spectral harmonicity (AUROC 0.78), provided the strongest signal for women. Lip corner–pulling muscle signal discriminated between diagnoses for both men (AUROC 0.61) and women (AUROC 0.62). Several psychiatric signs and symptoms were successfully inferred: blunted affect (AUROC 0.81), avolition (AUROC 0.72), lack of vocal inflection (AUROC 0.71), asociality (AUROC 0.63), and worthlessness (AUROC 0.61). Conclusions: This study represents advancement in efforts to capitalize on digital data to improve diagnostic assessment and supports the development of a new generation of innovative clinical tools by employing acoustic and facial data analysis. %M 35072648 %R 10.2196/24699 %U https://mental.jmir.org/2022/1/e24699 %U https://doi.org/10.2196/24699 %U http://www.ncbi.nlm.nih.gov/pubmed/35072648 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e34333 %T Automatic Assessment of Emotion Dysregulation in American, French, and Tunisian Adults and New Developments in Deep Multimodal Fusion: Cross-sectional Study %A Parra,Federico %A Benezeth,Yannick %A Yang,Fan %+ LE2I EA 7508, Université Bourgogne Franche-Comté, UFR Sciences et techniques, avenue Alain Savary, Dijon, 21000, France, 33 782132695, federico.parra@hotmail.com %K emotion dysregulation %K deep multimodal fusion %K small data %K psychometrics %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Emotion dysregulation is a key dimension of adult psychological functioning. There is an interest in developing a computer-based, multimodal, and automatic measure. Objective: We wanted to train a deep multimodal fusion model to estimate emotion dysregulation in adults based on their responses to the Multimodal Developmental Profile, a computer-based psychometric test, using only a small training sample and without transfer learning. Methods: Two hundred and forty-eight participants from 3 different countries took the Multimodal Developmental Profile test, which exposed them to 14 picture and music stimuli and asked them to express their feelings about them, while the software extracted the following features from the video and audio signals: facial expressions, linguistic and paralinguistic characteristics of speech, head movements, gaze direction, and heart rate variability derivatives. Participants also responded to the brief version of the Difficulties in Emotional Regulation Scale. We separated and averaged the feature signals that corresponded to the responses to each stimulus, building a structured data set. We transformed each person’s per-stimulus structured data into a multimodal codex, a grayscale image created by projecting each feature’s normalized intensity value onto a cartesian space, deriving each pixel’s position by applying the Uniform Manifold Approximation and Projection method. The codex sequence was then fed to 2 network types. First, 13 convolutional neural networks dealt with the spatial aspect of the problem, estimating emotion dysregulation by analyzing each of the codified responses. These convolutional estimations were then fed to a transformer network that decoded the temporal aspect of the problem, estimating emotional dysregulation based on the succession of responses. We introduce a Feature Map Average Pooling layer, which computes the mean of the convolved feature maps produced by our convolution layers, dramatically reducing the number of learnable weights and increasing regularization through an ensembling effect. We implemented 8-fold cross-validation to provide a good enough estimation of the generalization ability to unseen samples. Most of the experiments mentioned in this paper are easily replicable using the associated Google Colab system. Results: We found an average Pearson correlation (r) of 0.55 (with an average P value of <.001) between ground truth emotion dysregulation and our system’s estimation of emotion dysregulation. An average mean absolute error of 0.16 and a mean concordance correlation coefficient of 0.54 were also found. Conclusions: In psychometry, our results represent excellent evidence of convergence validity, suggesting that the Multimodal Developmental Profile could be used in conjunction with this methodology to provide a valid measure of emotion dysregulation in adults. Future studies should replicate our findings using a hold-out test sample. Our methodology could be implemented more generally to train deep neural networks where only small training samples are available. %M 35072643 %R 10.2196/34333 %U https://mental.jmir.org/2022/1/e34333 %U https://doi.org/10.2196/34333 %U http://www.ncbi.nlm.nih.gov/pubmed/35072643 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31935 %T The Relative Contributions of Live and Recorded Online Mindfulness Training Programs to Lower Stress in the Workplace: Longitudinal Observational Study %A Wolever,Ruth Q %A Finn,Michael T M %A Shields,Denise %+ Osher Center for Integrative Health at Vanderbilt, Department of Physical Medicine & Rehabilitation, Vanderbilt University School of Medicine, 3401 West End Ave, Suite 380, Nashville, TN, 37203, United States, 1 919 622 2819, ruth.wolever@vumc.org %K mindfulness %K live versus recorded %K synchronous %K asynchronous %K workplace %K digital health %K online %K live teaching %K contribution %K training %K stress %K longitudinal %K observational %K platform %K eHealth %K mental health %D 2022 %7 21.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite numerous gaps in the literature, mindfulness training in the workplace is rapidly proliferating. Many “online” or “digital mindfulness” programs do not distinguish between live teaching and recorded or asynchronous sessions, yet differences in delivery mode (eg, face-to-face, online live, online self-guided, other) may explain outcomes. Objective: The aim of this study was to use existing data from an online mindfulness solutions company to assess the relative contribution of live and recorded mindfulness training to lower perceived stress in employees. Methods: Perceived stress and the amount of live and recorded online mindfulness training accessed by employees were assessed during eMindful’s One-Percent Challenge (OPC). The OPC is a 30-day program wherein participants are encouraged to spend 1% of their day (14 minutes) practicing mindfulness meditation on the platform. We used linear mixed-effects models to assess the relationship between stress reduction and usage of components of the eMindful platform (live teaching and recorded options) while controlling for potential reporting bias (completion) and sampling bias. Results: A total of 8341 participants from 44 companies registered for the OPC, with 7757 (93.00%) completing stress assessments prior to the OPC and 2360 (28.29%) completing the postassessment. Approximately one-quarter of the participants (28.86%, 2407/8341) completed both assessments. Most of the completers (2161/2407, 89.78%) engaged in the platform at least once. Among all participants (N=8341), 8.78% (n=707) accessed only recorded sessions and 33.78% (n=2818) participated only in the live programs. Most participants engaged in both live and recorded options, with those who used any recordings (2686/8341, 32.20%) tending to use them 3-4 times. Controlling for completer status, any participation with the eMindful OPC reduced stress (B=–0.32, 95% CI –0.35 to –0.30, SE=0.01, t2393.25=–24.99, P<.001, Cohen d=–1.02). Participation in live programs drove the decrease in stress (B=–0.03, SE=0.01, t3258.61=–3.03, P=.002, d=–0.11), whereas participation in recorded classes alone did not. Regular practice across the month led to a greater reduction in stress. Conclusions: Our findings are in stark contrast to the rapid evolution of online mindfulness training for the workplace. While the market is reproducing apps and recorded teaching at an unprecedented pace, our results demonstrate that live mindfulness programs with recorded or on-demand programs used to supplement live practices confer the strongest likelihood of achieving a significant decrease in stress levels. %M 35060911 %R 10.2196/31935 %U https://www.jmir.org/2022/1/e31935 %U https://doi.org/10.2196/31935 %U http://www.ncbi.nlm.nih.gov/pubmed/35060911 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32211 %T A Virtual Coach (Motibot) for Supporting Healthy Coping Strategies Among Adults With Diabetes: Proof-of-Concept Study %A Bassi,Giulia %A Giuliano,Claudio %A Perinelli,Alessio %A Forti,Stefano %A Gabrielli,Silvia %A Salcuni,Silvia %+ Department of Developmental and Socialization Psychology, University of Padova, Via Venezia 8, Padova, 35131, Italy, 39 3477334405, giulia.bassi@phd.unipd.it %K virtual coach %K diabetes mellitus %K adults %K psychosocial factors %K mindfulness %K proof-of-concept study %K mobile phone %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Motivation is a core component of diabetes self-management because it allows adults with diabetes mellitus (DM) to adhere to clinical recommendations. In this context, virtual coaches (VCs) have assumed a central role in supporting and treating common barriers related to adherence. However, most of them are mainly focused on medical and physical purposes, such as the monitoring of blood glucose levels or following a healthy diet. Objective: This proof-of-concept study aims to evaluate the preliminary efficacy of a VC intervention for psychosocial support before and after the intervention and at follow-up. The intent of this VC is to motivate adults with type 1 DM and type 2 DM to adopt and cultivate healthy coping strategies to reduce symptoms of depression, anxiety, perceived stress, and diabetes-related emotional distress, while also improving their well-being. Methods: A total of 13 Italian adults with DM (18-51 years) interacted with a VC, called Motibot (motivational bot) using the Telegram messaging app. The interaction covered 12 sessions, each lasting 10 to 20 minutes, during which the user could dialogue with the VC by inputting text or tapping an option on their smartphone screen. Motibot is developed within the transtheoretical model of change to deliver the most appropriate psychoeducational intervention based on the user’s motivation to change. Results: Results showed that over the 12 sessions, there were no significant changes before and after the intervention and at follow-up regarding psychosocial factors. However, most users showed a downward trend over the 3 time periods in depression and anxiety symptoms, thereby presenting good psychological well-being and no diabetes-related emotional distress. In addition, users felt motivated, involved, encouraged, emotionally understood, and stimulated by Motibot during the interaction. Indeed, the analyses of semistructured interviews, using a text mining approach, showed that most users reported a perceived reduction in anxiety, depression, and/or stress symptoms. Moreover, users indicated the usefulness of Motibot in supporting and motivating them to find a mindful moment for themselves and to reflect on their own emotions. Conclusions: Motibot was well accepted by users, particularly because of the inclusion of mindfulness practices, which motivated them to adopt healthy coping skills. To this extent, Motibot provided psychosocial support for adults with DM, particularly for those with mild and moderate symptoms, whereas those with severe symptoms may benefit more from face-to-face psychotherapy. %M 35060918 %R 10.2196/32211 %U https://humanfactors.jmir.org/2022/1/e32211 %U https://doi.org/10.2196/32211 %U http://www.ncbi.nlm.nih.gov/pubmed/35060918 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e28003 %T The Challenges in Designing a Prevention Chatbot for Eating Disorders: Observational Study %A Chan,William W %A Fitzsimmons-Craft,Ellen E %A Smith,Arielle C %A Firebaugh,Marie-Laure %A Fowler,Lauren A %A DePietro,Bianca %A Topooco,Naira %A Wilfley,Denise E %A Taylor,C Barr %A Jacobson,Nicholas C %+ Center for m2Health, Palo Alto University, 5150 El Camino Real, Los Altos, CA, 94022, United States, 1 650 667 7193, wchan@paloaltou.edu %K chatbot %K eating disorders %K digital mental health %K prevention %K intervention development %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Chatbots have the potential to provide cost-effective mental health prevention programs at scale and increase interactivity, ease of use, and accessibility of intervention programs. Objective: The development of chatbot prevention for eating disorders (EDs) is still in its infancy. Our aim is to present examples of and solutions to challenges in designing and refining a rule-based prevention chatbot program for EDs, targeted at adult women at risk for developing an ED. Methods: Participants were 2409 individuals who at least began to use an EDs prevention chatbot in response to social media advertising. Over 6 months, the research team reviewed up to 52,129 comments from these users to identify inappropriate responses that negatively impacted users’ experience and technical glitches. Problems identified by reviewers were then presented to the entire research team, who then generated possible solutions and implemented new responses. Results: The most common problem with the chatbot was a general limitation in understanding and responding appropriately to unanticipated user responses. We developed several workarounds to limit these problems while retaining some interactivity. Conclusions: Rule-based chatbots have the potential to reach large populations at low cost but are limited in understanding and responding appropriately to unanticipated user responses. They can be most effective in providing information and simple conversations. Workarounds can reduce conversation errors. %M 35044314 %R 10.2196/28003 %U https://formative.jmir.org/2022/1/e28003 %U https://doi.org/10.2196/28003 %U http://www.ncbi.nlm.nih.gov/pubmed/35044314 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e32140 %T Patterns of Suicide Ideation Across Eight Countries in Four Continents During the COVID-19 Pandemic Era: Repeated Cross-sectional Study %A Schluter,Philip J %A Généreux,Mélissa %A Hung,Kevin KC %A Landaverde,Elsa %A Law,Ronald P %A Mok,Catherine Pui Yin %A Murray,Virginia %A O'Sullivan,Tracey %A Qadar,Zeeshan %A Roy,Mathieu %+ School of Health Sciences, University of Canterbury - Te Whare Wananga o Waitaha, Private Bag 4800, Christchurch, 8140, New Zealand, 64 275106239, philip.schluter@canterbury.ac.nz %K pandemic %K infodemic %K psychosocial impacts %K sense of coherence %K suicide ideation %K epidemiology %K suicide %K pattern %K COVID-19 %K cross-sectional %K mental health %K misinformation %K risk %K prevalence %K gender %K age %K sociodemographic %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and countries’ response measures have had a globally significant mental health impact. This mental health burden has also been fueled by an infodemic: an information overload that includes misinformation and disinformation. Suicide, the worst mental health outcome, is a serious public health problem that can be prevented with timely, evidence-based, and often low-cost interventions. Suicide ideation, one important risk factor for suicide, is thus important to measure and monitor, as are the factors that may impact on it. Objective: This investigation had 2 primary aims: (1) to estimate and compare country-specific prevalence of suicide ideation at 2 different time points, overall and by gender and age groups, and (2) to investigate the influence of sociodemographic and infodemic variables on suicide ideation. Methods: A repeated, online, 8-country (Canada, the United States, England, Switzerland, Belgium, Hong Kong, Philippines, and New Zealand), cross-sectional study was undertaken with adults aged ≥18 years, with measurement wave 1 conducted from May 29, 2020 to June 12, 2020 and measurement wave 2 conducted November 6-18, 2021. Self-reported suicide ideation was derived from item 9 of the Patient Health Questionnaire-9 (PHQ-9). Age-standardized suicide ideation rates were reported, a binomial regression model was used to estimate suicide ideation indication rates for each country and measurement wave, and logistic regression models were then employed to relate sociodemographic, pandemic, and infodemic variables to suicide ideation. Results: The final sample totaled 17,833 adults: 8806 (49.4%) from measurement wave 1 and 9027 (50.6%) from wave 2. Overall, 24.2% (2131/8806) and 27.5% (2486/9027) of participants reported suicide ideation at measurement waves 1 and 2, respectively, a difference that was significant (P<.001). Considerable variability was observed in suicide ideation age-standardized rates between countries, ranging from 15.6% in Belgium (wave 1) to 42.9% in Hong Kong (wave 2). Frequent social media usage was associated with increased suicide ideation at wave 2 (adjusted odds ratio [AOR] 1.47, 95% CI 1.25-1.72; P<.001) but not wave 1 (AOR 1.11, 95% CI 0.96-1.23; P=.16). However, having a weaker sense of coherence (SOC; AOR 3.80, 95% CI 3.18-4.55 at wave 1 and AOR 4.39, 95% CI 3.66-5.27 at wave 2; both P<.001) had the largest overall effect size. Conclusions: Suicide ideation is prevalent and significantly increasing over time in this COVID-19 pandemic era, with considerable variability between countries. Younger adults and those residing in Hong Kong carried disproportionately higher rates. Social media appears to have an increasingly detrimental association with suicide ideation, although having a stronger SOC had a larger protective effect. Policies and promotion of SOC, together with disseminating health information that explicitly tackles the infodemic’s misinformation and disinformation, may importantly reduce the rising mental health morbidity and mortality triggered by this pandemic. %M 34727524 %R 10.2196/32140 %U https://publichealth.jmir.org/2022/1/e32140 %U https://doi.org/10.2196/32140 %U http://www.ncbi.nlm.nih.gov/pubmed/34727524 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 1 %P e30724 %T mHealth Solutions for Perinatal Mental Health: Scoping Review and Appraisal Following the mHealth Index and Navigation Database Framework %A Spadaro,Benedetta %A Martin-Key,Nayra A %A Funnell,Erin %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K digital mental health %K perinatal mental health %K pregnancy %K MIND %K mobile phone %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The ever-increasing pressure on health care systems has resulted in the underrecognition of perinatal mental disorders. Digital mental health tools such as apps could provide an option for accessible perinatal mental health screening and assessment. However, there is a lack of information regarding the availability and features of perinatal app options. Objective: This study aims to evaluate the current state of diagnostic and screening apps for perinatal mental health available on the Google Play Store (Android) and Apple App Store (iOS) and to review their features following the mHealth Index and Navigation Database framework. Methods: Following a scoping review approach, the Apple App Store and Google Play Store were systematically searched to identify perinatal mental health assessment apps. A total of 14 apps that met the inclusion criteria were downloaded and reviewed in a standardized manner using the mHealth Index and Navigation Database framework. The framework comprised 107 questions, allowing for a comprehensive assessment of app origin, functionality, engagement features, security, and clinical use. Results: Most apps were developed by for-profit companies (n=10), followed by private individuals (n=2) and trusted health care companies (n=2). Out of the 14 apps, 3 were available only on Android devices, 4 were available only on iOS devices, and 7 were available on both platforms. Approximately one-third of the apps (n=5) had been updated within the last 180 days. A total of 12 apps offered the Edinburgh Postnatal Depression Scale in its original version or in rephrased versions. Engagement, input, and output features included reminder notifications, connections to therapists, and free writing features. A total of 6 apps offered psychoeducational information and references. Privacy policies were available for 11 of the 14 apps, with a median Flesch-Kincaid reading grade level of 12.3. One app claimed to be compliant with the Health Insurance Portability and Accountability Act standards and 2 apps claimed to be compliant with General Data Protection Regulation. Of the apps that could be accessed in full (n=10), all appeared to fulfill the claims stated in their description. Only 1 app referenced a relevant peer-reviewed study. All the apps provided a warning for use, highlighting that the mental health assessment result should not be interpreted as a diagnosis or as a substitute for medical care. Only 3 apps allowed users to export or email their mental health test results. Conclusions: These results indicate that there are opportunities to improve perinatal mental health assessment apps. To this end, we recommend focusing on the development and validation of more comprehensive assessment tools, ensuring data protection and safety features are adequate for the intended app use, and improving data sharing features between users and health care professionals for timely support. %M 35037894 %R 10.2196/30724 %U https://mhealth.jmir.org/2022/1/e30724 %U https://doi.org/10.2196/30724 %U http://www.ncbi.nlm.nih.gov/pubmed/35037894 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 1 %P e34103 %T A New Digital Assessment of Mental Health and Well-being in the Workplace: Development and Validation of the Unmind Index %A Sierk,Anika %A Travers,Eoin %A Economides,Marcos %A Loe,Bao Sheng %A Sun,Luning %A Bolton,Heather %+ Unmind Ltd, 180 Borough High Street, London, SE1 1LB, United Kingdom, eoin.travers@unmind.com %K mental health %K well-being %K mHealth %K measurement %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Unmind is a workplace, digital, mental health platform with tools to help users track, maintain, and improve their mental health and well-being (MHWB). Psychological measurement plays a key role on this platform, providing users with insights on their current MHWB, the ability to track it over time, and personalized recommendations, while providing employers with aggregate information about the MHWB of their workforce. Objective: Due to the limitations of existing measures for this purpose, we aimed to develop and validate a novel well-being index for digital use, to capture symptoms of common mental health problems and key aspects of positive well-being. Methods: In Study 1A, questionnaire items were generated by clinicians and screened for face validity. In Study 1B, these items were presented to a large sample (n=1104) of UK adults, and exploratory factor analysis was used to reduce the item pool and identify coherent subscales. In Study 2, the final measure was presented to a new nationally representative UK sample (n=976), along with a battery of existing measures, with 238 participants retaking the Umind Index after 1 week. The factor structure and measurement invariance of the Unmind Index was evaluated using confirmatory factor analysis, convergent and discriminant validity by estimating correlations with existing measures, and reliability by examining internal consistency and test-retest intraclass correlations. Results: Studies 1A and 1B yielded a 26-item measure with 7 subscales: Calmness, Connection, Coping, Happiness, Health, Fulfilment, and Sleep. Study 2 showed that the Unmind Index is fitted well by a second-order factor structure, where the 7 subscales all load onto an overall MHWB factor, and established measurement invariance by age and gender. Subscale and total scores correlate well with existing mental health measures and generally diverge from personality measures. Reliability was good or excellent across all subscales. Conclusions: The Unmind Index is a robust measure of MHWB that can help to identify target areas for intervention in nonclinical users of a mental health app. We argue that there is value in measuring mental ill health and mental well-being together, rather than treating them as separate constructs. %M 35037895 %R 10.2196/34103 %U https://mental.jmir.org/2022/1/e34103 %U https://doi.org/10.2196/34103 %U http://www.ncbi.nlm.nih.gov/pubmed/35037895 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e32331 %T The Effectiveness of Serious Games for Alleviating Depression: Systematic Review and Meta-analysis %A Abd-Alrazaq,Alaa %A Al-Jafar,Eiman %A Alajlani,Mohannad %A Toro,Carla %A Alhuwail,Dari %A Ahmed,Arfan %A Reagu,Shuja Mohd %A Al-Shorbaji,Najeeb %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, PO Box 34110, Doha Al Luqta St, Ar-Rayyan, Doha, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K serious games %K exergames %K depression %K cognitive behavioral therapy %K systematic reviews %K meta-analysis %D 2022 %7 14.1.2022 %9 Review %J JMIR Serious Games %G English %X Background: Depression is a common mental disorder characterized by disturbances in mood, thoughts, or behaviors. Serious games, which are games that have a purpose other than entertainment, have been used as a nonpharmacological therapeutic intervention for depression. Previous systematic reviews have summarized evidence of effectiveness of serious games in reducing depression symptoms; however, they are limited by design and methodological shortcomings. Objective: This study aimed to assess the effectiveness of serious games in alleviating depression by summarizing and pooling the results of previous studies. Methods: A systematic review of randomized controlled trials (RCTs) was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The search sources included 6 bibliographic databases (eg, MEDLINE, PsycINFO, IEEE Xplore), the search engine “Google Scholar,” and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently carried out the study selection, data extraction, risk of bias assessment, and quality of evidence appraisal. Results of the included studies were synthesized narratively and statistically, as appropriate, according to the type of serious games (ie, exergames or computerized cognitive behavioral therapy [CBT] games). Results: From an initial 966 citations retrieved, 27 studies met the eligibility criteria, and 16 studies were eventually included in meta-analyses. Very low-quality evidence from 7 RCTs showed no statistically significant effect of exergames on the severity of depressive symptoms as compared with conventional exercises (P=.12). Very low-quality evidence from 5 RCTs showed a statistically and clinically significant difference in the severity of depressive symptoms (P=.004) between exergame and control groups, favoring exergames over no intervention. Very low-quality evidence from 7 RCTs showed a statistically and clinically significant effect of computerized CBT games on the severity of depressive symptoms in comparison with no intervention (P=.003). Conclusions: Serious games have the potential to alleviate depression as other active interventions do. However, we could not draw definitive conclusions regarding the effectiveness of serious games due to the high risk of bias in the individual studies examined and the low quality of meta-analyzed evidence. Therefore, we recommend that health care providers consider offering serious games as an adjunct to existing interventions until further, more robust evidence is available. Future studies should assess the effectiveness of serious games that are designed specifically to alleviate depression and deliver other therapeutic modalities, recruit participants with depression, and avoid biases by following recommended guidelines for conducting and reporting RCTs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021232969; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=232969 %M 35029530 %R 10.2196/32331 %U https://games.jmir.org/2022/1/e32331 %U https://doi.org/10.2196/32331 %U http://www.ncbi.nlm.nih.gov/pubmed/35029530 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e33525 %T Exploring Empathy and Compassion Using Digital Narratives (the Learning to Care Project): Protocol for a Multiphase Mixed Methods Study %A Ferrari,Manuela %A Fazeli,Sahar %A Mitchell,Claudia %A Shah,Jai %A Iyer,Srividya N %+ Department of Psychiatry, McGill University, 6875 Boulevard LaSalle, Montreal, QC, H4H 1R3, Canada, 1 5147616131 ext 3445, manuela.ferrari@mcgill.ca %K digital narratives %K fundraising campaigns %K mixed methods %K randomized controlled trial %K stigma and discrimination %D 2022 %7 13.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital stories—first-person, self-made, 2- to 3-minute videos—generate awareness, impart knowledge, and promote understanding on topics such as mental illness. Digital stories are a narrative-based art form often created by individuals without formal training in filmmaking to relate personal experiences. Somewhat like digital narratives, video testimonies created within the social marketing or fundraising campaigns of government agencies and private or public corporations aim to reduce the stigma of mental illness while supporting research and services. In video testimonies, personal stories are captured on camera by professional filmmakers. Sharing critical life events greatly benefits tellers and listeners alike, supporting catharsis, healing, connectiveness, and citizenship. Objective: This study explores digital stories and video testimonies featuring mental illness and recovery in their ability to elicit empathy and compassion while reducing stigma among viewers. Methods: Using mixed methods, phase 1 will involve a search of Canadian social marketing activities and fundraising campaigns concerning mental illness and recovery. Phase 2 will involve the organization of digital storytelling workshops in which participants will create digital stories about their own experiences of mental illness and recovery. In phase 3, a pilot randomized controlled trial will be undertaken to compare marketing and fundraising campaigns with digital stories for their impact on viewers, whereas phase 4 will focus on knowledge dissemination. Results: Ethics approval for this study was received in March 2021. Data on the feasibility of the study design and the results of the controlled trial will be generated. This study will produce new knowledge on effective ways of promoting mental health awareness and decreasing stigma, with practical importance for future social marketing and fundraising campaigns. The anticipated time for completion within the 2-year study period includes 9 months for phase 1 (knowledge synthesis activities identifying social marketing and fundraising campaigns) and phase 2 (storytelling workshops), 11 months for phase 3 (feasibility assessment and data collection: randomized controlled trial), and 2 months for phase 4 (knowledge dissemination). Conclusions: The knowledge generated will have practical implications for the public and for future social marketing and fundraising campaigns promoted by government agencies as well as nonprofit and for-profit organizations by enhancing our understanding of how individuals and societies respond to stories of mental distress and what prompts citizens to help others. Trial Registration: ClinicalTrials.gov NCT04881084; https://clinicaltrials.gov/ct2/show/NCT04881084 International Registered Report Identifier (IRRID): PRR1-10.2196/33525 %M 35023844 %R 10.2196/33525 %U https://www.researchprotocols.org/2022/1/e33525 %U https://doi.org/10.2196/33525 %U http://www.ncbi.nlm.nih.gov/pubmed/35023844 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30026 %T Engagement Strategies to Improve Adherence and Retention in Web-Based Mindfulness Programs: Systematic Review %A Winter,Natalie %A Russell,Lahiru %A Ugalde,Anna %A White,Victoria %A Livingston,Patricia %+ Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 3 5227 1100, n.heynsbergh@deakin.edu.au %K chronic disease %K chronic illness %K digital health %K digital technology %K internet mindfulness %K mindfulness based stress reduction %K patient dropouts %K mobile phone %D 2022 %7 12.1.2022 %9 Review %J J Med Internet Res %G English %X Background: Web-based mindfulness programs may be beneficial in improving the well-being outcomes of those living with chronic illnesses. Adherence to programs is a key indicator in improving outcomes; however, with the digitization of programs, it is necessary to enhance engagement and encourage people to return to digital health platforms. More information is needed on how engagement strategies have been used in web-based mindfulness programs to encourage adherence. Objective: The aim of this study is to develop a list of engagement strategies for web-based mindfulness programs and evaluate the impact of engagement strategies on adherence. Methods: A narrative systematic review was conducted across the MEDLINE Complete, CINAHL Complete, APA PsycINFO, and Embase databases and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines. Articles were screened using the population, intervention, comparator, and outcome framework. Adults aged >18 years with chronic health conditions were included in the study. Mindfulness interventions, including those in combination with mindfulness-based cognitive therapy, delivered on the web through the internet or smartphone technology were included. Interventions lasted at least 2 weeks. Studies with a randomized controlled trial design or a pilot randomized controlled trial design were included. Engagement strategies, including web-based program features and facilitator-led strategies, adherence, and retention, were included. Results: A total of 1265 articles were screened, of which 19 were relevant and were included in the review. On average, 70.98% (2258/3181) of the study participants were women with a mean age of 46 (SD 13) years. Most commonly, mindfulness programs were delivered to people living with mental health conditions (8/19, 42%). Of the 19 studies, 8 (42%) used only program features to encourage adherence, 5 (26%) used facilitator-led strategies, and 6 (32%) used a combination of the two. Encouraging program adherence was the most common engagement strategy used, which was used in 77% (10/13) of the facilitator-led studies and 57% (8/14) of the program feature studies. Nearly two-thirds (63%) of the studies provided a definition of adherence, which varied between 50% and 100% completion across studies. The overall mean participant compliance to the mindfulness programs was 56% (SD 15%). Most studies (10/19, 53%) had a long-term follow-up, with the most common follow-up period being 12 weeks after intervention (3/10, 30%). After the intervention, the mean retention was 78% (SD 15%). Conclusions: Engagement strategies in web-based mindfulness programs comprise reminders to use the program. Other features may be suitable for encouraging adherence to interventions, and a facilitator-led component may result in higher retention. There is variance in the way adherence is measured, and intervention lengths and follow-up periods are inconsistent. More thorough reporting and a standardized framework for measuring adherence are needed to more accurately assess adherence and engagement strategies. %M 35019851 %R 10.2196/30026 %U https://www.jmir.org/2022/1/e30026 %U https://doi.org/10.2196/30026 %U http://www.ncbi.nlm.nih.gov/pubmed/35019851 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e34792 %T Single-Group Trial of an Internet-Delivered Insomnia Intervention Among Higher-Intensity Family Caregivers: Rationale and Protocol for a Mixed Methods Study %A Shaffer,Kelly M %A Ritterband,Lee M %A You,Wen %A Buysse,Daniel J %A Mattos,Meghan K %A Camacho,Fabian %A Glazer,Jillian V %A Klinger,Julie %A Donovan,Heidi %+ Center for Behavioral Health and Technology, University of Virginia, PO Box 801075, Charlottesville, VA, 22908, United States, 1 4349821022, kshaffer@virginia.edu %K family caregiver %K cognitive behavioral therapy %K insomnia %K sleep initiation and maintenance disorders %K eHealth %K protocol %K mobile phone %D 2022 %7 12.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Family caregivers are more likely to experience insomnia relative to noncaregivers but have significant barriers to accessing gold standard cognitive behavioral therapy for insomnia treatment. Delivering interventions to caregivers through the internet may help increase access to care, particularly among higher-intensity caregivers who provide assistance with multiple care tasks over many hours per week. Although there are existing internet interventions that have been thoroughly studied and demonstrated as effective in the general population, the extent to which these interventions may be effective for caregivers without tailoring to address this population’s unique psychosocial needs has not been studied. Objective: The goal of this trial is to determine what tailoring may be necessary for which caregivers to ensure they receive optimal benefit from an existing evidence-based, internet-delivered cognitive behavioral therapy for insomnia program named Sleep Healthy Using the Internet (SHUTi). Specifically, we will test the association between caregivers’ engagement with SHUTi and their caregiving context characteristics (ie, caregiving strain, self-efficacy, and guilt) and environment (ie, proximity to care recipient; functional status, cognitive status, and problem behavior of care recipient; and type of care provided). Among caregivers using the program, we will also test the associations between change in known treatment mechanisms (sleep beliefs and sleep locus of control) and caregiving context factors. Methods: A total of 100 higher-intensity caregivers with significant insomnia symptoms will be recruited from across the United States to receive access to SHUTi in an open-label trial with mixed methods preassessments and postassessments. At postassessment (9 weeks following preassessment completion), participants will be categorized according to their engagement with the program (nonusers, incomplete users, or complete users). Study analyses will address 3 specific aims: to examine the association between caregivers’ engagement with SHUTi and their caregiving context (aim 1a); to describe caregivers’ barriers to and motivations for SHUTi engagement from open-ended survey responses (aim 1b); and among caregivers using SHUTi, to determine whether cognitive mechanisms of change targeted by SHUTi are associated with differences in caregiving context (aim 2). Results: Institutional review board approvals have been received. Data collection is anticipated to begin in December 2021 and is expected to be completed in 2023. Conclusions: Findings will inform the next research steps for tailoring and testing SHUTi for optimal impact and reach among caregivers. Beyond implication to the SHUTi program, the findings will be translatable across intervention programs and will hold significant promise to reduce inefficiencies in developing digital health interventions for caregivers while also increasing their impact and reach for this underserved population. Trial Registration: ClinicalTrials.gov; NCT04986904; https://clinicaltrials.gov/ct2/show/NCT04986904?term=NCT04986904 International Registered Report Identifier (IRRID): PRR1-10.2196/34792 %M 35019846 %R 10.2196/34792 %U https://www.researchprotocols.org/2022/1/e34792 %U https://doi.org/10.2196/34792 %U http://www.ncbi.nlm.nih.gov/pubmed/35019846 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27939 %T Effectiveness of Live Health Professional–Led Group eHealth Interventions for Adult Mental Health: Systematic Review of Randomized Controlled Trials %A Currie,Cheryl L %A Larouche,Richard %A Voss,M Lauren %A Trottier,Maegan %A Spiwak,Rae %A Higa,Erin %A Scott,David R %A Tallow,Treena %+ Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada, 1 4033324060, cheryl.currie@uleth.ca %K systematic review %K telemedicine %K eHealth %K mHealth %K e-therapy %K mobile interventions %K internet %K adult %K mental health %K anxiety %K depression %K substance use %K bereavement %K physical activity %K CBT %K psychotherapy %K group %K synchronous %K videoconference %K teleconference %D 2022 %7 11.1.2022 %9 Review %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had adverse impacts on mental health and substance use worldwide. Systematic reviews suggest eHealth interventions can be effective at addressing these problems. However, strong positive eHealth outcomes are often tied to the intensity of web-based therapist guidance, which has time and cost implications that can make the population scale-up of more effective interventions difficult. A way to offset cost while maintaining the intensity of therapist guidance is to offer eHealth programs to groups rather than more standard one-on-one formats. Objective: This systematic review aims to assess experimental evidence for the effectiveness of live health professional–led group eHealth interventions on mental health, substance use, or bereavement among community-dwelling adults. Within the articles selected for our primary aim, we also seek to examine the impact of interventions that encourage physical activity compared with those that do not. Methods: Overall, 4 databases (MEDLINE, CINAHL, PsycINFO, and the Cochrane Library) were searched in July 2020. Eligible studies were randomized controlled trials (RCTs) of eHealth interventions led by health professionals and delivered entirely to adult groups by videoconference, teleconference, or webchat. Eligible studies reported mental health, substance use, or bereavement as primary outcomes. The results were examined by outcome, eHealth platform, and intervention length. Postintervention data were used to calculate effect size by study. The findings were summarized using the Synthesis Without Meta-Analysis guidelines. Risk of bias was assessed using the Cochrane Collaboration Tool. Results: Of the 4099 identified studies, 21 (0.51%) RCTs representing 20 interventions met the inclusion criteria. These studies examined mental health outcomes among 2438 participants (sample size range: 47-361 participants per study) across 7 countries. When effect sizes were pooled, live health professional–led group eHealth interventions had a medium effect on reducing anxiety compared with inactive (Cohen d=0.57) or active control (Cohen d=0.48), a medium to small effect on reducing depression compared with inactive (Cohen d=0.61) or active control (Cohen d=0.21), and mixed effects on mental distress and coping. Interventions led by videoconference, and those that provided 8-12 hours of live health professional–led group contact had more robust effects on adult mental health. Risk of bias was high in 91% (19/21) of the studies. Heterogeneity across interventions was significant, resulting in low to very low quality of evidence. No eligible RCT was found that examined substance use, bereavement, or physical activity. Conclusions: Live eHealth group interventions led by health professionals can foster moderate improvements in anxiety and moderate to small improvements in depression among community-based adults, particularly those delivered by videoconference and those providing 8-12 hours of synchronous engagement. Trial Registration: PROSPERO CRD42020187551; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=187551 International Registered Report Identifier (IRRID): RR2-10.1186/s13643-020-01479-3 %M 34878409 %R 10.2196/27939 %U https://www.jmir.org/2022/1/e27939 %U https://doi.org/10.2196/27939 %U http://www.ncbi.nlm.nih.gov/pubmed/34878409 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31175 %T Examining Tweet Content and Engagement of Users With Tweets About Hikikomori in Japanese: Mixed Methods Study of Social Withdrawal %A Pereira-Sanchez,Victor %A Alvarez-Mon,Miguel Angel %A Horinouchi,Toru %A Kawagishi,Ryo %A Tan,Marcus P J %A Hooker,Elizabeth R %A Alvarez-Mon,Melchor %A Teo,Alan R %+ Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcala, Campus Universitario – C/ 19, Av, de Madrid, Km 33,600, Alcala de Henares, Spain, 34 91 885 4505, maalvarezdemon@icloud.com %K hikikomori %K loneliness %K social isolation %K social withdrawal %K Twitter %K hidden youth %K mobile phone %D 2022 %7 11.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Hikikomori is a form of severe social withdrawal that is particularly prevalent in Japan. Social media posts offer insight into public perceptions of mental health conditions and may also inform strategies to identify, engage, and support hard-to-reach patient populations such as individuals affected by hikikomori. Objective: In this study, we seek to identify the types of content on Twitter related to hikikomori in the Japanese language and to assess Twitter users’ engagement with that content. Methods: We conducted a mixed methods analysis of a random sample of 4940 Japanese tweets from February to August 2018 using a hashtag (#hikikomori). Qualitative content analysis included examination of the text of each tweet, development of a codebook, and categorization of tweets into relevant codes. For quantitative analysis (n=4859 tweets), we used bivariate and multivariate logistic regression models, adjusted for multiple comparisons, and estimated the predicted probabilities of tweets receiving engagement (likes or retweets). Results: Our content analysis identified 9 codes relevant to tweets about hikikomori: personal anecdotes, social support, marketing, advice, stigma, educational opportunities, refuge (ibasho), employment opportunities, and medicine and science. Tweets about personal anecdotes were the most common (present in 2747/4859, 56.53% of the tweets), followed by social support (902/4859, 18.56%) and marketing (624/4859, 12.84%). In the adjusted models, tweets coded as stigma had a lower predicted probability of likes (−33 percentage points, 95% CI −42 to −23 percentage points; P<.001) and retweets (−11 percentage points, 95% CI −18 to −4 percentage points; P<.001), personal anecdotes had a lower predicted probability of retweets (−8 percentage points, 95% CI −14 to −3 percentage points; P=.002), marketing had a lower predicted probability of likes (−13 percentage points, 95% CI −21 to −6 percentage points; P<.001), and social support had a higher predicted probability of retweets (+15 percentage points, 95% CI 6-24 percentage points; P=.001), compared with all tweets without each of these codes. Conclusions: Japanese tweets about hikikomori reflect a unique array of topics, many of which have not been identified in prior research and vary in their likelihood of receiving engagement. Tweets often contain personal stories of hikikomori, suggesting the potential to identify individuals with hikikomori through Twitter. %M 35014971 %R 10.2196/31175 %U https://www.jmir.org/2022/1/e31175 %U https://doi.org/10.2196/31175 %U http://www.ncbi.nlm.nih.gov/pubmed/35014971 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e27631 %T Combining Farmers’ Preferences With Evidence-Based Strategies to Prevent and Lower Farmers’ Distress: Co-design and Acceptability Testing of ifarmwell %A Gunn,Kate M %A Skaczkowski,Gemma %A Dollman,James %A Vincent,Andrew D %A Short,Camille E %A Brumby,Susan %A Barrett,Alison %A Harrison,Nathan %A Turnbull,Deborah %+ Department of Rural Health, Allied Health and Human Performance, University of South Australia, City East Campus BJ2-03, North Terrace, Adelaide, 5001, Australia, 61 417852537, kate.gunn@unisa.edu.au %K farm %K agriculture %K rural %K drought %K mental health %K stress %K coping %K online intervention %K acceptance and commitment therapy %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support. Objective: This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. Methods: Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years; 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) “sheep, cattle and/or grain farmers.” Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology. Results: This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies—ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health–related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. Conclusions: Sequential integration of research evidence, expert knowledge, and farmers’ preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526 %M 35014963 %R 10.2196/27631 %U https://humanfactors.jmir.org/2022/1/e27631 %U https://doi.org/10.2196/27631 %U http://www.ncbi.nlm.nih.gov/pubmed/35014963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33438 %T Patients’ Expectations and Experiences With a Mental Health–Focused Supportive Text Messaging Program: Mixed Methods Evaluation %A Shalaby,Reham %A Vuong,Wesley %A Eboreime,Ejemai %A Surood,Shireen %A Greenshaw,Andrew J %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre (WMC), 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 17807144315, vincent.agyapong@nshealth.ca %K supportive text messages %K patients’ experience %K mental health %K mixed methods %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based services are an economical and easily scalable means of support that uses existing technology. Text4Support is a supportive, complementary text messaging service that supports people with different mental health conditions after they are discharged from inpatient psychiatric care. Objective: In this study, we aim to assess user satisfaction with the Text4Support service to gain a better understanding of subscribers’ experiences. Methods: This was a mixed methods study using secondary data from a pilot observational controlled trial. The trial included 181 patients discharged from acute psychiatric care and distributed into 4 randomized groups. Out of the 4 study groups in the initial study, 2 groups who received supportive text messages (89/181, 49.2% of patients), either alone or alongside a peer support worker, were included. Thematic and descriptive analyses were also performed. Differences in feedback based on sex at birth and primary diagnosis were determined using univariate analysis. The study was registered with ClinicalTrials.gov (trial registration number: NCT03404882). Results: Out of 89 participants, 36 (40%) completed the follow-up survey. The principal findings were that Text4Support was well perceived with a high satisfaction rate either regarding the feedback of the messages or their perceived impact. Meanwhile, there was no statistically significant difference between satisfactory items based on the subscriber’s sex at birth or primary diagnosis. The patients’ initial expectations were either neutral or positive in relation to the expected nature or the impact of the text messages received on their mental well-being. In addition, the subscribers were satisfied with the frequency of the messages, which were received once daily for 6 consecutive months. The participants recommended more personalized messages or mutual interaction with health care personnel. Conclusions: Text4Support was generally well perceived by patients after hospital discharge, regardless of their sex at birth or mental health diagnosis. Further personalization and interactive platforms were recommended by participants that may need to be considered when designing similar future services. %M 35014972 %R 10.2196/33438 %U https://formative.jmir.org/2022/1/e33438 %U https://doi.org/10.2196/33438 %U http://www.ncbi.nlm.nih.gov/pubmed/35014972 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32220 %T Implementation of the Flexible Assertive Community Treatment (FACT) Model in Norway: eHealth Assessment Study %A Bønes,Erlend %A Granja,Conceição %A Solvoll,Terje %+ Norwegian Centre for e-Health Research, University Hospital of North Norway, PO Box 35, Tromsø, 9038, Norway, 47 97655680, erlend.bones@ehealthresearch.no %K mental health %K FACT %K electronic health records %K eHealth %K FACT implementation %K EHR %K implementation %K assessment %K model %K community %K treatment %K policy %K regulation %K infrastructure %K literature %K challenge %K intervention %D 2022 %7 10.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Flexible Assertive Community Treatment (FACT) is a model for treatment of long-term severe mental disorders. This method has become more widespread in Norway. Objective: The objective of our study was to examine how the implementation of FACT teams in Norway has been affected by eHealth policy, infrastructure, and regulations. Another objective was to examine existing literature on eHealth interventions and challenges within FACT teams. Methods: We have examined Norwegian policy regulating mental health services, laws and regulations, eHealth infrastructure, relevant literature on FACT teams, and current implementation of FACT in Norway. Results: FACT teams are a wanted part of the Norwegian service system, but the current eHealth infrastructure makes sharing of data within teams and levels of health care challenging, even if eHealth regulations allow such sharing. This has been shown to be an issue in the current implementation of FACT teams in Norway. There is little or no existing research on the eHealth challenges facing FACT teams. Conclusions: Weaknesses in the Norwegian eHealth infrastructure have been a barrier for an easy implementation of FACT teams in Norway. It is difficult to share information between the different levels of health care. We need systems that allow for easy, secure sharing of health information to and between the FACT team members and other involved health care workers. %M 35006087 %R 10.2196/32220 %U https://www.jmir.org/2022/1/e32220 %U https://doi.org/10.2196/32220 %U http://www.ncbi.nlm.nih.gov/pubmed/35006087 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e27000 %T Heterogeneity of Prevalence of Social Media Addiction Across Multiple Classification Schemes: Latent Profile Analysis %A Cheng,Cecilia %A Ebrahimi,Omid V %A Luk,Jeremy W %+ Social and Health Psychology Lab, Department of Psychology, The University of Hong Kong, Pokfulam, China (Hong Kong), 852 39174224, ceci-cheng@hku.hk %K behavioral addiction %K compulsive social media use %K information technology addiction %K mental health %K psychological assessment %K sensitivity %K social network site %K social networking %K well-being %D 2022 %7 10.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: As social media is a major channel of interpersonal communication in the digital age, social media addiction has emerged as a novel mental health issue that has raised considerable concerns among researchers, health professionals, policy makers, mass media, and the general public. Objective: The aim of this study is to examine the prevalence of social media addiction derived from 4 major classification schemes (strict monothetic, strict polythetic, monothetic, and polythetic), with latent profiles embedded in the empirical data adopted as the benchmark for comparison. The extent of matching between the classification of each scheme and the actual data pattern was evaluated using sensitivity and specificity analyses. The associations between social media addiction and 2 comorbid mental health conditions—depression and anxiety—were investigated. Methods: A cross-sectional web-based survey was conducted, and the replicability of findings was assessed in 2 independent samples comprising 573 adults from the United Kingdom (261/573, 45.6% men; mean age 43.62 years, SD 12.24 years) and 474 adults from the United States (224/474, 47.4% men; mean age 44.67 years, SD 12.99 years). The demographic characteristics of both samples were similar to those of their respective populations. Results: The prevalence estimates of social media addiction varied across the classification schemes, ranging from 1% to 15% for the UK sample and 0% to 11% for the US sample. The latent profile analysis identified 3 latent groups for both samples: low-risk, at-risk, and high-risk. The sensitivity, specificity, and negative predictive values were high (83%-100%) for all classification schemes, except for the relatively lower sensitivity (73%-74%) for the polythetic scheme. However, the polythetic scheme had high positive predictive values (88%-94%), whereas such values were low (2%-43%) for the other 3 classification schemes. The group membership yielded by the polythetic scheme was largely consistent (95%-96%) with that of the benchmark. Conclusions: Among the classification schemes, the polythetic scheme is more well-balanced across all 4 indices. %M 35006084 %R 10.2196/27000 %U https://www.jmir.org/2022/1/e27000 %U https://doi.org/10.2196/27000 %U http://www.ncbi.nlm.nih.gov/pubmed/35006084 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e32017 %T Piloting an Innovative Concept of e–Mental Health and mHealth Workshops With Medical Students Using a Participatory Co-design Approach and App Prototyping: Case Study %A Dederichs,Melina %A Nitsch,Felix Jan %A Apolinário-Hagen,Jennifer %+ Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, Heinrich Heine University Düsseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany, 49 211 81 06477, meded100@hhu.de %K participatory design %K co-design %K mHealth %K medical student %K eHealth %K medical education %K mental health %K mobile phone %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: Medical students show low levels of e–mental health literacy. Moreover, there is a high prevalence of common mental illnesses among medical students. Mobile health (mHealth) apps can be used to maintain and promote medical students’ well-being. To date, the potential of mHealth apps for promoting mental health among medical students is largely untapped because they seem to lack familiarity with mHealth. In addition, little is known about medical students’ preferences regarding mHealth apps for mental health promotion. There is a need for guidance on how to promote competence-based learning on mHealth apps in medical education. Objective: The aim of this case study is to pilot an innovative concept for an educative workshop following a participatory co-design approach and to explore medical students’ preferences and ideas for mHealth apps through the design of a hypothetical prototype. Methods: We conducted a face-to-face co-design workshop within an elective subject with 26 participants enrolled at a medical school in Germany on 5 consecutive days in early March 2020. The aim of the workshop was to apply the knowledge acquired from the lessons on e–mental health and mHealth app development. Activities during the workshop included group work, plenary discussions, storyboarding, developing personas (prototypical users), and designing prototypes of mHealth apps. The workshop was documented in written and digitalized form with the students’ permission. Results: The participants’ feedback suggests that the co-design workshop was well-received. The medical students presented a variety of ideas for the design of mHealth apps. Among the common themes that all groups highlighted in their prototypes were personalization, data security, and the importance of scientific evaluation. Conclusions: Overall, this case study indicates the feasibility and acceptance of a participatory design workshop for medical students. The students made suggestions for improvements at future workshops (eg, use of free prototype software, shift to e-learning, and more time for group work). Our results can be (and have already been) used as a starting point for future co-design workshops to promote competence-based collaborative learning on digital health topics in medical education. %M 35006085 %R 10.2196/32017 %U https://mededu.jmir.org/2022/1/e32017 %U https://doi.org/10.2196/32017 %U http://www.ncbi.nlm.nih.gov/pubmed/35006085 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30565 %T Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study %A Burn,Anne-Marie %A Ford,Tamsin J %A Stochl,Jan %A Jones,Peter B %A Perez,Jesus %A Anderson,Joanna K %+ Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, , Cambridge, CB2 0SZ, United Kingdom, 44 1223 465 192, amb278@medschl.cam.ac.uk %K mental health %K assessment %K young people %K youth %K schools %K computerized adaptive testing %K mobile apps %K user-centered design %K coproduction %K qualitative study %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods: This study involved 2 iterative design feedback cycles—an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools. %M 35006079 %R 10.2196/30565 %U https://formative.jmir.org/2022/1/e30565 %U https://doi.org/10.2196/30565 %U http://www.ncbi.nlm.nih.gov/pubmed/35006079 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e26526 %T Use of a Mobile Peer Support App Among Young People With Nonsuicidal Self-injury: Small-scale Randomized Controlled Trial %A Kruzan,Kaylee Payne %A Whitlock,Janis %A Bazarova,Natalya N %A Bhandari,Aparajita %A Chapman,Julia %+ Center for Behavioral Intervention Technologies, Northwestern University, 750 N Lake Shore Drive, Chicago, IL, 60611, United States, 1 312 503 6585, kaylee.kruzan@northwestern.edu %K nonsuicidal self-injury %K randomized controlled trial %K mobile app %K peer support %K urges %K digital intervention %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Nonsuicidal self-injury (NSSI) is a widespread behavior among adolescents and young adults. Although many individuals who self-injure do not seek treatment, there is evidence for web-based help-seeking through web-based communities and mobile peer support networks. However, few studies have rigorously tested the efficacy of such platforms on outcomes relevant for NSSI recovery. Objective: The aim of this small-scale preregistered randomized controlled trial is to provide preliminary insight into the shorter- and longer-term efficacy of the use of a peer support app, TalkLife, in reducing NSSI frequency and urges and increasing readiness to change. In addition, we explore contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Methods: Individuals aged 16-25 years with current (within 3 months) and chronic (>6 episodes in the past year) NSSI history were eligible to participate in this study. After baseline assessments, the intervention group was instructed to use the app actively (eg, post or comment at least three times per week) and the control group received weekly psychoeducational materials through email, for 8 weeks. Follow-up was assessed at 1 month and 2 months. Linear mixed modeling was used to evaluate condition and time point effects for the primary outcomes of NSSI frequency and urges, readiness to change, contact with informal support, interest in therapy, and attitudes toward professional help–seeking. Results: A total of 131 participants were included in the analysis. We evidenced a significant effect of condition on NSSI frequency such that the participants using the peer support app self-injured less over the course of the study (mean 1.30, SE 0.18) than those in the control condition (mean 1.62, SE 0.18; P=.02; η2=0.02). We also evidenced a significant condition effect of readiness to change such that the treatment participants reported greater confidence in their ability to change their NSSI behavior (mean 6.28, SE 0.41) than the control participants (mean 5.67, SE 0.41; P=.04; η2=0.02). No significant differences were observed for contact with informal support, interest in therapy, or attitudes toward professional help–seeking. Conclusions: Use of the peer support app was related to reduced NSSI frequency and greater confidence in one’s ability to change NSSI behavior over the course of the study period, but no effects on NSSI urges, contact with informal support, interest in therapy, or attitudes toward professional help–seeking were observed. The findings provide preliminary support for considering the use of mobile peer support apps as a supplement to NSSI intervention and point to the need for larger-scale trials. Trial Registration: Open Science Foundation; https://osf.io/3uay9 %M 35006076 %R 10.2196/26526 %U https://formative.jmir.org/2022/1/e26526 %U https://doi.org/10.2196/26526 %U http://www.ncbi.nlm.nih.gov/pubmed/35006076 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e31801 %T Development of a Web-Based, Guided Self-help, Acceptance and Commitment Therapy–Based Intervention for Weight Loss Maintenance: Evidence-, Theory-, and Person-Based Approach %A Richards,Rebecca %A Jones,Rebecca A %A Whittle,Fiona %A Hughes,Carly A %A Hill,Andrew J %A Lawlor,Emma R %A Bostock,Jennifer %A Bates,Sarah %A Breeze,Penny R %A Brennan,Alan %A Thomas,Chloe V %A Stubbings,Marie %A Woolston,Jennifer %A Griffin,Simon J %A Ahern,Amy L %+ Medical Research Council Epidemiology Unit, University of Cambridge School of Clinical Medicine, Level 3 Institute of Metabolic Science, Cambridge, CB2 0SL, United Kingdom, 44 1223 769129, Rebecca.richards@mrc-epid.cam.ac.uk %K weight management %K eHealth %K acceptance and commitment therapy %K third-wave cognitive behavioral therapy %K guided self-help %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The long-term impact and cost-effectiveness of weight management programs depend on posttreatment weight maintenance. There is growing evidence that interventions based on third-wave cognitive behavioral therapy, particularly acceptance and commitment therapy (ACT), could improve long-term weight management; however, these interventions are typically delivered face-to-face by psychologists, which limits the scalability of these types of intervention. Objective: The aim of this study is to use an evidence-, theory-, and person-based approach to develop an ACT-based intervention for weight loss maintenance that uses digital technology and nonspecialist guidance to minimize the resources needed for delivery at scale. Methods: Intervention development was guided by the Medical Research Council framework for the development of complex interventions in health care, Intervention Mapping Protocol, and a person-based approach for enhancing the acceptability and feasibility of interventions. Work was conducted in two phases: phase 1 consisted of collating and analyzing existing and new primary evidence and phase 2 consisted of theoretical modeling and intervention development. Phase 1 included a synthesis of existing evidence on weight loss maintenance from previous research, a systematic review and network meta-analysis of third-wave cognitive behavioral therapy interventions for weight management, a qualitative interview study of experiences of weight loss maintenance, and the modeling of a justifiable cost for a weight loss maintenance program. Phase 2 included the iterative development of guiding principles, a logic model, and the intervention design and content. Target user and stakeholder panels were established to inform each phase of development, and user testing of successive iterations of the prototype intervention was conducted. Results: This process resulted in a guided self-help ACT-based intervention called SWiM (Supporting Weight Management). SWiM is a 4-month program consisting of weekly web-based sessions for 13 consecutive weeks followed by a 4-week break for participants to reflect and practice their new skills and a final session at week 18. Each session consists of psychoeducational content, reflective exercises, and behavioral experiments. SWiM includes specific sessions on key determinants of weight loss maintenance, including developing skills to manage high-risk situations for lapses, creating new helpful habits, breaking old unhelpful habits, and learning to manage interpersonal relationships and their impact on weight management. A trained, nonspecialist coach provides guidance for the participants through the program with 4 scheduled 30-minute telephone calls and 3 further optional calls. Conclusions: This comprehensive approach facilitated the development of an intervention that is based on scientific theory and evidence for supporting people with weight loss maintenance and is grounded in the experiences of the target users and the context in which it is intended to be delivered. The intervention will be refined based on the findings of a planned pilot randomized controlled trial. %M 34994698 %R 10.2196/31801 %U https://formative.jmir.org/2022/1/e31801 %U https://doi.org/10.2196/31801 %U http://www.ncbi.nlm.nih.gov/pubmed/34994698 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e32550 %T A Text Messaging–Enhanced Intervention for African American Patients With Heart Failure, Depression, and Anxiety (TXT COPE-HF): Protocol for a Pilot Feasibility Study %A Cornelius,Judith %A Whitaker-Brown,Charlene %A Smoot,Jaleesa %A Hart,Sonia %A Lewis,Zandria %A Smith,Olivia %+ School of Nursing, University of North Carolina at Charlotte, 9201 University City Blvd, Charlotte, NC, 28223, United States, 1 7046877978, jbcornel@uncc.edu %K African American %K heart failure %K depression %K anxiety %K assessment %K decision %K administration %K production %K topical expert %K integration %K training and testing model %K text messaging %K SMS %K minorities %K behavior therapy %D 2022 %7 7.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: African Americans have a higher incidence rate of heart failure (HF) and an earlier age of HF onset compared to those of other racial and ethnic groups. Scientific literature suggests that by 2030, African Americans will have a 30% increased prevalence rate of HF coupled with depression. In addition to depression, anxiety is a predictor of worsening functional capacity, decreased quality of life, and increased hospital readmission rates. There is no consensus on the best way to treat patients with HF, depression, and anxiety. One promising type of treatment—cognitive behavioral therapy (CBT)—has been shown to significantly improve patients’ quality of life and treatment compliance, but CBT has not been used with SMS text messaging reminders to enhance the effect of reducing symptoms of depression and anxiety in racial and ethnic minority patients with HF. Objective: The objectives of our study are to (1) adapt and modify the Creating Opportunities for Personal Empowerment (COPE) curriculum for delivery to patients with HF by using an SMS text messaging component to improve depression and anxiety symptoms, (2) administer the adapted intervention to 10 patients to examine the feasibility and acceptability of the approach and modify it as needed, and (3) examine trends in depression and anxiety symptoms postintervention. We hypothesize that patients will show an improvement in depression scores and anxiety symptoms postintervention. Methods: The study will comprise a mixed methods approach. We will use the eight steps of the ADAPT-ITT (assessment, decision, administration, production, topical expert, integration, training, and testing) model to adapt the intervention. The first step in this feasibility study will involve assembling individuals from the target population (n=10) to discuss questions on a specific topic. In phase 2, we will examine the feasibility and acceptability of the enhanced SMS text messaging intervention (TXT COPE-HF [Texting With COPE for Patients With HF]) and its preliminary effects with 10 participants. The Beck Depression Inventory will be used to assess depression, the State-Trait Anxiety Inventory will be used to assess anxiety, and the Healthy Beliefs and Lifestyle Behavior surveys will be used to assess participants’ lifestyle beliefs and behavior changes. Changes will be compared from baseline to end point by using paired 2-tailed t tests. An exit focus group (n=10) will be held to examine facilitators and barriers to the SMS text messaging protocol. Results: The pilot feasibility study was funded by the Academy for Clinical Research and Scholarship. Institutional review board approval was obtained in April 2021. Data collection and analysis are expected to conclude by November 2021 and April 2022, respectively. Conclusions: The study results will add to the literature on the effectiveness of an SMS text messaging CBT-enhanced intervention in reducing depression and anxiety among African American patients with HF. International Registered Report Identifier (IRRID): PRR1-10.2196/32550 %M 34994709 %R 10.2196/32550 %U https://www.researchprotocols.org/2022/1/e32550 %U https://doi.org/10.2196/32550 %U http://www.ncbi.nlm.nih.gov/pubmed/34994709 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e30077 %T Effectiveness of Digital Counseling Environments on Anxiety, Depression, and Adherence to Treatment Among Patients Who Are Chronically Ill: Systematic Review %A Paalimäki-Paakki,Karoliina %A Virtanen,Mari %A Henner,Anja %A Nieminen,Miika T %A Kääriäinen,Maria %+ Research Unit of Nursing Science and Health Management, University of Oulu, Aapistie 5 A, Oulu, 90220, Finland, 358 505365959, karoliina.paalimaki-paakki@oamk.fi %K mHealth %K mobile health %K eHealth %K digital health %K mobile apps %K smartphone apps %K web-based %K telemedicine %K chronic diseases %K noncommunicable diseases %K web-based interventions %K mobile phone %D 2022 %7 6.1.2022 %9 Review %J J Med Internet Res %G English %X Background: Patients who are chronically ill need novel patient counseling methods to support their self-care at different stages of the disease. At present, knowledge of how effective digital counseling is at managing patients’ anxiety, depression, and adherence to treatment seems to be fragmented, and the development of digital counseling will require a more comprehensive view of this subset of interventions. Objective: This study aims to identify and synthesize the best available evidence on the effectiveness of digital counseling environments at improving anxiety, depression, and adherence to treatment among patients who are chronically ill. Methods: Systematic searches of the EBSCO (CINAHL), PubMed, Scopus, and Web of Science databases were conducted in May 2019 and complemented in October 2020. The review considered studies that included adult patients aged ≥18 years with chronic diseases; interventions evaluating digital (mobile, web-based, and ubiquitous) counseling interventions; and anxiety, depression, and adherence to treatment, including clinical indicators related to adherence to treatment, as outcomes. Methodological quality was assessed using the standardized Joanna Briggs Institute critical appraisal tool for randomized controlled trials or quasi-experimental studies. As a meta-analysis could not be conducted because of considerable heterogeneity in the reported outcomes, narrative synthesis was used to synthesize the results. Results: Of the 2056 records screened, 20 (0.97%) randomized controlled trials, 4 (0.19%) pilot randomized controlled trials, and 2 (0.09%) quasi-experimental studies were included. Among the 26 included studies, 10 (38%) digital, web-based interventions yielded significantly positive effects on anxiety, depression, adherence to treatment, and the clinical indicators related to adherence to treatment, and another 18 (69%) studies reported positive, albeit statistically nonsignificant, changes among patients who were chronically ill. The results indicate that an effective digital counseling environment comprises high-quality educational materials that are enriched with multimedia elements and activities that engage the participant in self-care. Because of the methodological heterogeneity of the included studies, it is impossible to determine which type of digital intervention is the most effective for managing anxiety, depression, and adherence to treatment. Conclusions: This study provides compelling evidence that digital, web-based counseling environments for patients who are chronically ill are more effective than, or at least comparable to, standard counseling methods; this suggests that digital environments could complement standard counseling. %M 34989681 %R 10.2196/30077 %U https://www.jmir.org/2022/1/e30077 %U https://doi.org/10.2196/30077 %U http://www.ncbi.nlm.nih.gov/pubmed/34989681 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e31367 %T Centering Lived Experience in Developing Digital Interventions for Suicide and Self-injurious Behaviors: User-Centered Design Approach %A Kruzan,Kaylee Payne %A Meyerhoff,Jonah %A Biernesser,Candice %A Goldstein,Tina %A Reddy,Madhu %A Mohr,David C %+ Center for Behavioral Intervention Technologies, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, Chicago, IL, 60611, United States, 1 3125036585, kaylee.kruzan@northwestern.edu %K user-centered design %K intervention %K suicide %K nonsuicidal self-injury %K lived experience %K technology-enabled services %K digital intervention %K engagement %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The prevalence of self-injurious thoughts and behaviors (SITB) signals a growing public health crisis. Despite a recognized need for improved and scalable interventions, the field of SITB intervention faces several challenges: existing interventions are often time and resource intensive, most individuals with SITB do not seek formal mental health care, and efficacious treatments are characterized by small effects. Combined, these challenges indicate a need for improved SITB interventions for individuals in formal treatment and those who are not treatment engaged but are at high risk of worsening mental health and future suicide attempts. Objective: We present a methodological approach and set of techniques that may address these challenges by centering the lived experience of individuals with SITB in the process of developing needed services: user-centered design (UCD). Methods: We highlight the value of UCD in the context of digital interventions for SITB by describing the UCD approach and explicating how it can be leveraged to include lived experience throughout the development and evaluation process. We provide a detailed case example highlighting 3 phases of the early development process that can be used to design an intervention that is engaging and meets end-user needs. In addition, we point to novel applications of UCD to complement new directions in SITB research. Results: In this paper, we offer a 2-pronged approach to meet these challenges. First, in terms of addressing access to effective interventions, digital interventions hold promise to extend the reach of evidence-based treatments outside of brick-and-mortar health care settings. Second, to address challenges related to treatment targets and engagement, we propose involving individuals with lived experience in the design and research process. Conclusions: UCD offers a well-developed and systematic process to center the unique needs, preferences, and perceived barriers of individuals with lived SITB experience in the development and evaluation of digital interventions. %M 34951602 %R 10.2196/31367 %U https://mental.jmir.org/2021/12/e31367 %U https://doi.org/10.2196/31367 %U http://www.ncbi.nlm.nih.gov/pubmed/34951602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30268 %T Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design %A Adams,Zachary %A Grant,Miyah %A Hupp,Samantha %A Scott,Taylor %A Feagans,Amanda %A Phillips,Meredith Lois %A Bixler,Kristina %A Nallam,Phani Teja %A La Putt,Dorothy %+ Department of Psychiatry, Indiana University School of Medicine, 340 W 10th St., Indianapolis, IN, 46202, United States, 1 317 278 0591, zwadams@iu.edu %K mobile health %K user-centered design %K adolescents %K substance use disorders %K mental health %K mHealth %K cognitive behavioral therapy %K homework %K technology acceptance model %K trauma %K mobile phone %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Treating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined. Objective: This study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns. Methods: Adolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality. Results: Participants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language. Conclusions: The novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes. %M 34951593 %R 10.2196/30268 %U https://formative.jmir.org/2021/12/e30268 %U https://doi.org/10.2196/30268 %U http://www.ncbi.nlm.nih.gov/pubmed/34951593 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e22107 %T Effectiveness and Moderators of an Internet-Based Mobile-Supported Stress Management Intervention as a Universal Prevention Approach: Randomized Controlled Trial %A Ebert,David Daniel %A Franke,Marvin %A Zarski,Anna-Carlotta %A Berking,Matthias %A Riper,Heleen %A Cuijpers,Pim %A Funk,Burkhardt %A Lehr,Dirk %+ Department of Sport and Health Sciences, Technical University of Munich, Georg-Brauchle-Ring 60/62, TUM Campus D, Munich, 80992, Germany, 49 15116781057, david.daniel.ebert@tum.de %K stress management intervention %K universal prevention %K occupational health %K moderators %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Emerging evidence indicates the effectiveness of internet-based mobile-supported stress management interventions (iSMIs) in highly stressed employees. It is yet unclear, however, whether iSMIs are also effective without a preselection process in a universal prevention approach, which more closely resembles routine occupational health care. Moreover, evidence for whom iSMIs might be suitable and for whom not is scarce. Objective: The aim of this study was to evaluate the iSMI GET.ON Stress in a universal prevention approach without baseline inclusion criteria and to examine the moderators of the intervention effects. Methods: A total of 396 employees were randomly assigned to the intervention group or the 6-month waiting list control group. The iSMI consisted of 7 sessions and 1 booster session and offered no therapeutic guidance. Self-report data were assessed at baseline, 7 weeks, and at 6 months following randomization. The primary outcome was perceived stress. Several a priori defined moderators were explored as potential effect modifiers. Results: Participants in the intervention group reported significantly lower perceived stress at posttreatment (d=0.71, 95% CI 0.51-0.91) and at 6-month follow-up (d=0.61, 95% CI 0.41-0.81) compared to those in the waiting list control group. Significant differences with medium-to-large effect sizes were found for all mental health and most work-related outcomes. Resilience (at 7 weeks, P=.04; at 6 months, P=.01), agreeableness (at 7 weeks, P=.01), psychological strain (at 6 months, P=.04), and self-regulation (at 6 months, P=.04) moderated the intervention effects. Conclusions: This study indicates that iSMIs can be effective in a broad range of employees with no need for preselection to achieve substantial effects. The subgroups that might not profit had extreme values on the respective measures and represented only a very small proportion of the investigated sample, thereby indicating the broad applicability of GET.ON Stress. Trial Registration: German Clinical Trials Register DRKS00005699; https://www.drks.de/DRKS00005699 %M 34941541 %R 10.2196/22107 %U https://www.jmir.org/2021/12/e22107 %U https://doi.org/10.2196/22107 %U http://www.ncbi.nlm.nih.gov/pubmed/34941541 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e32794 %T Using Personalized Anchors to Establish Routine Meditation Practice With a Mobile App: Randomized Controlled Trial %A Stecher,Chad %A Sullivan,Mariah %A Huberty,Jennifer %+ College of Health Solutions, Arizona State University, 550 North 3rd Str, Phoenix, AZ, 85004, United States, 1 602 496 0957, chad.stecher@asu.edu %K mindfulness %K meditation %K mobile meditation app %K behavioral persistence %K habit formation %K randomized controlled trial %K mental health %K physical health %K app engagement %K routine %D 2021 %7 22.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical and mental health benefits can be attained from persistent, long-term performance of mindfulness meditation with a mobile meditation app, but in general, few mobile health app users persistently engage at a level necessary to attain the corresponding health benefits. Anchoring or pairing meditation with a mobile app to an existing daily routine can establish an unconsciously initiated meditation routine that may improve meditation persistence. Objective: The purpose of this study was to test the use of either personalized anchors or fixed anchors for establishing a persistent meditation app routine with the mobile app, Calm. Methods: We conducted a randomized controlled trial and randomly assigned participants to one of 3 study groups: (1) a personalized anchor (PA) group, (2) fixed anchor (FA) group, or (3) control group that did not use the anchoring strategy. All participants received app-delivered reminder messages to meditate for at least 10 minutes a day using the Calm app for an 8-week intervention period, and app usage data continued to be collected for an additional 8-week follow-up period to measure meditation persistence. Baseline, week 8, and week 16 surveys were administered to assess demographics, socioeconomic status, and changes in self-reported habit strength. Results: A total of 101 participants across the 3 study groups were included in the final analysis: (1) PA (n=56), (2) FA (n=49), and (3) control group (n=62). Participants were predominantly White (83/101, 82.2%), female (77/101, 76.2%), and college educated (ie, bachelor’s or graduate degree; 82/101, 81.2%). The FA group had a significantly higher average odds of daily meditation during the intervention (1.14 odds ratio [OR]; 95% CI 1.02-1.33; P=.04), and all participants experienced a linear decline in their odds of daily meditation during the 8-week intervention (0.96 OR; 95% CI 0.95-0.96; P<.001). Importantly, the FA group showed a significantly smaller decline in the linear trend of their odds of daily meditation during the 8-week follow-up (their daily trend increased by 1.04 OR from their trend during the intervention; 95% CI 1.01-1.06; P=.03). Additionally, those who more frequently adhered to their anchoring strategy during the intervention typically used anchors that occurred in the morning and showed a significantly smaller decline in their odds of daily meditation during the 8-week follow-up period (1.13 OR; 95% CI 1.02-1.35; P=.007). Conclusions: The FA group had more persistent meditation with the app, but participants in the FA or PA groups who more frequently adhered to their anchoring strategy during the intervention had the most persistent meditation routines, and almost all of these high anchorers used morning anchors. These findings suggest that the anchoring strategy can create persistent meditation routines with a mobile app. However, future studies should combine anchoring with additional intervention tools (eg, incentives) to help more participants successfully establish an anchored meditation routine. Trial Registration: ClinicalTrials.gov NCT04378530; https://clinicaltrials.gov/ct2/show/NCT04378530 %M 34941558 %R 10.2196/32794 %U https://mhealth.jmir.org/2021/12/e32794 %U https://doi.org/10.2196/32794 %U http://www.ncbi.nlm.nih.gov/pubmed/34941558 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e27991 %T The Extent of User Involvement in the Design of Self-tracking Technology for Bipolar Disorder: Literature Review %A Majid,Shazmin %A Reeves,Stuart %A Figueredo,Grazziela %A Brown,Susan %A Lang,Alexandra %A Moore,Matthew %A Morriss,Richard %+ School of Computer Science, Horizon Centre for Doctoral Training, University of Nottingham, Computer Science Building, Wollaton Rd, Nottingham, NG8 1BB, United Kingdom, 44 7713508981, shazmin.majid1@nottingham.ac.uk %K user-centered design %K participatory design %K human-computer interaction %K patient and public involvement %K self-monitoring technology %K bipolar disorder %K mobile phone %D 2021 %7 20.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: The number of self-monitoring apps for bipolar disorder (BD) is increasing. The involvement of users in human-computer interaction (HCI) research has a long history and is becoming a core concern for designers working in this space. The application of models of involvement, such as user-centered design, is becoming standardized to optimize the reach, adoption, and sustained use of this type of technology. Objective: This paper aims to examine the current ways in which users are involved in the design and evaluation of self-monitoring apps for BD by investigating 3 specific questions: are users involved in the design and evaluation of technology? If so, how does this happen? And what are the best practice ingredients regarding the design of mental health technology? Methods: We reviewed the available literature on self-tracking technology for BD and make an overall assessment of the level of user involvement in design. The findings were reviewed by an expert panel, including an individual with lived experience of BD, to form best practice ingredients for the design of mental health technology. This combines the existing practices of patient and public involvement and HCI to evolve from the generic guidelines of user-centered design and to those that are tailored toward mental health technology. Results: For the first question, it was found that out of the 11 novel smartphone apps included in this review, 4 (36%) self-monitoring apps were classified as having no mention of user involvement in design, 1 (9%) self-monitoring app was classified as having low user involvement, 4 (36%) self-monitoring apps were classified as having medium user involvement, and 2 (18%) self-monitoring apps were classified as having high user involvement. For the second question, it was found that despite the presence of extant approaches for the involvement of the user in the process of design and evaluation, there is large variability in whether the user is involved, how they are involved, and to what extent there is a reported emphasis on the voice of the user, which is the ultimate aim of such design approaches. For the third question, it is recommended that users are involved in all stages of design with the ultimate goal of empowering and creating empathy for the user. Conclusions: Users should be involved early in the design process, and this should not just be limited to the design itself, but also to associated research ensuring end-to-end involvement. Communities in health care–based design and HCI design need to work together to increase awareness of the different methods available and to encourage the use and mixing of the methods as well as establish better mechanisms to reach the target user group. Future research using systematic literature search methods should explore this further. %M 34931992 %R 10.2196/27991 %U https://mental.jmir.org/2021/12/e27991 %U https://doi.org/10.2196/27991 %U http://www.ncbi.nlm.nih.gov/pubmed/34931992 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e30000 %T Understanding Engagement Strategies in Digital Interventions for Mental Health Promotion: Scoping Review %A Saleem,Maham %A Kühne,Lisa %A De Santis,Karina Karolina %A Christianson,Lara %A Brand,Tilman %A Busse,Heide %+ Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, Bremen, 28359, Germany, 49 42121856 ext 923, saleem@leibniz-bips.de %K digital interventions %K mental health promotion %K engagement %K scoping review %K mobile phone %D 2021 %7 20.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: Digital interventions offer a solution to address the high demand for mental health promotion, especially when facing physical contact restrictions or lacking accessibility. Engagement with digital interventions is critical for their effectiveness; however, retaining users’ engagement throughout the intervention is challenging. It remains unclear what strategies facilitate engagement with digital interventions that target mental health promotion. Objective: Our aim is to conduct a scoping review to investigate user engagement strategies and methods to evaluate engagement with digital interventions that target mental health promotion in adults. Methods: This scoping review adheres to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews. The search was conducted in 7 electronic databases from inception to April 2020. The inclusion criteria for studies were as follows: adult (aged ≥18 years) users of digital interventions for mental health promotion from the general population; any digital intervention for mental health promotion; and user engagement strategies described in the intervention design. We extracted the following data items: study characteristics, digital intervention (type and engagement strategy), evaluation of engagement strategy (method and result specifying whether the strategy was effective at facilitating engagement), and features of engagement (extent of use and subjective experience of users). Results: A total of 2766 studies were identified, of which 16 (0.58%) met the inclusion criteria. The 16 studies included randomized controlled trials (6/16, 37%), studies analyzing process data (5/16, 31%), observational studies (3/16, 19%), and qualitative studies (2/16, 13%). The digital interventions for mental health promotion were either web based (12/16, 75%) or mobile app based (4/16, 25%). The engagement strategies included personalized feedback about intervention content or users’ mental health status; guidance regarding content and progress through e-coaching; social forums, and interactivity with peers; content gamification; reminders; and flexibility and ease of use. These engagement strategies were deemed effective based on qualitative user feedback or responses on questionnaires or tools (4/16, 25%), usability data (5/16, 31%), or both (7/16, 44%). Most studies identified personalized support in the form of e-coaching, peer support through a social platform, personalized feedback, or joint videoconference sessions as an engaging feature. Conclusions: Personalized support during the intervention, access to social support, and personalized feedback seem to promote engagement with digital interventions for mental health promotion. These findings need to be interpreted with caution because the included studies were heterogeneous, had small sample sizes, and typically did not address engagement as the primary outcome. Despite the importance of user engagement for the effectiveness of digital interventions, this field has not yet received much attention. Further research is needed on the effectiveness of different strategies required to facilitate user engagement in digital interventions for mental health promotion. %M 34931995 %R 10.2196/30000 %U https://mental.jmir.org/2021/12/e30000 %U https://doi.org/10.2196/30000 %U http://www.ncbi.nlm.nih.gov/pubmed/34931995 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26584 %T Quality Social Connection as an Active Ingredient in Digital Interventions for Young People With Depression and Anxiety: Systematic Scoping Review and Meta-analysis %A Dewa,Lindsay H %A Lawrance,Emma %A Roberts,Lily %A Brooks-Hall,Ellie %A Ashrafian,Hutan %A Fontana,Gianluca %A Aylin,Paul %+ Institute of Global Health Innovation, Imperial College London, Reynolds Building, 3rd Floor, London, W6 8RP, United Kingdom, 44 020 7594 0815, l.dewa@imperial.ac.uk %K mental health %K digital interventions %K young people %K quality social connection %K depression %K anxiety %K systematic review %K meta-analysis %K patient and public involvement %K mobile phone %D 2021 %7 17.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Disrupted social connections may negatively affect youth mental health. In contrast, sustained quality social connections (QSCs) can improve mental health outcomes. However, few studies have examined how these quality connections affect depression and anxiety outcomes within digital interventions, and conceptualization is limited. Objective: The aim of this study is to conceptualize, appraise, and synthesize evidence on QSC within digital interventions (D-QSC) and the impact on depression and anxiety outcomes for young people aged 14-24 years. Methods: A systematic scoping review and meta-analysis was conducted using the Joanna Briggs Institute methodological frameworks and guided by experts with lived experience. Reporting was guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). The MEDLINE, Embase, PsycINFO, and CINAHL databases were searched against a comprehensive combination of key concepts on June 24, 2020. The search concepts included young people, digital intervention, depression, anxiety, and social connection. Google was also searched. A reviewer independently screened abstracts and titles and full text, and 9.99% (388/3882) of these were screened by a second reviewer. A narrative synthesis was used to structure the findings on indicators of D-QSC and mechanisms that facilitate the connection. Indicators of D-QSC from the included studies were synthesized to produce a conceptual framework. Results: Of the 5715 publications identified, 42 (0.73%) were included. Among the included studies, there were 23,319 participants. Indicators that D-QSC was present varied and included relatedness, having a sense of belonging, and connecting to similar people. However, despite the variation, most of the indicators were associated with improved outcomes for depression and anxiety. Negative interactions, loneliness, and feeling ignored indicated that D-QSC was not present. In 24% (10/42) of the applicable studies, a meta-analysis showed a significant decrease in depression (–25.6%, 95% CI –0.352 to –0.160; P<.001) and anxiety (–15.1%, 95% CI –0.251 to –0.051; P=.003) after a D-QSC. Digital mechanisms that helped create a quality connection included anonymity, confidentiality, and peer support. In contrast, mechanisms that hindered the connection included disconnection from the real world and inability to see body language. Data synthesis also identified a 5-component conceptual framework of D-QSC that included rapport, identity and commonality, valued interpersonal dynamic, engagement, and responded to and accepted. Conclusions: D-QSC is an important and underconsidered component for youth depression and anxiety outcomes. Researchers and developers should consider targeting improved QSC between clinicians and young people within digital interventions for depression. Future research should build on our framework to further examine relationships among individual attributes of QSC, various digital interventions, and different populations. %M 34927592 %R 10.2196/26584 %U https://www.jmir.org/2021/12/e26584 %U https://doi.org/10.2196/26584 %U http://www.ncbi.nlm.nih.gov/pubmed/34927592 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31844 %T The Effects of Virtual Reality Treatment on Prefrontal Cortex Activity in Patients With Social Anxiety Disorder: Participatory and Interactive Virtual Reality Treatment Study %A Lee,Hojun %A Choi,JongKwan %A Jung,Dooyoung %A Hur,Ji-Won %A Cho,Chul-Hyun %+ Department of Psychiatry, College of Medicine, Chungnam National University, 82 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea, 82 044 995 4775, david0203@gmail.com %K anxiety %K social anxiety disorder %K virtual reality %K fNIRS %K brain activity %K prefrontal cortex %K effectiveness %D 2021 %7 17.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Attempts to use virtual reality (VR) as a treatment for various psychiatric disorders have been made recently, and many researchers have identified the effects of VR in psychiatric disorders. Studies have reported that VR therapy is effective in social anxiety disorder (SAD). However, there is no prior study on the neural correlates of VR therapy in patients with SAD. Objective: The aim of this study is to find the neural correlates of VR therapy by evaluating the treatment effectiveness of VR in patients with SAD using portable functional near-infrared spectroscopy (fNIRS). Methods: Patients with SAD (n=28) were provided with 6 sessions of VR treatment that was developed for exposure to social situations with a recording system of each participant’s self-introduction in VR. After each VR treatment session, the first-person view (video 1) and third-person view (video 2) clips of the participant’s self-introduction were automatically generated. The functional activities of prefrontal regions were measured by fNIRS while watching videos 1 and 2 with a cognitive task, before and after whole VR treatment sessions, and after the first session of VR treatment. We compared the data of fNIRS between patients with SAD and healthy controls (HCs; n=27). Results: We found that reduction in activities of the right frontopolar prefrontal cortex (FPPFC) in HCs was greater than in the SAD group at baseline (t=–2.01, P=.049). Comparing the frontal cortex activation before and after VR treatment sessions in the SAD group showed significant differences in activities of the FPPFC (right: t=–2.93, P<.001; left: t=–2.25, P=.03) and the orbitofrontal cortex (OFC) (right: t=–2.10, P=.045; left: t=–2.21, P=.04) while watching video 2. Conclusions: Activities of the FPPFC and OFC were associated with symptom reduction after VR treatment for SAD. Our study findings might provide a clue to understanding the mechanisms underlying VR treatment for SAD. Trial Registration: Clinical Research Information Service (CRIS) KCT0003854; https://tinyurl.com/559jp2kp %M 34801979 %R 10.2196/31844 %U https://www.jmir.org/2021/12/e31844 %U https://doi.org/10.2196/31844 %U http://www.ncbi.nlm.nih.gov/pubmed/34801979 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e33452 %T Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study %A Wu,Monica S %A Wickham,Robert E %A Chen,Shih-Yin %A Chen,Connie %A Lungu,Anita %+ Lyra Health, 287 Lorton Ave, Burlingame, CA, 94010, United States, 1 877 505 7147, mwu@lyrahealth.com %K blended care %K cognitive-behavioral therapy %K depression %K anxiety %K digital %K phase %K mental health %K digital health %K digital therapy %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Depression and anxiety incur significant personal and societal costs. Effective psychotherapies exist, such as cognitive behavioral therapy (CBT); however, timely access to quality care is limited by myriad barriers. Blended care therapy models incorporate traditional face-to-face therapy with scalable, digital components of care, expanding the reach of evidence-based care. Objective: The aim of this study is to determine the effectiveness of a blended care CBT program (BC-CBT) in real-world settings and examine the unique impacts of the (1) digital components of care (video lessons and digital exercises) and (2) phase of treatment (early versus late) in decreasing symptoms of anxiety and depression. Methods: This retrospective cohort analysis included 3401 US-based individuals enrolled in a BC-CBT program, who presented with clinical levels of depression and/or anxiety. The treatment program consisted of regular therapy sessions augmented by clinician-assigned digital video lessons and exercises. A growth curve model incorporating time-varying covariates examined the relationship between engagement with BCT components (ie, therapy sessions, digital video lessons, and digital exercises) during the early (weeks 0-7) and late (weeks 8-15) phases of treatment, and weekly symptom reports on depression and anxiety measures. Results: On average, a significant decline in depression and anxiety symptoms was observed during the initial weeks of treatment (P<.001), with a continued, though slower, decline over subsequent weeks (P<.001). Each session completed was associated with significant decreases in anxiety (b=–0.72) and depression (b=–0.83) in the early phase, as well as in the late phase (anxiety, b=–0.47; depression, b=–0.27). Significant decreases in anxiety (b=–0.15) and depression (b=–0.12) were observed for time spent on video lessons (measured in 10-minute intervals) in the early phase of treatment. Engaging with exercises was associated with statistically significant increases in anxiety symptoms (b=0.03) during the early phase of treatment. However, sensitivity analyses examining the effects of exercises in isolation revealed significant decreases in anxiety (b=–0.05) in the early phase, suggesting a potential suppression effect in the larger model. Conclusions: Using a retrospective cohort design, therapy sessions and digital video lessons were uniquely predictive of improvements in depression and anxiety symptoms, and their effects were modulated based on the phase of treatment (early vs late). Future research should investigate whether other treatment variables, such as therapeutic alliance or familiarity with technology, are related to differential effects on various components of care. %M 34927591 %R 10.2196/33452 %U https://formative.jmir.org/2021/12/e33452 %U https://doi.org/10.2196/33452 %U http://www.ncbi.nlm.nih.gov/pubmed/34927591 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30482 %T Awareness, Prevention, Detection, and Therapy Applications for Depression and Anxiety in Serious Games for Children and Adolescents: Systematic Review %A Martinez,Kim %A Menéndez-Menéndez,Maria Isabel %A Bustillo,Andres %+ Department of History, Geography and Communication, University of Burgos, Don Juan de Austria, Burgos, 09001, Spain, 34 947 49 91 12, kmartinez@ubu.es %K serious games %K depression %K anxiety %K children %K adolescents %K virtual reality %K mental health %K detection %K awareness %K prevention %K therapy %D 2021 %7 16.12.2021 %9 Review %J JMIR Serious Games %G English %X Background: Depression and anxiety in children and adolescents are major health problems worldwide. In recent years, serious games research has advanced in the development of tools to address these mental health conditions. However, there has not been an extensive analysis of these games, their tendencies, and capacities. Objective: This review aims to gather the most current serious games, published from 2015 to 2020, with a new approach focusing on their applications: awareness, prevention, detection, and therapy. The purpose is also to analyze the implementation, development, and evaluation of these tools to obtain trends, strengths, and weaknesses for future research lines. Methods: The identification of the serious games through a literature search was conducted on the databases PubMed, Scopus, Wiley, Taylor and Francis, Springer, PsycINFO, PsycArticles, Web of Science, and Science Direct. The identified records were screened to include only the manuscripts meeting these criteria: a serious game for PC, smartphone, or virtual reality; developed by research teams; targeting only depression or anxiety or both; aiming specifically at children or adolescents. Results: A total of 34 studies have been found that developed serious games for PC, smartphone, and virtual reality devices and tested them in children and adolescents. Most of the games address both conditions and are applied in prevention and therapy. Nevertheless, there is a trend that anxiety is targeted more in childhood and depression targeted more in adolescence. Regarding design, the game genres arcade minigames, adventure worlds, and social simulations are used, in this order. For implementation, these serious games usually require sessions of 1 hour and are most often played using a PC. Moreover, the common evaluation tools are normalized questionnaires that measure acquisition of skills or reduction of symptoms. Most studies collect and compare these data before and after the participants play. Conclusions: The results show that more awareness and detection games are needed, as well as games that mix the awareness, prevention, detection, and therapy applications. In addition, games for depression and anxiety should equally target all age ranges. For future research, the development and evaluation of serious games should be standardized, so the implementation of serious games as tools would advance. The games should always offer support while playing, in addition to collecting data on participant behavior during the game to better analyze their learning. Furthermore, there is an open line regarding the use of virtual reality for these games due to the capabilities offered by this technology. %M 34927589 %R 10.2196/30482 %U https://games.jmir.org/2021/4/e30482 %U https://doi.org/10.2196/30482 %U http://www.ncbi.nlm.nih.gov/pubmed/34927589 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e26814 %T An Adjunctive Internet-Based Intervention to Enhance Treatment for Depression in Adults: Randomized Controlled Trial %A Pérez,J Carola %A Fernández,Olga %A Cáceres,Cristián %A Carrasco,Álvaro E %A Moessner,Markus %A Bauer,Stephanie %A Espinosa-Duque,Daniel %A Gloger,Sergio %A Krause,Mariane %+ Facultad de Psicología, Universidad del Desarrollo, Avda La Plaza 680, Las Condes, Santiago, 7610658, Chile, 56 997 051 989, janetperez@udd.cl %K depression %K e-mental health %K blended care %K internet %D 2021 %7 16.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Internet-based interventions promise to enhance the accessibility of mental health care for a greater number of people and in more remote places. Their effectiveness has been shown for the prevention and treatment of various mental disorders. However, their potential when delivered as add-on to conventional treatment (ie, blended care) is less clear. Objective: The aim of this study is to study the effectiveness of an internet intervention (ASCENSO) implemented in addition to face-to-face treatment as usual (TAU) for depression. Methods: A 2-arm, parallel-group, randomized controlled trial was conducted in an outpatient private mental health care center in Chile. In all, 167 adults, diagnosed with major depressive disorder, without severe comorbidities, and with internet access, were included. Eighty-four participants were assigned to the intervention group and received medical and psychological TAU from the mental health center plus access to the ASCENSO online platform. The control group (n=83) received only TAU. The ASCENSO platform includes psycho-educational information, depressive symptom monitoring and feedback, and managing emergencies based on the principles of cognitive behavioral therapy. Emergency management was mental health provider–assisted. TAU includes access to primary care physicians and psychiatrists, to a brief individual psychotherapy, and to medication when needed. The baseline questionnaires were administered in person, and 6- and 9-months assessments were conducted online. Depression symptoms and quality of life were measured by self-administered questionnaires, and treatment adherence was determined via the Mental Health Center’s internal records. The usage of ASCENSO was assessed by server logs. Reduction on depressive symptomatology was considered as the primary outcome of the intervention and quality of life as a secondary outcome. Results: Of the 84 participants in the intervention group, 5 participants (6%) never accessed the online platform. Of the remaining 79 participants who accessed ASCENSO, 1 (1%, 1/79) did not answer any of the symptom questionnaire, and most participants (72/79, 91%) answered the monitoring questionnaires irregularly. The ASCENSO intervention implemented in addition to face-to-face care did not improve the outcome of the usual care delivered at the mental health center, either in terms of reduction of depressive symptoms (F2,6087= 0.48; P=.62) or in the improvement of quality of life (EQ-5D-3L: F2,7678=0.24; P=.79 and EQ-VAS: F2,6670= 0.13; P=.88). In contrast, for the primary (F2,850=78.25; P<.001) and secondary outcomes (EQ-5D-3L: F2,1067=37.87; EQ-VAS: F2,4390= 51.69; P<.001) in both groups, there was an improvement from baseline to 6 months (P<.001), but there was no change at 9 months. In addition, no effects on adherence to or use of TAU were found. Finally, the dropout rate for the face-to-face treatment component was 54% (45/84) for the intervention group versus 39% (32/83) for the control group (P=.07). Conclusions: The fact that the adjunctive access to ASCENSO did not improve outcome could be due to both the rather high effectiveness of TAU and to patients’ limited use of the online platform. Trial Registration: ClinicalTrials.gov NCT03093467; https://clinicaltrials.gov/ct2/show/NCT03093467 %M 34927594 %R 10.2196/26814 %U https://mental.jmir.org/2021/12/e26814 %U https://doi.org/10.2196/26814 %U http://www.ncbi.nlm.nih.gov/pubmed/34927594 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31293 %T Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Adults With Psychiatric Disorders: Systematic and Meta-Analytic Review %A Matsumoto,Kazuki %A Hamatani,Sayo %A Shimizu,Eiji %+ Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo-ku,, Chiba, Japan, 81 43 226 2975, axpa0219@chiba-u.jp %K videoconference-delivered cognitive behavioral therapy %K depression %K anxiety %K psychiatric disorders %K systematic review %K meta-analysis %K digital health %K mental health %K cognitive therapy %K internet-based therapy %K cognition %K neurodevelopment %K communication technology %K health technology %K psychological disorders %K anxiety disorder %D 2021 %7 13.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy (CBT) is the gold standard of psychotherapy for psychiatric disorders. However, the format of delivering CBT in person limits access to the intervention. The advancements in information and communication technology, especially the internet, present an opportunity for cognitive behavioral therapists to service patients or clients in remote areas through videoconferencing. Although many randomized controlled trials of videoconference-delivered cognitive behavioral therapy (VCBT) have already been conducted, the overall estimated effect size of VCBT for psychiatric disorders has not been examined by systematic reviews and meta-analyses. Objective: This study attempts to evaluate the effectiveness of VCBT for psychiatric disorders through a systematic and meta-analytic review. Methods: A systematic review and meta-analysis of studies in which VCBT was directly compared to control groups (such as treatment as usual, attention control, wait-list control, and other minimal supports) was carried out. To identify previous studies that meet our study objective, 2 independent reviewers undertook a systematic search through seven databases: MEDLINE (via PubMed), Web of Science, Science Direct, PsycINFO, CINAHL, LILACS, and SciELO. Other databases (ClinicalTrials.gov and Cochrane Central Resister of Controlled Trials) were also checked. All studies included in the review were assessed using the quality criteria of the Cochrane Collaboration. Statistical analysis was performed by using Cochrane Review Manager (RevMan, version 5.4.0). Standardized mean difference was used in major meta-analyses where a P value of .05 or less was the threshold for statistical significance. A heterogeneity test and the chi-square test were performed to assess the presence and extent of statistical heterogeneity with significance set at P<.10. Funnel plots were visually inspected to assess the risk of bias. Subgroup analyses were conducted for each disorder to estimate intervention effects. Results: The systematic search resulted in 16 studies (total N=1745) that met the criteria for this study and were included in the review. There were 10 studies on depressive symptoms, 3 on chronic pain, 1 on generalized anxiety disorder, 1 on obsessive-compulsive disorder, and 1 on hypochondriasis. The quality and risk of bias was also assessed. Results showed a pooled effect size (Hedge g) post treatment of −0.49 (95% CI –0.68 to –0.29), indicating that VCBT is effective for clients with psychiatric disorders. Study quality did not affect outcomes. Conclusions: While the overall results indicate the effectiveness of VCBT, there are still only a limited number of studies on specific psychiatric and somatic conditions. Therefore, more randomized controlled trials are needed to establish the effectiveness of VCBT for different disorders. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42021224832; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=224832 %M 34898445 %R 10.2196/31293 %U https://www.jmir.org/2021/12/e31293 %U https://doi.org/10.2196/31293 %U http://www.ncbi.nlm.nih.gov/pubmed/34898445 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32450 %T The Life Goals Self-Management Mobile App for Bipolar Disorder: Consumer Feasibility, Usability, and Acceptability Study %A Ryan,Kelly A %A Smith,Shawna N %A Yocum,Anastasia K %A Carley,Isabel %A Liebrecht,Celeste %A Navis,Bethany %A Vest,Erica %A Bertram,Holli %A McInnis,Melvin G %A Kilbourne,Amy M %+ Department of Psychiatry, University of Michigan, 2101 Commonwealth Blvd, Suite C, Ann Arbor, MI, 48105, United States, 1 734 936 5524, karyan@umich.edu %K self-management %K app %K bipolar disorder %K symptom management %K mental health %K feasibility %K usability %K acceptability %K intervention %K bipolar %K coping %K survey %K engagement %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Life Goals is an evidence-based self-management intervention that assists individuals with bipolar disorder (BD) by aligning BD symptom coping strategies with their personal goals. The intervention can be availed via in-person and telephonic sessions, and it has been recently developed as an individualized, customizable mobile app. Objective: We examined the feasibility, usability, and acceptability of the Life Goals self-management app among individuals diagnosed with BD who used the app for up to 6 months. Methods: A total of 28 individuals with BD used the Life Goals app on their personal smartphone for 6 months. They completed key clinical outcome measurements of functioning, disability, and psychiatric symptoms at baseline, 3 months, and 6 months, in addition to a poststudy survey about usability and satisfaction. Results: Participants used the app for a median of 25 times (IQR 13-65.75), and for a longer time during the first 3 months of the study. The modules on depression and anxiety were the most frequently used, accounting for 35% and 22% of total usage, respectively. Overall, the study participants found the app useful (15/25, 60%) and easy to use (18/25, 72%), and they reported that the screen displayed the material adequately (22/25, 88%). However, less than half of the participants found the app helpful in managing their health (10/25, 40%) or in making progress on their wellness goals (9/25, 36%). Clinical outcomes showed a trend for improvements in mental and physical health and mania-related well-being. Conclusions: The Life Goals app showed feasibility of use among individuals with BD. Higher user engagement was observed in the initial 3 months with users interested more frequently in the mood modules than other wellness modules. Participants reported acceptability with the ease of app use and satisfaction with the app user interface, but the app showed low success in encouraging self-management within this small sample. The Life Goals app is a mobile health technology that can provide individuals with serious mental illness with more flexible access to evidence-based treatments. %M 34898452 %R 10.2196/32450 %U https://formative.jmir.org/2021/12/e32450 %U https://doi.org/10.2196/32450 %U http://www.ncbi.nlm.nih.gov/pubmed/34898452 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30668 %T Preventive Digital Mental Health for Children in Primary Schools: Acceptability and Feasibility Study %A Davies,Sian M %A Jardine,Jenni %A Gutridge,Kerry %A Bernard,Zara %A Park,Stephen %A Dawson,Tom %A Abel,Kathryn M %A Whelan,Pauline %+ GM.Digital Research Unit, Centre for Women's Mental Health, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 0161 306 7974, sian.davies-5@manchester.ac.uk %K digital mental health %K acceptability %K feasibility %K child and adolescent mental health and well-being %K school-based mental health care %K prevention %K digital assessment and monitoring %K reading screening or ability %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The incidence of mental health problems in children and adolescents in the United Kingdom has significantly increased in recent years, and more people are in contact with mental health services in Greater Manchester than in other parts of the country. Children and young people spend most of their time at school and with teachers. Therefore, schools and other educational settings may be ideal environments in which to identify those experiencing or those at the risk of developing psychological symptoms and provide timely support for children most at risk of mental health or related problems. Objective: This study aims to test the feasibility of embedding a low-cost, scalable, and innovative digital mental health intervention in schools in the Greater Manchester area. Methods: Two components of a 6-week digital intervention were implemented in a primary school in Greater Manchester: Lexplore, a reading assessment using eye-tracking technology to assess reading ability and detect early atypicality, and Lincus, a digital support and well-being monitoring platform. Results: Of the 115 children approached, 34 (29.6%) consented and took part; of these 34 children, all 34 (100%) completed the baseline Lexplore assessment, and 30 (88%) completed the follow-up. In addition, most children were classified by Lincus as regular (≥1 per week) survey users. Overall, the teaching staff and children found both components of the digital intervention engaging, usable, feasible, and acceptable. Despite the widespread enthusiasm and recognition of the potential added value from staff, we met significant implementation barriers. Conclusions: This study explored the acceptability and feasibility of a digital mental health intervention for schoolchildren. Further work is needed to evaluate the effectiveness of the digital intervention and to understand whether the assessment of reading atypicality using Lexplore can identify those who require additional help and whether they can also be supported by Lincus. This study provides high-quality pilot data and highlights the potential benefits of implementing digital assessment and mental health support tools in a primary school setting. %M 34898446 %R 10.2196/30668 %U https://formative.jmir.org/2021/12/e30668 %U https://doi.org/10.2196/30668 %U http://www.ncbi.nlm.nih.gov/pubmed/34898446 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e26665 %T Evaluation of Repeated Web-Based Screening for Predicting Postpartum Depression: Prospective Cohort Study %A Haßdenteufel,Kathrin %A Lingenfelder,Katrin %A Schwarze,Cornelia E %A Feisst,Manuel %A Brusniak,Katharina %A Matthies,Lina Maria %A Goetz,Maren %A Wallwiener,Markus %A Wallwiener,Stephanie %+ Department of Obstetrics and Gynecology, Heidelberg University, Im Neuenheimer Feld 440, Heidelberg, D-69120, Germany, 49 62215637551, stephanie.wallwiener@med.uni-heidelberg.de %K postpartum depression %K Edinburgh Postnatal Depression Scale %K screening %K pregnancy %K algorithm %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Postpartum depression (PPD) is a severe mental disorder that often results in poor maternal-infant attachment and negatively impacts infant development. Universal screening has recently been recommended to identify women at risk, but the optimal screening time during pregnancy has not been defined so far. Thus, web-based technologies with widespread use among women of childbearing age create new opportunities to detect pregnancies with a high risk for adverse mental health outcomes at an early stage. Objective: The aim of this study was to stratify the risk for PPD and to determine the optimal screening time during pregnancy by using a web-based screening tool collecting electronic patient-reported outcomes (ePROs) as the basis for a screening algorithm. Methods: In total, 214 women were repeatedly tested for depressive symptoms 5 times during and 3 times after pregnancy by using the Edinburgh Postnatal Depression Scale (EPDS), accessible on a web-based pregnancy platform, developed by the authors of this study. For each prenatal assessment, the area under the curve (AUC), sensitivity, specificity, and predictive values for PPD were calculated. Multivariate logistic regression analyses were applied to identify further potential predictors, such as age, education, parity, relationship quality, and anxiety, to increase predictive accuracy. Results: Digitally collected data from 214 pregnant women were analyzed. The predictive accuracy of depressive symptoms 3 and 6 months postpartum was reasonable to good regarding the screening in the second (AUC=0.85) and third (AUC=0.75) trimester. The multivariate logistic regression analyses resulted in an excellent AUC of 0.93 at 3 months and a good AUC of 0.87 at 6 months postpartum. Conclusions: The best predictive accuracy for PPD has been shown for screening between the 24th and the 28th gestational week (GW) and seems to be beneficial for identifying women at risk. In combination with the aforementioned predictive factors, the discriminatory power improved, particularly at 3 months postpartum. Screening for depression during pregnancy, combined with the women’s personal risk profile, can be used as a starting point for developing a digital screening algorithm. Thereby, web-based assessment tools constitute feasible, efficient, and cost-effective approaches. Thus, they seem to be beneficial in detecting high-risk pregnancies in order to improve maternal and infant birth outcomes in the long term. %M 34890349 %R 10.2196/26665 %U https://mental.jmir.org/2021/12/e26665 %U https://doi.org/10.2196/26665 %U http://www.ncbi.nlm.nih.gov/pubmed/34890349 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e31746 %T Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review %A Appleton,Rebecca %A Williams,Julie %A Vera San Juan,Norha %A Needle,Justin J %A Schlief,Merle %A Jordan,Harriet %A Sheridan Rains,Luke %A Goulding,Lucy %A Badhan,Monika %A Roxburgh,Emily %A Barnett,Phoebe %A Spyridonidis,Spyros %A Tomaskova,Magdalena %A Mo,Jiping %A Harju-Seppänen,Jasmine %A Haime,Zoë %A Casetta,Cecilia %A Papamichail,Alexandra %A Lloyd-Evans,Brynmor %A Simpson,Alan %A Sevdalis,Nick %A Gaughran,Fiona %A Johnson,Sonia %+ NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 2039872554, r.appleton@ucl.ac.uk %K telemental health %K COVID-19 %K remote care %K telemedicine %K mental health %K systematic review, implementation science %D 2021 %7 9.12.2021 %9 Review %J J Med Internet Res %G English %X Background: Early in 2020, mental health services had to rapidly shift from face-to-face models of care to delivering the majority of treatments remotely (by video or phone call or occasionally messaging) due to the COVID-19 pandemic. This resulted in several challenges for staff and patients, but also in benefits such as convenience or increased access for people with impaired mobility or in rural areas. There is a need to understand the extent and impacts of telemental health implementation, and barriers and facilitators to its effective and acceptable use. This is relevant both to future emergency adoption of telemental health and to debates on its future use in routine mental health care. Objective: To investigate the adoption and impacts of telemental health approaches during the COVID-19 pandemic, and facilitators and barriers to optimal implementation. Methods: Four databases (PubMed, PsycINFO, CINAHL, and Web of Science) were searched for primary research relating to remote working, mental health care, and the COVID-19 pandemic. Preprint servers were also searched. Results of studies were synthesized using framework synthesis. Results: A total of 77 papers met our inclusion criteria. In most studies, the majority of contacts could be transferred to a remote form during the pandemic, and good acceptability to service users and clinicians tended to be reported, at least where the alternative to remote contacts was interrupting care. However, a range of impediments to dealing optimal care by this means were also identified. Conclusions: Implementation of telemental health allowed some continuing support to the majority of service users during the COVID-19 pandemic and has value in an emergency situation. However, not all service users can be reached by this means, and better evidence is now needed on long-term impacts on therapeutic relationships and quality of care, and on impacts on groups at risk of digital exclusion and how to mitigate these. Trial Registration: PROSPERO International prospective register of systematic reviews CRD42021211025; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021211025 %M 34709179 %R 10.2196/31746 %U https://www.jmir.org/2021/12/e31746 %U https://doi.org/10.2196/31746 %U http://www.ncbi.nlm.nih.gov/pubmed/34709179 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e17314 %T Evaluation of a Web-Based Stress Management Program for Persons Experiencing Work-Related Stress in Sweden (My Stress Control): Randomized Controlled Trial %A Eklund,Caroline %A Söderlund,Anne %A Elfström,Magnus L %+ Department of Physical Therapy, School of Health, Care and Social Welfare, Mälardalen University, Box 883, Västerås, 72123, Sweden, 46 736484426, caroline.eklund@mdh.se %K behavior change %K behavior medicine %K internet %K stress prevention %D 2021 %7 9.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Stress is one of the most common reasons for sick leave. Web-based interventions have the potential to reach an unlimited number of users at a low cost and have been shown to be effective in addressing several health-related problems. Handling stress on an individual level is related to behavior change. To support behavioral changes in stress management, My Stress Control (MSC) was developed. The development of MSC was based on several health psychology theories and models; however, central in the development were Social Cognitive Theory, Theory of Reasoned Action, Theory of Planned Behavior, Transactional Theory of Stress and Coping, and the Transtheoretical Model and Stages of Change. MSC is a fully automated program. The program is tailored to the user’s specific needs for stress management and behavior change. Objective: In this study, we aim to conduct a randomized controlled trial to evaluate the extent to which MSC affects perceived stress in persons experiencing work-related stress. Methods: This was a randomized controlled trial with 2 arms. Study participants were recruited by visiting the worksites and workplace meetings. Participants were assigned to the intervention or wait-list group. Web-based questionnaires were used before and after the intervention to collect data. Perceived stress measured using the Perceived Stress Scale-14 was the primary outcome measurement. Analyses were conducted for both between-group and within-group changes. Results: A total of 92 participants were included in this study: 48 (52%) in the intervention group and 44 (48%) in the wait-list group. Overall, 25% (12/48) of participants in the intervention group and 43% (19/44) of participants in the wait-list group completed the postintervention assessment. There were no significant effects on perceived stress between the intervention and wait-list groups or within the groups. A small effect size (Cohen d=0.25) was found when comparing mean change over time on the primary outcome measure between the intervention and wait-list groups. In addition, a small effect size was found between pre- and postintervention assessments within the intervention group (Cohen d=0.38) as well as within the wait-list group (Cohen d=0.25). Conclusions: The effect of MSC on perceived stress remains uncertain. As adherence was low in the intervention group, elements or features that facilitate adherence and engagement must be further developed before firmer conclusions regarding the effect of MSC can be made. Trial Registration: ClinicalTrials.gov NCT03077568; https://clinicaltrials.gov/ct2/show/NCT03077568 %M 34889772 %R 10.2196/17314 %U https://mental.jmir.org/2021/12/e17314 %U https://doi.org/10.2196/17314 %U http://www.ncbi.nlm.nih.gov/pubmed/34889772 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e17185 %T Internet and Face-to-face Cognitive Behavioral Therapy for Postnatal Depression Compared With Treatment as Usual: Randomized Controlled Trial of MumMoodBooster %A Milgrom,Jeannette %A Danaher,Brian G %A Seeley,John R %A Holt,Christopher J %A Holt,Charlene %A Ericksen,Jennifer %A Tyler,Milagra S %A Gau,Jeff M %A Gemmill,Alan W %+ Parent-Infant Research Institute, Heidelberg Repatriation Hospital, 300 Waterdale Rd, Heidelberg Heights, 3081, Australia, 61 3 9496 4496, alan.gemmill@austin.org.au %K postnatal depression %K postpartum depression %K postnatal anxiety %K postpartum anxiety %K cognitive behavioral therapy %K internet intervention %K web-based intervention %K randomized controlled trial %K online intervention %K treatment %K mobile phone %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND. Objective: This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT). Methods: In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up. Results: Of the 116 participants, 107 (92.2%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6% and 47.7% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups. Conclusions: In this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment. Trial Registration: Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683&isReview=true %M 34889742 %R 10.2196/17185 %U https://www.jmir.org/2021/12/e17185 %U https://doi.org/10.2196/17185 %U http://www.ncbi.nlm.nih.gov/pubmed/34889742 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26733 %T Effects of Social Networking Service (SNS) Addiction on Mental Health Status in Chinese University Students: Structural Equation Modeling Approach Using a Cross-sectional Online Survey %A Wang,Tingxuan %A Wong,Janet Y H %A Wang,Man Ping %A Li,Amanda Chiu Yin %A Kim,Sang Suk %A Lee,Jung Jae %+ School of Nursing, The University of Hong Kong, 4/F William MW Mong Block Building, 21 Sassoon Rd, Pokfulam, Hong Kong, China, 852 39176971, leejay@hku.hk %K social networking service %K SNS %K addiction %K depression %K anxiety %K psychosocial status %K youth %K mental health %D 2021 %7 8.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although social networking services (SNSs) have become popular among young people, problematic SNS use has also increased. However, little is known about SNS addiction and its association with SNS use patterns and mental health status. Objective: This study aims to test the mediating role of SNS addiction between SNS use patterns and mental health status among Chinese university students in Hong Kong (HK). Methods: An online cross-sectional survey was conducted using a convenience sampling method. In total, 533 university students (323 [66.9%] female, mean age [SD]=20.87 [2.68] years) were recruited from February to March 2019. Multiple linear regression was used to assess the association between SNS use and SNS addiction. Structural equation modeling (SEM) was performed to examine the pathways and associations among SNS use, SNS addiction, psychosocial status, and mental health status (including anxiety and depressive symptoms). Results: A longer time spent on SNSs per day (>3 h), a longer time spent on each SNS access (≥31 min), a higher frequency of SNS access (≤every 30 min), a longer duration of SNS use before sleeping (≥61 min), and a shorter duration from waking to first SNS use (≤5 min) were significantly associated with a higher level of SNS addiction (adjusted beta [aβ]=6.03, 95% CI 4.66-7.40; aβ=4.99, 95% CI 3.14-6.83; aβ=5.89, 95% CI 4.14-7.64; aβ=5.92, 95% CI 4.19-7.65; and aβ=3.27, 95% CI 1.73-4.82, respectively). SEM showed a significant mediating effect of SNS addiction in the relationship between SNS use and psychosocial status, and mental health status, including an indirect effect (β=0.63, 95% CI 0.37-0.93) and the total effect (β=0.44, 95% CI 0.19-0.72), while the direct effect was insignificant (β=–0.19, 95% CI –0.49 to 0.08). Conclusions: SNS use patterns were associated with SNS addiction, and SNS addiction mediated the associations between SNS use, psychosocial status, and mental health status of Chinese university students in HK. The findings suggest that screening for and addressing excessive SNS use are needed to prevent SNS addiction and mental distress among young people. %M 34889760 %R 10.2196/26733 %U https://www.jmir.org/2021/12/e26733 %U https://doi.org/10.2196/26733 %U http://www.ncbi.nlm.nih.gov/pubmed/34889760 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e29661 %T Effectiveness and Feasibility of Internet-Based Interventions for Grief After Bereavement: Systematic Review and Meta-analysis %A Zuelke,Andrea E %A Luppa,Melanie %A Löbner,Margrit %A Pabst,Alexander %A Schlapke,Christine %A Stein,Janine %A Riedel-Heller,Steffi G %+ Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Str. 55, Leipzig, 04103, Germany, 49 3419715483, andrea.zuelke@medizin.uni-leipzig.de %K grief %K systematic review %K meta-analysis %K internet-based %K online therapy %D 2021 %7 8.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: Although grief and its symptoms constitute a normal reaction to experiences of loss, some of those affected still report elevated levels of distress after an extended period, often termed complicated grief. Beneficial treatment effects of face-to-face therapies, for example, grief counseling or cognitive behavioral therapy against complicated grief, have been reported. Evaluations of internet- and mobile-based interventions targeting symptoms of grief in bereaved individuals with regard to objective quality criteria are currently lacking. Objective: We aim to conduct a systematic review and meta-analysis on the effectiveness and feasibility of internet- and mobile-based interventions against symptoms of grief after bereavement. Methods: We conducted systematic literature searches of randomized controlled trials or feasibility studies published before January 9, 2020, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, in PubMed, PsycINFO, Web of Science Core Collection, and the Cochrane Library. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations system. We further assessed aspects of feasibility and rated quality of interventions using criteria suggested by an expert panel on mental health care (German Association for Psychiatry, Psychotherapy, and Psychosomatics). A random-effects meta-analysis was conducted to assess between-group effect sizes. Results: In total, 9 trials (N=1349) were included. Of these, 7 studies were analyzed meta-analytically. Significant effects were found for symptoms of grief (g=0.54, 95% CI 0.32-0.77), depression (g=0.44, 95% CI 0.20-0.68), and posttraumatic stress (g=0.82, 95% CI 0.63-1.01). Heterogeneity was moderate for grief and depression (I2=48.75% and 55.19%, respectively) and low for posttraumatic stress symptoms (I2=0%). The overall quality of evidence was graded low (grief and depression) to moderate (posttraumatic stress). User satisfaction with the interventions was high, as was the quality of the interventions assessed using objective quality criteria. Conclusions: Internet- or mobile-based interventions might constitute an effective treatment approach against symptoms of grief in bereaved adults. However, the small sample sizes and limited number of studies included in the review warrant further investigation. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42012002100; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131428 %M 34889769 %R 10.2196/29661 %U https://mental.jmir.org/2021/12/e29661 %U https://doi.org/10.2196/29661 %U http://www.ncbi.nlm.nih.gov/pubmed/34889769 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 12 %P e11055 %T Reliability and Confirmatory Factor Analysis (CFA) of a Paper- Versus App-Administered Resilience Scale in Scottish Youths: Comparative Study %A Mcgeough,Julienne %A Gallagher-Mitchell,Thomas %A Clark,Dan Philip Andrew %A Harrison,Neil %+ Department of Psychology, Liverpool Hope University, Hope Park, Liverpool, L16 9JD, United Kingdom, 44 1512913073, mcgeouj@hope.ac.uk %K resilience %K psychometrics %K app administration %K cyberpsychology %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adequately measuring resilience is important to support young people and children who may need to access resources through social work or educational settings. A widely accepted measure of youth resilience has been developed previously and has been shown to be suitable for vulnerable youth. While the measure is completed by the young person on paper, it has been designed to be worked through with a teacher or social worker in case further clarification is required. However, this method is time consuming and, when faced with large groups of pupils who need assessment, can be overwhelming for schools and practitioners. This study assesses app software with a built-in avatar that can guide young persons through the assessment and its interpretation. Objective: Our primary objective is to compare the reliability and psychometric properties of a mobile software app to a paper version of the Child and Youth Resilience measure (CYRM-28). Second, this study assesses the use of the CYRM-28 in a Scottish youth population (aged 11-18 years). Methods: Following focus groups and discussion with teachers, social workers, and young people, an avatar was developed by a software company and integrated into an android smartphone app designed to ask questions via the device’s inbuilt text-to-voice engine. In total, 714 students from 2 schools in North East Scotland completed either a paper version or app version of the CYRM-28. A cross-sectional design was used, and students completed their allocated version twice, with a 2-week period in between each testing. All participants could request clarification either from a guidance teacher (paper version) or from the in-built software glossary (app version). Results: Test and retest correlations showed that the app version performed better than the paper version of the questionnaire (paper version: r303=0.81; P<.001; 95% CI 0.77-0.85; app version: r413=0.84; P<.001; 95% CI 0.79-0.89). Fisher r to z transformation revealed a significant difference in the correlations (Z=–2.97, P<.01). Similarly, Cronbach α in both conditions was very high (app version: α=.92; paper version: α=.87), suggesting item redundancy. Ordinarily, this would lead to a possible removal of highly correlated items; however, our primary objective was to compare app delivery methods over a pen-and-paper mode and was hence beyond the scope of the study. Fisher r to z transformation revealed a significant difference in the correlations (Z=–3.69, P<.01). A confirmatory factor analysis supported the 3-factor solution (individual, relational, and contextual) and reported a good model fit (χ215=27.6 [n=541], P=.24). Conclusions: ALEX, an avatar with an integrated voice guide, had higher reliability when measuring resilience than a paper version with teacher assistance. The CFA reports similar structure using the avatar when compared against the original validation. %M 34878995 %R 10.2196/11055 %U https://mhealth.jmir.org/2021/12/e11055 %U https://doi.org/10.2196/11055 %U http://www.ncbi.nlm.nih.gov/pubmed/34878995 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e34591 %T Adapting Evidence-Based Early Psychosis Intervention Services for Virtual Delivery: Protocol for a Pragmatic Mixed Methods Implementation and Evaluation Study %A Tempelaar,Wanda %A Barwick,Melanie %A Crawford,Allison %A Voineskos,Aristotle %A Addington,Donald %A Addington,Jean %A Alexander,Tallan %A Baluyut,Crystal %A Bromley,Sarah %A Durbin,Janet %A Foussias,George %A Ford,Catherine %A de Freitas,Lauren %A Jindani,Seharish %A Kirvan,Anne %A Kurdyak,Paul %A Pauly,Kirstin %A Polillo,Alexia %A Roby,Rachel %A Sockalingam,Sanjeev %A Sosnowski,Alexandra %A Villanueva,Victoria %A Wang,Wei %A Kozloff,Nicole %+ Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, McCain Complex Care and Recovery Building B1, 1025 Queen Street West, Toronto, ON, M6J 1H4, Canada, 1 4165358501, wanda.tempelaar@camh.ca %K virtual care delivery %K early psychosis intervention %K mixed methods implementation %D 2021 %7 7.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Timely and comprehensive treatment in the form of early psychosis intervention (EPI) has become the standard of care for youth with psychosis. While EPI services were designed to be delivered in person, the COVID-19 pandemic required many EPI programs to rapidly transition to virtual delivery, with little evidence to guide intervention adaptations or to support the effectiveness and satisfaction with virtual EPI services. Objective: This study aims to explore the adaptations required to deliver NAVIGATE, a model of coordinated specialty care used in EPI, in a virtual format. This study will evaluate implementation of the NAVIGATE model delivered virtually by describing the nature of the adaptations to the intervention, assessing fidelity to the EPI model and the satisfaction of clients, family members, and care providers. We will investigate barriers and facilitators to virtual NAVIGATE implementation, service engagement, and health equity impacts of this work. Methods: The Centre for Addiction and Mental Health (Toronto, Ontario, Canada) transitioned to delivering NAVIGATE virtually early in the COVID-19 pandemic. The Framework for Reporting Adaptations and Modifications for Evidence-Based Interventions will be used to describe the adaptations required to deliver NAVIGATE virtually. Fidelity to the EPI model will be measured using the First Episode Psychosis Services Fidelity Scale and fidelity to NAVIGATE will be assessed by investigating adherence to its core components. Implementation facilitators and barriers will be explored using semistructured interviews with providers informed by the Consolidated Framework for Implementation Research. Satisfaction with virtually delivered NAVIGATE will be assessed with virtual client and provider experience surveys and qualitative interviews with clients, family members, and providers. Service engagement data will be collected through review of medical records, and potential impacts of virtually delivered NAVIGATE on different population groups will be assessed with the Health Equity Impact Assessment. Results: Virtual clinical delivery of NAVIGATE started in March 2020 with additional adaptations and data collection is ongoing. Data will be analyzed using descriptive statistics and survival analysis for quantitative data. Qualitative data will be analyzed using thematic content analysis. Integration of qualitative and quantitative data will occur at the data collection, interpretation, and reporting levels following a convergent design. Conclusions: This study will provide information regarding the type of intervention adaptations required for virtual delivery of NAVIGATE for youth with early psychosis, ensuring access to high-quality care for this population during the pandemic and beyond by guiding future implementation in similar contexts. International Registered Report Identifier (IRRID): DERR1-10.2196/34591 %M 34806990 %R 10.2196/34591 %U https://www.researchprotocols.org/2021/12/e34591 %U https://doi.org/10.2196/34591 %U http://www.ncbi.nlm.nih.gov/pubmed/34806990 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e28141 %T A Digital Health Innovation to Prevent Relapse and Support Recovery in Youth Receiving Specialized Services for First-Episode Psychosis: Protocol for a Pilot Pre-Post, Mixed Methods Study of Horyzons-Canada (Phase 2) %A Lal,Shalini %A Gleeson,John F %A D'Alfonso,Simon %A Etienne,Geraldine %A Joober,Ridha %A Lepage,Martin %A Lee,Hajin %A Alvarez-Jimenez,Mario %+ School of Rehabilitation, Faculty of Medicine, University of Montréal, CP 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada, 1 514 890 8000 ext 31581, shalini.lal@umontreal.ca %K psychotic disorders %K mental health %K telemedicine %K young adult %K mental health services %K e–mental health %K virtual care %K schizophrenia %K eHealth %K social support %K therapy %K psychiatry %K psychology %D 2021 %7 7.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychotic disorders are among the most disabling of all mental disorders. The first-episode psychosis (FEP) often occurs during adolescence or young adulthood. Young people experiencing FEP often face multiple barriers in accessing a comprehensive range of psychosocial services, which have predominantly been delivered in person. New models of service delivery that are accessible, sustainable, and engaging are needed to support recovery in youth diagnosed with FEP. Objective: In this paper, we describe a protocol to implement and evaluate the acceptability, safety, and potential efficacy of an online psychosocial therapeutic intervention designed to sustain recovery and prevent relapses in young adults diagnosed with FEP. This intervention was originally developed and tested in Australia and has been adapted for implementation and evaluation in Canada and is called Horyzons-Canada (HoryzonsCa). Methods: This cohort study is implemented in a single-center and applies a pre-post mixed methods (qualitative-quantitative convergent) design. The study involves recruiting 20 participants from a specialized early intervention program for psychosis located in Montreal, Canada and providing them with access to the HoryzonsCa intervention for 8 weeks. Data collection includes interview-based psychometric measures, self-reports, focus groups, and interviews. Results: This study received funding from the Brain and Behavior Research Foundation (United States), the Quebec Health Research Funding Agency (Canada), and the Canada Research Chairs Program. The study was approved by the Research Ethics Board of the Centre intégré universitaire de santé et de services sociaux de l'Ouest-de-l'Île-de-Montréal on April 11, 2018 (#IUSMD 17-54). Data were collected from August 16, 2018, to April 29, 2019, and a final sample of 20 individuals participated in the baseline and follow-up interviews, among which 9 participated in the focus groups. Data analysis and reporting are in process. The results of the study will be submitted for publication in 2021. Conclusions: This study will provide preliminary evidence on the acceptability, safety, and potential efficacy of using a digital health innovation adapted for the Canadian context to deliver specialized mental health services to youth diagnosed with FEP. Trial Registration: ISRCTN Registry ISRCTN43182105; https://www.isrctn.com/ISRCTN43182105 International Registered Report Identifier (IRRID): RR1-10.2196/28141 %M 34879000 %R 10.2196/28141 %U https://www.researchprotocols.org/2021/12/e28141 %U https://doi.org/10.2196/28141 %U http://www.ncbi.nlm.nih.gov/pubmed/34879000 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e32948 %T The Application of e-Mental Health in Response to COVID-19: Scoping Review and Bibliometric Analysis %A Ellis,Louise A %A Meulenbroeks,Isabelle %A Churruca,Kate %A Pomare,Chiara %A Hatem,Sarah %A Harrison,Reema %A Zurynski,Yvonne %A Braithwaite,Jeffrey %+ Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, Sydney, NSW 2113, Australia, 61 9850 2484, louise.ellis@mq.edu.au %K e-mental health %K mental health %K COVID-19 %K bibliometrics %K health systems %D 2021 %7 6.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic and its mitigation measures and impacts, such as shelter-in-place orders, social isolation, restrictions on freedoms, unemployment, financial insecurity, and disrupted routines, have led to declines in mental health worldwide and concomitant escalating demands for mental health services. Under the circumstances, electronic mental health (e-mental health) programs and services have rapidly become the “new normal.” Objective: The aim of this study was to assess key characteristics and evidence gaps in the e-mental health literature published in relation to the COVID-19 pandemic via a scoping review and bibliometric analysis. Methods: We conducted a search of four academic databases (ie, MEDLINE, Embase, PsycInfo, and CINAHL) for documents published from December 31, 2019, to March 31, 2021, using keywords for e-mental health and COVID-19. Article information was extracted that was relevant to the review objective, including journal, type of article, keywords, focus, and corresponding author. Information was synthesized by coding these attributes and was then summarized through descriptive statistics and narrative techniques. Article influence was examined from Altmetric and CiteScore data, and a network analysis was conducted on article keywords. Results: A total of 356 publications were included in the review. Articles on e-mental health quickly thrived early in the pandemic, with most articles being nonempirical, chiefly commentaries or opinions (n=225, 63.2%). Empirical publications emerged later and became more frequent as the pandemic progressed. The United States contributed the most articles (n=160, 44.9%), though a notable number came from middle-income countries (n=59, 16.6%). Articles were spread across 165 journals and had above-average influence (ie, almost half of the articles were in the top 25% of output scores by Altmetric, and the average CiteScore across articles was 4.22). The network analysis of author-supplied keywords identified key topic areas, including specific mental disorders, eHealth modalities, issues and challenges, and populations of interest. These were further explored via full-text analysis. Applications of e-mental health during the pandemic overcame, or were influenced by, system, service, technology, provider, and patient factors. Conclusions: COVID-19 has accelerated applications of e-mental health. Further research is needed to support the implementation of e-mental health across system and service infrastructures, alongside evidence of the relative effectiveness of e-mental health in comparison to traditional modes of care. %M 34666306 %R 10.2196/32948 %U https://mental.jmir.org/2021/12/e32948 %U https://doi.org/10.2196/32948 %U http://www.ncbi.nlm.nih.gov/pubmed/34666306 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e32007 %T Examining the Theoretical Framework of Behavioral Activation for Major Depressive Disorder: Smartphone-Based Ecological Momentary Assessment Study %A van Genugten,Claire Rosalie %A Schuurmans,Josien %A Hoogendoorn,Adriaan W %A Araya,Ricardo %A Andersson,Gerhard %A Baños,Rosa %A Botella,Cristina %A Cerga Pashoja,Arlinda %A Cieslak,Roman %A Ebert,David Daniel %A García-Palacios,Azucena %A Hazo,Jean-Baptiste %A Herrero,Rocío %A Holtzmann,Jérôme %A Kemmeren,Lise %A Kleiboer,Annet %A Krieger,Tobias %A Smoktunowicz,Ewelina %A Titzler,Ingrid %A Topooco,Naira %A Urech,Antoine %A Smit,Johannes H %A Riper,Heleen %+ Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, Oldenaller 1, Amsterdam, 1081HJ, Netherlands, 31 0207884666, c.genugten@ggzingeest.nl %K depression %K behavioral activation %K theoretical framework %K ecological momentary assessment %K random-intercept cross-lagged panel model %K behavior %K framework %K EMA %K smartphone %K mental health %K treatment %K engagement %K mood %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA derive from Lewinsohn et al’s theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA. Objective: This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA. Methods: Data were collected as part of the “European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual” trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models. Results: The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not. Conclusions: The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients. Trial Registration: ClinicalTrials.gov, NCT02542891, https://clinicaltrials.gov/ct2/show/NCT02542891; German Clinical Trials Register, DRKS00006866, https://tinyurl.com/ybja3xz7; Netherlands Trials Register, NTR4962, https://www.trialregister.nl/trial/4838; ClinicalTrials.Gov, NCT02389660, https://clinicaltrials.gov/ct2/show/NCT02389660; ClinicalTrials.gov, NCT02361684, https://clinicaltrials.gov/ct2/show/NCT02361684; ClinicalTrials.gov, NCT02449447, https://clinicaltrials.gov/ct2/show/NCT02449447; ClinicalTrials.gov, NCT02410616, https://clinicaltrials.gov/ct2/show/NCT02410616; ISRCTN registry, ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725 %M 34874888 %R 10.2196/32007 %U https://mental.jmir.org/2021/12/e32007 %U https://doi.org/10.2196/32007 %U http://www.ncbi.nlm.nih.gov/pubmed/34874888 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e30439 %T Language, Speech, and Facial Expression Features for Artificial Intelligence–Based Detection of Cancer Survivors’ Depression: Scoping Meta-Review %A Smrke,Urška %A Mlakar,Izidor %A Lin,Simon %A Musil,Bojan %A Plohl,Nejc %+ Faculty of Electrical Engineering and Computer Science, University of Maribor, Koroška cesta 46, Maribor, 2000, Slovenia, 386 31262861, urska.smrke@um.si %K artificial intelligence %K cancer %K depression %K facial expression %K language %K oncology %K review %K screening %K speech %K symptom %D 2021 %7 6.12.2021 %9 Review %J JMIR Ment Health %G English %X Background: Cancer survivors often experience disorders from the depressive spectrum that remain largely unrecognized and overlooked. Even though screening for depression is recognized as essential, several barriers prevent its successful implementation. It is possible that better screening options can be developed. New possibilities have been opening up with advances in artificial intelligence and increasing knowledge on the connection of observable cues and psychological states. Objective: The aim of this scoping meta-review was to identify observable features of depression that can be intercepted using artificial intelligence in order to provide a stepping stone toward better recognition of depression among cancer survivors. Methods: We followed a methodological framework for scoping reviews. We searched SCOPUS and Web of Science for relevant papers on the topic, and data were extracted from the papers that met inclusion criteria. We used thematic analysis within 3 predefined categories of depression cues (ie, language, speech, and facial expression cues) to analyze the papers. Results: The search yielded 1023 papers, of which 9 met the inclusion criteria. Analysis of their findings resulted in several well-supported cues of depression in language, speech, and facial expression domains, which provides a comprehensive list of observable features that are potentially suited to be intercepted by artificial intelligence for early detection of depression. Conclusions: This review provides a synthesis of behavioral features of depression while translating this knowledge into the context of artificial intelligence–supported screening for depression in cancer survivors. %M 34874883 %R 10.2196/30439 %U https://mental.jmir.org/2021/12/e30439 %U https://doi.org/10.2196/30439 %U http://www.ncbi.nlm.nih.gov/pubmed/34874883 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e33495 %T Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Protocol for the Development and Rapid-Response Deployment %A Fung,Kenneth %A Liu,Jenny JW %A Vahabi,Mandana %A Li,Alan Tai-Wai %A Zurowski,Mateusz %A Wong,Josephine Pui-Hing %+ Department of Psychiatry, Faculty of Medicine, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada, 1 (416) 603 5349, ken.fung@uhn.ca %K COVID %K COVID-19 %K coronavirus %K pandemic %K resilience %K acceptance commitment therapy %K group empowerment %D 2021 %7 6.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During a global pandemic, it is critical to rapidly deploy a psychological intervention to support the mental health and resilience of highly affected individuals and communities. Objective: This is the rationale behind the development and implementation of the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training, an online, blended, skills building intervention to increase the resilience and well-being of participants while promoting their individual and collective empowerment and capacity building. Methods: Based on acceptance and commitment therapy (ACT) and social justice–based group empowerment psychoeducation (GEP), we developed the Acceptance and Commitment to Empowerment (ACE) model to enhance psychological resilience and collective empowerment. The PACER program consists of 6 online, interactive, self-guided modules complemented by 6 weekly, 90-minute, videoconference, facilitator-led, group sessions. Results: As of August 2021, a total of 325 participants had enrolled in the PACER program. Participants include frontline health care providers and Chinese-Canadian community members. Conclusions: The PACER program is an innovative intervention program with the potential for increasing resilience and empowerment while reducing mental distress during the pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/33495 %M 34726602 %R 10.2196/33495 %U https://www.researchprotocols.org/2021/12/e33495 %U https://doi.org/10.2196/33495 %U http://www.ncbi.nlm.nih.gov/pubmed/34726602 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e27462 %T Effects of a Novel, Transdiagnostic, Hybrid Ecological Momentary Intervention for Improving Resilience in Youth (EMIcompass): Protocol for an Exploratory Randomized Controlled Trial %A Schick,Anita %A Paetzold,Isabell %A Rauschenberg,Christian %A Hirjak,Dusan %A Banaschewski,Tobias %A Meyer-Lindenberg,Andreas %A Boehnke,Jan R %A Boecking,Benjamin %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Square J5, Mannheim, 68159, Germany, 49 621 1703 1930, ulrich.reininghaus@zi-mannheim.de %K experience sampling methodology (ESM) %K ecological momentary assessment (EMA) %K mobile intervention %K at-risk individuals %K smartphone training %K blended care %K mental health %K stress reactivity %K mobile phone %D 2021 %7 3.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Most mental disorders first emerge in youth and, in their early stages, surface as subthreshold expressions of symptoms comprising a transdiagnostic phenotype of psychosis, mania, depression, and anxiety. Elevated stress reactivity is one of the most widely studied mechanisms underlying psychotic and affective mental health problems. Thus, targeting stress reactivity in youth is a promising indicated and translational preventive strategy for adverse mental health outcomes that could develop later in life and for improving resilience. Compassion-focused interventions offer a wide range of innovative therapeutic techniques that are particularly amenable to being implemented as ecological momentary interventions (EMIs), a specific type of mobile health intervention, to enable youth to access interventions in a given moment and context in daily life. This approach may bridge the current gap in youth mental health care. Objective: This study aims to investigate the clinical feasibility, candidate underlying mechanisms, and initial signals of the efficacy of a novel, transdiagnostic, hybrid EMI for improving resilience to stress in youth—EMIcompass. Methods: In an exploratory randomized controlled trial, youth aged between 14 and 25 years with current distress, a broad Clinical High At-Risk Mental State, or the first episode of a severe mental disorder will be randomly allocated to the EMIcompass intervention (ie, EMI plus face-to-face training sessions) in addition to treatment as usual or a control condition of treatment as usual only. Primary (stress reactivity) and secondary candidate mechanisms (resilience, interpersonal sensitivity, threat anticipation, negative affective appraisals, and momentary physiological markers of stress reactivity), as well as primary (psychological distress) and secondary outcomes (primary psychiatric symptoms and general psychopathology), will be assessed at baseline, postintervention, and at the 4-week follow-up. Results: The first enrollment was in August 2019, and as of May 2021, enrollment and randomization was completed (N=92). We expect data collection to be completed by August 2021. Conclusions: This study is the first to establish feasibility, evidence on underlying mechanisms, and preliminary signals of the efficacy of a compassion-focused EMI in youth. If successful, a confirmatory randomized controlled trial will be warranted. Overall, our approach has the potential to significantly advance preventive interventions in youth mental health provision. Trial Registration: German Clinical Trials Register DRKS00017265; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017265 International Registered Report Identifier (IRRID): DERR1-10.2196/27462 %M 34870613 %R 10.2196/27462 %U https://www.researchprotocols.org/2021/12/e27462 %U https://doi.org/10.2196/27462 %U http://www.ncbi.nlm.nih.gov/pubmed/34870613 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e26987 %T Clinical Efficacy and Psychological Mechanisms of an App-Based Digital Therapeutic for Generalized Anxiety Disorder: Randomized Controlled Trial %A Roy,Alexandra %A Hoge,Elizabeth A %A Abrante,Pablo %A Druker,Susan %A Liu,Tao %A Brewer,Judson A %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI, 02903, United States, 1 401 863 2826, judson_brewer@brown.edu %K anxiety %K generalized anxiety disorder %K worry %K mindfulness %K mHealth %K digital therapeutics %K mobile phone %D 2021 %7 2.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Current treatments for generalized anxiety disorder (GAD) often yield suboptimal outcomes, partly because of insufficient targeting of underlying psychological mechanisms (eg, avoidance reinforcement learning). Mindfulness training (MT) has shown efficacy for anxiety; yet, widespread adoption has been limited, partly because of the difficulty in scaling in-person–based delivery. Digital therapeutics are emerging as potentially viable treatments; however, very few have been empirically validated. Objective: The aim of this study is to test the efficacy and mechanism of an app-delivered MT that was designed to target a potential mechanism of anxiety (reinforcement learning), based on which previous studies have shown concern regarding feedback and the perpetuation of anxiety through negative reinforcement. Methods: Individuals with GAD were recruited using social media advertisements and randomized during an in-person visit to receive treatment as usual (n=33) or treatment as usual+app−delivered MT (Unwinding Anxiety; n=32). The latter was composed of 30 modules to be completed over a 2-month period. Associated changes in outcomes were assessed using self-report questionnaires 1 and 2 months after treatment initiation. Results: We randomized 65 participants in this study, and a modified intent-to-treat approach was used for analysis. The median number of modules completed by the MT group was 25.5 (IQR 17) out of 30; 46% (13/28) of the participants completed the program. In addition, the MT group demonstrated a significant reduction in anxiety (GAD-7) compared with the control group at 2 months (67% vs 14%; median change in GAD-7: –8.5 [IQR 6.5] vs –1.0 [IQR 5.0]; P<.001; 95% CI 6-10). Increases in mindfulness at 1 month (nonreactivity subscale) mediated decreases in worry at 2 months (Penn State Worry Questionnaire; P=.02) and decreases in worry at 1 month mediated reductions in anxiety at 2 months (P=.03). Conclusions: To our knowledge, this is the first report on the efficacy and mechanism of an app-delivered MT for GAD. These findings demonstrate the clinical efficacy of MT as a digital therapeutic for individuals with anxiety (number needed to treat=1.6). These results also link recent advances in our mechanistic understanding of anxiety with treatment development, showing that app-delivered MT targets key reinforcement learning pathways, resulting in tangible, clinically meaningful reductions in worry and anxiety. Evidence-based, mechanistically targeted digital therapeutics have the potential to improve health at a population level at a low cost. Trial Registration: ClinicalTrials.gov NCT03683472; https://clinicaltrials.gov/ct2/show/NCT03683472 %M 34860673 %R 10.2196/26987 %U https://www.jmir.org/2021/12/e26987 %U https://doi.org/10.2196/26987 %U http://www.ncbi.nlm.nih.gov/pubmed/34860673 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 12 %P e29243 %T Evaluation of an Online System for Routine Outcome Monitoring: Cross-sectional Survey Study %A Wiebe,Deanna E %A Remers,Shannon %A Nippak,Pria %A Meyer,Julien %+ Department of Health Services Management, Ryerson University, 55 Dundas Street West, 8th floor, TRS 2-042, Toronto, ON, M5G 2C3, Canada, 1 416 979 5000 ext 6409, dwiebe@ryerson.ca %K routine outcome monitoring %K progress monitoring and feedback %K outcome measures %K web-based outcome monitoring %K routine outcome monitoring software %K outcome measurement questionnaire %K measurement-based care %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The use of routine outcome monitoring (ROM) in the treatment of mental health has emerged as a method of improving psychotherapy treatment outcomes. Despite this, very few clinicians regularly use ROM in clinical practice. Online ROM has been suggested as a solution to increase adoption. Objective: The aim of this study is to identify the influence of moving ROM online on client completion rates of self-reported outcome measures and to identify implementation and utilization barriers to online ROM by assessing clinicians’ views on their experience using the online system over previous paper-based methods. Methods: Client completion rates of self-reported outcome measures were compared pre- and postimplementation of an online system of ROM. In addition, a survey questionnaire was administered to 324 mental health service providers regarding their perception of the benefits with an online system of ROM. Results: Client completion rates of self-reported measures increased from 15.62% (427/2734) to 53.98% (1267/2347) after they were moved online. Furthermore, 57% (56/98) of service providers found the new system less time-consuming than the previous paper-based ROM, and 64% (63/98) found that it helped monitor clients. However, the perceived value of the system remains in doubt as only 23% (23/98) found it helped them identify clients at risk for treatment failure, and only 18% (18/98) found it strengthened the therapeutic alliance. Conclusions: Although the current study suggests mixed results regarding service providers’ views on their experience using an online system for ROM, it has identified barriers and challenges that are actionable for improvement. %M 34855615 %R 10.2196/29243 %U https://mental.jmir.org/2021/12/e29243 %U https://doi.org/10.2196/29243 %U http://www.ncbi.nlm.nih.gov/pubmed/34855615 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30053 %T A Conversational Artificial Intelligence Agent for a Mental Health Care App: Evaluation Study of Its Participatory Design %A Danieli,Morena %A Ciulli,Tommaso %A Mousavi,Seyed Mahed %A Riccardi,Giuseppe %+ Speech and Interactive Signal Lab, Department of Engineering and Computer Science, Università degli Studi di Trento, Via Sommarive 5, Povo di Trento, Trento, 38123, Italy, 39 0461282087, morena.danieli@unitn.it %K mental health care %K conversational AI %K mHealth %K personal health care agents %K participatory design %K psychotherapy %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile apps for mental health are available on the market. Although they seem to be promising for improving the accessibility of mental health care, little is known about their acceptance, design methodology, evaluation, and integration into psychotherapy protocols. This makes it difficult for health care professionals to judge whether these apps may help them and their patients. Objective: Our aim is to describe and evaluate a protocol for the participatory design of mobile apps for mental health. In this study, participants and psychotherapists are engaged in the early phases of the design and development of the app empowered by conversational artificial intelligence (AI). The app supports interventions for stress management training based on cognitive behavioral theory. Methods: A total of 21 participants aged 33-61 years with mild to moderate levels of stress, anxiety, and depression (assessed by administering the Italian versions of the Symptom Checklist-90-Revised, Occupational Stress Indicator, and Perceived Stress Scale) were assigned randomly to 2 groups, A and B. Both groups received stress management training sessions along with cognitive behavioral treatment, but only participants assigned to group A received support through a mobile personal health care agent, designed for mental care and empowered by AI techniques. Psychopathological outcomes were assessed at baseline (T1), after 8 weeks of treatment (T2), and 3 months after treatment (T3). Focus groups with psychotherapists who administered the therapy were held after treatment to collect their impressions and suggestions. Results: Although the intergroup statistical analysis showed that group B participants could rely on better coping strategies, group A participants reported significant improvements in obsessivity and compulsivity and positive distress symptom assessment. The psychotherapists’ acceptance of the protocol was good. In particular, they were in favor of integrating an AI-based mental health app into their practice because they could appreciate the increased engagement of patients in pursuing their therapy goals. Conclusions: The integration into practice of an AI-based mobile app for mental health was shown to be acceptable to both mental health professionals and users. Although it was not possible in this experiment to show that the integration of AI-based conversational technologies into traditional remote psychotherapy significantly decreased the participants’ levels of stress and anxiety, the experimental results showed significant trends of reduction of symptoms in group A and their persistence over time. The mental health professionals involved in the experiment reported interest in, and acceptance of, the proposed technology as a promising tool to be included in a blended model of psychotherapy. %M 34855607 %R 10.2196/30053 %U https://formative.jmir.org/2021/12/e30053 %U https://doi.org/10.2196/30053 %U http://www.ncbi.nlm.nih.gov/pubmed/34855607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28734 %T Transitioning From In-Person to Remote Clinical Research on Depression and Traumatic Brain Injury During the COVID-19 Pandemic: Study Modifications and Preliminary Feasibility From a Randomized Controlled Pilot Study %A Fisher,Lauren B %A Tuchman,Sylvie %A Curreri,Andrew J %A Markgraf,Maggie %A Nyer,Maren B %A Cassano,Paolo %A Iverson,Grant L %A Fava,Maurizio %A Zafonte,Ross D %A Pedrelli,Paola %+ Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 6th Floor, Boston, MA, 02114, United States, 1 617 643 0877, fisher.lauren@mgh.harvard.edu %K COVID-19 %K telemental health %K clinical trial %K traumatic brain injury %K depression %K cognitive behavioral therapy %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions. Objective: This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely. Methods: Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior. Results: High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session. Conclusions: Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI. Trial Registration: ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070 %M 34662285 %R 10.2196/28734 %U https://formative.jmir.org/2021/12/e28734 %U https://doi.org/10.2196/28734 %U http://www.ncbi.nlm.nih.gov/pubmed/34662285 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e28117 %T Relationship Between Illness Representations and Symptoms of Internet Gaming Disorder Among Young People: Cross-Lagged Model %A Yang,Xue %A Wong,Kei Man %A She,Rui %A Zhao,Chengjia %A Ding,Nani %A Xu,Huihui %A Tu,Xiaolian %A Lai,Xinyi %A Zhang,Guohua %+ Institute of Aging, Key Laboratory of Alzheimer's Disease of Zhejiang Province, Wenzhou Medical University, University Town, Chashan, Wenzhou, 325035, China, 86 +8613957764528, zghcnu@wmu.edu.cn %K illness representations %K internet gaming disorder %K youth %K cross-lagged model %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The common-sense model of illness suggests that mental representations of health threats may affect one’s behavioral reactions to them and health status. Internet gaming disorder is a newly defined mental disorder. Illness representations of internet gaming disorder may affect one’s risk of internet gaming disorder. In turn, symptoms of internet gaming disorder may affect one’s perceptions of the disorder. Objective: This study aimed to investigate the relationships between illness representations and symptoms of internet gaming disorder in college students. Methods: A 1-year longitudinal study was conducted with a convenience sample of Chinese college students (n=591; 342/591, 57.9% female). Results: Of the participants, 10.1% (60/591) and 9.1% (54/591) were classified as having probable internet gaming disorder at baseline (T1) and follow-up (T2), respectively. The correlations between some dimensions of illness representations regarding internet gaming disorder (ie, consequence, timeline, personal control, treatment control, and concern) at T1 and symptoms of internet gaming disorder at T2 and between symptoms of internet gaming disorder at T1 and the dimensions of illness representations at T2 (ie, consequence, timeline, personal control, and emotional response) were statistically significant. The cross-lagged model fit the data well ((χ2/df=2.28, comparative fit index=.95, root mean square error of approximation=.06) and showed that internet gaming disorder at T1 was positively associated with unfavorable illness representations at T2. Conclusions: Individuals with more severe symptoms of internet gaming disorder had more pessimistic perceptions about the disorder. Such cognitive perceptions may affect one’s emotional and behavioral reactions towards the disorder (eg, greater levels of depression and low self-control intention) and should be modified by educational programs and psychological interventions. %M 34851298 %R 10.2196/28117 %U https://games.jmir.org/2021/4/e28117 %U https://doi.org/10.2196/28117 %U http://www.ncbi.nlm.nih.gov/pubmed/34851298 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e32199 %T Examining the Effectiveness of Gamification in Mental Health Apps for Depression: Systematic Review and Meta-analysis %A Six,Stephanie G %A Byrne,Kaileigh A %A Tibbett,Thomas P %A Pericot-Valverde,Irene %+ Department of Psychology, Clemson University, 418 Brackett Hall, Clemson, SC, 29634, United States, 1 864 656 3935, kaileib@clemson.edu %K depression %K reward %K gamification %K mental health apps %K apps %D 2021 %7 29.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Previous research showed that computerized cognitive behavioral therapy can effectively reduce depressive symptoms. Some mental health apps incorporate gamification into their app design, yet it is unclear whether features differ in their effectiveness to reduce depressive symptoms over and above mental health apps without gamification. Objective: The aim of this study was to determine whether mental health apps with gamification elements differ in their effectiveness to reduce depressive symptoms when compared to those that lack these elements. Methods: A meta-analysis of studies that examined the effect of app-based therapy, including cognitive behavioral therapy, acceptance and commitment therapy, and mindfulness, on depressive symptoms was performed. A total of 5597 articles were identified via five databases. After screening, 38 studies (n=8110 participants) remained for data extraction. From these studies, 50 total comparisons between postintervention mental health app intervention groups and control groups were included in the meta-analysis. Results: A random effects model was performed to examine the effect of mental health apps on depressive symptoms compared to controls. The number of gamification elements within the apps was included as a moderator. Results indicated a small to moderate effect size across all mental health apps in which the mental health app intervention effectively reduced depressive symptoms compared to controls (Hedges g=–0.27, 95% CI –0.36 to –0.17; P<.001). The gamification moderator was not a significant predictor of depressive symptoms (β=–0.03, SE=0.03; P=.38), demonstrating no significant difference in effectiveness between mental health apps with and without gamification features. A separate meta-regression also did not show an effect of gamification elements on intervention adherence (β=–1.93, SE=2.28; P=.40). Conclusions: The results show that both mental health apps with and without gamification elements were effective in reducing depressive symptoms. There was no significant difference in the effectiveness of mental health apps with gamification elements on depressive symptoms or adherence. This research has important clinical implications for understanding how gamification elements influence the effectiveness of mental health apps on depressive symptoms. %M 34847058 %R 10.2196/32199 %U https://mental.jmir.org/2021/11/e32199 %U https://doi.org/10.2196/32199 %U http://www.ncbi.nlm.nih.gov/pubmed/34847058 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29742 %T Mechanisms of Change in Digital Health Interventions for Mental Disorders in Youth: Systematic Review %A Domhardt,Matthias %A Engler,Sophie %A Nowak,Hannah %A Lutsch,Arne %A Baumel,Amit %A Baumeister,Harald %+ Department of Clinical Psychology and Psychotherapy, Ulm University, Lise-Meitner-Str. 16, Ulm, D-89081, Germany, 49 73150 32803, matthias.domhardt@uni-ulm.de %K children and adolescents %K mental disorders %K mediator %K mechanisms of change %K digital health intervention %K psychotherapy %K mobile phone %D 2021 %7 26.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) are efficacious for several mental disorders in youth; however, integrated, evidence-based knowledge about the mechanisms of change in these interventions is lacking. Objective: This systematic review aims to comprehensively evaluate studies on mediators and mechanisms of change in different DHIs for common mental disorders in children and adolescents. Methods: A systematic literature search of the electronic databases Cochrane Central Register of Controlled Trials, Embase, MEDLINE, and PsycINFO was conducted, complemented by backward and forward searches. Two independent reviewers selected studies for inclusion, extracted the data, and rated the methodological quality of eligible studies (ie, risk of bias and 8 quality criteria for process research). Results: A total of 25 studies that have evaluated 39 potential mediators were included in this review. Cognitive mediators were the largest group of examined intervening variables, followed by a broad range of emotional and affective, interpersonal, parenting behavior, and other mediators. The mediator categories with the highest percentages of significant intervening variables were the groups of affective mediators (4/4, 100%) and combined cognitive mediators (13/19, 68%). Although more than three-quarters of the eligible studies met 5 or more quality criteria, causal conclusions have been widely precluded. Conclusions: The findings of this review might guide the empirically informed advancement of DHIs, contributing to improved intervention outcomes, and the discussion of methodological recommendations for process research might facilitate mediation studies with more pertinent designs, allowing for conclusions with higher causal certainty in the future. %M 34842543 %R 10.2196/29742 %U https://www.jmir.org/2021/11/e29742 %U https://doi.org/10.2196/29742 %U http://www.ncbi.nlm.nih.gov/pubmed/34842543 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e27404 %T Self-directed Technology-Based Therapeutic Methods for Adult Patients Receiving Mental Health Services: Systematic Review %A Saad,Anthony %A Bruno,Deanna %A Camara,Bettina %A D’Agostino,Josephine %A Bolea-Alamanac,Blanca %+ Department of Psychiatry, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 6473312707, Blanca.BoleaAlamanac@wchospital.ca %K digital therapeutics %K self-directed %K mental health %K telehealth %K technology %K mobile applications %K telemedicine %K internet %K mobile phone %D 2021 %7 26.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Technological interventions used to treat illnesses and promote health are grouped under the umbrella term of digital therapeutics. The use of digital therapeutics is becoming increasingly common in mental health. Although many technologies are currently being implemented, research supporting their usability, efficacy, and risk requires further examination, especially for those interventions that can be used without support. Objective: This review aims to identify the evidence-based, self-directed, technology-based methods of care that can be used in adult patients after they are discharged from mental health services. The interventions reviewed are automated with no human input required (either at the patient’s or at the technology’s end), so the patients can implement them without any support. Methods: A systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and PROSPERO (International Prospective Register of Systematic Reviews) guidelines in 3 databases: PubMed, Web of Science, and OVID. The inclusion criteria were self-directed, automated, and technology-based interventions related to mental health, primarily for adults, having a solid evaluation process. The interventions had to be self-directed, in that the participants could use the technology without any external guidance. Results: We identified 36 papers that met the inclusion criteria: 26 randomized controlled trials, 9 nonrandomized controlled trial quantitative studies, and 1 qualitative study. The technologies used included websites, automated text messaging, phone apps, videos, computer software, and integrated voice response. There were 22 studies focused on internet-based cognitive behavioral therapies as a therapeutic paradigm compared with the waitlist, web-based human-delivered therapy, and other interventions. Among these studies, 14 used paradigms other than the internet-based cognitive behavioral therapy. Of the 8 studies comparing guided and unguided digital care, 3 showed no differences, 3 favored guided interventions, and 2 favored unguided interventions. The research also showed that dropout rates were as high as 80%, citing potential problems with the acceptability of the suggested technologies. Conclusions: There is limited research on the efficacy and suitability of self-directed technology-based care options for mental health. Digital technologies have the potential to bridge the gap between ambulatory care and independent living. However, these interventions may need to be developed collaboratively with the users to encourage their acceptability and to avoid high dropout rates. %M 34842556 %R 10.2196/27404 %U https://mental.jmir.org/2021/11/e27404 %U https://doi.org/10.2196/27404 %U http://www.ncbi.nlm.nih.gov/pubmed/34842556 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e26521 %T Burden and Help-Seeking Behaviors Linked to Problem Gambling and Gaming: Observational Quantitative and Qualitative Analysis %A Luquiens,Amandine %A von Hammerstein,Cora %A Benyamina,Amine %A Perney,Pascal %+ Universitary Hospital of Nîmes, University of Montpellier, Place Robert Debré, Nîmes, 30000, France, 33 466022569, amandineluquiens@gmail.com %K gambling %K gaming %K helpline %K burden, relatives %K qualitative research %D 2021 %7 26.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Models based on the uniqueness of addiction processes between behavioral addictions are highly contentious, and the inclusion of gaming disorder in the addiction nosography remains controversial. An exploratory approach could clarify a hypothesized common and subjectively identifiable process in addictive behaviors and the necessarily different expressions of the disorder due to behavior specificities, in particular the sociocultural characteristics and profiles of users. Objective: The aim of this study was to describe the nature of contacts to a help service by exploring commonality and specificities of burden and help-seeking for problem gambling or gaming. Methods: This was an observational quantitative-qualitative study. We included all contacts (ie, online questions and contacts by phone or chat when the helper completed a summary) to a helpline for gamers, gamblers, and relatives over a 7-year period. We constituted a text corpus with online questions and summaries of contacts by phone or chat. We collected basic sociodemographic data, including the device used to contact the service (phone or internet), contacting the service for oneself (“user”) or being a relative of a user and type of relative, gambling (yes/no), gaming (yes/no), and age and sex of the gambler/gamer. We describe the corpus descriptively and report the computerized qualitative analysis of online questions, chat, and summary of phone calls. We performed a descendant hierarchical analysis on the data. Results: A total of 14,564 contacts were made to the helpline, including 10,017 users and 4547 relatives. The corpus was composed of six classes: (1) gaming specificities, (2) shared psychological distress and negative emotions, (3) the procedure for being banned from gambling, (4) the provided help, (5) gambling specificities, and (6) financial problems. Conclusions: Negative emotions and shared distress linked to gambling and gaming support current scientific consensus that these behaviors can produce psychological distress in se; however, meaningful differences were observed in core symptoms of addiction between gamers and gamblers, beyond specificities related to the behavior itself: loss of control was elicited in the class corresponding to gambling specificities and not by gamers and their relatives. %M 34842562 %R 10.2196/26521 %U https://mental.jmir.org/2021/11/e26521 %U https://doi.org/10.2196/26521 %U http://www.ncbi.nlm.nih.gov/pubmed/34842562 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30624 %T Effects of Emotional Expressiveness of a Female Digital Human on Loneliness, Stress, Perceived Support, and Closeness Across Genders: Randomized Controlled Trial %A Loveys,Kate %A Sagar,Mark %A Zhang,Xueyuan %A Fricchione,Gregory %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Building 507, Level 3, 22-30 Park Avenue, Auckland, 1023, New Zealand, 64 9 923 6756, e.broadbent@auckland.ac.nz %K computer agent %K digital human %K emotional expressiveness %K loneliness %K closeness %K social support %K stress %K human-computer interaction %K voice %K face %K physiology %D 2021 %7 25.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Loneliness is a growing public health problem that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Social support interventions have been shown to reduce loneliness, including when delivered through technology. Digital humans are a new type of computer agent that show promise as supportive peers in health care. For digital humans to be effective and engaging support persons, it is important that they develop closeness with people. Closeness can be increased by emotional expressiveness, particularly in female relationships. However, it is unknown whether emotional expressiveness improves relationships with digital humans and affects physiological responses. Objective: The aim of this study is to investigate whether emotional expression by a digital human can affect psychological and physiological outcomes and whether the effects are moderated by the user’s gender. Methods: A community sample of 198 adults (101 women, 95 men, and 2 gender-diverse individuals) was block-randomized by gender to complete a 15-minute self-disclosure conversation with a female digital human in 1 of 6 conditions. In these conditions, the digital human varied in modality richness and emotional expression on the face and in the voice (emotional, neutral, or no face; emotional or neutral voice). Perceived loneliness, closeness, social support, caring perceptions, and stress were measured after each interaction. Heart rate, skin temperature, and electrodermal activity were assessed during each interaction. 3-way factorial analyses of variance with post hoc tests were conducted. Results: Emotional expression in the voice was associated with greater perceptions of caring and physiological arousal during the interaction, and unexpectedly, with lower feelings of support. User gender moderated the effect of emotional expressiveness on several outcomes. For women, an emotional voice was associated with increased closeness, social support, and caring perceptions, whereas for men, a neutral voice increased these outcomes. For women, interacting with a neutral face was associated with lower loneliness and subjective stress compared with no face. Interacting with no face (ie, a voice-only black screen) resulted in lower loneliness and subjective stress for men, compared with a neutral or emotional face. No significant results were found for heart rate or skin temperature. However, average electrodermal activity was significantly higher for men while interacting with an emotional voice. Conclusions: Emotional expressiveness in a female digital human has different effects on loneliness, social, and physiological outcomes for men and women. The results inform the design of digital human support persons and have theoretical implications. Further research is needed to evaluate how more pronounced emotional facial expressions in a digital human might affect the results. Trial Registration: Australia New Zealand Clinical Trials Registry (ANZCTR) ACTRN12621000865819; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=381816&isReview %M 34842540 %R 10.2196/30624 %U https://www.jmir.org/2021/11/e30624 %U https://doi.org/10.2196/30624 %U http://www.ncbi.nlm.nih.gov/pubmed/34842540 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e29487 %T Studies of Depression and Anxiety Using Reddit as a Data Source: Scoping Review %A Boettcher,Nick %+ Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada, 1 (403) 220 4286, nkboettc@ucalgary.ca %K depression %K anxiety %K mental health %K Reddit %K social media %K review %D 2021 %7 25.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: The study of depression and anxiety using publicly available social media data is a research activity that has grown considerably over the past decade. The discussion platform Reddit has become a popular social media data source in this nascent area of study, in part because of the unique ways in which the platform is facilitative of research. To date, no work has been done to synthesize existing studies on depression and anxiety using Reddit. Objective: The objective of this review is to understand the scope and nature of research using Reddit as a primary data source for studying depression and anxiety. Methods: A scoping review was conducted using the Arksey and O’Malley framework. MEDLINE, Embase, CINAHL, PsycINFO, PsycARTICLES, Scopus, ScienceDirect, IEEE Xplore, and ACM academic databases were searched. Inclusion criteria were developed using the participants, concept, and context framework outlined by the Joanna Briggs Institute Scoping Review Methodology Group. Eligible studies featured an analytic focus on depression or anxiety and used naturalistic written expressions from Reddit users as a primary data source. Results: A total of 54 studies were included in the review. Tables and corresponding analyses delineate the key methodological features, including a comparatively larger focus on depression versus anxiety, an even split of original and premade data sets, a widespread analytic focus on classifying the mental health states of Reddit users, and practical implications that often recommend new methods of professionally delivered monitoring and outreach for Reddit users. Conclusions: Studies of depression and anxiety using Reddit data are currently driven by a prevailing methodology that favors a technical, solution-based orientation. Researchers interested in advancing this research area will benefit from further consideration of conceptual issues surrounding the interpretation of Reddit data with the medical model of mental health. Further efforts are also needed to locate accountability and autonomy within practice implications, suggesting new forms of engagement with Reddit users. %M 34842560 %R 10.2196/29487 %U https://mental.jmir.org/2021/11/e29487 %U https://doi.org/10.2196/29487 %U http://www.ncbi.nlm.nih.gov/pubmed/34842560 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29666 %T Effects of Internet-Based Cognitive Behavioral Therapy for Harmful Alcohol Use and Alcohol Dependence as Self-help or With Therapist Guidance: Three-Armed Randomized Trial %A Johansson,Magnus %A Berman,Anne H %A Sinadinovic,Kristina %A Lindner,Philip %A Hermansson,Ulric %A Andréasson,Sven %+ Department of Global Public Health, Karolinska Institutet, Solnavägen 1E, Stockholm, 11365, Sweden, 46 727249971, magnus.johansson.1@ki.se %K alcohol dependence %K alcohol use disorders %K internet-based interventions %K internet-based cognitive behavioral therapy %K ICBT %K cognitive behavioral therapy %K CBT %K eHealth %K alcohol use %K substance abuse %K outcomes %K help-seeking behavior %K internet-based interventions %K alcohol dependence %K mobile phone %D 2021 %7 24.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Alcohol use is a major contributor to health loss. Many persons with harmful use or alcohol dependence do not obtain treatment because of limited availability or stigma. They may use internet-based interventions as an alternative way of obtaining support. Internet-based interventions have previously been shown to be effective in reducing alcohol consumption in studies that included hazardous use; however, few studies have been conducted with a specific focus on harmful use or alcohol dependence. The importance of therapist guidance in internet-based cognitive behavioral therapy (ICBT) programs is still unclear. Objective: This trial aims to investigate the effects of a web-based alcohol program with or without therapist guidance among anonymous adult help-seekers. Methods: A three-armed randomized controlled trial was conducted to compare therapist-guided ICBT and self-help ICBT with an information-only control condition. Swedish-speaking adult internet users with alcohol dependence (3 or more International Classification of Diseases, Tenth Revision criteria) or harmful alcohol use (alcohol use disorder identification test>15) were included in the study. Participants in the therapist-guided ICBT and self-help ICBT groups had 12-week access to a program consisting of 5 main modules, as well as a drinking calendar with automatic feedback. Guidance was given by experienced therapists trained in motivational interviewing. The primary outcome measure was weekly alcohol consumption in standard drinks (12 g of ethanol). Secondary outcomes were alcohol-related problems measured using the total alcohol use disorder identification test-score, diagnostic criteria for alcohol dependence and alcohol use disorder, depression, anxiety, health, readiness to change, and access to other treatments or support. Follow-up was conducted 3 (posttreatment) and 6 months after recruitment. Results: During the recruitment period, from March 2015 to March 2017, 1169 participants were included. Participants had a mean age of 45 (SD 13) years, and 56.72% (663/1169) were women. At the 3-month follow-up, the therapist-guided ICBT and control groups differed significantly in weekly alcohol consumption (−3.84, 95% Cl −6.53 to −1.16; t417=2.81; P=.005; Cohen d=0.27). No significant differences were found in weekly alcohol consumption between the self-help ICBT group and the therapist-guided ICBT at 3 months, between the self-help ICBT and the control group at 3 months, or between any of the groups at the 6-month follow-up. A limitation of the study was the large number of participants who were completely lost to follow-up (477/1169, 40.8%). Conclusions: In this study, a therapist-guided ICBT program was not found to be more effective than the same program in a self-help ICBT version for reducing alcohol consumption or other alcohol-related outcomes. In the short run, therapist-guided ICBT was more effective than information. Only some internet help-seekers may need a multisession program and therapist guidance to change their drinking when they use internet-based interventions. Trial Registration: ClinicalTrials.gov NCT02377726; https://clinicaltrials.gov/ct2/show/NCT02377726 %M 34821563 %R 10.2196/29666 %U https://www.jmir.org/2021/11/e29666 %U https://doi.org/10.2196/29666 %U http://www.ncbi.nlm.nih.gov/pubmed/34821563 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e26397 %T A Mobile Intervention for Self-Efficacious and Goal-Directed Smartphone Use in the General Population: Randomized Controlled Trial %A Keller,Jan %A Roitzheim,Christina %A Radtke,Theda %A Schenkel,Konstantin %A Schwarzer,Ralf %+ Department of Education and Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 8385 4906, jan.keller@fu-berlin.de %K problematic smartphone use %K smartphone unlocks %K smartphone time %K behavior change %K self-efficacy %K action planning %K digital detox %K time-out %K randomized controlled trial %D 2021 %7 23.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: People spend large parts of their everyday life using their smartphones. Despite various advantages of the smartphone for daily life, problematic forms of smartphone use exist that are related to negative psychological and physiological consequences. To reduce problematic smartphone use, existing interventions are oftentimes app-based and include components that help users to monitor and restrict their smartphone use by setting timers and blockers. These kinds of digital detox interventions, however, fail to exploit psychological resources, such as through promoting self-efficacious and goal-directed smartphone use. Objective: The aim of this study is to evaluate the theory-based smartphone app “Not Less But Better” that was developed to make people aware of psychological processes while using the smartphone and to support them in using their smartphone in accordance with their goals and values. Methods: In a randomized controlled trial, effects of a 20-day intervention app consisting of five 4-day training modules to foster a goal-directed smartphone use were evaluated. In the active control condition (treatment as usual), participants received a digital detox treatment and planned daily time-outs of at least 1 hour per day. Up to a 3-week follow-up, self-reported problematic smartphone use, objectively measured daily smartphone unlocks, time of smartphone use, self-efficacy, and planning towards goal-directed smartphone use were assessed repeatedly. Linear 2-level models tested intervention effects. Mediation models served to analyze self-efficacy and planning as potential mechanisms of the intervention. Results: Out of 232 enrolled participants, 110 (47.4%; 55 participants in each condition) provided data at postintervention and 88 (37.9%; 44 participants in each condition) at 3-week follow-up. Both conditions manifested substantial reductions in problematic smartphone use and in the amount of time spent with the smartphone. The number of daily unlocks did not change over time. Further, modelling changes in self-efficacy as a mediator between the intervention and problematic smartphone use at follow-up fit well to the data and showed an indirect effect (b=–0.09; 95% bias-corrected bootstrap CI –0.26 to –0.01), indicating that self-efficacy was an important intervention mechanism. Another mediation model revealed an indirect effect from changes in planning via smartphone unlocks at postintervention on problematic smartphone use at follow-up (b=–0.029, 95% bias-corrected bootstrap CI –0.078 to –0.003). Conclusions: An innovative, theory-based intervention app on goal-directed smartphone use has been found useful in lowering problematic smartphone use and time spent with the smartphone. However, observed reductions in both outcomes were not superior to the active control condition (ie, digital detox treatment). Nonetheless, the present findings highlight the importance in promoting self-efficacy and planning goal-directed smartphone use to achieve improvements in problematic smartphone use. This scalable intervention app appears suitable for practical use and as an alternative to common digital detox apps. Future studies should address issues of high attrition by adding just-in-time procedures matched to smartphone users’ needs. Trial Registration: German Clinical Trials Register DRKS00017606; https://tinyurl.com/27c9kmwy %M 34817388 %R 10.2196/26397 %U https://mhealth.jmir.org/2021/11/e26397 %U https://doi.org/10.2196/26397 %U http://www.ncbi.nlm.nih.gov/pubmed/34817388 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e29664 %T Reactance to Social Authority in a Sugar Reduction Informational Video: Web-Based Randomized Controlled Trial of 4013 Participants %A Hachaturyan,Violetta %A Adam,Maya %A Favaretti,Caterina %A Greuel,Merlin %A Gates,Jennifer %A Bärnighausen,Till %A Vandormael,Alain %+ Heidelberg Institute of Global Health, University of Heidelberg, 130.3 Im Neuenheimer Feld, Heidelberg, 69210, Germany, 49 6221 56 5344, alain.vandormael@uni-heidelberg.de %K sugar reduction %K reactance %K animated video %K digital intervention %K health communication %D 2021 %7 22.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Short and animated story-based (SAS) videos can be an effective strategy for promoting health messages. However, health promotion strategies often motivate the rejection of health messages, a phenomenon known as reactance. In this study, we examine whether the child narrator of a SAS video (perceived as nonthreatening, with low social authority) minimizes reactance to a health message about the consumption of added sugars. Objective: This study aims to determine whether our SAS intervention video attenuates reactance to the sugar message when compared with a content placebo video (a health message about sunscreen) and a placebo video (a nonhealth message about earthquakes) and determine if the child narrator is more effective at reducing reactance to the sugar message when compared with the mother narrator (equivalent social authority to target audience) or family physician narrator (high social authority) of the same SAS video. Methods: This is a web-based randomized controlled trial comparing an intervention video about sugar reduction narrated by a child, the child’s mother, or the family physician with a content placebo video about sunscreen use and a placebo video about earthquakes. The primary end points are differences in the antecedents to reactance (proneness to reactance, threat level of the message), its components (anger and negative cognition), and outcomes (source appraisal and attitude). We performed analysis of variance on data collected (N=4013) from participants aged 18 to 59 years who speak English and reside in the United Kingdom. Results: Between December 9 and December 11, 2020, we recruited 38.62% (1550/4013) men, 60.85% (2442/4013) women, and 0.52% (21/4013) others for our study. We found a strong causal relationship between the persuasiveness of the content promoted by the videos and the components of reactance. Compared with the placebo (mean 1.56, SD 0.63) and content placebo (mean 1.76, SD 0.69) videos, the intervention videos (mean 1.99, SD 0.83) aroused higher levels of reactance to the message content (P<.001). We found no evidence that the child narrator (mean 1.99, SD 0.87) attenuated reactance to the sugar reduction message when compared with the physician (mean 1.95, SD 0.79; P=.77) and mother (mean 2.03, SD 0.83; P=.93). In addition, the physician was perceived as more qualified, reliable, and having more expertise than the child (P<.001) and mother (P<.001) narrators. Conclusions: Although children may be perceived as nonthreatening messengers, we found no evidence that a child narrator attenuated reactance to a SAS video about sugar consumption when compared with a physician. Furthermore, our intervention videos, with well-intended goals toward audience health awareness, aroused higher levels of reactance when compared with the placebo videos. Our results highlight the challenges in developing effective interventions to promote persuasive health messages. Trial Registration: German Clinical Trials Registry DRKS00022340; https://tinyurl.com/mr8dfena International Registered Report Identifier (IRRID): RR2-10.2196/25343 %M 34813490 %R 10.2196/29664 %U https://www.jmir.org/2021/11/e29664 %U https://doi.org/10.2196/29664 %U http://www.ncbi.nlm.nih.gov/pubmed/34813490 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 4 %P e27630 %T Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants’ Experiences %A Xiang,Xiaoling %A Kayser,Jay %A Sun,Yihang %A Himle,Joseph %+ School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI, 48109, United States, 1 7347636581, xiangxi@umich.edu %K internet-based cognitive behavioral therapy %K homebound older adults %K home care %K direct care workers %K depression %K qualitative study %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Depression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities. Objective: This study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression. Methods: The participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research. Results: Three themes and various subthemes emerged related to participants’ experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants’ perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement. Conclusions: iCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence. Trial Registration: ClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289 %M 34813491 %R 10.2196/27630 %U https://aging.jmir.org/2021/4/e27630 %U https://doi.org/10.2196/27630 %U http://www.ncbi.nlm.nih.gov/pubmed/34813491 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30889 %T Gender-Based Differences and Associated Factors Surrounding Excessive Smartphone Use Among Adolescents: Cross-sectional Study %A Claesdotter-Knutsson,Emma %A André,Frida %A Fridh,Maria %A Delfin,Carl %A Hakansson,Anders %A Lindström,Martin %+ Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Sofiavägen 2D, Lund, SE-22241, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K smartphone %K cell phone %K adolescent %K sleep %K anxiety %K substance use %K nicotine %K alcohol drinking %K smartphone use %K addiction %K behavioral addiction %K worry %K pathology %K internet %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Excessive smartphone use is a new and debated phenomenon frequently mentioned in the context of behavioral addiction, showing both shared and distinct traits when compared to pathological gaming and gambling. Objective: The aim of this study is to describe excessive smartphone use and associated factors among adolescents, focusing on comparisons between boys and girls. Methods: This study was based on data collected through a large-scale public health survey distributed in 2016 to pupils in the 9th grade of primary school and those in the 2nd grade of secondary school. Bayesian binomial regression models, with weakly informative priors, were used to examine whether the frequency of associated factors differed between those who reported excessive smartphone use and those who did not. Results: The overall response rate was 77% (9143/11,868) among 9th grade pupils and 73.4% (7949/10,832) among 2nd grade pupils, resulting in a total of 17,092 responses. Based on the estimated median absolute percentage differences, along with associated odds ratios, we found that excessive smartphone use was associated with the use of cigarettes, alcohol, and other substances. The reporting of anxiety and worry along with feeling low more than once a week consistently increased the odds of excessive smartphone use among girls, whereas anxiety and worry elevated the odds of excessive smartphone use among boys. The reporting of less than 7 hours of sleep per night was associated with excessive smartphone use in all 4 study groups. Conclusions: The results varied across gender and grade in terms of robustness and the size of estimated difference. However, excessive smartphone use was associated with a higher frequency of multiple suspected associated factors, including ever having tried smoking, alcohol, or other substances; poor sleep; and often feeling low and feeling anxious. This study sheds light on some features and distinctions of a potentially problematic behavior among adolescents. %M 34813492 %R 10.2196/30889 %U https://pediatrics.jmir.org/2021/4/e30889 %U https://doi.org/10.2196/30889 %U http://www.ncbi.nlm.nih.gov/pubmed/34813492 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e32306 %T A Smartphone-Based Self-Management Intervention for Individuals with Bipolar Disorder (LiveWell): Qualitative Study on User Experiences of the Behavior Change Process %A Jonathan,Geneva K %A Dopke,Cynthia A %A Michaels,Tania %A Martin,Clair R %A Ryan,Chloe %A McBride,Alyssa %A Babington,Pamela %A Goulding,Evan H %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 680 N Lake Shore Dr Suite 1520, Chicago, IL, 60660, United States, 1 312 503 1189, e-goulding@fsm.northwestern.edu %K behavioral intervention technology %K mHealth %K bipolar disorder %K depression %K illness management %K smartphone %K behavior change %K early warning signs %K self-management %K qualitative %K behavior %K intervention %K management %K user experience %K perception %K utilization %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Bipolar disorder is a severe mental illness characterized by recurrent episodes of depressed, elevated, and mixed mood states. The addition of psychotherapy to pharmacological management can decrease symptoms, lower relapse rates, and improve quality of life; however, access to psychotherapy is limited. Mental health technologies such as smartphone apps are being studied as a means to increase access to and enhance the effectiveness of adjunctive psychotherapies for bipolar disorder. Individuals with bipolar disorder find this intervention format acceptable, but our understanding of how people utilize and integrate these tools into their behavior change and maintenance processes remains limited. Objective: The objective of this study was to explore how individuals with bipolar disorder perceive and utilize a smartphone intervention for health behavior change and maintenance. Methods: Individuals with bipolar disorder were recruited via flyers placed at university-affiliated and private outpatient mental health practices to participate in a pilot study of LiveWell, a smartphone-based self-management intervention. At the end of the study, all participants completed in-depth qualitative exit interviews. The behavior change framework developed to organize the intervention design was used to deductively code behavioral targets and determinants involved in target engagement. Inductive coding was used to identify themes not captured by this framework. Results: In terms of behavioral targets, participants emphasized the importance of managing mood episode–related signs and symptoms. They also discussed the importance of maintaining regular routines, sleep duration, and medication adherence. Participants emphasized that receiving support from a coach as well as seeking and receiving assistance from family, friends, and providers were important for managing behavioral targets and staying well. In terms of determinants, participants stressed the important role of monitoring for their behavior change and maintenance efforts. Monitoring facilitated self-awareness and reflection, which was considered valuable for staying well. Some participants also felt that the intervention facilitated learning information necessary for managing bipolar disorder but others felt that the information provided was too basic. Conclusions: In addition to addressing acceptability, satisfaction, and engagement, a person-based design of mental health technologies can be used to understand how people experience the impact of these technologies on their behavior change and maintenance efforts. This understanding may then be used to guide ongoing intervention development. The participants’ perceptions aligned with the intervention’s primary behavioral targets and use of a monitoring tool as a core intervention feature. Participant feedback further indicates that developing additional content and tools to address building and engaging social support may be an important avenue for improving LiveWell. A comprehensive behavior change framework to understand participant perceptions of their behavior change and maintenance efforts may help facilitate ongoing intervention development. %M 34813488 %R 10.2196/32306 %U https://mental.jmir.org/2021/11/e32306 %U https://doi.org/10.2196/32306 %U http://www.ncbi.nlm.nih.gov/pubmed/34813488 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30590 %T Effectiveness of Self-Guided Virtual Reality–Based Cognitive Behavioral Therapy for Panic Disorder: Randomized Controlled Trial %A Shin,Bokyoung %A Oh,Jooyoung %A Kim,Byung-Hoon %A Kim,Hesun Erin %A Kim,Hyunji %A Kim,Suji %A Kim,Jae-Jin %+ Department of Psychiatry, Yonsei University College of Medicine, Gangnam Severance Hospital, Yonsei University Health System, 211 Eonju-ro, Gangnam-gu, Seoul, 06273, Republic of Korea, 82 2 2019 3342, ojuojuoju@yuhs.ac %K virtual reality %K panic disorder %K cognitive behavioral therapy %K exposure therapy %K intervention %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Virtual reality (VR) is as effective a technique as traditional cognitive behavioral therapy (CBT) and a promising tool for treating panic disorder symptoms because VR exposure can be safer and has better acceptability than in vivo exposure and is more immersive than exposure through imagination. CBT techniques can be delivered more effectively using VR as well. So far, VR has required high-quality devices, but the development of mobile VR technology has improved user availability. At the same time, a well-structured form of VR can be reproduced and used anywhere. This means that VR can be used to provide a self-guided form of treatment and address the high treatment costs of evidence-based therapy and the lack of professional therapists. This study aimed to investigate the potential of self-guided VR as an alternative to high-cost treatment. Objective: The main goal of this study was to offer data about the efficacy of a mobile app-based self-led VR CBT in the treatment of panic disorder. Methods: A total of 54 subjects with panic disorder were enrolled in this study and randomly assigned to either the VR treatment group or waitlist group. The VR treatment was designed to be total 12 sessions for 4 weeks. The VR treatment consists of 4 steps in which patients are gradually exposed to phobic stimuli while learning to cope with panic symptoms in each stage. The effectiveness of treatment was assessed through the Panic Disorder Severity Scale, Hamilton Rating Scale for Depression, Body Sensations Questionnaire, Albany Panic and Phobia Questionnaire, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale, Korean Inventory of Social Avoidance and Distress Scale, Korean Inventory of Depressive Symptomatology, and Perceived Stress Scale. In addition, physiological changes using heart rate variability were evaluated. Results: In within-group analyses, the VR treatment group exhibited improvements in panic disorder symptoms, anxiety, and depression after 4 weeks, while the waitlist group did not show any significant improvement. Compared to the waitlist group, the VR treatment group showed significantly greater improvements in the Panic Disorder Severity Scale in both completer analysis and intention-to-treat analysis. Heart rate variability in the VR treatment group showed improvement in normalized high frequency from baseline to postassessment with no significant differences in any outcome measure between groups. Conclusions: The self-guided, mobile app-based VR intervention was effective in the treatment of panic symptoms and restoring the autonomic nervous system demonstrating the validity of the use of VR for self-guided treatment. VR treatment can be a cost-effective therapeutic approach. Trial Registration: ClinicalTrials.gov NCT04985019; https://clinicaltrials.gov/ct2/show/NCT04985019 %M 34813486 %R 10.2196/30590 %U https://mental.jmir.org/2021/11/e30590 %U https://doi.org/10.2196/30590 %U http://www.ncbi.nlm.nih.gov/pubmed/34813486 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30309 %T Momentary Manifestations of Negative Symptoms as Predictors of Clinical Outcomes in People at High Risk for Psychosis: Experience Sampling Study %A Paetzold,Isabell %A Hermans,Karlijn S F M %A Schick,Anita %A Nelson,Barnaby %A Velthorst,Eva %A Schirmbeck,Frederike %A , %A van Os,Jim %A Morgan,Craig %A van der Gaag,Mark %A de Haan,Lieuwe %A Valmaggia,Lucia %A McGuire,Philip %A Kempton,Matthew %A Myin-Germeys,Inez %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J 5 1, Mannheim, 68159, Germany, 49 62117031931, ulrich.reininghaus@zi-mannheim.de %K ecological momentary assessment %K psychotic disorder %K psychopathology %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Negative symptoms occur in individuals at ultrahigh risk (UHR) for psychosis. Although there is evidence that observer ratings of negative symptoms are associated with level of functioning, the predictive value of subjective experience in daily life for individuals at UHR has not been studied yet. Objective: This study therefore aims to investigate the predictive value of momentary manifestations of negative symptoms for clinical outcomes in individuals at UHR. Methods: Experience sampling methodology was used to measure momentary manifestations of negative symptoms (blunted affective experience, lack of social drive, anhedonia, and social anhedonia) in the daily lives of 79 individuals at UHR. Clinical outcomes (level of functioning, illness severity, UHR status, and transition status) were assessed at baseline and at 1- and 2-year follow-ups. Results: Lack of social drive, operationalized as greater experienced pleasantness of being alone, was associated with poorer functioning at the 2-year follow-up (b=−4.62, P=.01). Higher levels of anhedonia were associated with poorer functioning at the 1-year follow-up (b=5.61, P=.02). Higher levels of social anhedonia were associated with poorer functioning (eg, disability subscale: b=6.36, P=.006) and greater illness severity (b=−0.38, P=.045) at the 1-year follow-up. In exploratory analyses, there was evidence that individuals with greater variability of positive affect (used as a measure of blunted affective experience) experienced a shorter time to remission from UHR status at follow-up (hazard ratio=4.93, P=.005). Conclusions: Targeting negative symptoms in individuals at UHR may help to predict clinical outcomes and may be a promising target for interventions in the early stages of psychosis. %M 34807831 %R 10.2196/30309 %U https://mental.jmir.org/2021/11/e30309 %U https://doi.org/10.2196/30309 %U http://www.ncbi.nlm.nih.gov/pubmed/34807831 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30479 %T Implementing the Routine Use of Electronic Mental Health Screening for Youth in Primary Care: Systematic Review %A Martel,Rhiannon %A Shepherd,Matthew %A Goodyear-Smith,Felicity %+ Department of General Practice & Primary Health Care, Faculty of Medical & Health Science, University of Auckland, 22 Park Road, Grafton, Auckland, 1142, New Zealand, 64 99232357, f.goodyear-smith@auckland.ac.nz %K adolescent %K mental health %K risk behavior %K screening %K primary care %D 2021 %7 19.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Adolescents often present at primary care clinics with nonspecific physical symptoms when, in fact, they have at least 1 mental health or risk behavior (psychosocial) issue with which they would like help but do not disclose to their care provider. Despite global recommendations, over 50% of youths are not screened for mental health and risk behavior issues in primary care. Objective: This review aimed to examine the implementation, acceptability, feasibility, benefits, and barriers of e-screening tools for mental health and risk behaviors among youth in primary care settings. Methods: Electronic databases—MEDLINE, CINAHL, Scopus, and the Cochrane Database of Systematic Reviews—were searched for studies on the routine screening of youth in primary care settings. Screening tools needed to be electronic and screen for at least 1 mental health or risk behavior issue. A total of 11 studies that were reported in 12 articles, of which all were from high-income countries, were reviewed. Results: e-Screening was largely proven to be feasible and acceptable to youth and their primary care providers. Preconsultation e-screening facilitated discussions about sensitive issues and increased disclosure by youth. However, barriers such as the lack of time, training, and discomfort in raising sensitive issues with youth continued to be reported. Conclusions: To implement e-screening, clinicians need to change their behaviors, and e-screening processes must become normalized into their workflows. Co-designing and tailoring screening implementation frameworks to meet the needs of specific contexts may be required to ensure that clinicians overcome initial resistances and perceived barriers and adopt the required processes in their work. %M 34807833 %R 10.2196/30479 %U https://mental.jmir.org/2021/11/e30479 %U https://doi.org/10.2196/30479 %U http://www.ncbi.nlm.nih.gov/pubmed/34807833 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 5 %N 2 %P e32351 %T The Effects of a Digital Mental Health Intervention in Adults With Cardiovascular Disease Risk Factors: Analysis of Real-World User Data %A Montgomery,Robert M %A Boucher,Eliane M %A Honomichl,Ryan D %A Powell,Tyler A %A Guyton,Sharelle L %A Bernecker,Samantha L %A Stoeckl,Sarah Elizabeth %A Parks,Acacia C %+ Happify Health, 51 E 12th St 5th floor, New York, NY, 10003, United States, 1 917 261 6933, robmontgomery@happify.com %K digital mental health %K digital health %K mobile apps %K mobile health %K internet-based intervention %K happiness %K subjective well-being %K anxiety %K cardiovascular health %K high blood pressure %K high cholesterol %K diabetes %K cardiovascular disease risk %K real-world data %D 2021 %7 19.11.2021 %9 Original Paper %J JMIR Cardio %G English %X Background: The American Heart Association has identified poor mental health as a key barrier to healthy behavior change for those with cardiovascular disease (CVD) risk factors such as high blood pressure, high cholesterol, and diabetes. Digital mental health interventions, like those delivered via the internet to computers or smartphones, may provide a scalable solution to improving the mental and physical health of this population. Happify is one such intervention and has demonstrated evidence of efficacy for improving aspects of mental health in both the general population and in users with chronic conditions. Objective: The objectives of this analysis of real-world data from Happify users with self-reported CVD risk factors, including high blood pressure and cholesterol, diabetes, and heart disease, were to examine whether these users would report improvements in subjective well-being and anxiety over time (H1) and use of Happify as recommended would be associated with significantly greater improvement in subjective well-being and anxiety over time compared to less-than-recommended usage (H2). Methods: Data were obtained from existing Happify users who reported the aforementioned CVD risk factors. The sample included 1803 users receiving at least 6 weeks’ exposure to Happify (ranging from 42 days to 182 days) who completed at least one activity and two assessments within the app during that time. Subjective well-being was assessed with the Happify Scale, a 9-item measure of positive emotionality and life satisfaction, and anxiety was assessed with the Generalized Anxiety Disorder 2 (GAD-2). To evaluate H1, changes over time in both outcomes were assessed using mixed effects linear regression models, controlling for demographics and usage. For H2, an interaction term was added to the models to assess whether usage as recommended was associated with greater improvement over time. Results: Both hypotheses were supported. For both the Happify scale and GAD-2, the initial multivariable model without an interaction demonstrated an effect for time from baseline, and the addition of the interaction term between time and recommended use was significant as well. Conclusions: This analysis of real-world data provides preliminary evidence that Happify users with self-reported CVD risk factors including high blood pressure or cholesterol, diabetes, and heart disease experienced improved well-being and anxiety over time and that those who used Happify as recommended experienced greater improvements in these aspects of mental health than those who completed fewer activities. These findings extend previous research, which demonstrated that engagement with Happify as recommended was associated with improved well-being among physically healthy users and in those with chronic conditions, to a new population for whom mental health is especially critical: those at risk of developing CVD. %M 34806986 %R 10.2196/32351 %U https://cardio.jmir.org/2021/2/e32351 %U https://doi.org/10.2196/32351 %U http://www.ncbi.nlm.nih.gov/pubmed/34806986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e27835 %T Conceptualizations of Cyberchondria and Relations to the Anxiety Spectrum: Systematic Review and Meta-analysis %A Schenkel,Sandra K %A Jungmann,Stefanie M %A Gropalis,Maria %A Witthöft,Michael %+ Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-University Mainz, Wallstraße 3, Mainz, 55122, Germany, 49 61313939202, s.schenkel@uni-mainz.de %K cyberchondria %K health anxiety %K online health information seeking %K anxiety %K systematic review %K meta-analysis %D 2021 %7 18.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Cyberchondria describes the detrimental effects of health-related internet use. Current conceptualizations agree that cyberchondria is associated with anxiety-related pathologies and may best be conceptualized as a safety behavior; however, little is known about its exact underlying mechanisms. Objective: This systematic review and meta-analysis aims to give an overview of the conceptualizations of cyberchondria and its relation to anxiety-related pathologies, quantify the strength of association to health anxiety by using meta-analyses, highlight gaps in the literature, and outline a hypothetical integrative cognitive-behavioral model of cyberchondria based on the available empirical evidence. Methods: A systematic literature search was conducted using PubMed, Web of Science, and PsycINFO electronic databases. A total of 25 studies were included for qualitative synthesis and 7 studies, comprising 3069 individuals, were included for quantitative synthesis. The meta-analysis revealed a strong association of cyberchondria (r=0.63) and its subfacets (r=0.24-0.66) with health anxiety. Results: The results indicate that cyberchondria is a distinct construct related to health anxiety, obsessive-compulsive symptoms, intolerance of uncertainty, and anxiety sensitivity. Further studies should distinguish between state and trait markers of anxiety-related pathologies and use experimental and naturalistic longitudinal designs to differentiate among risk factors, triggers, and consequences related to cyberchondria. Conclusions: Health-related internet use in the context of health anxiety is best conceptualized as health-related safety behavior maintained through intermittent reinforcement. Here, we present a corresponding integrative cognitive-behavioral model. %M 34792473 %R 10.2196/27835 %U https://www.jmir.org/2021/11/e27835 %U https://doi.org/10.2196/27835 %U http://www.ncbi.nlm.nih.gov/pubmed/34792473 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e32876 %T Machine Learning–Based Predictive Modeling of Anxiety and Depressive Symptoms During 8 Months of the COVID-19 Global Pandemic: Repeated Cross-sectional Survey Study %A Hueniken,Katrina %A Somé,Nibene Habib %A Abdelhack,Mohamed %A Taylor,Graham %A Elton Marshall,Tara %A Wickens,Christine M %A Hamilton,Hayley A %A Wells,Samantha %A Felsky,Daniel %+ Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, 250 College St, 12th Floor, Toronto, ON, M5T 1R8, Canada, 1 (416) 535 8501 ext 33587, Daniel.Felsky@camh.ca %K mental health %K machine learning %K COVID-19 %K emotional distress %K emotion %K distress %K prediction %K model %K anxiety %K depression %K symptom %K cross-sectional %K survey %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 global pandemic has increased the burden of mental illness on Canadian adults. However, the complex combination of demographic, economic, and lifestyle factors and perceived health risks contributing to patterns of anxiety and depression has not been explored. Objective: The aim of this study is to harness flexible machine learning methods to identify constellations of factors related to symptoms of mental illness and to understand their changes over time during the COVID-19 pandemic. Methods: Cross-sectional samples of Canadian adults (aged ≥18 years) completed web-based surveys in 6 waves from May to December 2020 (N=6021), and quota sampling strategies were used to match the English-speaking Canadian population in age, gender, and region. The surveys measured anxiety and depression symptoms, sociodemographic characteristics, substance use, and perceived COVID-19 risks and worries. First, principal component analysis was used to condense highly comorbid anxiety and depression symptoms into a single data-driven measure of emotional distress. Second, eXtreme Gradient Boosting (XGBoost), a machine learning algorithm that can model nonlinear and interactive relationships, was used to regress this measure on all included explanatory variables. Variable importance and effects across time were explored using SHapley Additive exPlanations (SHAP). Results: Principal component analysis of responses to 9 anxiety and depression questions on an ordinal scale revealed a primary latent factor, termed “emotional distress,” that explained 76% of the variation in all 9 measures. Our XGBoost model explained a substantial proportion of variance in emotional distress (r2=0.39). The 3 most important items predicting elevated emotional distress were increased worries about finances (SHAP=0.17), worries about getting COVID-19 (SHAP=0.17), and younger age (SHAP=0.13). Hopefulness was associated with emotional distress and moderated the impacts of several other factors. Predicted emotional distress exhibited a nonlinear pattern over time, with the highest predicted symptoms in May and November and the lowest in June. Conclusions: Our results highlight factors that may exacerbate emotional distress during the current pandemic and possible future pandemics, including a role of hopefulness in moderating distressing effects of other factors. The pandemic disproportionately affected emotional distress among younger adults and those economically impacted. %M 34705663 %R 10.2196/32876 %U https://mental.jmir.org/2021/11/e32876 %U https://doi.org/10.2196/32876 %U http://www.ncbi.nlm.nih.gov/pubmed/34705663 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e31007 %T Impact of Virtual Reality-Based Therapies on Cognition and Mental Health of Stroke Patients: Systematic Review and Meta-analysis %A Zhang,Qi %A Fu,Yu %A Lu,Yanhui %A Zhang,Yating %A Huang,Qifang %A Yang,Yajie %A Zhang,Ke %A Li,Mingzi %+ School of Nursing, Peking University, 38 Xueyuan Road, Beijing, 100191, China, 86 010 82805230, limingzi2000@163.com %K virtual reality %K stroke %K cognition %K depression %K mental health %D 2021 %7 17.11.2021 %9 Review %J J Med Internet Res %G English %X Background: Stroke remains one of the major chronic illnesses worldwide that health care organizations will need to address for the next several decades. Individuals poststroke are subject to levels of cognitive impairment and mental health problems. Virtual reality (VR)-based therapies are new technologies used for cognitive rehabilitation and the management of psychological outcomes. Objective: This study performed a meta-analysis to evaluate the effects of VR-based therapies on cognitive function and mental health in patients with stroke. Methods: A comprehensive database search was performed using PubMed, MEDLINE (Ovid), Embase, Cochrane Library, and APA PsycINFO databases for randomized controlled trials (RCTs) that studied the effects of VR on patients with stroke. We included trials published up to April 15, 2021, that fulfilled our inclusion and exclusion criteria. The literature was screened, data were extracted, and the methodological quality of the included trials was assessed. Meta-analysis was performed using RevMan 5.3 software. Results: A total of 894 patients from 23 RCTs were included in our meta-analysis. Compared to traditional rehabilitation therapies, the executive function (standard mean difference [SMD]=0.88, 95% confidence interval [CI]=0.06-1.70, P=.03), memory (SMD=1.44, 95% CI=0.21-2.68, P=.02), and visuospatial function (SMD=0.78, 95% CI=0.23-1.33, P=.006) significantly improved among patients after VR intervention. However, there were no significant differences observed in global cognitive function, attention, verbal fluency, depression, and the quality of life (QoL). Conclusions: The findings of our meta-analysis showed that VR-based therapies are efficacious in improving executive function, memory, and visuospatial function in patients with stroke. For global cognitive function, attention, verbal fluency, depression, and the QoL, further research is required. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021252788; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=252788 %M 34787571 %R 10.2196/31007 %U https://www.jmir.org/2021/11/e31007 %U https://doi.org/10.2196/31007 %U http://www.ncbi.nlm.nih.gov/pubmed/34787571 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29760 %T A Smoking Cessation App for Nondaily Smokers (Version 2 of the Smiling Instead of Smoking App): Acceptability and Feasibility Study %A Hoeppner,Bettina B %A Siegel,Kaitlyn R %A Carlon,Hannah A %A Kahler,Christopher W %A Park,Elyse R %A Hoeppner,Susanne S %+ Recovery Research Institute, Department of Psychiatry, Massachusetts General Hospital, 151 Merrimac Street, 6th Floor, Boston, MA, 02114, United States, 1 617 643 1988, bhoeppner@mgh.harvard.edu %K nondaily %K smoking cessation %K smartphone app %K positive psychology %K mHealth %K happiness %K mobile phone %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent evidence highlights the significant detrimental impact of nondaily smoking on health and its disproportionate prevalence in underserved populations; however, little work has been done to develop treatments specifically geared toward quitting nondaily smoking. Objective: This study aims to test the feasibility, acceptability, and conceptual underpinnings of version 2 of the Smiling Instead of Smoking (SiS2) smartphone app, which was developed specifically for nondaily smokers and uses a positive psychology approach. Methods: In a prospective, single-group study, nondaily smokers (N=100) were prescribed use of the SiS2 app for 7 weeks while undergoing a quit attempt. The app assigned daily positive psychology exercises and behavioral tasks every 2 to 3 days, which guided smokers through using the smoking cessation tools offered in the app. Participants answered surveys at baseline and at 2, 6, 12, and 24 weeks postquit. Feasibility was evaluated based on app use and acceptability based on survey responses. The underlying conceptual framework was tested by examining whether theorized within-person changes occurred from baseline to end of treatment on scales measuring self-efficacy, desire to smoke, and processing of self-relevant health information (ie, pros and cons of smoking, importance of the pros and cons of quitting, and motivation). Results: Participants used the SiS2 app on an average of 24.7 (SD 13.8) days out of the 49 prescribed days. At the end of treatment, most participants rated the functions of the app as very easy to use (eg, 70/95, 74% regarding cigarette log and 59/95, 62% regarding happiness exercises). The average score on the System Usability Scale was 79.8 (SD 17.3; A grade; A+ ≥84.1, B+ <78.8). Most participants reported that the app helped them in their quit attempt (83/95, 87%), and helped them stay positive while quitting (78/95, 82%). Large effects were found for within-person decreases in the desire to smoke (b=−1.5, 95% CI −1.9 to −1.1; P<.001; gav=1.01), the importance of the pros of smoking (b=-20.7, 95% CI −27.2 to −14.3; P<.001; gav=0.83), and perceived psychoactive benefits of smoking (b=−0.8, 95% CI −1.0 to −0.5; P<.001; gav=0.80). Medium effects were found for increases in self-efficacy for remaining abstinent when encountering internal (b=13.1, 95% CI 7.6 to 18.7; P<.001; gav=0.53) and external (b=11.2, 95% CI 6.1 to 16.1; P<.001; gav=0.49) smoking cues. Smaller effects, contrary to expectations, were found for decreases in motivation to quit smoking (P=.005) and the perceived importance of the pros of quitting (P=.009). Self-reported 30-day point prevalence abstinence rates were 40%, 56%, and 56% at 6, 12, and 24 weeks after the quit day, respectively. Conclusions: The SiS2 app was feasible and acceptable, showed promising changes in constructs relevant to smoking cessation, and had high self-reported quit rates by nondaily smokers. The SiS2 app warrants testing in a randomized controlled trial. %M 34787577 %R 10.2196/29760 %U https://formative.jmir.org/2021/11/e29760 %U https://doi.org/10.2196/29760 %U http://www.ncbi.nlm.nih.gov/pubmed/34787577 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e33599 %T Prevalence and Temporal Trends Analysis of Screening and Diagnostic Instruments in Posttraumatic Stress Disorder: Text Mining Study %A Zong,Hui %A Hu,Binyang %A Han,Yang %A Li,Zuofeng %A Zhang,Xiaoyan %+ Research Center for Translational Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, 1239 Siping Rd, Shanghai, 200092, China, 86 02165980233, xyzhang@tongji.edu.cn %K posttraumatic stress disorder %K instruments %K prevalence %K clinical trials %K text mining %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Various instruments for patient screening and diagnosis have been developed for and applied in posttraumatic stress disorder (PTSD). Objective: This study comprehensively investigates the prevalence and temporal trends of the most widely used instruments in PTSD-related studies. Methods: A total of 1345 files of registered clinical trials from ClinicalTrials.gov and 9422 abstracts from the PubMed database from 2005 to 2020 were downloaded for this study. The instruments applied in clinical trials were manually annotated, and instruments in abstracts were recognized using exact string matching. The prevalence score of an instrument in a certain period was calculated as the number of studies divided by the number of instances of the instrument. By calculating the yearly prevalence index of each instrument, we conducted a trends analysis and compared the trends in index change between instruments. Results: A total of 4178 instrument synonyms were annotated, which were mapped to 1423 unique instruments. In the 16 years from 2005 to 2020, only 10 instruments were used more than once per year; the 4 most used instruments were the PTSD Checklist, the Clinician-Administered PTSD Disorder Scale, the Patient Health Questionnaire, and the Beck Depression Inventory. There were 18 instruments whose yearly prevalence index score exceeded 0.1 at least once during the 16 years. The changes in trends and time points of partial instruments in clinical trials and PubMed abstracts were highly consistent. The average time duration of a PTSD-related trial was 1495.5 days or approximately 4 years from submission to ClinicalTrial.gov to publication in a journal. Conclusions: The application of widely accepted and appropriate instruments can help improve the reliability of research results in PTSD-related clinical studies. With extensive text data obtained from real clinical trials and published articles, we investigated and compared the usage of instruments in the PTSD research community. %M 34666307 %R 10.2196/33599 %U https://mental.jmir.org/2021/11/e33599 %U https://doi.org/10.2196/33599 %U http://www.ncbi.nlm.nih.gov/pubmed/34666307 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e25455 %T Clinician Perspectives on Using Computational Mental Health Insights From Patients’ Social Media Activities: Design and Qualitative Evaluation of a Prototype %A Yoo,Dong Whi %A Ernala,Sindhu Kiranmai %A Saket,Bahador %A Weir,Domino %A Arenare,Elizabeth %A Ali,Asra F %A Van Meter,Anna R %A Birnbaum,Michael L %A Abowd,Gregory D %A De Choudhury,Munmun %+ School of Interactive Computing, Georgia Institute of Technology, 756 W Peachtree St NW, Atlanta, GA, 30308, United States, 1 4043858603, yoo@gatech.edu %K mental health %K social media %K information technology %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Previous studies have suggested that social media data, along with machine learning algorithms, can be used to generate computational mental health insights. These computational insights have the potential to support clinician-patient communication during psychotherapy consultations. However, how clinicians perceive and envision using computational insights during consultations has been underexplored. Objective: The aim of this study is to understand clinician perspectives regarding computational mental health insights from patients’ social media activities. We focus on the opportunities and challenges of using these insights during psychotherapy consultations. Methods: We developed a prototype that can analyze consented patients’ Facebook data and visually represent these computational insights. We incorporated the insights into existing clinician-facing assessment tools, the Hamilton Depression Rating Scale and Global Functioning: Social Scale. The design intent is that a clinician will verbally interview a patient (eg, How was your mood in the past week?) while they reviewed relevant insights from the patient’s social media activities (eg, number of depression-indicative posts). Using the prototype, we conducted interviews (n=15) and 3 focus groups (n=13) with mental health clinicians: psychiatrists, clinical psychologists, and licensed clinical social workers. The transcribed qualitative data were analyzed using thematic analysis. Results: Clinicians reported that the prototype can support clinician-patient collaboration in agenda-setting, communicating symptoms, and navigating patients’ verbal reports. They suggested potential use scenarios, such as reviewing the prototype before consultations and using the prototype when patients missed their consultations. They also speculated potential negative consequences: patients may feel like they are being monitored, which may yield negative effects, and the use of the prototype may increase the workload of clinicians, which is already difficult to manage. Finally, our participants expressed concerns regarding the prototype: they were unsure whether patients’ social media accounts represented their actual behaviors; they wanted to learn how and when the machine learning algorithm can fail to meet their expectations of trust; and they were worried about situations where they could not properly respond to the insights, especially emergency situations outside of clinical settings. Conclusions: Our findings support the touted potential of computational mental health insights from patients’ social media account data, especially in the context of psychotherapy consultations. However, sociotechnical issues, such as transparent algorithmic information and institutional support, should be addressed in future endeavors to design implementable and sustainable technology. %M 34783667 %R 10.2196/25455 %U https://mental.jmir.org/2021/11/e25455 %U https://doi.org/10.2196/25455 %U http://www.ncbi.nlm.nih.gov/pubmed/34783667 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28874 %T Mobile Diary App Versus Paper-Based Diary Cards for Patients With Borderline Personality Disorder: Economic Evaluation %A Laursen,Sidsel Lund %A Helweg-Jørgensen,Stig %A Langergaard,Astrid %A Søndergaard,Jesper %A Sørensen,Sabrina Storgaard %A Mathiasen,Kim %A Lichtenstein,Mia Beck %A Ehlers,Lars Holger %+ Department of Clinical Medicine, Danish Center for Healthcare Improvements, Aalborg University, Fredrik Bajers Vej 5, Aalborg Oest, 9220, Denmark, 45 99408257, lehlers@dcm.aau.dk %K borderline personality disorder %K dialectical behavior therapy %K mobile app %K psychotherapy %K cost-consequence %K mHealth %K mobile phone %D 2021 %7 11.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The cost-effectiveness of using a mobile diary app as an adjunct in dialectical behavior therapy (DBT) in patients with borderline personality disorder is unknown. Objective: This study aims to perform an economic evaluation of a mobile diary app compared with paper-based diary cards in DBT treatment for patients with borderline personality disorder in a psychiatric outpatient facility. Methods: This study was conducted alongside a pragmatic, multicenter, randomized controlled trial. The participants were recruited at 5 Danish psychiatric outpatient facilities and were randomized to register the emotions, urges, and skills used in a mobile diary app or on paper-based diary cards. The participants in both groups received DBT delivered by the therapists. A cost-consequence analysis with a time horizon of 12 months was performed. Consequences included quality-adjusted life years (QALYs), depression severity, borderline severity, suicidal behavior, health care use, treatment compliance, and system usability. All relevant costs were included. Focus group interviews were conducted with patients, therapists, researchers, and industry representatives to discuss the potential advantages and disadvantages of using a mobile diary app. Results: A total of 78 participants were included in the analysis. An insignificantly higher number of participants in the paper group dropped out before the start of treatment (P=.07). Of those starting treatment, participants in the app group had an average of 37.1 (SE 27.55) more days of treatment and recorded an average of 3.16 (SE 5.10) more skills per week than participants in the paper group. Participants in both groups had a QALY gain and a decrease in depression severity, borderline severity, and suicidal behavior. Significant differences were found in favor of the paper group for both QALY gain (adjusted difference −0.054; SE 0.03) and reduction in depression severity (adjusted difference −1.11; SE 1.57). The between-group difference in total costs ranged from US $107.37 to US $322.10 per participant during the 12 months. The use of services in the health care sector was similar across both time points and groups (difference: psychiatric hospitalization <5 and <5; general practice −1.32; SE 3.68 and 2.02; SE 3.19). Overall, the patients showed high acceptability and considered the app as being easy to use. Therapists worried about potential negative influences on the therapist-patient interaction from new work tasks accompanying the introduction of the new technology but pointed at innovation potential from digital database registrations. Conclusions: This study suggests both positive and negative consequences of mobile diary apps as adjuncts to DBT compared with paper diary cards. More research is needed to draw conclusions regarding its cost-effectiveness. Trial Registration: ClinicalTrials.gov NCT03191565; http://clinicaltrials.gov/ct2/show/NCT03191565 International Registered Report Identifier (IRRID): RR2-10.2196/17737 %M 34762057 %R 10.2196/28874 %U https://www.jmir.org/2021/11/e28874 %U https://doi.org/10.2196/28874 %U http://www.ncbi.nlm.nih.gov/pubmed/34762057 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e22369 %T Remote Digital Psychiatry for Mobile Mental Health Assessment and Therapy: MindLogger Platform Development Study %A Klein,Arno %A Clucas,Jon %A Krishnakumar,Anirudh %A Ghosh,Satrajit S %A Van Auken,Wilhelm %A Thonet,Benjamin %A Sabram,Ihor %A Acuna,Nino %A Keshavan,Anisha %A Rossiter,Henry %A Xiao,Yao %A Semenuta,Sergey %A Badioli,Alessandra %A Konishcheva,Kseniia %A Abraham,Sanu Ann %A Alexander,Lindsay M %A Merikangas,Kathleen R %A Swendsen,Joel %A Lindner,Ariel B %A Milham,Michael P %+ MATTER Lab, Child Mind Institute, 101 East 56th Street, New York, NY, 10022, United States, 1 347 577 2091, arno@childmind.org %K mental health %K mHealth %K mobile health %K digital health %K eHealth %K digital psychiatry %K digital phenotyping %K teletherapy %K mobile device %K mobile phone %K smartphone %K ecological momentary assessment %K ecological momentary intervention %K EMA %K EMI %K ESM %K experience sampling %K experience sampling methods %D 2021 %7 11.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health. Objective: This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations. Methods: We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform’s configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study. Results: Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users’ data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser–based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings. Conclusions: We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health–related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population. %M 34762054 %R 10.2196/22369 %U https://www.jmir.org/2021/11/e22369 %U https://doi.org/10.2196/22369 %U http://www.ncbi.nlm.nih.gov/pubmed/34762054 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e29866 %T The Influence of Gender and Age on the Outcomes of and Adherence to a Digital Interdisciplinary Mental Health Promotion Intervention in an Australasian Nonclinical Setting: Cohort Study %A Przybylko,Geraldine %A Morton,Darren %A Morton,Jason %A Renfrew,Melanie %+ Lifestyle Medicine and Health Research Centre, Avondale University, 582 Freemans Drive, Cooranbong, 2265, Australia, 61 418574001, geraldineprzybylko@eliawellness.com %K age %K gender %K adherence %K digital health %K interdisciplinary %K mental health %K promotion %K intervention %K lifestyle medicine %K positive psychology %K multicomponent %K lifestyle %K outcome %K cohort study %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The global prevalence of mental health disorders is at a crisis point, particularly in the wake of COVID-19, prompting calls for the development of digital interdisciplinary mental health promotion interventions (MHPIs) for nonclinical cohorts. However, the influence of gender and age on the outcomes of and adherence to MHPIs is not well understood. Objective: The aim of this study was to determine the influence of gender and age on the outcomes of and adherence to a 10-week digital interdisciplinary MHPI that integrates strategies from positive psychology and lifestyle medicine and utilizes persuasive systems design (PSD) principles in a nonclinical setting. Methods: This study involved 488 participants who completed the digital interdisciplinary MHPI. Participants completed a pre and postintervention questionnaire that used: (1) the “mental health” and “vitality” subscales from the Short Form 36 (SF-36) Health Survey; (2) the Depression, Anxiety and Stress Scale (DASS-21); and (3) Satisfaction With Life Scale (SWL). Adherence to the digital interdisciplinary MHPI was measured by the number of educational videos the participants viewed and the extent to which they engaged in experiential challenge activities offered as part of the program. Results: On average, the participants (N=488; mean age 47.1 years, SD 14.1; 77.5% women) demonstrated statistically significant improvements in all mental health and well-being outcome measures, and a significant gender and age interaction was observed. Women tended to experience greater improvements than men in the mental health and well-being measures, and older men experienced greater improvements than younger men in the mental health and vitality subscales. Multiple analysis of variance results of the adherence measures indicated a significant difference for age but not gender. No statistically significant interaction between gender and age was observed for adherence measures. Conclusions: Digital interdisciplinary MHPIs that utilize PSD principles can improve the mental health and well-being of nonclinical cohorts, regardless of gender or age. Hence, there may be a benefit in utilizing PSD principles to develop universal MHPIs such as that employed in this study, which can be used across gender and age groups. Future research should examine which PSD principles optimize universal digital interdisciplinary MHPIs. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000993190; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377889 and Australian New Zealand Clinical Trials Registry ACTRN12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx %M 34762058 %R 10.2196/29866 %U https://mental.jmir.org/2021/11/e29866 %U https://doi.org/10.2196/29866 %U http://www.ncbi.nlm.nih.gov/pubmed/34762058 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30313 %T Development of a Severity Score and Comparison With Validated Measures for Depression and Anxiety: Validation Study %A Lynch,William %A Platt,Michael L %A Pardes,Adam %+ NeuroFlow, Inc, 111 S Independence Mall E, Suite 701, Philadelphia, PA, United States, 1 267 671 7316, adam@neuroflow.com %K PHQ-9 %K GAD-7 %K depression assessment %K anxiety assessment %K measurement-based care %K integrated behavioral health %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Less than 10% of the individuals seeking behavioral health care receive measurement-based care (MBC). Technology has the potential to implement MBC in a secure and efficient manner. To test this idea, a mobile health (mHealth) platform was developed with the goal of making MBC easier to deliver by clinicians and more accessible to patients within integrated behavioral health care. Data from over 3000 users of the mHealth platform were used to develop an output severity score, a robust screening measure for depression and anxiety. Objective: The aim of this study is to compare severity scores with scores from validated assessments for depression and anxiety and scores from clinician review to evaluate the potential added value of this new measure. Methods: The severity score uses patient-reported and passively collected data related to behavioral health on an mHealth platform. An artificial intelligence–derived algorithm was developed that condenses behavioral health data into a single, quantifiable measure for longitudinal tracking of an individual’s depression and anxiety symptoms. Linear regression and Bland-Altman analyses were used to evaluate the relationships and differences between severity scores and Personal Health Questionnaire-9 (PHQ-9) or Generalized Anxiety Disorder-7 (GAD-7) scores from over 35,000 mHealth platform users. The severity score was also compared with a review by a panel of expert clinicians for a subset of 250 individuals. Results: Linear regression results showed a strong correlation between the severity score and PHQ-9 (r=0.74; P<.001) and GAD-7 (r=0.80; P<.001) changes. A strong positive correlation was also found between the severity score and expert panel clinical review (r=0.80-0.84; P<.001). However, Bland-Altman analysis and the evaluation of outliers on regression analysis showed that the severity score was significantly different from the PHQ-9. Conclusions: Clinicians can reliably use the mHealth severity score as a proxy measure for screening and monitoring behavioral health symptoms longitudinally. The severity score may identify at-risk individuals who are not identified by the PHQ-9. Further research is warranted to evaluate the sensitivity and specificity of the severity score. %M 34757319 %R 10.2196/30313 %U https://formative.jmir.org/2021/11/e30313 %U https://doi.org/10.2196/30313 %U http://www.ncbi.nlm.nih.gov/pubmed/34757319 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e27897 %T Mediating Effects of Stigma and Depressive Symptoms in a Social Media–Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial %A Li,Yiran %A Guo,Yan %A Hong,Y Alicia %A Zeng,Chengbo %A Zeng,Yu %A Zhang,Hanxi %A Zhu,Mengting %A Qiao,Jiaying %A Cai,Weiping %A Li,Linghua %A Liu,Cong %+ Department of Medical Statistics, School of Public Health, Sun Yat-sen University, #74 2nd Zhongshan Road, Guangzhou, 510080, China, 86 020 87334202, guoy8@mail.sysu.edu.cn %K mHealth %K HIV %K depressive symptoms %K quality of life %K structural equation model %D 2021 %7 9.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions. Objective: This study aims to explore the intervention mechanisms of a social media–based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period. Methods: We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants’ QOL. Results: About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported. Conclusions: These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media–based interventions that can address HIV-related stigma and alleviate depressive symptoms. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019 %M 34751654 %R 10.2196/27897 %U https://www.jmir.org/2021/11/e27897 %U https://doi.org/10.2196/27897 %U http://www.ncbi.nlm.nih.gov/pubmed/34751654 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30580 %T A Text Message Intervention for Adolescents With Depression and Their Parents or Caregivers to Overcome Cognitive Barriers to Mental Health Treatment Initiation: Focus Groups and Pilot Trial %A Suffoletto,Brian %A Goldstein,Tina %A Brent,David %+ Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 4129016892, suffbp@stanford.edu %K adolescent %K depression %K help seeking %K text message %K intervention %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many adolescents with depression do not pursue mental health treatment following a health care provider referral. We developed a theory-based automated SMS text message intervention (Text to Connect [T2C]) that attempts to reduce cognitive barriers to the initiation of mental health care. Objective: In this two-phase study, we seek to first understand the potential of T2C and then test its engagement, usability, and potential efficacy among adolescents with depression and their parents or caregivers. Methods: In phase 1, we conducted focus groups with adolescents with depression (n=9) and their parents or caregivers (n=9) separately, and transcripts were examined to determine themes. In phase 2, we conducted an open trial of T2C comprising adolescents with depression referred to mental health care (n=43) and their parents or caregivers (n=28). We assessed usability by examining program engagement, usability ratings, and qualitative feedback at the 4-week follow-up. We also assessed potential effectiveness by examining changes in perceived barriers to treatment and mental health care initiation from baseline to 4 weeks. Results: In phase 1, we found that the themes supported the T2C approach. In phase 2, we observed high engagement with daily negative affect check-ins, high usability ratings, and decreased self-reported barriers to mental health treatment over time among adolescents. Overall, 52% (22/42) of the adolescents who completed follow-up reported that they had attended an appointment with a mental health care specialist. Of the 20 adolescents who had not attended a mental health care appointment, 5% (1/20) reported that it was scheduled for a future date, 10% (2/20) reported that the primary care site did not have the ability to help them schedule a mental health care appointment, and 15% (3/20) reported that they were no longer interested in receiving mental health care. Conclusions: The findings from this study suggest that T2C is acceptable to adolescents with depression and most parents or caregivers; it is used at high rates; and it may be helpful to reduce cognitive barriers to mental health care initiation. %M 34751665 %R 10.2196/30580 %U https://formative.jmir.org/2021/11/e30580 %U https://doi.org/10.2196/30580 %U http://www.ncbi.nlm.nih.gov/pubmed/34751665 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31170 %T Mobile Apps That Promote Emotion Regulation, Positive Mental Health, and Well-being in the General Population: Systematic Review and Meta-analysis %A Eisenstadt,Mia %A Liverpool,Shaun %A Infanti,Elisa %A Ciuvat,Roberta Maria %A Carlsson,Courtney %+ Evidence Based Practice Unit, Anna Freud National Centre for Children and Families and University College London, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 7989165986, mia.eisenstadt@annafreud.org %K systematic review %K MHapp, mHealth %K mental health %K well-being %K emotion regulation %K mobile apps %K effectiveness %K monitoring %K management %K mental health app %D 2021 %7 8.11.2021 %9 Review %J JMIR Ment Health %G English %X Background: Among the general public, there appears to be a growing need and interest in receiving digital mental health and well-being support. In response to this, mental health apps (MHapps) are becoming available for monitoring, managing, and promoting positive mental health and well-being. Thus far, evidence supports favorable outcomes when users engage with MHapps, yet there is a relative paucity of reviews on apps that support positive mental health and well-being. Objective: We aimed to systematically review the available research on MHapps that promote emotion regulation, positive mental health, and well-being in the general population aged 18-45 years. More specifically, the review aimed at providing a systematic description of the theoretical background and features of MHapps while evaluating any potential effectiveness. Methods: A comprehensive literature search of key databases, including MEDLINE (via Ovid), EMBASE (via Ovid), PsycINFO (via Ovid), Web of Science, and the Cochrane Register of Controlled Trials (CENTRAL), was performed until January 2021. Studies were included if they described standalone mental health and well-being apps for adults without a formal mental health diagnosis. The quality of all studies was assessed against the Mixed Methods Appraisal Tool. In addition, the Cochrane Risk-of-Bias tool (RoB-2) was used to assess randomized control trials (RCTs). Data were extracted using a modified extraction form from the Cochrane Handbook of Systematic Reviews. A narrative synthesis and meta-analysis were then undertaken to address the review aims. Results: In total, 3156 abstracts were identified. Of these, 52 publications describing 48 MHapps met the inclusion criteria. Together, the studies evaluated interventions across 15 countries. Thirty-nine RCTs were identified suggesting some support for the role of individual MHapps in improving and promoting mental health and well-being. Regarding the pooled effect, MHapps, when compared to controls, showed a small effect for reducing mental health symptoms (k=19, Hedges g=–0.24, 95% CI –0.34 to –0.14; P<.001) and improving well-being (k=13, g=0.17, 95% CI 0.05-0.29, P=.004), and a medium effect for emotion regulation (k=6, g=0.49, 95% CI 0.23-0.74, P<.001). There is also a wide knowledge base of creative and innovative ways to engage users in techniques such as mood monitoring and guided exercises. Studies were generally assessed to contribute unclear or a high risk of bias, or to be of medium to low methodological quality. Conclusions: The emerging evidence for MHapps that promote positive mental health and well-being suggests promising outcomes. Despite a wide range of MHapps, few apps specifically promote emotion regulation. However, our findings may position emotion regulation as an important mechanism for inclusion in future MHapps. A fair proportion of the included studies were pilot or feasibility trials (k=17, 33%), and full-scale RCTs reported high attrition rates and nondiverse samples. Given the number and pace at which MHapps are being released, further robust research is warranted to inform the development and testing of evidence-based programs. %M 34747713 %R 10.2196/31170 %U https://mental.jmir.org/2021/11/e31170 %U https://doi.org/10.2196/31170 %U http://www.ncbi.nlm.nih.gov/pubmed/34747713 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e24471 %T Suicide Risk and Protective Factors in Online Support Forum Posts: Annotation Scheme Development and Validation Study %A Chancellor,Stevie %A Sumner,Steven A %A David-Ferdon,Corinne %A Ahmad,Tahirah %A De Choudhury,Munmun %+ Department of Computer Science & Engineering, University of Minnesota - Twin Cities, 200 Union Street SE, 4-189 Keller Hall, Minneapolis, MN, 55455, United States, 1 612 625 4002, steviec@umn.edu %K online communities %K suicide crisis %K construct validity %K annotation scheme %K Reddit %K annotation %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Online communities provide support for individuals looking for help with suicidal ideation and crisis. As community data are increasingly used to devise machine learning models to infer who might be at risk, there have been limited efforts to identify both risk and protective factors in web-based posts. These annotations can enrich and augment computational assessment approaches to identify appropriate intervention points, which are useful to public health professionals and suicide prevention researchers. Objective: This qualitative study aims to develop a valid and reliable annotation scheme for evaluating risk and protective factors for suicidal ideation in posts in suicide crisis forums. Methods: We designed a valid, reliable, and clinically grounded process for identifying risk and protective markers in social media data. This scheme draws on prior work on construct validity and the social sciences of measurement. We then applied the scheme to annotate 200 posts from r/SuicideWatch—a Reddit community focused on suicide crisis. Results: We documented our results on producing an annotation scheme that is consistent with leading public health information coding schemes for suicide and advances attention to protective factors. Our study showed high internal validity, and we have presented results that indicate that our approach is consistent with findings from prior work. Conclusions: Our work formalizes a framework that incorporates construct validity into the development of annotation schemes for suicide risk on social media. This study furthers the understanding of risk and protective factors expressed in social media data. This may help public health programming to prevent suicide and computational social science research and investigations that rely on the quality of labels for downstream machine learning tasks. %M 34747705 %R 10.2196/24471 %U https://mental.jmir.org/2021/11/e24471 %U https://doi.org/10.2196/24471 %U http://www.ncbi.nlm.nih.gov/pubmed/34747705 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e27282 %T Identifying App-Based Meditation Habits and the Associated Mental Health Benefits: Longitudinal Observational Study %A Stecher,Chad %A Berardi,Vincent %A Fowers,Rylan %A Christ,Jaclyn %A Chung,Yunro %A Huberty,Jennifer %+ College of Health Solutions, Arizona State University, 500 N 3rd Street, Phoenix, AZ, 85003, United States, 1 6024960957, chad.stecher@asu.edu %K behavioral habits %K habit formation %K mindfulness meditation %K mental health %K mHealth %K mobile health %K dynamic time warping %K mobile phone %D 2021 %7 4.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Behavioral habits are often initiated by contextual cues that occur at approximately the same time each day; so, it may be possible to identify a reflexive habit based on the temporal similarity of repeated daily behavior. Mobile health tools provide the detailed, longitudinal data necessary for constructing such an indicator of reflexive habits, which can improve our understanding of habit formation and help design more effective mobile health interventions for promoting healthier habits. Objective: This study aims to use behavioral data from a commercial mindfulness meditation mobile phone app to construct an indicator of reflexive meditation habits based on temporal similarity and estimate the association between temporal similarity and meditation app users’ perceived health benefits. Methods: App-use data from June 2019 to June 2020 were analyzed for 2771 paying subscribers of a meditation mobile phone app, of whom 86.06% (2359/2771) were female, 72.61% (2012/2771) were college educated, 86.29% (2391/2771) were White, and 60.71% (1664/2771) were employed full-time. Participants volunteered to complete a survey assessing their perceived changes in physical and mental health from using the app. Receiver operating characteristic curve analysis was used to evaluate the ability of the temporal similarity measure to predict future behavior, and variable importance statistics from random forest models were used to corroborate these findings. Logistic regression was used to estimate the association between temporal similarity and self-reported physical and mental health benefits. Results: The temporal similarity of users’ daily app use before completing the survey, as measured by the dynamic time warping (DTW) distance between app use on consecutive days, significantly predicted app use at 28 days and at 6 months after the survey, even after controlling for users’ demographic and socioeconomic characteristics, total app sessions, duration of app use, and number of days with any app use. In addition, the temporal similarity measure significantly increased in the area under the receiver operating characteristic curve (AUC) for models predicting any future app use in 28 days (AUC=0.868 with DTW and 0.850 without DTW; P<.001) and for models predicting any app use in 6 months (AUC=0.821 with DTW and 0.802 without DTW; P<.001). Finally, a 1% increase in the temporal similarity of users’ daily meditation practice with the app over 6 weeks before the survey was associated with increased odds of reporting mental health improvements, with an odds ratio of 2.94 (95% CI 1.832-6.369). Conclusions: The temporal similarity of the meditation app use was a significant predictor of future behavior, which suggests that this measure can identify reflexive meditation habits. In addition, temporal similarity was associated with greater perceived mental health benefits, which demonstrates that additional mental health benefits may be derived from forming reflexive meditation habits. %M 34734826 %R 10.2196/27282 %U https://www.jmir.org/2021/11/e27282 %U https://doi.org/10.2196/27282 %U http://www.ncbi.nlm.nih.gov/pubmed/34734826 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e30711 %T Web-Based Eye Movement Desensitization and Reprocessing for Adults With Suicidal Ideation: Protocol for a Randomized Controlled Trial %A Winkler,Olga %A Dhaliwal,Raman %A Greenshaw,Andrew %A O'Shea,Katie %A Abba-Aji,Adam %A Chima,Chidi %A Purdon,Scot E %A Burback,Lisa %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 780 342 5410, burback@ualberta.ca %K suicide %K trauma %K eye movement desensitization and reprocessing (EMDR) %K telemedicine %K psychotherapy %K digital health %K eHealth %K remote delivery %K virtual care %D 2021 %7 4.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adversity and traumatic experiences increase the likelihood of suicidal thoughts and behaviors. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based, trauma-focused psychotherapy that desensitizes painful memories, so that reminders in the present no longer provoke overwhelming emotional responses. Preliminary evidence suggests that EMDR can be used as an acute intervention in suicidal patients, including those with major depressive disorder. In addition, because of social distancing restrictions during the COVID-19 pandemic, clinicians have been using EMDR on the web and, in the absence of formal evaluations of web-based EMDR, informal reports indicate good results. Objective: The primary aim of this randomized controlled trial is to investigate whether remotely delivered EMDR (targeting experiences associated with suicidal thinking) reduces suicidal thoughts. Secondary aims include examining the impact of remotely delivered EMDR on symptoms of depression, anxiety, posttraumatic stress, emotional dysregulation, and dissociation. We will also report on adverse events in the EMDR group to explore whether targeting suicidal ideation with EMDR is safe. Finally, we will compare dropout rates between the treatment groups. Methods: In this randomized controlled trial, 80 adults who express suicidal ideation and meet the study criteria will receive either 12 sessions of twice weekly EMDR plus treatment as usual or treatment as usual alone. EMDR sessions will focus on the most distressing and intrusive memories associated with suicidal ideation. Data for primary and secondary objectives will be collected at baseline, 2 months, and 4 months after enrollment. A subsequent longer-term analysis, beyond the scope of this protocol, will examine differences between the groups with respect to the number of posttreatment emergency room visits, hospitalizations, and overall health care use in the year before and after therapy. Results: The protocol was approved by the University of Alberta Research Health Ethics Board (protocol ID Pro00090989). Funding for this study was provided by the Mental Health Foundation (grant RES0048906). Recruitment started in May 2021, with a projected completion date of March 2023. Conclusions: The results of this trial will contribute to knowledge on whether web-based delivery of EMDR is a safe and effective treatment for reducing suicidal ideation and potentially reducing the incidence of suicide attempts in this patient population. Trial Registration: ClinicalTrials.gov NCT04181047; https://clinicaltrials.gov/ct2/show/NCT04181047 International Registered Report Identifier (IRRID): DERR1-10.2196/30711 %M 34734835 %R 10.2196/30711 %U https://www.researchprotocols.org/2021/11/e30711 %U https://doi.org/10.2196/30711 %U http://www.ncbi.nlm.nih.gov/pubmed/34734835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e31274 %T Adherence With Online Therapy vs Face-to-Face Therapy and With Online Therapy vs Care as Usual: Secondary Analysis of Two Randomized Controlled Trials %A Lippke,Sonia %A Gao,Lingling %A Keller,Franziska Maria %A Becker,Petra %A Dahmen,Alina %+ Department of Psychology and Methods, Jacobs University Bremen, Campus Ring 1, Bremen, 28759, Germany, 49 421200 ext 4730, s.lippke@jacobs-university.de %K psychotherapeutic aftercare %K medical rehabilitation %K online therapy %K face-to-face therapy %K care as usual %K retention %K dropout %D 2021 %7 3.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Adherence to internet-delivered interventions targeting mental health such as online psychotherapeutic aftercare is important for the intervention’s impact. High dropout rates limit the impact and generalizability of findings. Baseline differences may be putting patients at risk for dropping out, making comparisons between online with face-to-face (F2F) therapy and care as usual (CAU) necessary to examine. Objective: This study investigated adherence to online, F2F, and CAU interventions as well as study dropout among these groups and the subjective evaluation of the therapeutic relationship. Sociodemographic, social-cognitive, and health-related variables were considered. Methods: In a randomized controlled trial, 6023 patients were recruited, and 300 completed the baseline measures (T1), 144 completed T2 (retention 44%-52%), and 95 completed T3 (retention 24%-36%). Sociodemographic variables (eg, age, gender, marital status, educational level), social-cognitive determinants (eg, self-efficacy, social support), health-related variables (eg, depressiveness), and expectation towards the treatment for patients assigned to online or F2F were measured at T1. Results: There were no significant differences between the groups regarding dropout rates (χ21=0.02-1.06, P≥.30). Regarding adherence to the treatment condition, the online group outperformed the F2F and CAU conditions (P≤.01), indicating that patients randomized into the F2F and CAU control groups were much more likely to show nonadherent behavior in comparison with the online therapy groups. Within study groups, gender differences were significant only in the CAU group at T2, with women being more likely to drop out. At T3, age and marital status were also only significant in the CAU group. Patients in the online therapy group were significantly more satisfied with their treatment than patients in the F2F group (P=.02; Eta²=.09). Relationship satisfaction and success satisfaction were equally high (P>.30; Eta²=.02). Combining all study groups, patients who reported lower depressiveness scores at T1 (T2: odds ratio [OR] 0.55, 95% CI 0.35-0.87; T3: OR 0.56, 95% CI 0.37-0.92) were more likely to be retained, and patients who had higher self-efficacy (T2: OR 0.57, 95% CI 0.37-0.89; T3: OR 0.52, 95% CI 0.32-0.85) were more likely to drop out at T2 and T3. Additionally, at T3, the lower social support that patients reported was related to a higher likelihood of remaining in the study (OR 0.68, 95% CI 0.48-0.96). Comparing the 3 intervention groups, positive expectation was significantly related with questionnaire completion at T2 and T3 after controlling for other variables (T2: OR 1.64, 95% CI 1.08-2.50; T3: OR 1.59, 95% CI 1.01-2.51). Conclusions: While online interventions have many advantages over F2F variants such as saving time and effort to commute to F2F therapy, they also create difficulties for therapists and hinder their ability to adequately react to patients’ challenges. Accordingly, patient characteristics that might put them at risk for dropping out or not adhering to the treatment plan should be considered in future research and practice. Online aftercare, as described in this research, should be provided more often to medical rehabilitation patients. Trial Registration: ClinicalTrials.gov NCT04989842; https://clinicaltrials.gov/ct2/show/NCT04989842 %M 34730541 %R 10.2196/31274 %U https://www.jmir.org/2021/11/e31274 %U https://doi.org/10.2196/31274 %U http://www.ncbi.nlm.nih.gov/pubmed/34730541 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e30961 %T An Online Assessment to Evaluate the Role of Cognitive Biases and Emotion Regulation Strategies for Mental Health During the COVID-19 Lockdown of 2020: Structural Equation Modeling Study %A Blanco,Ivan %A Boemo,Teresa %A Sanchez-Lopez,Alvaro %+ Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, Campus de Somosaguas, Pozuelo de Alarcon, 28223, Spain, 34 650692547, ivan.blanco.martinez@ucm.es %K COVID-19 %K emotion regulation %K cognitive biases %K psychological adjustment %K resilience %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Extant research supports causal roles of cognitive biases in stress regulation under experimental conditions. However, their contribution to psychological adjustment in the face of ecological major stressors has been largely unstudied. Objective: We developed a novel online method for the ecological examination of attention and interpretation biases during major stress (ie, the COVID-19 lockdown in March/April 2020) and tested their relations with the use of emotion regulation strategies (ie, reappraisal and rumination) to account for individual differences in psychological adjustment to major COVID-19–related stressors (ie, low depression and anxiety, and high well-being and resilience). Methods: Participants completed an online protocol evaluating the psychological impact of COVID-19–related stressors and the use of emotion regulation strategies in response to them, during the initial weeks of the lockdown of March/April 2020. They also completed a new online cognitive task designed to remotely assess attention and interpretation biases for negative information. The psychometric properties of the online cognitive bias assessments were very good, supporting their feasibility for ecological evaluation. Results: Structural equation models showed that negative interpretation bias was a direct predictor of worst psychological adjustment (higher depression and anxiety, and lower well-being and resilience; χ29=7.57; root mean square error of approximation=0.000). Further, rumination mediated the influence of interpretation bias in anxiety (P=.045; 95% CI 0.03-3.25) and resilience (P=.001; 95% CI −6.34 to −1.65), whereas reappraisal acted as a mediator of the influence of both attention (P=.047; 95% CI −38.71 to −0.16) and interpretation biases (P=.04; 95% CI −5.25 to −0.12) in well-being. Conclusions: This research highlights the relevance of individual processes of attention and interpretation during periods of adversity and identifies modifiable protective factors that can be targeted through online interventions. %M 34517337 %R 10.2196/30961 %U https://mental.jmir.org/2021/11/e30961 %U https://doi.org/10.2196/30961 %U http://www.ncbi.nlm.nih.gov/pubmed/34517337 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e25298 %T A Text Messaging Intervention (StayWell at Home) to Counteract Depression and Anxiety During COVID-19 Social Distancing: Pre-Post Study %A Aguilera,Adrian %A Hernandez-Ramos,Rosa %A Haro-Ramos,Alein Y %A Boone,Claire Elizabeth %A Luo,Tiffany Christina %A Xu,Jing %A Chakraborty,Bibhas %A Karr,Chris %A Darrow,Sabrina %A Figueroa,Caroline Astrid %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC7400, School of Social Welfare, Berkeley, CA, 94720, United States, 1 (510) 642 8564, aguila@berkeley.edu %K mobile health %K COVID-19 %K text messaging %K cognitive behavioral therapy %K anxiety %K depression %K microrandomized trials %K mHealth %K intervention %K mental health %K SMS %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Social distancing and stay-at-home orders are critical interventions to slow down person-to-person transmission of COVID-19. While these societal changes help contain the pandemic, they also have unintended negative consequences, including anxiety and depression. We developed StayWell, a daily skills-based SMS text messaging program, to mitigate COVID-19–related depression and anxiety symptoms among people who speak English and Spanish in the United States. Objective: This paper describes the changes in StayWell participants’ anxiety and depression levels after 60 days of exposure to skills-based SMS text messages. Methods: We used self-administered, empirically supported web-based questionnaires to assess the demographic and clinical characteristics of StayWell participants. Anxiety and depression were measured using the 2-item Generalized Anxiety Disorder (GAD-2) scale and the 8-item Patient Health Questionnaire-8 (PHQ-8) scale at baseline and 60-day timepoints. We used 2-tailed paired t tests to detect changes in PHQ-8 and GAD-2 scores from baseline to follow-up measured 60 days later. Results: The analytic sample includes 193 participants who completed both the baseline and 60-day exit questionnaires. At the 60-day time point, there were significant reductions in both PHQ-8 and GAD-2 scores from baseline. We found an average reduction of –1.72 (95% CI –2.35 to –1.09) in PHQ-8 scores and –0.48 (95% CI –0.71 to –0.25) in GAD-2 scores. These improvements translated to an 18.5% and 17.2% reduction in mean PHQ-8 and GAD-2 scores, respectively. Conclusions: StayWell is an accessible, low-intensity population-level mental health intervention. Participation in StayWell focused on COVID-19 mental health coping skills and was related to improved depression and anxiety symptoms. In addition to improvements in outcomes, we found high levels of engagement during the 60-day intervention period. Text messaging interventions could serve as an important public health tool for disseminating strategies to manage mental health. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): RR2-10.2196/23592 %M 34543230 %R 10.2196/25298 %U https://mental.jmir.org/2021/11/e25298 %U https://doi.org/10.2196/25298 %U http://www.ncbi.nlm.nih.gov/pubmed/34543230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31064 %T Acceptability, Engagement, and Exploratory Outcomes of an Emotional Well-being App: Mixed Methods Preliminary Evaluation and Descriptive Analysis %A Eisenstadt,Amelia %A Liverpool,Shaun %A Metaxa,Athina-Marina %A Ciuvat,Roberta Maria %A Carlsson,Courtney %+ Evidence Based Practice Unit, University College London and Anna Freud National Centre for Children and Families, The Kantor Centre of Excellence, 4-8 Rodney Street, London, N1 9JH, United Kingdom, 44 20 7794 2313, mia.eisenstadt@annafreud.org %K smartphone %K app %K well-being %K awareness %K mental health %K formative %K mobile phone %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is growing evidence suggesting that the emotional well-being of the public has been negatively affected in the past year. Consequently, demand for well-being support has increased. Although there is substantial empirical support for mental health apps that target diagnosed conditions, there is less research on emotional well-being apps. Among existing well-being apps, few studies have been conducted on apps that are based on lived experience and those that seek to enhance users’ understanding of their emotional patterns. Thus, the acceptability of these novel apps requires further evaluation before upscaling. Objective: This evaluation aims to describe the acceptability, engagement, and preliminary outcomes of using an app (Paradym) designed to promote emotional well-being and positive mental health. Methods: This is a pre-post, mixed-methods, single-arm evaluation that is aggregated with digital analytics data. We anonymously collected real-world data on the demographics and well-being of the participants as well as the usability and acceptance of the app using validated questionnaires and open-ended questions. Participants tested the app for a minimum of 2 weeks before completing the follow-up measures. Google Analytics was used to record the level of app engagement. Chi-square and 2-tailed t tests were conducted to analyze quantitative data, and a thematic analysis approach was adopted for qualitative data. Results: A total of 115 participants completed baseline questionnaires, of which 79.1% (91/115) users downloaded the app. The sample was diverse in terms of ethnicity, including 43.4% (50/115) people who self-identified as belonging to minority ethnic groups. Most of the participants were female (78/115, 67.8%) and between the ages of 18 and 25 years (39/115, 33.9%). A total of 34 app users who completed questionnaires at baseline and follow-up provided valuable feedback to inform the future directions of Paradym. Favorable themes emerged describing the app’s content, functionality, and underlying principles. Although usability feedback varied across items, a considerable number of participants (22/34, 64%) found that the app was easy to use. Google Analytics revealed that at least 79% (27/34) of people used the app daily. On the basis of preliminary observations, app users experience increased mental well-being. Post hoc analyses indicated that the reduction in depression scores (t33=−2.16) and the increase in the well-being measures (t33=2.87) were statistically significant. No adverse events were reported during the follow-up period. Conclusions: The findings of this evaluation are encouraging and document positive preliminary evidence for the Paradym app. %M 34569466 %R 10.2196/31064 %U https://formative.jmir.org/2021/11/e31064 %U https://doi.org/10.2196/31064 %U http://www.ncbi.nlm.nih.gov/pubmed/34569466 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29280 %T Organizational Readiness for Implementing an Internet-Based Cognitive Behavioral Therapy Intervention for Depression Across Community Mental Health Services in Albania and Kosovo: Directed Qualitative Content Analysis %A Doukani,Asmae %A Cerga Pashoja,Arlinda %A Fanaj,Naim %A Qirjako,Gentiana %A Meksi,Andia %A Mustafa,Sevim %A Vis,Christiaan %A Hug,Juliane %+ Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 7787447507, arlinda.cerga-pashoja@lshtm.ac.uk %K e-mental health %K digital mental health %K internet-based cognitive behavioral therapy %K implementation science %K organizational readiness for implementing change %K community mental health center %K qualitative interviews %K content analysis %K Albania and Kosovo %D 2021 %7 1.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of digital mental health programs such as internet-based cognitive behavioral therapy (iCBT) holds promise in increasing the quality and access of mental health services. However very little research has been conducted in understanding the feasibility of implementing iCBT in Eastern Europe. Objective: The aim of this study was to qualitatively assess organizational readiness for implementing iCBT for depression within community mental health centers (CMHCs) across Albania and Kosovo. Methods: We used qualitative semistructured focus group discussions that were guided by Bryan Weiner’s model of organizational readiness for implementing change. The questions broadly explored shared determination to implement change (change commitment) and shared belief in their collective capability to do so (change efficacy). Data were collected between November and December 2017. A range of health care professionals working in and in association with CMHCs were recruited from 3 CMHCs in Albania and 4 CMHCs in Kosovo, which were participating in a large multinational trial on the implementation of iCBT across 9 countries (Horizon 2020 ImpleMentAll project). Data were analyzed using a directed approach to qualitative content analysis, which used a combination of both inductive and deductive approaches. Results: Six focus group discussions involving 69 mental health care professionals were conducted. Participants from Kosovo (36/69, 52%) and Albania (33/69, 48%) were mostly females (48/69, 70%) and nurses (26/69, 38%), with an average age of 41.3 years. A directed qualitative content analysis revealed several barriers and facilitators potentially affecting the implementation of digital CBT interventions for depression in community mental health settings. While commitment for change was high, change efficacy was limited owing to a range of situational factors. Barriers impacting “change efficacy” included lack of clinical fit for iCBT, high stigma affecting help-seeking behaviors, lack of human resources, poor technological infrastructure, and high caseload. Facilitators included having a high interest and capability in receiving training for iCBT. For “change commitment,” participants largely expressed welcoming innovation and that iCBT could increase access to treatments for geographically isolated people and reduce the stigma associated with mental health care. Conclusions: In summary, participants perceived iCBT positively in relation to promoting innovation in mental health care, increasing access to services, and reducing stigma. However, a range of barriers was also highlighted in relation to accessing the target treatment population, a culture of mental health stigma, underdeveloped information and communications technology infrastructure, and limited appropriately trained health care workforce, which reduce organizational readiness for implementing iCBT for depression. Such barriers may be addressed through (1) a public-facing campaign that addresses mental health stigma, (2) service-level adjustments that permit staff with the time, resources, and clinical supervision to deliver iCBT, and (3) establishment of a suitable clinical training curriculum for health care professionals. Trial Registration: ClinicalTrials.gov NCT03652883; https://clinicaltrials.gov/ct2/show/NCT03652883 %M 34723822 %R 10.2196/29280 %U https://formative.jmir.org/2021/11/e29280 %U https://doi.org/10.2196/29280 %U http://www.ncbi.nlm.nih.gov/pubmed/34723822 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27908 %T Toward an Extended Definition of Major Depressive Disorder Symptomatology: Digital Assessment and Cross-validation Study %A Martin-Key,Nayra A %A Mirea,Dan-Mircea %A Olmert,Tony %A Cooper,Jason %A Han,Sung Yeon Sarah %A Barton-Owen,Giles %A Farrag,Lynn %A Bell,Emily %A Eljasz,Pawel %A Cowell,Daniel %A Tomasik,Jakub %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K major depressive disorder %K subthreshold depression, transdiagnostic symptoms %K digital assessment %K digital mental health %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diagnosing major depressive disorder (MDD) is challenging, with diagnostic manuals failing to capture the wide range of clinical symptoms that are endorsed by individuals with this condition. Objective: This study aims to provide evidence for an extended definition of MDD symptomatology. Methods: Symptom data were collected via a digital assessment developed for a delta study. Random forest classification with nested cross-validation was used to distinguish between individuals with MDD and those with subthreshold symptomatology of the disorder using disorder-specific symptoms and transdiagnostic symptoms. The diagnostic performance of the Patient Health Questionnaire–9 was also examined. Results: A depression-specific model demonstrated good predictive performance when distinguishing between individuals with MDD (n=64) and those with subthreshold depression (n=140) (area under the receiver operating characteristic curve=0.89; sensitivity=82.4%; specificity=81.3%; accuracy=81.6%). The inclusion of transdiagnostic symptoms of psychopathology, including symptoms of depression, generalized anxiety disorder, insomnia, emotional instability, and panic disorder, significantly improved the model performance (area under the receiver operating characteristic curve=0.95; sensitivity=86.5%; specificity=90.8%; accuracy=89.5%). The Patient Health Questionnaire–9 was excellent at identifying MDD but overdiagnosed the condition (sensitivity=92.2%; specificity=54.3%; accuracy=66.2%). Conclusions: Our findings are in line with the notion that current diagnostic practices may present an overly narrow conception of mental health. Furthermore, our study provides proof-of-concept support for the clinical utility of a digital assessment to inform clinical decision-making in the evaluation of MDD. %M 34709182 %R 10.2196/27908 %U https://formative.jmir.org/2021/10/e27908 %U https://doi.org/10.2196/27908 %U http://www.ncbi.nlm.nih.gov/pubmed/34709182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26810 %T Impulsivity, Self-control, Interpersonal Influences, and Maladaptive Cognitions as Factors of Internet Gaming Disorder Among Adolescents in China: Cross-sectional Mediation Study %A Yu,Yanqiu %A Mo,Phoenix Kit-Han %A Zhang,Jianxin %A Li,Jibin %A Lau,Joseph Tak-Fai %+ Center for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ngan Shing St, Sha Tin, Hong Kong, Hong Kong, 852 2252 8713, jlau@cuhk.edu.hk %K cognition %K adolescent health %K health risk behaviors %K internet %K self-control %K China %D 2021 %7 27.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Gaming disorder, including internet gaming disorder (IGD), was recently defined by the World Health Organization as a mental disease in the 11th Revision of the International Classification of Diseases (ICD-11). Thus, reducing IGD is warranted. Maladaptive cognitions related to internet gaming (MCIG) have been associated with IGD, while impulsivity, self-control, parental influences, and peer influences are key risk factors of IGD. Previous literature suggests that MCIG is associated with the aforementioned 4 risk factors and IGD, and may thus mediate between these risk factors and IGD. These potential mediations, if significant, imply that modification of MCIG may possibly alleviate these risk factors’ harmful impacts on increasing IGD. These mediation hypotheses were tested in this study for the first time. Objective: This study tested the mediation effects of MCIG between intrapersonal factors (impulsivity and self-control) and IGD, and between interpersonal factors (parental influences and peer influences) and IGD among adolescents in China. Methods: An anonymous, cross-sectional, and self-administered survey was conducted among secondary school students in classroom settings in Guangzhou and Chengdu, China. All grade 7 to 9 students (7 to 9 years of formal education) of 7 secondary schools were invited to join the study, and 3087 completed the survey. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) checklist was used to assess IGD. MCIG was assessed by using the Chinese version of the Revised Internet Gaming Cognition Scale. Impulsivity, self-control, and parental or peer influences were measured by using the motor subscale of the Barratt Impulsiveness Scale, the Brief Self-Control Scale, and the modified interpersonal influence scale, respectively. Structural equation modeling was conducted to examine the mediation effects of MCIG between these risk factors and IGD. Results: The prevalence of IGD was 13.57% (418/3081) and 17.67% (366/2071) among all participants and adolescent internet gamers, respectively. The 3 types of MCIG (perceived rewards of internet gaming, perceived urges for playing internet games, and perceived unwillingness to stop playing without completion of gaming tasks) were positively associated with IGD. Impulsivity, self-control, parental influences, and peer influences were all significantly associated with the 3 types of MCIG and IGD. The 3 types of MCIG partially mediated the associations between the studied factors and IGD (effect size of 30.0% to 37.8%). Conclusions: Impulsivity, self-control, and interpersonal influences had both direct and indirect effects via MCIG on IGD. Modifications of the 3 types of MCIG can potentially reduce the harmful impacts of impulsivity and interpersonal influences on IGD and enhance the protective effect of self-control against IGD. Future longitudinal studies are warranted. %M 34704960 %R 10.2196/26810 %U https://www.jmir.org/2021/10/e26810 %U https://doi.org/10.2196/26810 %U http://www.ncbi.nlm.nih.gov/pubmed/34704960 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e30169 %T A Chatbot to Engage Parents of Preterm and Term Infants on Parental Stress, Parental Sleep, and Infant Feeding: Usability and Feasibility Study %A Wong,Jill %A Foussat,Agathe C %A Ting,Steven %A Acerbi,Enzo %A van Elburg,Ruurd M %A Mei Chien,Chua %+ Department of Neonatology, KK Women’s and Children’s Hospital, 100 Bukit Timah Rd, Singapore, 229899, Singapore, 65 6394 1240, chua.mei.chien@singhealth.com.sg %K chatbot %K parental stress %K parental sleep %K infant feeding %K preterm infants %K term infants %K sleep %K stress %K eHealth %K support %K anxiety %K usability %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parents commonly experience anxiety, worry, and psychological distress in caring for newborn infants, particularly those born preterm. Web-based therapist services may offer greater accessibility and timely psychological support for parents but are nevertheless labor intensive due to their interactive nature. Chatbots that simulate humanlike conversations show promise for such interactive applications. Objective: The aim of this study is to explore the usability and feasibility of chatbot technology for gathering real-life conversation data on stress, sleep, and infant feeding from parents with newborn infants and to investigate differences between the experiences of parents with preterm and term infants. Methods: Parents aged ≥21 years with infants aged ≤6 months were enrolled from November 2018 to March 2019. Three chatbot scripts (stress, sleep, feeding) were developed to capture conversations with parents via their mobile devices. Parents completed a chatbot usability questionnaire upon study completion. Responses to closed-ended questions and manually coded open-ended responses were summarized descriptively. Open-ended responses were analyzed using the latent Dirichlet allocation method to uncover semantic topics. Results: Of 45 enrolled participants (20 preterm, 25 term), 26 completed the study. Parents rated the chatbot as “easy” to use (mean 4.08, SD 0.74; 1=very difficult, 5=very easy) and were “satisfied” (mean 3.81, SD 0.90; 1=very dissatisfied, 5 very satisfied). Of 45 enrolled parents, those with preterm infants reported emotional stress more frequently than did parents of term infants (33 vs 24 occasions). Parents generally reported satisfactory sleep quality. The preterm group reported feeding problems more frequently than did the term group (8 vs 2 occasions). In stress domain conversations, topics linked to “discomfort” and “tiredness” were more prevalent in preterm group conversations, whereas the topic of “positive feelings” occurred more frequently in the term group conversations. Interestingly, feeding-related topics dominated the content of sleep domain conversations, suggesting that frequent or irregular feeding may affect parents’ ability to get adequate sleep or rest. Conclusions: The chatbot was successfully used to collect real-time conversation data on stress, sleep, and infant feeding from a group of 45 parents. In their chatbot conversations, term group parents frequently expressed positive emotions, whereas preterm group parents frequently expressed physical discomfort and tiredness, as well as emotional stress. Overall, parents who completed the study gave positive feedback on their user experience with the chatbot as a tool to express their thoughts and concerns. Trial Registration: ClinicalTrials.gov NCT03630679; https://clinicaltrials.gov/ct2/show/NCT03630679 %M 34544679 %R 10.2196/30169 %U https://pediatrics.jmir.org/2021/4/e30169 %U https://doi.org/10.2196/30169 %U http://www.ncbi.nlm.nih.gov/pubmed/34544679 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29397 %T Predictors of Booster Engagement Following a Web-Based Brief Intervention for Alcohol Misuse Among National Guard Members: Secondary Analysis of a Randomized Controlled Trial %A Coughlin,Lara N %A Blow,Frederic C %A Walton,Maureen %A Ignacio,Rosalinda V %A Walters,Heather %A Massey,Lynn %A Barry,Kristen L %A McCormick,Richard %+ Addiction Center, Department of Psychiatry, University of Michigan, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 734 615 4774, laraco@med.umich.edu %K alcohol use %K National Guard %K brief intervention %K boosters %K engagement %D 2021 %7 26.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Alcohol misuse is a major health concern among military members. Reserve component members face unique barriers as they live off base with limited access to behavioral health services. Web and app-based brief interventions are a promising means to improve access to treatment for those who misuse alcohol, with the use of booster sessions to enhance effectiveness, solidify gains, and reinforce changes. However, little is known about who will engage in booster sessions. Objective: This study aims to evaluate booster engagement across booster delivery modalities (Web and Peer) and identify participant-specific factors associated with booster session engagement. Methods: Following a brief web-based alcohol misuse intervention in National Guard members (N=739), we examined engagement in a series of three booster sessions. Using unadjusted and adjusted models, demographic and clinical characteristics that may serve as predictors of booster session engagement were examined across the 2 arms of the trial with different types of booster sessions: peer-delivered (N=245) and web-delivered (N=246). Results: Booster session completion was greater for Peer than Web Booster sessions, with 142 (58%) service members in the Peer Booster arm completing all three boosters compared with only 108 (44%) of participants in the Web Booster arm (χ23=10.3; P=.006). In a model in which the 2 groups were combined, socioeconomic factors predicted booster engagement. In separate models, the demographic and clinical predictors of booster engagement varied between the 2 delivery modalities. Conclusions: The use of peer-delivered boosters, especially among subsets of reserve members at risk of lack of engagement, may foster greater uptake and improve treatment outcomes. Trial Registration: ClinicalTrials.gov NCT02181283; https://clinicaltrials.gov/ct2/show/NCT02181283 %M 34698652 %R 10.2196/29397 %U https://mental.jmir.org/2021/10/e29397 %U https://doi.org/10.2196/29397 %U http://www.ncbi.nlm.nih.gov/pubmed/34698652 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e31742 %T Automated Virtual Reality Cognitive Therapy for People With Psychosis: Protocol for a Qualitative Investigation Using Peer Research Methods %A Bond,Jessica %A Robotham,Dan %A Kenny,Alexandra %A Pinfold,Vanessa %A Kabir,Thomas %A Andleeb,Humma %A Larkin,Michael %A Martin,Jennifer L %A Brown,Susan %A Bergin,Aislinn D %A Petit,Ariane %A Rosebrock,Laina %A Lambe,Sinéad %A Freeman,Daniel %A Waite,Felicity %+ McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, United Kingdom, 44 20 7922 7871, JessicaBond@mcpin.org %K virtual reality %K therapy %K schizophrenia %K agoraphobia %K peer research %K qualitative methods %K implementation %K mental health %K psychosis %K cognitive therapy %D 2021 %7 25.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Many people with psychosis experience difficulties in everyday social situations. Anxiety can make life challenging, leading to withdrawal. Cognitive therapy, using active in vivo learning, enables people to overcome fears. These treatments are not readily available to people with psychosis. Automated virtual reality (VR) therapy is a potential route to increase accessibility. The gameChange automated VR cognitive therapy is designed to help people overcome anxious avoidance and build confidence in everyday social situations. A virtual coach guides the person through the treatment. Understanding user experience is key to facilitating future implementation. Peer research methods, in which people with lived experience of the issues being studied are involved in collecting and analyzing data, may be useful in developing this understanding. This encourages researchers to draw on their lived experience to explore participant perspectives and co-create knowledge. Objective: The primary objective is to use a peer research approach to explore the participant experience of a novel automated VR therapy for anxious social avoidance. This includes understanding (1) the experience of anxious social avoidance in people with psychosis, (2) the experience of the gameChange automated VR cognitive therapy, and (3) any potential impact of the therapy in people’s lives. This will inform future implementation strategies. The secondary objective is to explore how peer research can be used to co-create knowledge. Methods: Semistructured interviews will be conducted with approximately 25 people with psychosis participating in the gameChange trial (ISRCTN17308399). Participants will be recruited from the five trial centers based in National Health Service mental health trusts across England. Interviews will be conducted by two researchers. One is a peer researcher with similar lived experience to the trial participants. The other has lived experiences of mental health issues that do not directly overlap with those of the trial participants. Interview questions will focus on an individual’s experience of anxious social avoidance, experiences of participating in the gameChange VR therapy, and any changes or impact following therapy. The interview schedule was developed in collaboration with the gameChange Lived Experience Advisory Panel (LEAP), comprising 10 project advisors with lived experience of psychosis. Interpretative phenomenological analysis and template analysis will be used to explore individual accounts. The LEAP will contribute to the analysis. Results: Data collection will be conducted from April to September 2021, and analysis will be conducted from June to October 2021. As of September 28, 2021, 20 participants had been interviewed, and coding is underway. Conclusions: The study, employing a peer research approach, may provide a unique insight into the experiences of anxious social avoidance in people with psychosis and its treatment using automated VR therapy. This will inform potential future implementation of VR automated therapies in mental health services. International Registered Report Identifier (IRRID): DERR1-10.2196/31742 %M 34694236 %R 10.2196/31742 %U https://www.researchprotocols.org/2021/10/e31742 %U https://doi.org/10.2196/31742 %U http://www.ncbi.nlm.nih.gov/pubmed/34694236 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e28262 %T Internet Search Activity of Young People With Mood Disorders Who Are Hospitalized for Suicidal Thoughts and Behaviors: Qualitative Study of Google Search Activity %A Moon,Khatiya C %A Van Meter,Anna R %A Kirschenbaum,Michael A %A Ali,Asra %A Kane,John M %A Birnbaum,Michael L %+ Department of Psychiatry, Zucker Hillside Hospital, 75-59 263rd Street, Kaufmann Building, Suite k204, Glen Oaks, NY, 11004, United States, 1 7184704367, kmoon2@northwell.edu %K suicide %K mood disorders %K depression %K internet %K search engine %K Google search %K digital health %K mobile health %K adolescent %K young adult %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Little is known about the internet search activity of people with suicidal thoughts and behaviors (STBs). This data source has the potential to inform both clinical and public health efforts, such as suicide risk assessment and prevention. Objective: We aimed to evaluate the internet search activity of suicidal young people to find evidence of suicidal ideation and behavioral health–related content. Methods: Individuals aged between 15 and 30 years (N=43) with mood disorders who were hospitalized for STBs provided access to their internet search history. Searches that were conducted in the 3-month period prior to hospitalization were extracted and manually evaluated for search themes related to suicide and behavioral health. Results: A majority (27/43, 63%) of participants conducted suicide-related searches. Participants searched for information that exactly matched their planned or chosen method of attempting suicide in 21% (9/43) of cases. Suicide-related search queries also included unusual suicide methods and references to suicide in popular culture. A majority of participants (33/43, 77%) had queries related to help-seeking themes, including how to find inpatient and outpatient behavioral health care. Queries related to mood and anxiety symptoms were found among 44% (19/43) of participants and included references to panic disorder, the inability to focus, feelings of loneliness, and despair. Queries related to substance use were found among 44% (19/43) of participants. Queries related to traumatic experiences were present among 33% (14/43) of participants. Few participants conducted searches for crisis hotlines (n=3). Conclusions: Individuals search the internet for information related to suicide prior to hospitalization for STBs. The improved understanding of the search activity of suicidal people could inform outreach, assessment, and intervention strategies for people at risk. Access to search data may also benefit the ongoing care of suicidal patients. %M 34677139 %R 10.2196/28262 %U https://mental.jmir.org/2021/10/e28262 %U https://doi.org/10.2196/28262 %U http://www.ncbi.nlm.nih.gov/pubmed/34677139 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29989 %T Examining the Preliminary Effectiveness and Acceptability of a Web-Based Training Program for Australian Secondary School Teachers: Pilot Study of the BEAM (Building Educators’ Skills in Adolescent Mental Health) Program %A Parker,Belinda L %A Anderson,Melissa %A Batterham,Philip J %A Gayed,Aimee %A Subotic-Kerry,Mirjana %A Achilles,Melinda R %A Chakouch,Cassandra %A Werner-Seidler,Aliza %A Whitton,Alexis E %A O’Dea,Bridianne %+ Black Dog Institute, 3 Hospital Rd, Randwick, NSW, 2031, Australia, 61 29382 8509, b.odea@blackdog.org.au %K mental health %K training %K high school teachers %K youth %K mental health programs %K secondary schools %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Secondary schools are increasingly supporting adolescents’ mental health and well-being, yet many teachers report that they lack the skills and confidence to do so. Building Educators’ skills in Adolescent Mental Health (BEAM) is a web-based training program developed to improve secondary school teachers’ knowledge and confidence in caring for students’ mental health. Objective: This pilot study examined the preliminary effectiveness and acceptability of the BEAM program for improving mental health knowledge, attitudes, confidence, helping behaviors, and psychological distress among secondary school teachers. Methods: A single-arm pilot trial was conducted from July to December 2019 among secondary school teachers located in New South Wales, Australia, who were employed in leadership positions responsible for managing student well-being (ie, Year Advisors). Participants had access to the BEAM program for 6 weeks. Self-report surveys, delivered at baseline, postintervention (6-weeks post baseline) and 3-month follow-up (19 weeks post baseline) were used to measure changes in training outcomes. Acceptability was assessed by program use, barriers, satisfaction, and participants’ perceptions of program effectiveness. Results: A total of 70 secondary school teachers took part (mean age 36.5 years, SD 9.41 years, range 24-60 years). Significant improvements in confidence were reported at postintervention and 3-month follow-up. Significant improvements in helping behaviors were reported at 3-month follow-up only. There was also a significant reduction in psychological distress at postintervention. Participants agreed that the program content was easy to understand and relevant, but program completion was challenged by lack of time, competing priorities, and forgetfulness. Conclusions: Findings indicated that a web-based training program may be beneficial for improving secondary school teachers’ abilities to care for students’ mental health; however, program modifications are required to increase training completions. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619000821190, Universal Trial Number U1111-1232-7680; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377529 %M 34677134 %R 10.2196/29989 %U https://mental.jmir.org/2021/10/e29989 %U https://doi.org/10.2196/29989 %U http://www.ncbi.nlm.nih.gov/pubmed/34677134 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e32100 %T Outcomes of a Blended Care Coaching Program for Clients Presenting With Moderate Levels of Anxiety and Depression: Pragmatic Retrospective Study %A Wu,Monica S %A Chen,Shih-Yin %A Wickham,Robert E %A O’Neil-Hart,Shane %A Chen,Connie %A Lungu,Anita %+ Lyra Health, 287 Lorton Ave, Burlingame, CA, 94010, United States, 1 877 505 7147, mwu@lyrahealth.com %K blended care %K coaching %K cognitive %K behavior %K depression %K anxiety %K digital health %K retrospective %K mental health %K CBT %K cognitive behavioral therapy %K outcome %K video conference %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression and anxiety are leading causes of disability worldwide, but access to quality mental health care is limited by myriad factors. Cognitive-behavioral coaching is rooted in evidence-based principles and has the potential to address some of these unmet care needs. Harnessing technology to facilitate broader dissemination within a blended care model shows additional promise for overcoming barriers to care. Objective: The aim of this study is to evaluate the outcomes of a blended care coaching (BCC) program for clients presenting with moderate levels of anxiety and depression in real-world settings. Methods: This study examined retrospective data from US-based individuals (N=1496) who presented with moderate levels of depression and anxiety symptoms and who received blended care coaching services. Using a short-term framework, clients met with coaches via a secure video conference platform and also received digital video lessons and exercises. To evaluate the effectiveness of the BCC program, mixed effects modeling was used to examine growth trajectories of anxiety and depression scores over the course of care. Results: Out of the total sample of 1496 clients, 75.9% (n=1136) demonstrated reliable improvement, and 88.6% (n=1326) recovered based on either the Generalized Anxiety Disorder-7 scale (anxiety) or Patient Health Questionnaire-9 (depression). On average, clients exhibited a significant decline in anxiety and depression symptoms during the initial weeks of coaching, with a continued decline over subsequent weeks at a lower rate. Engaging in a coaching session was associated with lower anxiety (b=–1.04) and depression (b=–0.79) symptoms in the same week, as well as lower anxiety (b=–0.74) and depression (b=–0.91) symptoms the following week (P<.001). Conclusions: The BCC program demonstrated strong outcomes in decreasing symptomology for clients presenting with moderate levels of anxiety and depression. When clients received coaching sessions, significant decreases in symptoms were observed, reflecting the importance of session attendance. Additionally, the steepest declines in symptoms tended to occur during the initial weeks of coaching, emphasizing the importance of client buy-in and early engagement. Collectively, these findings have implications for addressing unmet mental health care needs in a more accessible, cost-effective manner. %M 34673534 %R 10.2196/32100 %U https://mental.jmir.org/2021/10/e32100 %U https://doi.org/10.2196/32100 %U http://www.ncbi.nlm.nih.gov/pubmed/34673534 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30491 %T Learning About the Current State of Digital Mental Health Interventions for Canadian Youth to Inform Future Decision-Making: Mixed Methods Study %A Kemp,Jessica %A Chorney,Jill %A Kassam,Iman %A MacDonald,Julie %A MacDonald,Tara %A Wozney,Lori %A Strudwick,Gillian %+ Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501, gillian.strudwick@camh.ca %K youth mental health %K digital mental health %K COVID-19 %K digital mental health interventions %K e-mental health %D 2021 %7 19.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased the demand for youth mental health services in Canada as disruptions to clinical care continue to persist due to the risk of transmission and exposure to the virus. Digital mental health interventions, including web-based resources and mobile apps, have provided opportunities to support youth mental health remotely across Canada. There is a need to better understand how these digital interventions are being selected, recommended, and used in various regions across Canada. Objective: A national jurisdictional scan was completed to (1) determine what web-based programs, apps, and websites are promoted and licensed in Canada for youth mental health; (2) identify criteria and decision-making processes that Canadian jurisdictions use to select web-based programs, apps, and websites for youth mental health; and (3) identify upcoming trends, innovations, and digital mental health possibilities that are emerging in the youth sector. Methods: The aims of the jurisdictional scan were addressed through a review of related academic and grey literature; stakeholder interviews, including individuals involved in various areas of the youth mental health sector; and a social media review of pertinent Twitter content. Results: A total of 66 web-based resources and apps were identified for use by youth in Canada. 16 stakeholder interviews were completed and included discussions with researchers, clinicians, youth organizations, and others involved in digital interventions for youth mental health. These discussions identified a limited use of frameworks used to guide decision-making processes when selecting digital interventions. Many clinicians agreed on a similar set of eligibility requirements for youth mental health apps and digital resources, such as the evidence base and cultural relevance of the intervention. Stakeholders also identified upcoming trends and innovations in the youth digital mental health space, including artificial intelligence, digital phenotyping, and personalized therapy. Over 4 weeks, 2184 tweets were reviewed to identify and compare global and national trends and innovations involving digital mental health and youth. Key trends included the promotion of regional chat services as well as the effects of the COVID-19 pandemic on youth mental health and access to care. Conclusions: As organizations begin to plan for the delivery of mental health care following the pandemic, there are concerns about the sustainability of these digital mental health interventions as well as a need for services to be more informed by the experiences and preferences of youth. %M 34665141 %R 10.2196/30491 %U https://www.jmir.org/2021/10/e30491 %U https://doi.org/10.2196/30491 %U http://www.ncbi.nlm.nih.gov/pubmed/34665141 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29764 %T Digital Health Literacy in Bipolar Disorder: International Web-Based Survey %A Morton,Emma %A Ho,Kendall %A Barnes,Steven J %A Michalak,Erin E %+ Department of Psychiatry, University of British Columbia, 420-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 3393, erin.michalak@ubc.ca %K eHealth %K health literacy %K bipolar disorder %K self-management %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Web-based resources can support people with bipolar disorder (BD) to improve their knowledge and self-management. However, publicly available resources are heterogeneous in terms of their quality and ease of use. Characterizing digital health literacy (the skillset that enable people to navigate and make use of health information in a web-based context) in BD will support the development of educational resources. Objective: The aim of this study was to develop understanding of digital health literacy and its predictors in people with BD. Methods: A web-based survey was used to explore self-reported digital health literacy (as measured by the e-Health Literacy Scale [eHEALS]) in people with BD. Multiple regression analysis was used to evaluate potential predictors, including demographic/clinical characteristics and technology use. Results: A total of 919 respondents (77.9% female; mean age 36.9 years) completed the survey. Older age (β=0.09; P=.01), postgraduate education (β=0.11; P=.01), and current use of self-management apps related to BD (β=0.13; P<.001) were associated with higher eHEALS ratings. Conclusions: Levels of self-reported digital health literacy were comparable or higher than other studies in the general population and specific physical/mental health conditions. However, individuals with BD who are younger, have completed less education, or are less familiar with mental health apps may require extra support to safely and productively navigate web-based health resources. Relevant educational initiatives are discussed. Future studies should evaluate skill development interventions for less digitally literate groups. %M 34665143 %R 10.2196/29764 %U https://mental.jmir.org/2021/10/e29764 %U https://doi.org/10.2196/29764 %U http://www.ncbi.nlm.nih.gov/pubmed/34665143 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e29160 %T A Mobile App to Identify Lifestyle Indicators Related to Undergraduate Mental Health (Smart Healthy Campus): Observational App-Based Ecological Momentary Assessment %A Brogly,Chris %A Shoemaker,J Kevin %A Lizotte,Daniel J %A Kueper,Jacqueline K %A Bauer,Michael %+ Faculty of Information and Media Studies, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada, 1 (519) 661 2111, cbrogly@uwo.ca %K smartphones %K undergraduates %K mental health %K lifestyle %K postsecondary institutions %K mHealth %K mobile application %K ecological momentary assessment %K mobile phone %D 2021 %7 19.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Undergraduate studies are challenging, and mental health issues can frequently occur in undergraduate students, straining campus resources that are already in demand for somatic problems. Cost-effective measures with ubiquitous devices, such as smartphones, offer the potential to deliver targeted interventions to monitor and affect lifestyle, which may result in improvements to student mental health. However, the avenues by which this can be done are not particularly well understood, especially in the Canadian context. Objective: The aim of this study is to deploy an initial version of the Smart Healthy Campus app at Western University, Canada, and to analyze corresponding data for associations between psychosocial factors (measured by a questionnaire) and behaviors associated with lifestyle (measured by smartphone sensors). Methods: This preliminary study was conducted as an observational app-based ecological momentary assessment. Undergraduate students were recruited over email, and sampling using a custom 7-item questionnaire occurred on a weekly basis. Results: First, the 7-item Smart Healthy Campus questionnaire, derived from fully validated questionnaires—such as the Brief Resilience Scale; General Anxiety Disorder-7; and Depression, Anxiety, and Stress Scale–21—was shown to significantly correlate with the mental health domains of these validated questionnaires, illustrating that it is a viable tool for a momentary assessment of an overview of undergraduate mental health. Second, data collected through the app were analyzed. There were 312 weekly responses and 813 sensor samples from 139 participants from March 2019 to March 2020; data collection concluded when COVID-19 was declared a pandemic. Demographic information was not collected in this preliminary study because of technical limitations. Approximately 69.8% (97/139) of participants only completed one survey, possibly because of the absence of any incentive. Given the limited amount of data, analysis was not conducted with respect to time, so all data were analyzed as a single collection. On the basis of mean rank, students showing more positive mental health through higher questionnaire scores tended to spend more time completing questionnaires, showed more signs of physical activity based on pedometers, and had their devices running less and plugged in charging less when sampled. In addition, based on mean rank, students on campus tended to report more positive mental health through higher questionnaire scores compared with those who were sampled off campus. Some data from students found in or near residences were also briefly examined. Conclusions: Given these limited data, participants tended to report a more positive overview of mental health when on campus and when showing signs of higher levels of physical activity. These early findings suggest that device sensors related to physical activity and location are useful for monitoring undergraduate students and designing interventions. However, much more sensor data are needed going forward, especially given the sweeping changes in undergraduate studies due to COVID-19. %M 34665145 %R 10.2196/29160 %U https://formative.jmir.org/2021/10/e29160 %U https://doi.org/10.2196/29160 %U http://www.ncbi.nlm.nih.gov/pubmed/34665145 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29615 %T Validity and Reliability of the Self-administered Psycho-TherApy-SystemS (SELFPASS) Item Pool for the Daily Mood Tracking of Depressive Symptoms: Cross-sectional Web-Based Survey %A Mayer,Gwendolyn %A Hummel,Svenja %A Gronewold,Nadine %A Oetjen,Neele %A Hilbel,Thomas %A Schultz,Jobst-Hendrik %+ Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Im Neuenheimer Feld 130 3, Heidelberg, 69120, Germany, 49 6221 56 35685, gwendolyn.mayer@med.uni-heidelberg.de %K self-management %K mood tracking %K validity %K reliability %K item pool %K questionnaire %K depression %K anxiety %K mood assessment %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: e-Mental health apps targeting depression have gained increased attention in mental health care. Daily self-assessment is an essential part of e-mental health apps. The Self-administered Psycho-TherApy-SystemS (SELFPASS) app is a self-management app to manage depressive and comorbid anxiety symptoms of patients with a depression diagnosis. A self-developed item pool with 40 depression items and 12 anxiety items is included to provide symptom-specific suggestions for interventions. However, the psychometric properties of the item pool have not yet been evaluated. Objective: The aim of this study is to investigate the validity and reliability of the SELFPASS item pool. Methods: A weblink with the SELFPASS item pool and validated mood assessment scales was distributed to healthy subjects and patients who had received a diagnosis of a depressive disorder within the last year. Two scores were derived from the SELFPASS item pool: SELFPASS depression (SP-D) and SELFPASS anxiety (SP-A). Reliability was examined using Cronbach α. Construct validity was assessed through Pearson correlations with the Patient Health Questionnaire-9 (PHQ-9), the General Anxiety Disorder Scale-7 (GAD-7), and the WHO-5-Wellbeing-Scale (WHO-5). Logistic regression analysis was performed as an indicator for concurrent criterion validity of SP-D and SP-A. Factor analysis was performed to provide information about the underlying factor structure of the item pool. Item-scale correlations were calculated in order to determine item quality. Results: A total of 284 participants were included, with 192 (67.6%) healthy subjects and 92 (32.4%) patients. Cronbach α was set to .94 for SP-D and α=.88 for SP-A. We found significant positive correlations between SP-D and PHQ-9 scores (r=0.87; P<.001) and between SP-A and GAD-7 scores (r=0.80; P<.001), and negative correlations between SP-D and WHO-5 scores (r=–0.80; P<.001) and between SP-A and WHO-5 scores (r=–0.69; P<.001). Increasing scores of SP-D and SP-A led to increased odds of belonging to the patient group (SP-D: odds ratio 1.03, 95% CI 1.01-1.05; P<.001; SP-A: 1.05, 1.05-1.01; P=.01). The item pool yielded 2 factors: one that consisted of mood-related items and another with somatic-related items. Conclusions: The SELFPASS item pool showed good psychometric properties in terms of reliability, construct, and criterion validity. The item pool is an appropriate source for daily mood tracking in future e-mental health apps among patients with depression. Our study provides general recommendations for future developments as well as recommendations within the item pool. %M 34661547 %R 10.2196/29615 %U https://mental.jmir.org/2021/10/e29615 %U https://doi.org/10.2196/29615 %U http://www.ncbi.nlm.nih.gov/pubmed/34661547 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e22199 %T Acceptance and Use of Telepsychology From the Clients’ Perspective: Questionnaire Study to Document Perceived Advantages and Barriers %A Sora,Beatriz %A Nieto,Rubén %A Montesano del Campo,Adrian %A Armayones,Manuel %+ Department of Psychology, Rovira i Virgili University, Campus Sescelades. Carretera Valls, s/n, Tarragona, 43007, Spain, 34 977558097 ext 8097, beatriz.sora@urv.cat %K telepsychology %K telepsychology advantages %K telepsychology barriers %K telepsychology use %K telepsychology usefulness %K intention to use telepsychology %D 2021 %7 15.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Telepsychology is increasingly being incorporated in clinical practice, being offered in many psychotherapy centers, especially after the impact of the pandemic. However, there seems to be a remarkable discrepancy between the offer, or interest in, and real-world uptake of e-mental health interventions among the population. A critical precondition is clients’ willingness to accept and use telepsychology, although this issue has thus far been overlooked in research. Objective: The aim of this study was to examine people’s acceptance and use of telepsychology by adopting an extended model of the unified theory of acceptance and use of technology (UTAUT) that integrates perceived telepsychology advantages and barriers, usefulness perceptions, behavioral intention, and telepsychology use. Methods: An online survey was conducted with a convenience sample of 514 participants. Structural equation models were computed to test a mediation model. Results: Results supported the UTAUT model to explain participants’ acceptance and use of telepsychology. They showed a causal chain in which perceived telepsychology advantages and barriers were related to telepsychology use through the perceived usefulness of and intention to use telepsychology. Conclusions: Telepsychology use may be explained according to the UTAUT model when coupled with participants’ perceptions of telepsychology advantages and barriers. Mental health stakeholders could consider these factors in order to increase the acceptance and use of telepsychology. %M 34652276 %R 10.2196/22199 %U https://mental.jmir.org/2021/10/e22199 %U https://doi.org/10.2196/22199 %U http://www.ncbi.nlm.nih.gov/pubmed/34652276 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32271 %T Acceptability, Engagement, and Effects of a Mobile Digital Intervention to Support Mental Health for Young Adults Transitioning to College: Pilot Randomized Controlled Trial %A Suffoletto,Brian %A Goldstein,Tina %A Gotkiewicz,Dawn %A Gotkiewicz,Emily %A George,Brandie %A Brent,David %+ Department of Emergency Medicine, Stanford University, 900 Welch Road, Suite 350, Palo Alto, CA, 94304, United States, 1 412 901 6892, suffbp@stanford.edu %K college %K mental health %K self-management %K digital intervention %K mHealth %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition from high school to college can exacerbate mental health problems in young adults yet barriers prevent seamless mental health care. Existing digital support tools show promise but are not yet designed to optimize engagement or implementation. Objective: The goal of the research was to test acceptability and effects of an automated digital Mobile Support Tool for Mental Health (MoST-MH) for young adults transitioning to college. Methods: Youths aged 18 years and older with a current mental health diagnosis preparing to transition to college (n=52; 85% female [45/52], 91% White [48/52]) were recruited from a primary care (n=31) and a mental health clinic (n=21). Participants were randomized 2:1 to either receive MoST-MH (n=34) or enhanced Usual Care (eUC; n=18). MoST-MH included periodic text message and web-based check-ins of emotional health, stressors, negative impacts, and self-efficacy that informed tailored self-care support messages. Both eUC and MoST-MH participants received links to a library of psychoeducational videos and were asked to complete web-based versions of the Mental Health Self-Efficacy Scale (MHSES), College Counseling Center Assessment of Psychological Symptoms (CCAPS), and Client Service Receipt Inventory for Mental Health (C-SRI) monthly for 3 months and the Post-Study System Usability Scale (PSSUQ) at 3-months. Results: MoST-MH participants were sent a median of 5 (range 3 to 10) text message check-in prompts over the 3-month study period and 100% were completed; participants were sent a median of 2 (range 1 to 8) web-based check-in prompts among which 78% (43/55) were completed. PSSUQ scores indicate high usability (mean score 2.0). Results from the completer analysis demonstrated reductions in mental health symptoms over time and significant between-group effects of MoST-MH compared to eUC on depressive symptom severity (d=0.36, 95% CI 0.08 to 0.64). No significant differences in mental health self-efficacy or mental health health care use were observed. Conclusions: In this pilot trial, we found preliminary evidence that MoST-MH was engaged with at high rates and found to be highly usable and reduced depression symptoms relative to eUC among youth with mental health disorders transitioning to college. Findings were measured during the COVID-19 pandemic, and the study was not powered to detect differences in outcomes between groups; therefore, further testing is needed. Trial Registration: ClinicalTrials.gov NCT04560075; https://clinicaltrials.gov/ct2/show/NCT04560075 %M 34647893 %R 10.2196/32271 %U https://formative.jmir.org/2021/10/e32271 %U https://doi.org/10.2196/32271 %U http://www.ncbi.nlm.nih.gov/pubmed/34647893 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e29495 %T Text Messaging Versus Email Messaging to Support Patients With Major Depressive Disorder: Protocol for a Randomized Hybrid Type II Effectiveness-Implementation Trial %A Adu,Medard Kofi %A Shalaby,Reham %A Eboreime,Ejemai %A Sapara,Adegboyega %A Nkire,Nnamdi %A Chawla,Rajan %A Chima,Chidi %A Achor,Michael %A Osiogo,Felix %A Chue,Pierre %A Greenshaw,Andrew J %A Agyapong,Vincent Israel %+ Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veterans' Memorial Lane, 8th Floor Abbie J. Lane Memorial Building QEII Health Sciences Centre, Halifax, NS, T6G 2B7, Canada, 1 7807144315, vincent.agyapong@nshealth.ca %K email messaging %K text messaging %K supportive %K major depressive disorder %K randomized trial %K mental health %K digital health %K mobile health %K mHealth %K patient care %K health policy %K decision-making %K health care resources %D 2021 %7 13.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Major depressive disorder (MDD) accounts for 40.5% of disability-adjusted life years caused by mental and substance use disorders. Barriers such as stigma and financial and physical access to care have been reported, highlighting the need for innovative, accessible, and cost-effective psychological interventions. The effectiveness of supportive SMS text messaging in alleviating depression symptoms has been proven in clinical trials, but this approach can only help those with mobile phones. Objective: This paper presents the protocol for a study that will aim to evaluate the feasibility, comparative effectiveness, and user satisfaction of daily supportive email messaging as an effective strategy compared to daily supportive text messaging as part of the treatment of patients with MDD. Methods: This trial will be carried out using a hybrid type II implementation-effectiveness design. This design evaluates the effectiveness of an implementation strategy or intervention, while also evaluating the implementation context associated with the intervention. Patients with MDD receiving usual care will be randomized to receive either daily supportive email messaging or daily supportive text messaging of the same content for 6 months. The Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the 5-item World Health Organization Well-Being Index will be used to evaluate the effectiveness of both strategies. The implementation evaluation will be guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, as well as the Consolidated Framework for Implementation Research. All outcome measures will be analyzed using descriptive and inferential statistics. Qualitative data will be analyzed using thematic analysis. Results: Data collection for this trial began in April 2021. We expect the study results to be available within 18 months of study commencement. The results will shed light on the feasibility, acceptability, and effectiveness of using automated emails as a strategy for delivering supportive messages to patients with MDD in comparison to text messaging. Conclusions: The outcome of this trial will have translational impact on routine patient care and access to mental health, as well as potentially support mental health policy decision-making for health care resource allocation. Trial Registration: ClinicalTrials.gov NCT04638231; https://clinicaltrials.gov/ct2/show/NCT04638231 International Registered Report Identifier (IRRID): DERR1-10.2196/29495 %M 34643541 %R 10.2196/29495 %U https://www.researchprotocols.org/2021/10/e29495 %U https://doi.org/10.2196/29495 %U http://www.ncbi.nlm.nih.gov/pubmed/34643541 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e25772 %T The Use of Task Shifting to Improve Treatment Engagement in an Internet-Based Mindfulness Intervention Among Chinese University Students: Randomized Controlled Trial %A Rodriguez,Marcus %A Eisenlohr-Moul,Tory A %A Weisman,Jared %A Rosenthal,M Zachary %+ Pitzer College, 1050 N Mills Ave, BN 205, Claremont, CA, 91711, United States, 1 9784605088, jweisman@pitzer.edu %K mindfulness %K mental health %K social support %K internet-based intervention %K treatment outcome %K university students %K smartphone %K mobile phone %D 2021 %7 13.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditional in-person psychotherapies are incapable of addressing global mental health needs. Use of computer-based interventions is one promising solution for closing the gap between the amount of global mental health treatment needed and received. Objective: Although many meta-analyses have provided evidence supporting the efficacy of self-guided, computer-based interventions, most report low rates of treatment engagement (eg, high attrition and low adherence). The aim of this study is to investigate the efficacy of an adjunctive treatment component that uses task shifting, wherein mental health care is provided by nonspecialist peer counselors to enhance engagement in an internet-based, self-directed, evidence-based mindfulness intervention among Chinese university students. Methods: From 3 universities across China, 54 students who reported at least mild stress, anxiety, or depression were randomly assigned to a 4-week internet-based mindfulness intervention (MIND) or to the intervention plus peer counselor support (MIND+), respectively. Be Mindful delivers all the elements of mindfulness-based cognitive therapy in an internet-based, 4-week course. Participants completed daily monitoring of mindfulness practice and mood, as well as baseline and posttreatment self-reported levels of depression, anxiety, stress, and trait mindfulness. We screened 56 volunteer peer counselor candidates who had no former training in the delivery of mental health services. Of these, 10 were invited to participate in a day-long training, and 4 were selected. Peer counselors were instructed to provide 6 brief (15-20 minute) sessions each week, to help encouraging participants to complete the internet-based intervention. Peer counselors received weekly web-based group supervision. Results: For both conditions, participation in the internet-based intervention was associated with significant improvements in mindfulness and mental health outcomes. The pre-post effect sizes (Cohen d) for mindfulness, depression, anxiety, and stress were 0.55, 0.95, 0.89, and 1.13, respectively. Participants assigned to the MIND+ (vs MIND) condition demonstrated significantly less attrition and more adherence, as indicated by a greater likelihood of completing posttreatment assessments (16/27, 59% vs 7/27, 26%; χ21=6.1; P=.01) and a higher percentage of course completion (72.6/100, 72.6% vs 50.7/100, 50.7%; t52=2.10; P=.04), respectively. No significant between-group differences in daily frequency and duration of mindfulness practice were observed. Multilevel logistic growth models showed that MIND+ participants reported significantly greater pre-post improvements in daily stress ratings (interaction estimate 0.39, SE 0.18; t317=2.29; P=.02) and depression (interaction estimate 0.38, SE 0.16; t330=2.37; P=.02) than those in the MIND condition. Conclusions: This study provides new insights into effective ways of leveraging technology and task shifting to implement large-scale mental health initiatives that are financially feasible, easily transportable, and quickly scalable in low-resource settings. The findings suggest that volunteer peer counselors receiving low-cost, low-intensity training and supervision may significantly improve participants’ indices of treatment engagement and mental health outcomes in an internet-based mindfulness intervention among Chinese university students. %M 34643532 %R 10.2196/25772 %U https://formative.jmir.org/2021/10/e25772 %U https://doi.org/10.2196/25772 %U http://www.ncbi.nlm.nih.gov/pubmed/34643532 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e25622 %T Supporting the Mental Health Needs of Military Partners Through the Together Webinar Program: Pilot Randomized Controlled Trial %A Hendrikx,Laura Josephine %A Murphy,Dominic %+ Combat Stress, Tyrwhitt House, Oaklawn Road, Leatherhead, KT22 0BX, United Kingdom, 44 01372 587 017, dominic.murphy@combatstress.com %K mental health support %K online group-based support %K military partners %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite an increased risk of psychological difficulties, there remains a lack of evidence-based support for the mental health needs of military partners. Objective: This study aims to investigate whether the Together Webinar Programme (TTP-Webinar), a 6-week structured, remote access group intervention would reduce military partners’ experience of common mental health difficulties and secondary trauma symptoms. Methods: A pilot randomized controlled trial was used to compare the TTP-Webinar intervention with a waitlist control. The sample was UK treatment-seeking veterans engaged in a mental health charity. A total of 196 military partners (1 male and 195 females; aged mean 42.28, SD 10.82 years) were randomly allocated to the intervention (n=97) or waitlist (n=99) condition. Outcome measures were self-reported measures of common mental health difficulties, secondary trauma symptoms, and overall quality of life rating. Results: Compared with the waitlist, military partners in the TTP-Webinar had reduced common mental health difficulties (P=.02) and secondary trauma symptoms (P=.001). However, there was no difference in quality-of-life ratings (P=.06). Conclusions: The results suggest that TTP-Webinar is an effective intervention to support the mental health difficulties of military partners. This study provides promising evidence that webinars may be an appropriate platform for providing group-based support. Trial Registration: ClinicalTrials.gov NCT05013398; https://clinicaltrials.gov/ct2/show/NCT05013398 %M 34636734 %R 10.2196/25622 %U https://mental.jmir.org/2021/10/e25622 %U https://doi.org/10.2196/25622 %U http://www.ncbi.nlm.nih.gov/pubmed/34636734 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e31173 %T A Personalized, Interactive, Cognitive Behavioral Therapy–Based Digital Therapeutic (MODIA) for Adjunctive Treatment of Opioid Use Disorder: Development Study %A Meyer,Björn %A Utter,Geri-Lynn %A Hillman,Catherine %+ GAIA AG, Hans-Henny-Jahnn-Weg 53, Hamburg, 22085, Germany, 49 40351052 ext 31, bjoern.meyer@gaia-group.com %K MODIA %K opioid use disorder %K digital therapeutic %K cognitive behavioral therapy %K medication-assisted treatment %K Broca %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Opioid use disorder (OUD) is characterized by the inability to control opioid use despite attempts to stop use and negative consequences to oneself and others. The burden of opioid misuse and OUD is a national crisis in the United States with substantial public health, social, and economic implications. Although medication-assisted treatment (MAT) has demonstrated efficacy in the management of OUD, access to effective counseling and psychosocial support is a limiting factor and a significant problem for many patients and physicians. Digital therapeutics are an innovative class of interventions that help prevent, manage, or treat diseases by delivering therapy using software programs. These applications can circumvent barriers to uptake, improve treatment adherence, and enable broad delivery of evidence-based management strategies to meet service gaps. However, few digital therapeutics specifically targeting OUD are available, and additional options are needed. Objective: To this end, we describe the development of the novel digital therapeutic MODIA. Methods: MODIA was developed by an international, multidisciplinary team that aims to provide effective, accessible, and sustainable management for patients with OUD. Although MODIA is aligned with principles of cognitive behavioral therapy, it was not designed to present any 1 specific treatment and uses a broad range of evidence-based behavior change techniques drawn from cognitive behavioral therapy, mindfulness, acceptance and commitment therapy, and motivational interviewing. Results: MODIA uses proprietary software that dynamically tailors content to the users’ responses. The MODIA program comprises 24 modules or “chats” that patients are instructed to work through independently. Patient responses dictate subsequent content, creating a “simulated dialogue” experience between the patient and program. MODIA also includes brief motivational text messages that are sent regularly to prompt patients to use the program and help them transfer therapeutic techniques into their daily routines. Thus, MODIA offers individuals with OUD a custom-tailored, interactive digital psychotherapy intervention that maximizes the personal relevance and emotional impact of the interaction. Conclusions: As part of a clinician-supervised MAT program, MODIA will allow more patients to begin psychotherapy concurrently with opioid maintenance treatment. We expect access to MODIA will improve the OUD management experience and provide sustainable positive outcomes for patients. %M 34623309 %R 10.2196/31173 %U https://mental.jmir.org/2021/10/e31173 %U https://doi.org/10.2196/31173 %U http://www.ncbi.nlm.nih.gov/pubmed/34623309 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e23465 %T Understanding University Students’ Experiences, Perceptions, and Attitudes Toward Peers Displaying Mental Health–Related Problems on Social Networking Sites: Online Survey and Interview Study %A Kim,Taewan %A Hong,Hwajung %+ Department of Industrial Design, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea, 82 42 350 4502, hwajung@kaist.ac.kr %K mental health %K social media %K social support %K peers %K peer support %K self-disclosure %D 2021 %7 5.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: College students’ mental health is at an all-time low. Students are increasingly disclosing their vulnerable, stigmatizing experiences on online social networking sites (SNSs). Peer support facilitated by SNSs can play a crucial role for the students in coping with mental health–related problems. Thus, it is imperative to understand how university students form perceptions, attitudes, and behaviors toward their peers who are dealing with mental health problems. Objective: This study aimed to provide a better understanding of how college students recognize, perceive, and react to signs of mental health problems in their peers on SNSs. Our ultimate goal in this study was to inform the design of SNSs that can facilitate online peer support. Methods: We conducted surveys with 226 students as well as semistructured interviews with 20 students at six universities in South Korea. Results: Of the 226 survey respondents, 150 (66.4%) reported that they recognized signs of a mental health problem on their friends’ SNS posts. However, a considerable number of respondents (62/150, 41.3%) were reluctant to offer support, even when they had identified friends who were at risk; this reluctance was due to a lack of knowledge or confidence and their desire to maintain a distance from at-risk peers to save their identity from stigmatization and to avoid emotional contagion online. Conclusions: Drawing on these results, we provide implications that could explain the construction of students’ perceptions regarding their peers’ mental health problems. We also provide design proposals for SNSs to serve as platforms that facilitate just-in-time and adaptive support exchanges among peers while mitigating stigma-related concerns. %M 34609315 %R 10.2196/23465 %U https://mental.jmir.org/2021/10/e23465 %U https://doi.org/10.2196/23465 %U http://www.ncbi.nlm.nih.gov/pubmed/34609315 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e17811 %T Young People’s Experiences of Engaging With Fitspiration on Instagram: Gendered Perspective %A Mayoh,Joanne %A Jones,Ian %+ Department of Sport and Event Management, Bournemouth University, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202968385, jmayoh@bournemouth.ac.uk %K social media %K gender %K physical fitness %K women’s health %K men’s health %K body ideals %D 2021 %7 4.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Fitness inspiration or fitspiration is a term used to describe web-based images of fit people, people in the gym, health foods, or inspirational quotes relating to diet and fitness being shared and consumed via visual social media. The popularity of this content is most notable via the Instagram platform. Currently, the majority of fitspiration research has focused on women’s experiences; however, increasingly, studies have pointed to the need to explore the gendered ways by which people engage with this content. Objective: The aim of this study is to explore how young men and women engage in fitspiration content on Instagram and provide a gendered analysis of how and why they consume this content. Methods: This study used a cross-sectional web-based survey (N=1213) of UK-based fitspiration users aged 18-24 years consisting of closed-ended questions to capture quantitative data. Results: The majority actively using Instagram for fitspiration (therefore eligible participants) were women (826/1175, 70.30%). Men were more likely to view content posted by athletes (χ21, N=1153=71.8; P=.001) and bodybuilders (χ21, N=1153=32.8; P<.001), whereas women were more likely to view content related to weight loss (χ21, N=1153=36.8; P<.001), diet plans (χ21, N=1153=11.9; P<.001), and celebrities’ content (χ21, N=1153=33.5; P<.001). Men were more likely to use fitspiration as a source of inspiration to exercise to gain muscle or get stronger (χ21, N=1147=17.9; P<.001), whereas women were more likely to use fitspiration as inspiration for healthy eating (χ21, N=1147=37.7; P<.001), or to exercise to diet or lose weight (χ21, N=1147=13.5; P<.001). Women were more likely to engage in passive behaviors such as viewing content on their feed (χ21, N=1139=7.9; P=.005) or scrolling through accounts (χ21, N=1139=15.2; P<.001), whereas men were more likely to engage in active consumption by tagging fitspiration accounts in posts (χ21, N=1139=7.2; P=.007), commenting on posts (χ21, N=1139=8.1; P=.004), and posting fitspiration content (χ21, N=1139=6.4; P=.01). Conclusions: Female fitspiration consumers engaged with content that reinforced the feminine thin but shapely ideal, whereas male users sought out content that reinforced the masculine muscular ideal. Male users were more likely to engage actively with content (eg, posting fitspiration content), while female users were more likely to engage passively (eg, scrolling through accounts, posts, or images). Future research should consider how fitspiration consumption reflects and reproduces oppressive gender ideology. %M 34605768 %R 10.2196/17811 %U https://www.jmir.org/2021/10/e17811 %U https://doi.org/10.2196/17811 %U http://www.ncbi.nlm.nih.gov/pubmed/34605768 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28765 %T Finding Relevant Psychoeducation Content for Adolescents Experiencing Symptoms of Depression: Content Analysis of User-Generated Online Texts %A Dysthe,Kim K %A Haavet,Ole R %A Røssberg,Jan I %A Brandtzaeg,Petter B %A Følstad,Asbjørn %A Klovning,Atle %+ Department of General Practice/Family Medicine, University of Oslo, Kirkeveien 166, Oslo, 0450, Norway, 47 22 85 05 50, k.k.dysthe@medisin.uio.no %K adolescent %K depression %K internet %K education %K preventive psychiatry %K early medical intervention %K self-report %K psychoeducation %K information content %K online %K digital health %K e-health %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Symptoms of depression are frequent in youth and may develop into more severe mood disorders, suggesting interventions should take place during adolescence. However, young people tend not to share mental problems with friends, family, caregivers, or professionals. Many receive misleading information when searching the internet. Among several attempts to create mental health services for adolescents, technological information platforms based on psychoeducation show promising results. Such development rests on established theories and therapeutic models. To fulfill the therapeutic potential of psychoeducation in health technologies, we lack data-driven research on young peoples’ demand for information about depression. Objective: Our objective is to gain knowledge about what information is relevant to adolescents with symptoms of depression. From this knowledge, we can develop a population-specific psychoeducation for use in different technology platforms. Methods: We conducted a qualitative, constructivist-oriented content analysis of questions submitted by adolescents aged 16-20 years to an online public information service. A sample of 100 posts containing questions on depression were randomly selected from a total of 870. For analysis, we developed an a priori codebook from the main information topics of existing psychoeducational programs on youth depression. The distribution of topic prevalence in the total volume of posts containing questions on depression was calculated. Results: With a 95% confidence level and a ±9.2% margin of error, the distribution analysis revealed the following categories to be the most prevalent among adolescents seeking advice about depression: self-management (33%, 61/180), etiology (20%, 36/180), and therapy (20%, 36/180). Self-management concerned subcategories on coping in general and how to open to friends, family, and caregivers. The therapy topic concerned therapy options, prognosis, where to seek help, and how to open up to a professional. We also found young people dichotomizing therapy and self-management as opposite entities. The etiology topic concerned stressors and risk factors. The diagnosis category was less frequently referred to (9%, 17/180). Conclusions: Self-management, etiology, and therapy are the most prevalent categories among adolescents seeking advice about depression. Young people also dichotomize therapy and self-management as opposite entities. Future research should focus on measures to promote self-management, measures to stimulate expectations of self-efficacy, information about etiology, and information about diagnosis to improve self-monitoring skills, enhancing relapse prevention. %M 34591021 %R 10.2196/28765 %U https://www.jmir.org/2021/9/e28765 %U https://doi.org/10.2196/28765 %U http://www.ncbi.nlm.nih.gov/pubmed/34591021 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30305 %T Effectiveness of an Internet-Based Machine-Guided Stress Management Program Based on Cognitive Behavioral Therapy for Improving Depression Among Workers: Protocol for a Randomized Controlled Trial %A Kawakami,Norito %A Imamura,Kotaro %A Watanabe,Kazuhiro %A Sekiya,Yuki %A Sasaki,Natsu %A Sato,Nana %A , %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 358413521, nkawakami@m.u-tokyo.ac.jp %K deep learning %K unguided intervention %K universal prevention %K workplace %K depression %K machine learning %D 2021 %7 29.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The effect of an unguided internet-based cognitive behavioral therapy (iCBT) stress management program on depression may be enhanced by applying artificial intelligence (AI) technologies to guide participants adopting the program. Objective: The aim of this study is to describe a research protocol to investigate the effect of a newly developed iCBT stress management program adopting AI technologies on improving depression among healthy workers during the COVID-19 pandemic. Methods: This study is a two-arm, parallel, randomized controlled trial. Participants (N=1400) will be recruited, and those who meet the inclusion criteria will be randomly allocated to the intervention or control (treatment as usual) group. A 6-week, six-module, internet-based stress management program, SMART-CBT, has been developed that includes machine-guided exercises to help participants acquire CBT skills, and it applies machine learning and deep learning technologies. The intervention group will participate in the program for 10 weeks. The primary outcome, depression, will be measured using the Beck Depression Inventory II at baseline and 3- and 6-month follow-ups. A mixed model repeated measures analysis will be used to test the intervention effect (group × time interactions) in the total sample (universal prevention) on an intention-to-treat basis. Results: The study was at the stage of recruitment of participants at the time of submission. The data analysis related to the primary outcome will start in January 2022, and the results might be published in 2022 or 2023. Conclusions: This is the first study to investigate the effectiveness of a fully automated machine-guided iCBT program for improving subthreshold depression among workers using a randomized controlled trial design. The study will explore the potential of a machine-guided stress management program that can be disseminated online to a large number of workers with minimal cost in the post–COVID-19 era. Trial Registration: UMIN Clinical Trials Registry（UMIN-CTR) UMIN000043897; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000050125 International Registered Report Identifier (IRRID): PRR1-10.2196/30305 %M 34460414 %R 10.2196/30305 %U https://www.researchprotocols.org/2021/9/e30305 %U https://doi.org/10.2196/30305 %U http://www.ncbi.nlm.nih.gov/pubmed/34460414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29412 %T Just-in-Time Adaptive Mechanisms of Popular Mobile Apps for Individuals With Depression: Systematic App Search and Literature Review %A Teepe,Gisbert W %A Da Fonseca,Ashish %A Kleim,Birgit %A Jacobson,Nicholas C %A Salamanca Sanabria,Alicia %A Tudor Car,Lorainne %A Fleisch,Elgar %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Weinbergstrasse 56/58, Zurich, 8092, Switzerland, 41 76 419 09 91, gteepe@ethz.ch %K depression %K digital mental health %K smartphone applications %K just-in-time adaptive interventions %K effectiveness %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of smartphone apps that focus on the prevention, diagnosis, and treatment of depression is increasing. A promising approach to increase the effectiveness of the apps while reducing the individual’s burden is the use of just-in-time adaptive intervention (JITAI) mechanisms. JITAIs are designed to improve the effectiveness of the intervention and reduce the burden on the person using the intervention by providing the right type of support at the right time. The right type of support and the right time are determined by measuring the state of vulnerability and the state of receptivity, respectively. Objective: The aim of this study is to systematically assess the use of JITAI mechanisms in popular apps for individuals with depression. Methods: We systematically searched for apps addressing depression in the Apple App Store and Google Play Store, as well as in curated lists from the Anxiety and Depression Association of America, the United Kingdom National Health Service, and the American Psychological Association in August 2020. The relevant apps were ranked according to the number of reviews (Apple App Store) or downloads (Google Play Store). For each app, 2 authors separately reviewed all publications concerning the app found within scientific databases (PubMed, Cochrane Register of Controlled Trials, PsycINFO, Google Scholar, IEEE Xplore, Web of Science, ACM Portal, and Science Direct), publications cited on the app’s website, information on the app’s website, and the app itself. All types of measurements (eg, open questions, closed questions, and device analytics) found in the apps were recorded and reviewed. Results: None of the 28 reviewed apps used JITAI mechanisms to tailor content to situations, states, or individuals. Of the 28 apps, 3 (11%) did not use any measurements, 20 (71%) exclusively used self-reports that were insufficient to leverage the full potential of the JITAIs, and the 5 (18%) apps using self-reports and passive measurements used them as progress or task indicators only. Although 34% (23/68) of the reviewed publications investigated the effectiveness of the apps and 21% (14/68) investigated their efficacy, no publication mentioned or evaluated JITAI mechanisms. Conclusions: Promising JITAI mechanisms have not yet been translated into mainstream depression apps. Although the wide range of passive measurements available from smartphones were rarely used, self-reported outcomes were used by 71% (20/28) of the apps. However, in both cases, the measured outcomes were not used to tailor content and timing along a state of vulnerability or receptivity. Owing to this lack of tailoring to individual, state, or situation, we argue that the apps cannot be considered JITAIs. The lack of publications investigating whether JITAI mechanisms lead to an increase in the effectiveness or efficacy of the apps highlights the need for further research, especially in real-world apps. %M 34309569 %R 10.2196/29412 %U https://www.jmir.org/2021/9/e29412 %U https://doi.org/10.2196/29412 %U http://www.ncbi.nlm.nih.gov/pubmed/34309569 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28538 %T Health Care Provider Perspectives on the Use of a Digital Behavioral Health App to Support Patients: Qualitative Study %A Silfee,Valerie %A Williams,Kelly %A Leber,Brett %A Kogan,Jane %A Nikolajski,Cara %A Szigethy,Eva %A Serio,Catherine %+ UPMC Health Plan, U.S. Steel Tower, 600 Grant Street, Pittsburgh, PA, 15219, United States, 1 4124549008, silfeev@upmc.edu %K digital health %K mHealth %K implementation %K cognitive behavioral therapy %K anxiety %K depression %K smartphone %K mobile phone %D 2021 %7 28.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the growing evidence indicating the efficacy of digital cognitive behavioral interventions (dCBIs) for behavioral health (BH) treatment, broad and consistent use of such interventions has been limited by knowledge obtained in real-world settings, including factors that impact provider uptake/referral. Engaging providers early in the implementation process offers an opportunity to explore their needs and behaviors, integrate interventions into workflows, and better understand provider setting capabilities. Objective: This study assessed providers’ views on the feasibility and acceptability of delivering a cognitive behavioral therapy (CBT)-based mobile app in multiple care settings. Methods: Participating providers included BH and physical health (PH) providers from a women’s health center, an outpatient BH clinic, and both rural/urban primary care settings. All participating providers cocreated workflows through facilitated workshops, including establishing feedback loops between the project team and providers and identifying clinical champions at each site. Over a 12-week period, the providers referred adult patients experiencing anxiety or depression to a mobile app-based dCBI, RxWell, and provided other indicated treatments as part of usual care. Referrals were completed by the providers through the electronic medical record. To better understand facilitators of and challenges in integrating RxWell into routine practice and perceptions of sustainability, a series of qualitative interviews was conducted. Interview data were analyzed to identify major themes using an inductive content analysis approach. Results: A total of 19 provider interviews were conducted to discover motivators and barriers for referring RxWell. The providers benefited from a focused discussion on how to incorporate the referral process into their workflow, and knowing the app content was rooted in evidence. Although the providers believed engaging in experiential learning was important, they indicated that more education on the digital health coach role and how to monitor patient progress is needed. The providers thought patient engagement may be impacted by motivation, a lack of comfort using a smartphone, or preference for in-person therapy. The providers also expressed enthusiasm in continuing to refer the app. They liked the ability to provide patients with support between sessions, to have an extra treatment option that teaches BH exercises, and to have a CBT treatment option that overcomes barriers (eg, wait times, copays, travel) to traditional therapy modalities. Conclusions: Digital intervention success in health care settings relies heavily on engagement of key stakeholders, such as providers, in both design and implementation of the intervention and focused evaluation within intended care setting(s). Scaling digital interventions to meet the mental health needs of patients in usual care settings leans on thoughtfully constructed and streamlined workflows to enable seamless referral of patients by providers. Our findings strongly suggest that providers are supportive of digital tool integration to support the mental health of patients and endorse its use within their routine workflow. %M 34529583 %R 10.2196/28538 %U https://formative.jmir.org/2021/9/e28538 %U https://doi.org/10.2196/28538 %U http://www.ncbi.nlm.nih.gov/pubmed/34529583 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28700 %T Longitudinal Relationships Among Fear of COVID-19, Smartphone Online Self-Disclosure, Happiness, and Psychological Well-being: Survey Study %A Matthes,Jörg %A Koban,Kevin %A Neureiter,Ariadne %A Stevic,Anja %+ Department of Communication, University of Vienna, Währinger Straße 29, R. 7.45, Vienna, 1090, Austria, 43 1 4277 493 39, kevin.koban@univie.ac.at %K COVID-19 pandemic %K fear %K self-disclosure %K happiness, well-being %K panel study %K smartphones %K online platform %K social media %D 2021 %7 27.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given that governmental prevention measures restricted most face-to-face communications, online self-disclosure via smartphones emerged as an alternative coping strategy that aimed at reducing the impact of the COVID-19 pandemic on people’s psychological health. Prepandemic research demonstrated that online self-disclosure benefits people’s psychological health by establishing meaningful relationships, obtaining social support, and achieving self-acceptance, particularly in times of crisis. However, it is unclear whether these dynamics transition well to lockdown conditions where online self-disclosure must stand almost entirely on its own. Longitudinal investigations are needed to gain insights into the psychological functionalities of online self-disclosure during the COVID-19 pandemic. Objective: This study aimed to determine the temporal associations between smartphone online self-disclosure (as a communicative behavior) and critical indicators of psychological health (including psychopathological, as well as hedonic and eudaimonic states) during the first COVID-19 lockdown in Austria. Methods: We conducted a representative 2-wave panel survey between late March/April 2020 and May 2020. A total of 416 participants completed both waves (43.1% attrition rate, given n=731 participants who completed the first wave). A partially metric measurement invariant overtime structural equation model was used to determine the temporal associations among online self-disclosure, fear of COVID-19, happiness, and psychological well-being. Results: The analysis revealed that fear of COVID-19 significantly predicted online self-disclosure over time (b=0.24, P=.003) and happiness over time (b=−0.14, P=.04), but not psychological well-being (b=0.03, P=.48), that is, stronger COVID-19 fears at T1 prompted more online self-disclosure and less happiness at T2. Online self-disclosure, on the other hand, significantly predicted happiness (b=0.09, P=.02), but neither fear of COVID-19 (b=−0.01, P=.57) nor psychological well-being (b=−0.01, P=.57) over time. Participants who engaged more strongly in online self-disclosure at T1 felt happier at T2, but they did not differ from less-disclosing participants concerning COVID-19 fears and psychological well-being at T2. Importantly, happiness and psychological well-being were significantly related over time (happiness T1 → psychological well-being T2: b=0.11, P<.001; psychological well-being T1 → happiness T2: b=0.42, P<.001). Conclusions: Our findings suggest that online self-disclosure might play a pivotal role in coping with pandemic stressors. With restrictions on their options, individuals increasingly turn to their smartphones and social media to disclose their feelings, problems, and concerns during lockdown. While online self-disclosure might not alleviate fears or improve psychological well-being, our results demonstrate that it made people experience more happiness during this crisis. This psychological resource may help them withstand the severe psychological consequences of the COVID-19 crisis over longer timeframes. %M 34519657 %R 10.2196/28700 %U https://www.jmir.org/2021/9/e28700 %U https://doi.org/10.2196/28700 %U http://www.ncbi.nlm.nih.gov/pubmed/34519657 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 3 %P e26084 %T A Cognitive Behavioral Therapy–, Biofeedback-, and Game-Based eHealth Intervention to Treat Anxiety in Children and Young People With Long-Term Physical Conditions (Starship Rescue): Co-design and Open Trial %A Thabrew,Hiran %A Stasiak,Karolina %A Kumar,Harshali %A Naseem,Tarique %A Frampton,Christopher %A Merry,Sally %+ Department of Psychological Medicine, University of Auckland, Building 507, School of Medicine, Level 3, 22-30 Park Avenue, Grafton, Auckland, 1011, New Zealand, 64 21 402 055, h.thabrew@auckland.ac.nz %K long-term physical conditions %K chronic illness %K anxiety %K eHealth %K gaming %K young people %K treatment %K cognitive behavioral therapy %K biofeedback %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Approximately 10%-12% of New Zealand children and young people have long-term physical conditions (chronic illnesses) and are more likely to develop psychological problems, particularly anxiety and depression. Delayed treatment leads to worse health care and poorer long-term outcomes. Recently, eHealth interventions, especially those based on principles of cognitive behavioral therapy and biofeedback, have been shown to be moderately effective in reducing anxiety. However, these modalities have rarely been combined. Young people have expressed a preference for well-designed and technology-based support to deal with psychological issues. Objective: This study aims to co-design and evaluate the acceptability and usability of a cognitive behavioral therapy and biofeedback-based, 5-module eHealth game called Starship Rescue and to provide preliminary evidence regarding its effectiveness in addressing anxiety and quality of life in young people with long-term physical conditions. Methods: Starship Rescue was co-designed with 15 children and young people from a tertiary hospital in New Zealand. Following this, 24 others aged 10-17 years participated in an open trial of the game, accessing it over an 8-week period. The acceptability of the game to all participants was assessed using a brief, open-ended questionnaire. More detailed feedback was obtained from a subset of 10 participants via semistructured interviews. Usability was evaluated via device-recorded frequency and duration of access on completion of the game and the System Usability Scale. Anxiety levels were measured at baseline, completion, and 3 months after completion of the game using the Generalized Anxiety Disorder 7-item scale and Spence Child Anxiety Scale, and at the start of each module and on completion using an embedded Likert visual analog scale. Quality of life was measured at baseline, completion, and 3 months after completion using the Pediatric Quality of Life Inventory scale. Results: Users gave Starship Rescue an overall rating of 5.9 out of 10 (range 3-10) and a mean score of 71 out of 100 (SD 11.7; minimum 47.5; maximum 90) on the System Usability Scale. The mean period for the use of the game was just over 11 weeks (78.8 days, 13.5 hours, 40 minutes). Significant reductions in anxiety were noted between the start and end of the game on the Generalized Anxiety Disorder 7-item scale (−4.6; P<.001), Spence Child Anxiety Scale (−9.6; P=.005), and the Likert visual analog scales (−2.4; P=.001). Quality of life also improved on the Pediatric Quality of Life Inventory scale (+4.3; P=.04). All changes were sustained at the 3-month follow-up. Conclusions: This study provides preliminary evidence for Starship Rescue as an acceptable, usable, and effective eHealth intervention for treating anxiety in young people with long-term physical conditions. Further evaluation is planned via a randomized controlled trial. Trial Registration: Australian New Zealand Clinical Trials Network Registry (ANZCTR) ACTRN12616001253493; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371443 %M 34559053 %R 10.2196/26084 %U https://games.jmir.org/2021/3/e26084 %U https://doi.org/10.2196/26084 %U http://www.ncbi.nlm.nih.gov/pubmed/34559053 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e29681 %T Virtual Reality for Supporting the Treatment of Depression and Anxiety: Scoping Review %A Baghaei,Nilufar %A Chitale,Vibhav %A Hlasnik,Andrej %A Stemmet,Lehan %A Liang,Hai-Ning %A Porter,Richard %+ Department of Natural and Computational Sciences, Massey University, Oteha Rohe Albany Highway, Albany, Auckland, 0632, New Zealand, 64 800 627 739, n.baghaei@massey.ac.nz %K virtual reality %K mental health %K depression %K anxiety %K CBT %D 2021 %7 23.9.2021 %9 Review %J JMIR Ment Health %G English %X Background: Mental health conditions pose a major challenge to health care providers and society at large. The World Health Organization predicts that by 2030, mental health conditions will be the leading cause of disease burden worldwide. The current need for mental health care is overwhelming. In New Zealand, 1 in 6 adults has been diagnosed with common mental disorders, such as depression and anxiety disorders, according to a national survey. Cognitive behavioral therapy (CBT) has been shown to effectively help patients overcome a wide variety of mental health conditions. Virtual reality exposure therapy (VRET) might be one of the most exciting technologies emerging in the clinical setting for the treatment of anxiety and depression. Objective: This study aims to investigate the virtual reality (VR) technologies currently being used to help support the treatment of depression and anxiety. We also aim to investigate whether and how CBT is included as part of VRET and look at the VR technologies and interventions that have been used in recent studies on depression and anxiety. Methods: We performed a scoping review. To identify significant studies, we decided to use already aggregated sources from the Google Scholar database. Overall, the goal of our search strategy was to limit the number of initial results related to VR in mental health to only a relevant minimum. Results: Using our defined keywords, Google Scholar identified >17,300 articles. After applying all the inclusion and exclusion criteria, we identified a total of 369 articles for further processing. After manual evaluation, 34 articles were shortlisted; of the 34 articles, 9 (26%) reported the use of CBT with VR. All of the articles were published between 2017 and 2021. Out of the 9 studies, CBT was conducted within a VR environment in 5 (56%) studies, whereas in the remaining 4 (44%) studies, CBT was used as an addition to VRET. All 9 studies reported the use of CBT either in vivo or in a virtual environment to be effective in supporting the treatment of anxiety or depression. Conclusions: Most studies demonstrated the use of VR to be effective for supporting the treatment of anxiety or depression in a range of settings and recommended its potential as a tool for use in a clinical environment. Even though standalone headsets are much easier to work with and more suitable for home use, the shift from tethered VR headsets to standalone headsets in the mental health environment was not observed. All studies that looked at the use of CBT either in vivo or in a virtual environment found it to be effective in supporting the treatment of anxiety or depression. %M 34554097 %R 10.2196/29681 %U https://mental.jmir.org/2021/9/e29681 %U https://doi.org/10.2196/29681 %U http://www.ncbi.nlm.nih.gov/pubmed/34554097 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28066 %T The Associations Between Mental Health Problems and Attitudes Toward Web-Based Health and Social Care Services: Evidence From a Finnish Population-Based Study %A Rantanen,Teemu %A Gluschkoff,Kia %A Silvennoinen,Piia %A Heponiemi,Tarja %+ Unit of Digital Education and Master Programmes, Laurea University of Applied Sciences, Ratatie 22, Vantaa, 01300, Finland, 358 408306149, teemu.rantanen@laurea.fi %K digital inclusion %K digital exclusion %K digital divide %K mental health %K attitudes %D 2021 %7 21.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The significance of web-based health and social care services has been highlighted in recent years. There is a risk that the digitalization of public services will reinforce the digital and social exclusion of vulnerable groups, such as individuals with mental health problems. Objective: This study aims to examine the associations between mental health problems and attitudes toward web-based health and social care services in the general population. The attitudes measured include lack of interest, perceived need for face-to-face encounters, and concern for safety. The study also evaluates whether sociodemographic characteristics (age, gender, education level, and poverty) modify these associations. Methods: Cross-sectional population-based data were collected from 4495 Finnish adults in 2017. Linear regression was used to examine the main effects and interactions of poor mental health and sociodemographic characteristics on attitudes toward web-based health and social care services. Results: The results show that mental health was associated with attitudes toward web-based health and social care services. Individuals with mental health problems were especially concerned about the safety of web-based services. Poor mental health was independently associated with negative attitudes toward web-based services over the effects of sociodemographic factors. Some of the associations between poor mental health and negative attitudes toward web-based services were stronger among older people and men. With regard to sociodemographic characteristics, particularly higher age, low education, and poverty were associated with negative attitudes toward web-based health and social care services. Conclusions: Poor mental health is associated with negative attitudes toward web-based health and social care services and thus indirectly with exclusion. It seems that being older and being male both reinforce the link between poor mental health and exclusion. In supporting the digital inclusion of people with mental health problems, attention should be paid to guidance and counseling, reliability, and the user-friendliness of web-based services as well as to the prevention of poverty. In addition, it is essential to see web-based services as complementary to, and not a substitute for, face-to-face services. %M 34546184 %R 10.2196/28066 %U https://www.jmir.org/2021/9/e28066 %U https://doi.org/10.2196/28066 %U http://www.ncbi.nlm.nih.gov/pubmed/34546184 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27570 %T Evaluation of a Commercial Mobile Health App for Depression and Anxiety (AbleTo Digital+): Retrospective Cohort Study %A Anton,Margaret T %A Greenberger,Heidi Mochari %A Andreopoulos,Evie %A Pande,Reena L %+ AbleTo, Inc, 320 W, 37th Street, 5th floor, New York, NY, 10018, United States, 1 (347) 926 5527, margaret.anton@ableto.com %K digital mental health %K mHealth %K iCBT %K coaching %K depression %K generalized anxiety %K social anxiety %K mobile phone %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital solutions, such as web-based and mobile interventions, have the potential to streamline pathways to mental health services and improve access to mental health care. Although a growing number of randomized trials have established the efficacy of digital interventions for common mental health problems, less is known about the real-world impact of these tools. AbleTo Digital+, a commercially available mental health app for depression and anxiety, offers a unique opportunity to understand the clinical impact of such tools delivered in a real-world context. Objective: The primary aim of this study is to examine the magnitude of change in depression and anxiety symptoms among individuals who used AbleTo Digital+ programs. The secondary aim is to evaluate Digital+ module completion, including the use of 1:1 coaching. Methods: In this retrospective cohort study, we analyzed previously collected and permanently deidentified data from a consecutive cohort of 1896 adults who initiated using one of the three Digital+ eight-module programs (depression, generalized anxiety, or social anxiety) between January 1 and June 30, 2020. Depression, generalized anxiety, and social anxiety symptoms were assessed within each program using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Social Phobia Inventory, respectively. Linear mixed effects models were built to assess the association between module completion and symptom change among users who completed at least four modules and had at least mild baseline symptom elevations, controlling for age, gender, and baseline symptom severity. Digital+ use, including module completion, 1:1 coaching calls, and in-app coach messaging, was also evaluated. Results: Significant effects were observed among depression (Cohen d=1.5), generalized anxiety (Cohen d=1.2), and social anxiety (Cohen d=1.0) program participants who completed at least four modules and had mild baseline elevations (n=470). Associations between module completion and change in depression (β=−1.2; P<.001), generalized anxiety (β=−1.1; P<.001), and social anxiety (β=−2.4; P<.001) symptom scores retained significance with covariate adjustment. Participants completed an average of 2.6 (SD 2.7) modules. The average total length of app use was 52.2 (SD 83.5) days. Approximately two-thirds of the users engaged in at least 1 coaching call (66.82%, 1267/1896) or in-app text messaging (66.09%, 1253/1896). Participants who completed at least four modules participated in significantly more coaching calls per module (mean 1.1, SD 0.7) than users who completed fewer than four modules (mean 1.0, SD 1.2; t1407=−2.1; P=.03). Conclusions: This study demonstrated that AbleTo Digital+ users experienced significant reductions in depression, generalized anxiety, and social anxiety symptoms throughout the program. %M 34546170 %R 10.2196/27570 %U https://formative.jmir.org/2021/9/e27570 %U https://doi.org/10.2196/27570 %U http://www.ncbi.nlm.nih.gov/pubmed/34546170 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e21316 %T Roles of Psychosocial Factors on the Association Between Online Social Networking Use Intensity and Depressive Symptoms Among Adolescents: Prospective Cohort Study %A Li,Ji-Bin %A Feng,Li-Fen %A Wu,Anise M S %A Mai,Jin-Chen %A Chen,Yu-Xia %A Mo,Phoenix K H %A Lau,Joseph T F %+ Center for Health Behaviours Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 5/F, School of Public Health, Prince of Wales Hospital, Hong Kong, China, 86 26376606, jlau@cuhk.edu.hk %K online social networking use intensity %K depressive symptoms %K psychosocial factors %K mediation and suppression %K longitudinal study %D 2021 %7 21.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The potential mechanisms underlying the association between online social networking use intensity and depressive symptoms are unclear and underresearched. Objective: We aimed to investigate the potential roles of interpersonal psychosocial factors on the association between online social networking use intensity and depressive symptoms among early adolescents. Methods: A total of 4237 adolescents from a 9-month longitudinal study were included. Score changes (indicated as △) for the social function use intensity (SFUI) and entertainment function use intensity (EFUI) subscales of the Online Social Networking Activity Intensity Scale and for friendship quality, perceived family support, perceived friend support, parent–adolescent conflict, social nonconfidence, and depressive symptoms were analyzed. The potential mediation effects of unfavorable psychosocial factors and suppression effects of favorable psychosocial factors on the association of △SFUI with △CES-D and the association of △EFUI with △CES-D were tested using hierarchical regression models. Results: The association between △SFUI and △CES-D was partially mediated by △mother–adolescent conflict (mediation effect size 5.11%, P=.02) and △social nonconfidence (mediation effect size 20.97%, P<.001) but partially suppressed by △friendship quality, △perceived family support, and △perceived friend support, with suppression effects of –0.011 (P=.003), –0.009 (P=.003), and –0.022 (P<.001), respectively. The association between △EFUI and △CES-D was partially mediated by △social nonconfidence (mediation effect size 30.65%, P<.001) but partially suppressed by △perceived family support and △perceived friend support, with suppression effects of –0.036 (P<.001) and –0.039 (P<.001), respectively. Conclusions: The association between online social networking use intensity and depressive symptoms was partially mediated through the indirect increase in social nonconfidence and mother–adolescent conflict; however, better perceived social support and friendship quality would partially compensate for the harmful impact of online social networking use intensity on depressive symptoms among early adolescents. %M 34546173 %R 10.2196/21316 %U https://www.jmir.org/2021/9/e21316 %U https://doi.org/10.2196/21316 %U http://www.ncbi.nlm.nih.gov/pubmed/34546173 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e29454 %T School-Based Suicide Risk Assessment Using eHealth for Youth: Systematic Scoping Review %A Exner-Cortens,Deinera %A Baker,Elizabeth %A Gray,Shawna %A Fernandez Conde,Cristina %A Rivera,Rocio Ramirez %A Van Bavel,Marisa %A Vezina,Elisabeth %A Ambrose,Aleta %A Pawluk,Chris %A Schwartz,Kelly D %A Arnold,Paul D %+ Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N1N4, Canada, 1 4032208871, deinera.exner2@ucalgary.ca %K suicide %K risk assessment %K youth %K eHealth %K school mental health %K mobile phone %D 2021 %7 21.9.2021 %9 Review %J JMIR Ment Health %G English %X Background: Suicide is a leading cause of death among youth and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including participating in risk assessments with students expressing suicidal ideation. In the context of the COVID-19 pandemic, many schools now need to offer mental health services, including suicide risk assessment, via eHealth platforms. Post pandemic, the use of eHealth risk assessments will support more accessible services for youth living in rural and remote areas. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment among youth. Objective: This study aims to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment among youth via eHealth (ie, information technologies that allow for remote communication). Methods: This review included peer-reviewed articles and gray literature published in English between 2000 and 2020. Although we did not find studies that specifically explored promising practices for school-based suicide risk assessment among youth via eHealth platforms, we found 12 peer-reviewed articles and 23 gray literature documents that contained relevant information addressing our broader study purpose; thus, these 35 sources were included in this review. Results: We identified five key recommendation themes for school-based suicide risk assessment among youth via eHealth platforms in the 12 peer-reviewed studies. These included accessibility, consent procedures, session logistics, safety planning, and internet privacy. Specific recommendation themes from the 23 gray literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature—consent procedures, session logistics, and safety planning. In addition, based on findings from the gray literature, we expanded the accessibility theme to a broader theme termed youth engagement, which included information on accessibility and building rapport, establishing a therapeutic space, and helping youth prepare for remote sessions. Finally, a new theme was identified in the gray literature findings, specifically concerning school mental health professional boundaries. A second key difference between the gray and peer-reviewed literature was the former’s focus on issues of equity and access and how technology can reinforce existing inequalities. Conclusions: For school mental health providers in need of guidance, we believe that these six recommendation themes (ie, youth engagement, school mental health professional boundaries, consent procedures, session logistics, safety planning, and internet privacy) represent the most promising directions for school-based suicide risk assessment among youth using eHealth tools. However, suicide risk assessment among youth via eHealth platforms in school settings represents a critical research gap. On the basis of the findings of this review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth. %M 34546178 %R 10.2196/29454 %U https://mental.jmir.org/2021/9/e29454 %U https://doi.org/10.2196/29454 %U http://www.ncbi.nlm.nih.gov/pubmed/34546178 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e28123 %T Digital Community Inclusion of Individuals With Serious Mental Illness: A National Survey to Map Digital Technology Use and Community Participation Patterns in the Digital Era %A Shpigelman,Carmit Noa %A Tal,Amir %A Zisman-Ilani,Yaara %+ Department of Community Mental Health, Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba-Khoushy Ave, Mount Carmel, Haifa, 3498838, Israel, 972 522817774, carmits@univ.haifa.ac.il %K mobile health %K technology %K digital community participation %K digital community inclusion %K serious mental illness %K recovery %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the growing interest in developing and using mobile health (mHealth) and digital technologies in mental health, little is known about the scope and nature of virtual community inclusion. Objective: The overarching goal of this study was to understand and conceptualize virtual community inclusion of individuals with serious mental illness (SMI). Specific objectives of this study were as follows: (1) mapping the prevalence, trends, and experiences related to mHealth and digital technology use among individuals with SMI; (2) comparing patterns of technology use by individuals with and those without SMI; and (3) examining whether use of mHealth and digital technologies predicts recovery among individuals with SMI. Methods: A web-based survey of technology use and virtual participation was developed and distributed among adults with and those without SMI via social media, national email discussion lists, nonprofit organizations, and advocacy groups. Results: A total of 381 adults aged 18 years or older participated in the survey, of whom 199 (52%) identified as having a SMI. Participants with SMI reported significantly greater access to technology and significantly fewer days of face-to-face participation in community activities than those without SMI. Among participants with SMI, greater technology use was positively associated with positive emotions and significantly predicted recovery. Conclusions: This study is the first to explore, map, and conceptualize virtual community inclusion among adults with SMI. Our findings indicate a gap in the literature and research on community inclusion and participation, and emphasize the need for virtual community inclusion, particularly during the COVID-19 pandemic and its future implications. %M 34546177 %R 10.2196/28123 %U https://mental.jmir.org/2021/9/e28123 %U https://doi.org/10.2196/28123 %U http://www.ncbi.nlm.nih.gov/pubmed/34546177 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30280 %T Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context %A Budhwani,Suman %A Fujioka,Jamie Keiko %A Chu,Cherry %A Baranek,Hayley %A Pus,Laura %A Wasserman,Lori %A Vigod,Simone %A Martin,Danielle %A Agarwal,Payal %A Mukerji,Geetha %+ Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, suman.budhwani@wchospital.ca %K virtual care %K mental health %K quality of care %K implementation %K COVID-19 %K digital health %K pandemic %K ambulatory care %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual care delivery within mental health has increased rapidly during the COVID-19 pandemic. Understanding facilitators and challenges to adoption and perceptions of the quality of virtual care when delivered at scale can inform service planning postpandemic. Objective: We sought to understand consistent facilitators and persistent challenges to adoption of virtual care and perceived impact on quality of care in an initial pilot phase prior to the pandemic and then during scaled use during the pandemic in the mental health department of an ambulatory care hospital. Methods: This study took place at Women’s College Hospital, an academic ambulatory hospital located in Toronto, Canada. We utilized a multimethods approach to collect quantitative data through aggregate utilization data of phone, video, and in-person visits prior to and during COVID-19 lockdown measures and through a provider experience survey administered to mental health providers (n=30). Qualitative data were collected through open-ended questions on provider experience surveys, focus groups (n=4) with mental health providers, and interviews with clinical administrative and implementation hospital staff (n=3). Results: Utilization data demonstrated slower uptake of video visits at launch and prior to COVID-19 lockdown measures in Ontario (pre-March 2020) and subsequent increased uptake of phone and video visits during COVID-19 lockdown measures (post-March 2020). Mental health providers and clinic staff highlighted barriers and facilitators to adoption of virtual care at the operational, behavioral, cultural, and system/policy levels such as required changes in workflows and scheduling, increased provider effort, provider and staff acceptance, and billing codes for physician providers. Much of the described provider experiences focused on perceived impact on quality of mental health care delivery, including perceptions on providing appropriate and patient-centered care, virtual care effectiveness, and equitable access to care for patients. Conclusions: Continued efforts to enhance suggested facilitators, reduce persistent challenges, and address provider concerns about care quality based on these findings can enable a hybrid model of patient-centered and appropriate care to emerge in the future, with options for in-person, video, and phone visits being used to meet patient and clinical needs as required. %M 34406967 %R 10.2196/30280 %U https://formative.jmir.org/2021/9/e30280 %U https://doi.org/10.2196/30280 %U http://www.ncbi.nlm.nih.gov/pubmed/34406967 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e31976 %T The Finding My Way UK Clinical Trial: Adaptation Report and Protocol for a Replication Randomized Controlled Efficacy Trial of a Web-Based Psychological Program to Support Cancer Survivors %A Hulbert-Williams,Nicholas J %A Leslie,Monica %A Hulbert-Williams,Lee %A Koczwara,Bogda %A Watson,Eila K %A Hall,Peter S %A Ashley,Laura %A Coulson,Neil S %A Jackson,Richard %A Millington,Sue %A , %A Beatty,Lisa %+ Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, United Kingdom, 44 1244511950, n.hulbertwilliams@chester.ac.uk %K cancer %K survivorship %K psychosocial intervention %K digital health %K quality of life %K protocol %K mobile phone %D 2021 %7 20.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer survivors frequently report a range of unmet psychological and supportive care needs; these often continue after treatment has finished and are predictive of psychological distress and poor health-related quality of life. Web-based interventions demonstrate good efficacy in addressing these concerns and are more accessible than face-to-face interventions. Finding My Way (FMW) is a web-based, psycho-educational, and cognitive behavioral therapy intervention for cancer survivors developed in Australia. Previous trials have demonstrated that FMW is acceptable, highly adhered to, and effective in reducing the impact of distress on quality of life while leading to cost savings through health resource use reduction. Objective: This study aims to adapt the Australian FMW website for a UK cancer care context and then undertake a single-blinded, randomized controlled trial of FMW UK against a treatment-as-usual waitlist control. Methods: To an extent, our trial design replicates the existing Australian randomized controlled trial of FMW. Following a comprehensive adaptation of the web resource, we will recruit 294 participants (147 per study arm) from across clinical sites in North West England and North Wales. Participants will have been diagnosed with cancer of any type in the last 6 months, have received anticancer treatment with curative intent, be aged ≥16 years, be proficient in English, and have access to the internet and an active email address. Participants will be identified and recruited through the National Institute for Health Research clinical research network. Measures of distress, quality of life, and health economic outcomes will be collected using a self-report web-based questionnaire at baseline, midtreatment, posttreatment, and both 3- and 6-month follow-up. Quantitative data will be analyzed using intention-to-treat mixed model repeated measures analysis. Embedded semistructured qualitative interviews will probe engagement with, and experiences of using, FMW UK and suggestions for future improvements. Results: The website adaptation work was completed in January 2021. A panel of cancer survivors and health care professionals provided feedback on the test version of FMW UK. Feedback was positive overall, although minor updates were made to website navigation, inclusivity, terminology, and the wording of the Improving Communication and Sexuality and Intimacy content. Recruitment for the clinical trial commenced in April 2021. We aim to report on findings from mid-2023. Conclusions: Replication studies are an important aspect of the scientific process, particularly in psychological and clinical trial literature, especially in different geographical settings. Before replicating the FMW trial in the UK setting, content updating was required. If FMW UK now replicates Australian findings, we will have identified a novel and cost-effective method of psychosocial care delivery for cancer survivors in the United Kingdom. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 14317248; https://www.isrctn.com/ISRCTN14317248 International Registered Report Identifier (IRRID): DERR1-10.2196/31976 %M 34542420 %R 10.2196/31976 %U https://www.researchprotocols.org/2021/9/e31976 %U https://doi.org/10.2196/31976 %U http://www.ncbi.nlm.nih.gov/pubmed/34542420 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28518 %T Assessing Professionals’ Adoption Readiness for eMental Health: Development and Validation of the eMental Health Adoption Readiness Scale %A Feijt,Milou A %A de Kort,Yvonne A W %A Westerink,Joyce H D M %A Bierbooms,Joyce J P A %A Bongers,Inge M B %A IJsselsteijn,Wijnand A %+ Human-Technology Interaction Group, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, De Rondom 70, Eindhoven, 5612 AP, Netherlands, 31 40 247 2889, m.a.feijt@tue.nl %K eMental health %K adoption of innovation %K mental health care %K scale development %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The last few decades have witnessed significant advances in the development of digital tools and applications for mental health care. Despite growing evidence for their effectiveness, acceptance and use of these tools in clinical practice remain low. Hence, a validated and easy-to-use instrument for assessing professionals’ readiness to adopt eMental health (EMH) is necessary to gain further insights into the process of EMH adoption and facilitate future research on this topic. Objective: The aim of this study is to develop and validate an instrument for assessing mental health care professionals’ readiness to adopt EMH. Methods: Item generation was guided by literature and inputs from mental health care professionals and experts in survey development. Exploratory factor analyses were conducted on an initial set of 29 items completed by a sample of mental health care professionals (N=432); thereafter, the scale was reduced to 15 items in an iterative process. The factor structure thus obtained was subsequently tested using a confirmatory factor analysis with a second sample of mental health care professionals (N=363). The internal consistency, convergent validity, and predictive validity of the eMental Health Adoption Readiness (eMHAR) Scale were assessed. Results: Exploratory factor analysis resulted in a 3-factor solution with 15 items. The factors were analyzed and labeled as perceived benefits and applicability of EMH, EMH proactive innovation, and EMH self-efficacy. These factors were confirmed through a confirmatory factor analysis. The total scale and subscales showed a good internal consistency (Cronbach α=.73-.88) along with acceptable convergent and predictive relationships with related constructs. Conclusions: The constructed eMHAR Scale showed a conceptually interpretable 3-factor structure having satisfactory characteristics and relationships with relevant concepts. Its ease of use allows for quick acquisition of data that can contribute to understanding and facilitating the process of adoption of EMH by clinical professionals. %M 34533469 %R 10.2196/28518 %U https://www.jmir.org/2021/9/e28518 %U https://doi.org/10.2196/28518 %U http://www.ncbi.nlm.nih.gov/pubmed/34533469 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28369 %T Mental Health Screening in General Practices as a Means for Enhancing Uptake of Digital Mental Health Interventions: Observational Cohort Study %A Whitton,Alexis E %A Hardy,Rebecca %A Cope,Kate %A Gieng,Chilin %A Gow,Leanne %A MacKinnon,Andrew %A Gale,Nyree %A O'Moore,Kathleen %A Anderson,Josephine %A Proudfoot,Judith %A Cockayne,Nicole %A O'Dea,Bridianne %A Christensen,Helen %A Newby,Jill Maree %+ Black Dog Institute, Hospital Road, Randwick, 2031, Australia, 61 293828507, a.whitton@unsw.edu.au %K depression %K anxiety %K general practice %K screening %K digital mental health %D 2021 %7 16.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital mental health interventions stand to play a critical role in managing the mental health impact of the COVID-19 pandemic. Thus, enhancing their uptake is a key priority. General practitioners (GPs) are well positioned to facilitate access to digital interventions, but tools that assist GPs in identifying suitable patients are lacking. Objective: This study aims to evaluate the suitability of a web-based mental health screening and treatment recommendation tool (StepCare) for improving the identification of anxiety and depression in general practice and, subsequently, uptake of digital mental health interventions. Methods: StepCare screens patients for symptoms of depression (9-item Patient Health Questionnaire) and anxiety (7-item Generalized Anxiety Disorder scale) in the GP waiting room. It provides GPs with stepped treatment recommendations that include digital mental health interventions for patients with mild to moderate symptoms. Patients (N=5138) from 85 general practices across Australia were invited to participate in screening. Results: Screening identified depressive or anxious symptoms in 43.09% (1428/3314) of patients (one-quarter were previously unidentified or untreated). The majority (300/335, 89.6%) of previously unidentified or untreated patients had mild to moderate symptoms and were candidates for digital mental health interventions. Although less than half were prescribed a digital intervention by their GP, when a digital intervention was prescribed, more than two-thirds of patients reported using it. Conclusions: Implementing web-based mental health screening in general practices can provide important opportunities for GPs to improve the identification of symptoms of mental illness and increase patient access to digital mental health interventions. Although GPs prescribed digital interventions less frequently than in-person psychotherapy or medication, the promising rates of uptake by GP-referred patients suggest that GPs can play a critical role in championing digital interventions and maximizing the associated benefits. %M 34528896 %R 10.2196/28369 %U https://www.jmir.org/2021/9/e28369 %U https://doi.org/10.2196/28369 %U http://www.ncbi.nlm.nih.gov/pubmed/34528896 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e28044 %T Testing the Differential Impact of an Internet-Based Mental Health Intervention on Outcomes of Well-being and Psychological Distress During COVID-19: Uncontrolled Intervention Study %A van Agteren,Joep %A Ali,Kathina %A Fassnacht,Daniel B %A Iasiello,Matthew %A Furber,Gareth %A Howard,Alexis %A Woodyatt,Lydia %A Musker,Michael %A Kyrios,Mike %+ Wellbeing and Resilience Centre, South Australian Health and Medical Research Institute, North Terrace, Adelaide, 5000, Australia, 61 881284944, joep.vanagteren@sahmri.com %K COVID-19 %K internet-based interventions %K mental health %K well-being %K intervention %K study %K impact %K internet %K online intervention %K distress %K resilience %K depression %K anxiety %K stress %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During COVID-19, the psychological distress and well-being of the general population has been precarious, increasing the need to determine the impact of complementary internet-based psychological interventions on both positive mental health as well as distress states. Psychological distress and mental well-being represent distinct dimensions of our mental health, and congruent changes in outcomes of distress and well-being do not necessarily co-occur within individuals. When testing intervention impact, it is therefore important to assess change in both outcomes at the individual level, rather than solely testing group differences in average scores at the group level. Objective: This study set out to investigate the differential impact of an internet-based group mental health intervention on outcomes of positive mental health (ie, well-being, life satisfaction, resilience) and indicators of psychological distress (ie, depression, anxiety, stress). Methods: A 5-week mental health intervention was delivered to 89 participants using the Zoom platform during 2020. Impact on outcomes of distress, well-being, and resilience was assessed at the start and end of the program with multiple analysis of variance (MANOVA) and reliable change indices (RCIs) being used to determine program impact at the group and individual levels, respectively. Results: The intervention significantly improved all mental health outcomes measured, (F6,83=5.60, P<.001; Wilks Λ=.71; partial η2=.29) showing small to moderate effect sizes on individual outcomes. The largest effect sizes were observed for life satisfaction and overall well-being (η2=.22 and η2=.2, respectively). Larger effect sizes were noted for those with problematic mental health scores at baseline. A total of 92% (82/89) of participants demonstrated reliable change in at least one mental health outcome. Differential response patterns using RCI revealed that more than one-half of the participants showed improvement in both mental well-being and psychological distress, over one-quarter in outcomes of well-being only, and almost one-fifth in distress only. Conclusions: The results provide evidence for the significant impact of an internet-based mental health intervention during COVID-19 and indicate the importance of assessing dimensions of both well-being and distress when determining mental health intervention effectiveness. %M 34357876 %R 10.2196/28044 %U https://mental.jmir.org/2021/9/e28044 %U https://doi.org/10.2196/28044 %U http://www.ncbi.nlm.nih.gov/pubmed/34357876 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e30833 %T Shift in Social Media App Usage During COVID-19 Lockdown and Clinical Anxiety Symptoms: Machine Learning–Based Ecological Momentary Assessment Study %A Ryu,Jihan %A Sükei,Emese %A Norbury,Agnes %A H Liu,Shelley %A Campaña-Montes,Juan José %A Baca-Garcia,Enrique %A Artés,Antonio %A Perez-Rodriguez,M Mercedes %+ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Icahn (East) Bldg, 4th Floor, L4-53, 1425 Madison Ave, New York, NY, 10029, United States, 1 241 9775, mercedes.perez@mssm.edu %K anxiety disorder %K COVID-19 %K social media %K public health %K digital phenotype %K ecological momentary assessment %K smartphone %K machine learning %K hidden Markov model %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety symptoms during public health crises are associated with adverse psychiatric outcomes and impaired health decision-making. The interaction between real-time social media use patterns and clinical anxiety during infectious disease outbreaks is underexplored. Objective: We aimed to evaluate the usage pattern of 2 types of social media apps (communication and social networking) among patients in outpatient psychiatric treatment during the COVID-19 surge and lockdown in Madrid, Spain and their short-term anxiety symptoms (7-item General Anxiety Disorder scale) at clinical follow-up. Methods: The individual-level shifts in median social media usage behavior from February 1 through May 3, 2020 were summarized using repeated measures analysis of variance that accounted for the fixed effects of the lockdown (prelockdown versus postlockdown), group (clinical anxiety group versus nonclinical anxiety group), the interaction of lockdown and group, and random effects of users. A machine learning–based approach that combined a hidden Markov model and logistic regression was applied to predict clinical anxiety (n=44) and nonclinical anxiety (n=51), based on longitudinal time-series data that comprised communication and social networking app usage (in seconds) as well as anxiety-associated clinical survey variables, including the presence of an essential worker in the household, worries about life instability, changes in social interaction frequency during the lockdown, cohabitation status, and health status. Results: Individual-level analysis of daily social media usage showed that the increase in communication app usage from prelockdown to lockdown period was significantly smaller in the clinical anxiety group than that in the nonclinical anxiety group (F1,72=3.84, P=.05). The machine learning model achieved a mean accuracy of 62.30% (SD 16%) and area under the receiver operating curve 0.70 (SD 0.19) in 10-fold cross-validation in identifying the clinical anxiety group. Conclusions: Patients who reported severe anxiety symptoms were less active in communication apps after the mandated lockdown and more engaged in social networking apps in the overall period, which suggested that there was a different pattern of digital social behavior for adapting to the crisis. Predictive modeling using digital biomarkers—passive-sensing of shifts in category-based social media app usage during the lockdown—can identify individuals at risk for psychiatric sequelae. %M 34524091 %R 10.2196/30833 %U https://mental.jmir.org/2021/9/e30833 %U https://doi.org/10.2196/30833 %U http://www.ncbi.nlm.nih.gov/pubmed/34524091 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26484 %T Opportunity, Challenge, or Both? Managing Adolescent Socioemotional and Mental Health During Web-Based Learning %A Evans,Yolanda %A Hutchinson,Jeffrey %A Ameenuddin,Nusheen %+ Division of Community Pediatric and Adolescent Medicine, Department of Pediatrics, Mayo Clinic, 200 First St SW, Rochester, MN, 55902, United States, 1 5072842511, ameenuddin.nusheen@mayo.edu %K pandemic %K technology %K media %K bullying %K mental health %K distance learning %D 2021 %7 15.9.2021 %9 Viewpoint %J JMIR Ment Health %G English %X The transition to web-based learning during the COVID-19 pandemic has highlighted the need to consider the benefits of and the risks associated with web-based technology for education, media use, and access to resources. Prior to the pandemic, children and adolescents had in-person access to peers; social relationships; educators; health care providers; and, in some cases, mental health resources and medical care in schools and community settings. Due to the introduction of universal masking and physical distancing guidelines to prevent the spread of COVID-19 in early 2020, methods for accessing these resources have shifted dramatically, as people now rely on web-based platforms to access such resources. This viewpoint will explore equity in access to technology for web-based learning, mental health (with a focus on students of color), and the challenge of cultivating meaningful relationships on web-based platforms. Challenges and possible solutions will be offered. %M 34524094 %R 10.2196/26484 %U https://mental.jmir.org/2021/9/e26484 %U https://doi.org/10.2196/26484 %U http://www.ncbi.nlm.nih.gov/pubmed/34524094 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26203 %T The Role of Mental Well-Being and Perceived Parental Supportiveness in Adolescents’ Problematic Internet Use: Moderation Analysis %A Hwang,Juwon %A Toma,Catalina L %+ School of Media and Strategic Communication, Oklahoma State University, 317-A Paul Miller Building, Stillwater, OK, 74078, United States, 1 6083324571, juwon.hwang.23@gmail.com %K problematic internet use %K PIU %K subjective mental well-being %K perceived parental supportiveness %K adolescents %K well-being %K young adult %K internet %K mental health %K support %K parent %K engagement %K social media %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given the growing number of adolescents exhibiting problematic internet use (PIU) and experiencing its harmful consequences, it is important to examine the factors associated with PIU. Existing research has identified perceived parental supportiveness and adolescents’ subjective mental well-being as strong predictors of PIU. However, it is unknown how these factors work together in shaping adolescents’ engagement in PIU. Objective: This paper aimed to examine the role played by adolescents’ perception of parental supportiveness in conjunction with their subjective mental well-being in shaping their PIU. Methods: The study analyzed one of the Technology & Adolescent Mental Wellness (TAM) data sets that were collected from a nationally representative cross-sectional sample. Adolescents self-reported their internet use behavior, perceived parental supportiveness, and subjective mental well-being through an online research panel survey. Hierarchical linear regression analysis with an interaction term was performed. Results: A total of 4592 adolescents, aged 12 to 17 years, completed the survey. Adolescents reported a mean age of 14.61 (SD 1.68) and were 46.4% (2130/4592) female and 66.9% (3370/4592) White. Findings revealed that, controlling for adolescents’ demographics and social media use, higher levels of perceived parental supportiveness (β=–.285, P<.001) and higher levels of subjective mental well-being (β=–.079, P<.001) were associated with a lower likelihood of adolescent PIU. The moderation analysis showed that the negative association between perceived parental supportiveness and PIU was stronger when adolescents reported high (vs low) levels of mental well-being (β=–.191, P<.001). Conclusions: This study shows that perceived parental supportiveness was a stronger protective factor than adolescents’ mental well-being against PIU. The protective power of perceived parental supportiveness against PIU was strongest when adolescents had high mental well-being. The highest risk of PIU occurred when adolescents’ mental well-being was high, but parents were perceived as unsupportive. Our findings suggest that parental supportiveness should be targeted as part of PIU prevention efforts. %M 34524093 %R 10.2196/26203 %U https://mental.jmir.org/2021/9/e26203 %U https://doi.org/10.2196/26203 %U http://www.ncbi.nlm.nih.gov/pubmed/34524093 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26197 %T Evaluating a Middle-School Digital Citizenship Curriculum (Screenshots): Quasi-Experimental Study %A Bickham,David S %A Moukalled,Summer %A Inyart,Heather K %A Zlokower,Rona %+ Digital Wellness Lab, Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, CMCH BCH3186, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 6173556031, david.bickham@childrens.harvard.edu %K digital citizenship %K cyberbullying %K evaluation %K media literacy %K middle school %K conflict resolution %K internet safety %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Screenshots is an in-school curriculum that seeks to develop positive digital social skills in middle school students with the long-term goal of improving their health and well-being. The program imparts knowledge and teaches skills upon which young adolescents can build a set of beliefs and behaviors that foster respectful interactions, prosocial conflict resolutions, and safe and secure use of communication technology. Intervening in this way can improve young people’s mental health by limiting their exposure to cyberbullying and other forms of negative online interactions. This study reports on an evaluation of the Screenshots program conducted with seventh graders in a public school system in a midsized New England city. Objective: This study aims to determine the effectiveness of the Screenshots program in increasing participants’ knowledge about key concepts of digital citizenship and in shifting beliefs and intended behaviors to align with prosocial and safe online interactions. In addition, the study examines whether the program has varying effects on males’ and females’ conflict and bullying resolution strategies. Methods: This quasi-experimental evaluation was conducted in four middle schools in which one group of seventh graders received the Screenshots curriculum and another did not. Before and after the curriculum, all students completed a questionnaire that measured their knowledge of and beliefs about digital citizenship and related online behavioral concepts, their attitudes regarding strategies for stopping online bullying, and their intended online conflict resolution behaviors. Results: The sample included 92 students who received the curriculum and 71 students who were included in the comparison group. Pre- to postinstruction retention rates ranged from 52% (33/63) to 84% (21/25), varying by school and condition. The results showed an increase in knowledge about key curricular concepts for some students (F1,32=9.97; P=.003). In response to some individual items, students decreased their belief supportive of a negative online behavior (F1,76=9.00; P=.004) and increased their belief consistent with an online safety behavior (F1,42=4.39; P=.04) compared with the comparison group. Gender moderated the results related to conflict resolution, with males from one school reducing their endorsement of an aggressive option (F2,40=5.77; P=.006) and males from another school increasing their reported tendency to pursue a nonaggressive option (F2,28=3.65; P=.04). On average, participants reported learning something new from the classes. Conclusions: This study represents a rare evaluation of an in-school digital citizenship program and demonstrates the effectiveness of Screenshots. Students’ increased knowledge of key curricular concepts represents a foundation for developing future beliefs and healthy behaviors. Differences in how adolescent males and females experience and perpetrate online aggression likely explain the conflict resolution findings and emphasize the need to examine gender differences in response to these programs. Students’ high ratings of the relevance of Screenshots’ content reinforce the need for this type of intervention. %M 34524098 %R 10.2196/26197 %U https://mental.jmir.org/2021/9/e26197 %U https://doi.org/10.2196/26197 %U http://www.ncbi.nlm.nih.gov/pubmed/34524098 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26154 %T How Our Technology Use Changed in 2020: Perspectives From Three Youths %A Fadiran,Babayosimi %A Lee,Jessica %A Lemminger,Jared %A Jolliff,Anna %+ Department of Pediatrics, University of Wisconsin - Madison, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 5035539361, ajolliff@wisc.edu %K mental health %K social media %K digital technology %K youth %K adolescent %K commentary %K technology %K wellness %D 2021 %7 15.9.2021 %9 Commentary %J JMIR Ment Health %G English %X The Technology and Adolescent Mental Wellness program (TAM) is a research program with the primary goals of promoting research on the topic of adolescent technology use and mental wellness, creatively disseminating that research, and fostering community among stakeholders. Our foundational question is this: How can technology support adolescent mental wellness? Youth are key stakeholders in pursuit of this foundational question. In this commentary, we invited 3 members of TAM’s youth advisory board to respond to the following question: “How did your technology use change in 2020?” Jessica, Jared, and Babayosimi describe their technology use during COVID-19 as dynamic, and neither uniformly positive nor negative. Further, these 3 youths differ in their perceptions of the same technologies—social media and online school, for example—as well as their perceived ability to self-regulate use of those technologies. We invite you to weigh these perspectives just as we do at TAM—not as empirical findings in themselves, but as examples of youth ideas for future empirical investigation. %M 34524108 %R 10.2196/26154 %U https://mental.jmir.org/2021/9/e26154 %U https://doi.org/10.2196/26154 %U http://www.ncbi.nlm.nih.gov/pubmed/34524108 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26134 %T Social Media Use, Physical Activity, and Internalizing Symptoms in Adolescence: Cross-sectional Analysis %A Rutter,Lauren A %A Thompson,Holly M %A Howard,Jacqueline %A Riley,Tennisha N %A De Jesús-Romero,Robinson %A Lorenzo-Luaces,Lorenzo %+ Department of Psychological and Brain Sciences, Indiana University Bloomington, 1101 E Tenth Street, Bloomington, IN, 47405, United States, 1 8128569953, larutter@iu.edu %K social media %K depression %K anxiety %K physical activity %K adolescence %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Most American adolescents have access to smartphones, and recent estimates suggest that they spend considerable time on social media compared with other physical and leisure activities. A large body of literature has established that social media use is related to poor mental health, but the complicated relationship between social media and symptoms of depression and anxiety in adolescents is yet to be fully understood. Objective: We aim to investigate the relationship between social media use and depression and anxiety symptoms in adolescents by exploring physical activity as a mediator. Methods: A Qualtrics survey manager recruited adult panel participants between February and March 2019, who indicated that they had adolescent children who spoke English. A total of 4592 adolescent-parent dyads completed the survey that took approximately 39 minutes. The survey entailed completing web-based questionnaires assessing various aspects of social media use, psychological symptoms, and psychosocial factors. The average age of the adolescent participants was 14.62 (SD 1.68; range 12-17) years, and the majority of the adolescent sample was male (2392/4592, 52.09%). Results: Total social media use was associated with more depressive symptoms (multiple R2=0.12; F3,4480=207.1; P<.001), anxiety (multiple R2=0.09; F3,4477=145.6; P<.001), and loneliness (multiple R2=0.06; F3,4512=98.06; P<.001), controlling for age and gender. Physical activity was associated with decreased depression and anxiety symptoms after controlling for other extracurricular activities and social media use (multiple R2=0.24; F5,4290=266.0; P<.001). There were significant differences in symptoms based on gender: female adolescents reported higher rates of social media use and males reported higher rates of depression. Nonbinary and transgender adolescents had higher rates of depression, anxiety, and loneliness than the female and male adolescents in the sample. Conclusions: In a nationally representative sample of adolescents, more social media use was associated with more severe symptoms of depression, anxiety, and loneliness. Increased physical activity was associated with decreased depression and anxiety symptoms. Physical activity partially mediated the relationship between social media use and depression and anxiety. As this was a cross-sectional study, we cannot conclude that social media use causes internalizing symptoms or that physical activity leads to decreased internalizing symptoms—there may be additional confounding variables producing the relationships we observed. Physical activity may protect against the potentially harmful effect of social media on some adolescents. The effect sizes were small to medium, and the results should be interpreted with caution. Other limitations of this study include our reliance on self-reporting. Future work should examine social media use beyond how much time adolescents spend using social media and instead focus on the nature of social media activity. %M 34524096 %R 10.2196/26134 %U https://mental.jmir.org/2021/9/e26134 %U https://doi.org/10.2196/26134 %U http://www.ncbi.nlm.nih.gov/pubmed/34524096 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26035 %T Perceived Facilitators of and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: Focus Group and Interview Study %A Radovic,Ana %A Anderson,Nathan %A Hamm,Megan %A George-Milford,Brandie %A Fascetti,Carrie %A Engster,Stacey %A Lindhiem,Oliver %+ Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, 120 Lytton Avenue, Pittsburgh, PA, 15213, United States, 1 4126927227, ana.radovic@chp.edu %K depression %K adolescent %K suicidality %K screening %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision-making to increase the utilization of evidence-based treatments. Objective: This qualitative study aims to describe multi-stakeholder perspectives of adolescents, parents, and providers to understand the potential barriers to the implementation of SW. Methods: We interviewed 11 parents and 11 adolescents and conducted two focus groups with 18 health care providers (PCPs, nurses, therapists, and staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks were inductively developed based on content. Transcripts were double coded, and disagreements were adjudicated to full agreement. Completed coding was used to produce thematic analyses of the interviews and focus groups. Results: We identified five main themes across the interviews and focus groups: parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; there is concern that accurate self-disclosure does not always occur during depression screening; SW is viewed as a tool that could facilitate depression screening and that might encourage more honesty in screening responses; parents, adolescents, and providers do not want SW to replace mental health discussions with providers; and providers want to maintain autonomy in treatment decisions. Conclusions: We identified that providers, parents, and adolescents are all concerned with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. Although SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead, SW focuses on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve the future implementation of SW. %M 34524090 %R 10.2196/26035 %U https://mental.jmir.org/2021/9/e26035 %U https://doi.org/10.2196/26035 %U http://www.ncbi.nlm.nih.gov/pubmed/34524090 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e26029 %T A Cyberbullying Media-Based Prevention Intervention for Adolescents on Instagram: Pilot Randomized Controlled Trial %A Kutok,Emily R %A Dunsiger,Shira %A Patena,John V %A Nugent,Nicole R %A Riese,Alison %A Rosen,Rochelle K %A Ranney,Megan L %+ Brown-Lifespan Center for Digital Health, 139 Point Street, Providence, RI, 02903, United States, 1 (401) 444 2557, megan_ranney@brown.edu %K cyberbullying %K adolescents %K mobile application %K messaging %K brief interventions %K social media %K recruitment %K mobile phone %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Between 15% and 70% of adolescents report experiencing cybervictimization. Cybervictimization is associated with multiple negative consequences, including depressed mood. Few validated, easily disseminated interventions exist to prevent cybervictimization and its consequences. With over 97% of adolescents using social media (such as YouTube, Facebook, Instagram, or Snapchat), recruiting and delivering a prevention intervention through social media and apps may improve accessibility of prevention tools for at-risk youth. Objective: This study aims to evaluate the feasibility and acceptability of and obtain preliminary outcome data on IMPACT (Intervention Media to Prevent Adolescent Cyber-Conflict Through Technology), a brief, remote app-based intervention to prevent and reduce the effect of cyberbullying. Methods: From January 30, 2020, to May 3, 2020, a national sample of 80 adolescents with a history of past-year cybervictimization was recruited through Instagram for a randomized control trial of IMPACT, a brief, remote research assistant–led intervention and a fully automated app-based program, versus enhanced web-based resources (control). Feasibility and acceptability were measured by consent, daily use, and validated surveys. Although not powered for efficacy, outcomes (victimization, bystander self-efficacy, and well-being) were measured using validated measures at 8 and 16 weeks and evaluated using a series of longitudinal mixed models. Results: Regarding feasibility, 24.5% (121/494) of eligible participants provided contact information; of these, 69.4% (84/121) completed full enrollment procedures. Of the participants enrolled, 45% (36/80) were randomized into the IMPACT intervention and 55% (44/80) into the enhanced web-based resources groups. All participants randomized to the intervention condition completed the remote intervention session, and 89% (77/80) of the daily prompts were answered. The retention rate was 99% (79/80) at 8 weeks and 96% (77/80) at 16 weeks for all participants. Regarding acceptability, 100% (36/36) of the intervention participants were at least moderately satisfied with IMPACT overall, and 92% (33/36) of the participants were at least moderately satisfied with the app. At both 8 and 16 weeks, well-being was significantly higher (β=1.17, SE 0.87, P=.02 at 8 weeks and β=3.24, SE 0.95, P<.001 at 16 weeks) and psychological stress was lower (β=−.66, SE 0.08, P=.04 at 8 weeks and β=−.89, SE 0.09, P<.001 at 16 weeks) among IMPACT users than among control group users. Participants in the intervention group attempted significantly more bystander interventions than those in the control group at 8 weeks (β=.82, SE 0.42; P=.02). Conclusions: This remote app-based intervention for victims of cyberbullying was feasible and acceptable, increased overall well-being and bystander interventions, and decreased psychological stress. Our findings are especially noteworthy given that the trial took place during the COVID-19 pandemic. The use of Instagram to recruit adolescents can be a successful strategy for identifying and intervening with those at the highest risk of cybervictimization. Trial Registration: ClinicalTrials.gov NCT04259216; http://clinicaltrials.gov/ct2/show/NCT04259216. %M 34524103 %R 10.2196/26029 %U https://mental.jmir.org/2021/9/e26029 %U https://doi.org/10.2196/26029 %U http://www.ncbi.nlm.nih.gov/pubmed/34524103 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30162 %T Assessing the Care Modality Preferences and Predictors for Digital Mental Health Treatment Seekers in a Technology-Enabled Stepped Care Delivery System: Cross-sectional Study %A Kozlov,Elissa %A McDarby,Meghan %A Prescott,Maximo %A Altman,Myra %+ Modern Health, 450 Sansome St, 12th Floor, San Francisco, CA, 94111, United States, 1 603 306 6231, myra@joinmodernhealth.com %K stepped care %K technology %K mental health care %K patient-centered care %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Access to mental health services continues to be a systemic problem in the United States and around the world owing to a variety of barriers including the limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple modalities of digital mental health care available to address their problems (eg, self-guided and group modalities, or one-to-one care with a provider). In fact, one-to-one, in-person treatment is the dominant care model with a masters- or doctoral-level trained mental health provider, and it may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care, but more research is needed to understand the care modality preferences of digital mental health care seekers because additional modalities become increasingly validated as effective treatment options. Objective: The purpose of this study was to describe and evaluate the predictors of care modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform. Methods: This exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology-enabled platform to optimize digital mental health care delivery. Chi-square tests and one-way analysis of variance (ANOVA) were conducted to evaluate associations among the categorical and continuous factors of interest and the preferred care modality. Bivariate logistic regression models were constructed to estimate the odds ratios (ORs) of preferring a one-on-one versus self-guided group, or no preference for digital mental health care modalities. Results: Data were analyzed for 3661 employees. The most common modality preference was one-on-one care (1613/3661, 44.06%). Approximately one-fourth of the digital mental health care seekers (881/3661, 24.06%) expressed a preference for pursuing self-guided care, and others (294/3661, 8.03%) expressed a preference for group care. The ORs indicated that individuals aged 45 years and above were significantly more likely to express a preference for self-guided care compared to individuals aged between 18 and 24 years (OR 2.47, 95% CI 1.70-3.59; P<.001). Individuals screening positive for anxiety (OR 0.73, 95% CI 0.62-0.86; P<.001) or depression (OR 0.79, 95% CI 0.66-0.95; P=.02) were more likely to prefer one-on-one care. Conclusions: Our findings elucidated that care modality preferences vary and are related to clinical severity factors and demographic variables among individuals seeking digital mental health care. %M 34343965 %R 10.2196/30162 %U https://formative.jmir.org/2021/9/e30162 %U https://doi.org/10.2196/30162 %U http://www.ncbi.nlm.nih.gov/pubmed/34343965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27745 %T Understanding Mental Health App Use Among Community College Students: Web-Based Survey Study %A Borghouts,Judith %A Eikey,Elizabeth V %A Mark,Gloria %A De Leon,Cinthia %A Schueller,Stephen M %A Schneider,Margaret %A Stadnick,Nicole %A Zheng,Kai %A Mukamel,Dana B %A Sorkin,Dara H %+ Department of Medicine, University of California, Irvine, 100 Theory, Irvine, CA, 92617, United States, 1 9498240246, jborghou@uci.edu %K mHealth %K mental health %K community college %K students %K structural equation modeling %K mobile apps %K services %K mental health services %K stress %K privacy %D 2021 %7 14.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health concerns are a significant issue among community college students, who often have less access to resources than traditional university college students. Mobile apps have the potential to increase access to mental health care, but there has been little research investigating factors associated with mental health app use within the community college population. Objective: This study aimed to understand facilitators of and barriers to mental health app use among community college students. Methods: A web-based survey was administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Structural equation modeling was used to test the relationships between the use of mental health apps, perceived stress, perceived need to seek help for mental health concerns, perceived stigma, past use of professional mental health services, privacy concerns, and social influence of other people in using mental health apps. Results: Of the 500 participants, 106 (21.2%) reported use of mental health apps. Perceived stress, perceived need to seek help, past use of professional services, and social influence were positively associated with mental health app use. Furthermore, the effect of stress was mediated by a perceived need to seek help. Privacy concerns were negatively associated with mental health app use. Stigma, age, and gender did not have a statistically significant effect. Conclusions: These findings can inform development of new digital interventions and appropriate outreach strategies to engage community college students in using mental health apps. %M 34519668 %R 10.2196/27745 %U https://www.jmir.org/2021/9/e27745 %U https://doi.org/10.2196/27745 %U http://www.ncbi.nlm.nih.gov/pubmed/34519668 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e30292 %T Designing Videos With and for Adults With ADHD for an Online Intervention: Participatory Design Study and Thematic Analysis of Evaluation %A Flobak,Eivind %A Nordby,Emilie Sektnan %A Guribye,Frode %A Kenter,Robin %A Nordgreen,Tine %A Lundervold,Astri J %+ Department of Information Science and Media Studies, University of Bergen, Faculty of Social Sciences, 5th Fl, Lauritz Meltzers House, Fosswinckels gate 6, Bergen, 5007, Norway, 47 41146623, eivind.flobak@uib.no %K participatory design %K ADHD %K online intervention %K video %K therapeutic content %K stigma %K attention deficit hyperactivity disorder %K design %K participatory %K intervention %K experience %K mental health %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adults with attention deficit hyperactivity disorder (ADHD) represent a heterogeneous group with both strengths and difficulties associated with the diagnosis. An online intervention attuned to their needs may improve their everyday functioning. When designing online interventions, it is important to adapt the therapeutic content to the values and needs of the target group. Objective: This paper describes and evaluates a participatory process used to produce content for an online intervention for adults with ADHD by producing video vignettes clarifying core training principles grounded in the participants' everyday experiences. Methods: We report on the qualitative data from 2 research phases: the design and evaluation of video vignettes for an online intervention. In the first phase, 12 adults with ADHD, 2 clinicians, and 2 research assistants participated in the production of video vignettes for the online intervention. In the second phase, participants (n=109) gave feedback on the videos as part of a clinical trial of the intervention. A subgroup (n=7) was interviewed in-depth regarding their experiences with the videos. The qualitative data were analyzed using thematic analysis. Results: In the first phase, the participants with ADHD contributed with experiences from challenging everyday situations. In the process, we navigated between therapeutic principles and the participants' experiential perspectives to create content relevant and consistent with the target group's values and experiences. In the second phase, we identified 3 themes related to the participants' experiences and interpretation of the video vignettes: (1) recognition of ADHD-related challenges, (2) connection with the characters and the situations, and (3) video protagonists as companions and role models for change. Conclusions: A participatory design process for designing online mental health interventions can be used to probe and balance between the therapeutic principles defined by clinicians and the participants’ experiences with mental health issues in the production of therapeutic content. In our study, the inclusion of video vignettes in an online intervention enabled a contextualized and relevant presentation of everyday experiences and psychosocial factors in the life of an adult with ADHD. Trial Registration: ClinicalTrials.gov NCT04511169; https://clinicaltrials.gov/ct2/show/NCT04511169 %M 34519666 %R 10.2196/30292 %U https://mental.jmir.org/2021/9/e30292 %U https://doi.org/10.2196/30292 %U http://www.ncbi.nlm.nih.gov/pubmed/34519666 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e25294 %T A Suite of Mobile Conversational Agents for Daily Stress Management (Popbots): Mixed Methods Exploratory Study %A Mauriello,Matthew Louis %A Tantivasadakarn,Nantanick %A Mora-Mendoza,Marco Antonio %A Lincoln,Emmanuel Thierry %A Hon,Grace %A Nowruzi,Parsa %A Simon,Dorien %A Hansen,Luke %A Goenawan,Nathaniel H %A Kim,Joshua %A Gowda,Nikhil %A Jurafsky,Dan %A Paredes,Pablo Enrique %+ Stanford School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA, 94305, United States, 1 650 723 2300, pparedes@stanford.edu %K conversational agents %K virtual agent %K chatbot %K therapy %K stress relief %K stress management %K mental health %K stress %K exploratory %K support %K mobile phone %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Approximately 60%-80% of the primary care visits have a psychological stress component, but only 3% of patients receive stress management advice during these visits. Given recent advances in natural language processing, there is renewed interest in mental health chatbots. Conversational agents that can understand a user’s problems and deliver advice that mitigates the effects of daily stress could be an effective public health tool. However, such systems are complex to build and costly to develop. Objective: To address these challenges, our aim is to develop and evaluate a fully automated mobile suite of shallow chatbots—we call them Popbots—that may serve as a new species of chatbots and further complement human assistance in an ecosystem of stress management support. Methods: After conducting an exploratory Wizard of Oz study (N=14) to evaluate the feasibility of a suite of multiple chatbots, we conducted a web-based study (N=47) to evaluate the implementation of our prototype. Each participant was randomly assigned to a different chatbot designed on the basis of a proven cognitive or behavioral intervention method. To measure the effectiveness of the chatbots, the participants’ stress levels were determined using self-reported psychometric evaluations (eg, web-based daily surveys and Patient Health Questionnaire-4). The participants in these studies were recruited through email and enrolled on the web, and some of them participated in follow-up interviews that were conducted in person or on the web (as necessary). Results: Of the 47 participants, 31 (66%) completed the main study. The findings suggest that the users viewed the conversations with our chatbots as helpful or at least neutral and came away with increasingly positive sentiment toward the use of chatbots for proactive stress management. Moreover, those users who used the system more often (ie, they had more than or equal to the median number of conversations) noted a decrease in depression symptoms compared with those who used the system less often based on a Wilcoxon signed-rank test (W=91.50; Z=−2.54; P=.01; r=0.47). The follow-up interviews with a subset of the participants indicated that half of the common daily stressors could be discussed with chatbots, potentially reducing the burden on human coping resources. Conclusions: Our work suggests that suites of shallow chatbots may offer benefits for both users and designers. As a result, this study’s contributions include the design and evaluation of a novel suite of shallow chatbots for daily stress management, a summary of benefits and challenges associated with random delivery of multiple conversational interventions, and design guidelines and directions for future research into similar systems, including authoring chatbot systems and artificial intelligence–enabled recommendation algorithms. %M 34519655 %R 10.2196/25294 %U https://formative.jmir.org/2021/9/e25294 %U https://doi.org/10.2196/25294 %U http://www.ncbi.nlm.nih.gov/pubmed/34519655 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30726 %T Using Electronically Delivered Therapy and Brain Imaging to Understand Obsessive-Compulsive Disorder Pathophysiology: Protocol for a Pilot Study %A Stephenson,Callum %A Malakouti,Niloufar %A Nashed,Joseph Y %A Salomons,Tim %A Cook,Douglas J %A Milev,Roumen %A Alavi,Nazanin %+ Centre for Neuroscience Studies, Faculty of Health Sciences, Queen's University, Botterell Hall, 18 Stuart Street, Kingston, ON, K7L 3N6, Canada, 1 2894075895, callum.stephenson@queensu.ca %K mental health %K obsessive-compulsive disorder %K cognitive behavioral therapy %K exposure ritual prevention %K electronic %K functional magnetic resonance imaging %K eHealth %K brain imaging %D 2021 %7 14.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Obsessive-compulsive disorder (OCD) is a debilitating and prevalent anxiety disorder. Although the basal ganglia and frontal cortex are the brain regions that are most commonly hypothesized to be involved in OCD, the exact pathophysiology is unknown. By observing the effects of proven treatments on brain activation levels, the cause of OCD can be better understood. Currently, the gold standard treatment for OCD is cognitive behavioral therapy (CBT) with exposure and response prevention. However, this is often temporally and geographically inaccessible, time consuming, and costly. Fortunately, CBT can be effectively delivered using the internet (electronically delivered CBT [e-CBT]) because of its structured nature, thus addressing these barriers. Objective: The aims of this study are to implement an e-CBT program for OCD and to observe its effects on brain activation levels using functional magnetic resonance imaging (MRI). It is hypothesized that brain activation levels in the basal ganglia and frontal cortex will decrease after treatment. Methods: Individuals with OCD will be offered a 16-week e-CBT program with exposure and response prevention mirroring in-person CBT content and administered through a secure web-based platform. The efficacy of the treatment will be evaluated using clinically validated symptomology questionnaires at baseline, at week 8, and after treatment (week 16). Using functional MRI at baseline and after treatment, brain activation levels will be assessed in the resting state and while exposed to anxiety-inducing images (eg, dirty dishes if cleanliness is an obsession). The effects of treatment on brain activation levels and the correlation between symptom changes and activation levels will be analyzed. Results: The study received initial ethics approval in December 2020, and participant recruitment began in January 2021. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 5 participants have been recruited. Data collection is expected to conclude by January 2022, and data analysis is expected to be completed by February 2022. Conclusions: The findings from this study can further our understanding of the causation of OCD and help develop more effective treatments for this disorder. Trial Registration: ClinicalTrials.gov NCT04630197; https://clinicaltrials.gov/ct2/show/NCT04630197. International Registered Report Identifier (IRRID): PRR1-10.2196/30726 %M 34348889 %R 10.2196/30726 %U https://www.researchprotocols.org/2021/9/e30726 %U https://doi.org/10.2196/30726 %U http://www.ncbi.nlm.nih.gov/pubmed/34348889 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e25017 %T The Effects of 3D Immersion Technology (3Scape) on Mental Health in Outpatients From a Short-Term Assessment, Rehabilitation, and Treatment Program: Feasibility Protocol for a Randomized Controlled Trial %A Miguel-Cruz,Antonio %A Ladurner,Anna-Maria %A Kohls-Wiebe,Megan %A Rawani,David %+ University of Alberta, 8205 114 St NW, 3-48 Corbett Hall, Edmonton, AB, T6G 2G4, Canada, 1 7802246641, miguelcr@ualberta.ca %K technology assessment %K mental health %K technology for rehabilitation %K clinical engineering %K biomedical engineering %D 2021 %7 14.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health conditions are prevalent among Canadians and are a leading cause of disability. Each year, 1 in 5 Canadians experiences a mental health issue. A total of 5% of people aged ≥65 years perceive their mental health as fair or poor, and 6.3% of them have mood disorders. Regarding older adults with cognitive impairments such as dementia, up to 40%-50% of them experience depression at some point. We believe that older adults can benefit significantly from information and telecommunication technologies as a strategy for improving mental health conditions such as depression and anxiety, while simultaneously improving their quality of life. 3Scape Systems Inc is an Alberta-based private company that has produced a series of specialized 3D videos designed to simulate real-life events and engage individuals living with mental health disorders and cognitive impairments such as dementia. Objective: This study aims to explore the trial design and effects of 3Scape videos on older adults’ symptoms of depression and anxiety and the efficacy of this technology in improving the quality of life of patients attending the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital and to provide data to estimate the parameters required to design a definitive randomized controlled trial. Methods: The trial will use a randomized controlled design comprising 15 intervention participants and 15 control group participants. The participants will be adults aged ≥65 years who are cognitively intact or have minimal cognitive impairment (ie, Montreal Cognitive Assessment score ≥18), and are clients of the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital. This study’s primary outcome variables are related to clients’ depressive and anxiety symptoms and their quality of life. The control group will receive the standard of care (ie, the Short-Term Assessment, Rehabilitation, and Treatment Psychiatry Day Hospital program at Glenrose Rehabilitation Hospital). The intervention group will receive the same standard of care as the control group and will use 3Scape Systems videos for therapeutic activities. Results: Our study is currently on hold because of the COVID-19 pandemic. The recruitment process is expected to resume by November 2021, and the primary impact analysis is expected to be conducted by February 2022. Conclusions: This study will provide valuable information such as the measurement of comparative intervention effects, perception of older adults and mental health therapists about the 3Scape Systems, the associated costs of treatment, and product costs. This will contribute to the evidence planning process, which will be crucial for the future adoption of 3Scape Systems. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 93685907; https://www.isrctn.com/ISRCTN93685907. International Registered Report Identifier (IRRID): PRR1-10.2196/25017 %M 34519669 %R 10.2196/25017 %U https://www.researchprotocols.org/2021/9/e25017 %U https://doi.org/10.2196/25017 %U http://www.ncbi.nlm.nih.gov/pubmed/34519669 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24624 %T Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh %A Rashid Soron,Tanjir %A Ashiq,Md Ashiqur Rahman %A Al-Hakeem,Marzia %A Chowdhury,Zaid Farzan %A Uddin Ahmed,Helal %A Afrooz Chowdhury,Chaman %+ Telepsychiatry Research and Innovation Network Ltd, 3D, 2nd Floor, Rupayan Trade Center, Bangla Motor, Dhaka, 1205, Bangladesh, 880 1718827138, tanjirsoron@gmail.com %K domestic violence %K COVID-19 %K mental health %K violence %K Bangladesh %K lockdown %K isolation %K anxiety %K stress %K telemental health %K telepsychiatry %K web-based survey %D 2021 %7 13.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence. Objective: In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care. Methods: We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation). Results: We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services. Conclusions: Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner. %M 34346893 %R 10.2196/24624 %U https://formative.jmir.org/2021/9/e24624 %U https://doi.org/10.2196/24624 %U http://www.ncbi.nlm.nih.gov/pubmed/34346893 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e31211 %T Implementation of an Internet-Based Acceptance and Commitment Therapy for Promoting Mental Health Among Migrant Live-in Caregivers in Canada: Protocol %A Fung,Kenneth Po-Lun %A Vahabi,Mandana %A Moosapoor,Masoomeh %A Akbarian,Abdolreza %A Jing-Wen Liu,Jenny %A Wong,Josephine Pui-Hing %+ Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada, 1 416 979 5000 ext 552725, mvahabi@ryerson.ca %K migrant live-in caregiver %K women %K mental health %K acceptance commitment therapy %K resiliency %K empowerment %D 2021 %7 13.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Psychological distress, isolation, feelings of powerlessness, and limited social support are realities faced by temporary migrant live-in caregivers in Canada. Furthermore, they experience multiple barriers in accessing mental health services due to their long work hours, limited knowledge of health resources, precarious employment, and immigration status. Objective: The Women Empowerment - Caregiver Acceptance & Resilience E-Learning (WE2CARE) project is a pilot intervention research project that aims to promote the mental well-being and resiliency of migrant live-in caregivers. The objectives include exploring the effectiveness of this program in achieving the following: (1) reducing psychological distress (depression, anxiety, and stress); (2) promoting committed actions of self-care; and (3) building mutual support social networks. Further, participants’ satisfaction with the intervention and their perceived barriers to and facilitators of practicing the self-care strategies embedded in WE2CARE will be examined. Methods: A total of 36 live-in caregivers residing in the Greater Toronto Area will be recruited and randomly assigned to either the intervention or waitlist control group. The intervention group will receive a 6-week web-based psychosocial intervention that will be based on Acceptance and Commitment Therapy (ACT). Standardized self-reported surveys will be administered online preintervention, postintervention, and at 6 weeks postintervention to assess mental distress (Depression, Anxiety and Stress Scale), psychological flexibility (Acceptance and Action Questionnaire), mindfulness (Cognitive and Affective Mindfulness Scale – Revised), and resilience (Multi-System Model of Resilience Inventory). In addition, two focus groups will be held with a subset of participants to explore their feedback on the utility of the WE2CARE program. Results: WE2CARE was funded in January 2019 for a year. The protocol was approved by the research ethics boards of Ryerson University (REB 2019-036) and the University of Toronto (RIS37623) in February and May 2019, respectively. Data collection started upon ethics approval and was completed by May 2020. A total of 29 caregivers completed the study and 20 participated in the focus groups. Data analyses are in progress and results will be published in 2021. Conclusions: WE2CARE could be a promising approach to reducing stress, promoting resilience, and providing a virtual space for peer emotional support and collaborative learning among socially isolated and marginalized women. The results of this pilot study will inform the adaptation of an ACT-based psychological intervention for online delivery and determine its utility in promoting mental health among disadvantaged and vulnerable populations. International Registered Report Identifier (IRRID): DERR1-10.2196/31211 %M 34515642 %R 10.2196/31211 %U https://www.researchprotocols.org/2021/9/e31211 %U https://doi.org/10.2196/31211 %U http://www.ncbi.nlm.nih.gov/pubmed/34515642 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e26513 %T Social Networking Site Use During the COVID-19 Pandemic and Its Associations With Social and Emotional Well-being in College Students: Survey Study %A Tuck,Alison B %A Thompson,Renee J %+ Department of Psychological and Brain Sciences, Washington University in St Louis, Campus Box 1125, One Brookings Drive, St Louis, MO, 63130, United States, 1 (314) 935 3502, alison.tuck@wustl.edu %K social media %K social networking sites %K COVID-19 %K loneliness %K well-being %D 2021 %7 7.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social distancing during the COVID-19 pandemic has reduced the frequency of in-person social interactions. College students were highly impacted, since many universities transferred curriculum from in-person to entirely online formats, physically separating students with little notice. With social distancing, their use of social networking sites (SNSs) likely changed during the COVID-19 pandemic, possibly holding implications for well-being. Objective: This study aimed to determine (1) how components of SNS use (ie, weekly frequency, time per day, habitual use, engagement, enjoyment, addiction, and emotional impact) changed from before to during COVID-19, (2) how these changes in SNS use were associated with pandemic-related social and emotional well-being, and (3) how SNS use and changes in use during the pandemic were associated with loneliness. Methods: College students (N=176) were surveyed during the time when their university campus in the United States was operating online. Participants completed the same SNS use questionnaires twice, once with regard to the month preceding the onset of COVID-19 and again with regard to the month since this time. They also reported the extent to which they experienced perceived change in social support resulting from the pandemic, pandemic-related stress, and general loneliness. Results: After the onset of COVID-19, participants showed an increase in daily time spent on SNSs (t169=5.53, d=0.42, P<.001), habitual use (t173=3.60, d=0.27, P<.001), and addiction (t173=4.96, d=0.38, P<.001); further, enjoyment on SNSs decreased (t173=–2.10, d=–0.16, P=.04) and the emotional impact of SNS activities became more negative (t172=–3.76, d=–0.29, P<.001). Increased perceived social support during COVID-19 was associated with changes in frequency of SNS use, time per day, addiction, and engagement (r>0.18 for all). Pandemic-related stress was associated with changes in SNS addiction and the extent to which one’s SNS content was related to the pandemic (r>0.20 for all). Loneliness was positively associated with SNS addiction (r=0.26) and negatively associated with SNS engagement (r=–0.19) during the pandemic. Loneliness was also negatively associated with changes in habit and engagement (r<–0.15 for all). Conclusions: Findings suggest that components of SNS use are associated with both positive and negative pandemic-related social outcomes, but largely negative pandemic-related emotional outcomes. Further, some components of SNS use are positively associated with loneliness (eg, addiction) while others show a negative association (eg, engagement). These findings provide a more nuanced picture of how SNS use is associated with social and emotional well-being during the time of a global health crisis when in-person interactions are scarce. %M 34313587 %R 10.2196/26513 %U https://formative.jmir.org/2021/9/e26513 %U https://doi.org/10.2196/26513 %U http://www.ncbi.nlm.nih.gov/pubmed/34313587 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e21348 %T Investigation of the Effects of an Online Support Group for Mental Health Problems on Stigma and Help-Seeking Among Japanese Adults: Cross-sectional Study %A Kobori,Osamu %A Yoshinaga,Naoki %+ Department of Psychology, International University of Health and Welfare, 4-1-26 Akasaka, Minato-ku, Tokyo, 1078402, Japan, 81 3 5574 3900, O.Kobori@iuhw.ac.jp %K online support group %K mental health %K depression %K stigma %K help-seeking %D 2021 %7 7.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Online support groups vary widely in both goals and structures owing to the rapid development of social networking services. Several studies have shown the potential effectiveness of online support groups, such as reducing psychological distress (eg, depression) among individuals with mental health problems. However, online support groups often do not aim at effectiveness regarding distress relief–related outcomes. Objective: This study aims to examine whether the use frequency of online support group platform functions (U2plus) is associated with lower stigma and higher consumer activation. Methods: A total of 350 U2plus users participated in a web-based survey. They were asked what therapy they had received in the past and how often they logged on to it, used each of its functions, and completed the following questionnaires: the Patient Health Questionnaire-9, the Devaluation-Discrimination Scale, and the General Help-Seeking Questionnaire. Results: Regarding the therapy received, 88% (308/350) of participants had taken medication for mental health problems, and 66.6% (233/350) had received psychotherapy or mental health counseling. Regarding use frequency, 21.7% (74/341) of the participants signed in to U2plus and used its functions more than once a week. The use frequency of U2plus functions was not correlated with perceived stigma, but the use frequency of some functions was weakly correlated with help-seeking intentions from formal sources (eg, doctors and psychologists). However, multiple regression analyses revealed that the use frequency of those functions did not uniquely predict help-seeking intentions. Conclusions: It was suggested that online support groups may serve as an alternative treatment option for those who are already undergoing pharmacological treatment and are willing to seek help from whatever source they deem helpful. %M 34491206 %R 10.2196/21348 %U https://formative.jmir.org/2021/9/e21348 %U https://doi.org/10.2196/21348 %U http://www.ncbi.nlm.nih.gov/pubmed/34491206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27137 %T Recovery Following Peer and Text Messaging Support After Discharge From Acute Psychiatric Care in Edmonton, Alberta: Controlled Observational Study %A Shalaby,Reham %A Hrabok,Marianne %A Spurvey,Pamela %A Abou El-Magd,Rabab M %A Knox,Michelle %A Rude,Rebecca %A Vuong,Wesley %A Surood,Shireen %A Urichuk,Liana %A Snaterse,Mark %A Greenshaw,Andrew J %A Li,Xin-Min %A Agyapong,Vincent Israel Opoku %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K peer support %K recovery %K controlled observational study %K inpatients %K mental health %K supportive text messages %D 2021 %7 3.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Peer support is an emotional, social, and practical help provided by nonprofessionals to assist others in sustaining health behaviors. Peer support is valued in recovery-oriented models of mental health and is becoming increasingly implemented at the organizational level. Text messaging is a relatively low-cost, high-impact, and easily scalable program that uses existing technology, is devoid of geographic barriers, and is easily accessible to end users. Objective: This study aims to evaluate the effectiveness of an innovative peer support system plus a supportive text messaging program on the recovery of discharged patients from acute psychiatric care. Methods: This prospective, rater blinded, controlled observational study included 181 patients who were discharged from acute psychiatric care. Patients were randomized to one of four conditions: treatment as usual (follow-up care), daily supportive text messages only, peer support only, or peer support plus daily supportive text messages. A standardized self-report measure of recovery (Recovery Assessment Scale [RAS]) was completed at baseline, 6 weeks, 3 months, and 6 months. Descriptive analysis, one-way analysis of variance, and repeated measures multivariate analysis of covariance were used to examine the changes in the RAS among the study groups and over the follow-up time points. Results: A total of 65 patients completed the assessments at each time point. For the overall sample, higher scores were found for the peer support plus text message condition compared with the text message only and treatment as usual condition on several scales (ie, willingness to ask for help and personal confidence and hope) and total score on the RAS, after 6 months of intervention. Conclusions: Peer support plus supportive text messaging seems to result in improved recovery compared with other interventions. It may be advisable to incorporate the two interventions as part of routine practice for patients with psychiatric disorders upon hospital discharge. %M 34477565 %R 10.2196/27137 %U https://formative.jmir.org/2021/9/e27137 %U https://doi.org/10.2196/27137 %U http://www.ncbi.nlm.nih.gov/pubmed/34477565 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28600 %T Optimizing the Periconception Lifestyle of Women With Overweight Using a Blended Personalized Care Intervention Combining eHealth and Face-to-face Counseling (eFUSE): Protocol for a Randomized Controlled Trial %A van der Windt,Melissa %A Schoenmakers,Sam %A Willemsen,Sten %A van Rossem,Lenie %A Steegers-Theunissen,Régine %+ Department of Obstetrics and Gynecology, Erasmus MC, University Medical Center, Wytemaweg 80, Rotterdam, 3015 CN, Netherlands, 31 107036815, r.steegers@erasmusmc.nl %K eHealth %K periconception period %K lifestyle intervention %K maternal and child health %K pregnancy %K birth outcomes %K healthy lifestyle %K psychotherapy %K obesity %K randomized controlled trial %K behavior change %D 2021 %7 3.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Maternal overweight has a substantial impact on reproductive, maternal, pregnancy, and neonatal outcomes with long-term and transgenerational health consequences. Interventions that aim to optimize periconception maternal lifestyle can improve maternal and fetal health during pregnancy and throughout the life course. However, it remains difficult to change and adopt adequate lifestyle behaviors. We hypothesize that additional psychological therapy targeting cognitive and affective factors substantially contribute to the effectiveness of these interventions. Objective: The proposed study aims to examine the feasibility and effectiveness of a blended personalized periconception lifestyle care intervention with additional psychological therapy aimed at women with a BMI≥25 and who are contemplating pregnancy or are already pregnant (≤12 weeks) in reducing inadequate lifestyle behaviors and improving early and late pregnancy outcome. Methods: The eHealth and Face-to-face Counseling (eFUSE) study follows a single-center two-arm randomized controlled trial design at the Erasmus MC, University Medical Center, with a multicenter regional referral. The female patients with overweight (BMI≥25), together with their male partner, will be stratified by pregnancy status (preconception vs pregnant) and randomized to receive either the blended personalized periconception lifestyle care intervention with additional psychological therapy (n=313) or usual care (n=313). The primary outcome is a change in the lifestyle risk score (between baseline and 24 weeks) between the randomization arms (difference in differences). Secondary outcomes include measurements defined as most relevant by the International Consortium for Health Outcomes Measurement, including behavioral determinants, patient satisfaction, provider feasibility, and maternal pregnancy and neonatal complications. Results: The study will be open for recruitment from Fall 2021 onward. Data collection is expected to be completed by the beginning of 2023, and the results are expected to be published by Fall 2023. Conclusions: This study will evaluate the feasibility and effectiveness of a blended periconception lifestyle intervention with additional psychological therapy, aimed at women with a BMI≥25. Positive results of this innovative care approach will be used for implementation in routine medical care of all women with overweight, with the ultimate aim to improve clinical outcomes of these high-risk pregnancies. Trial Registration: Netherlands Trial Register NL9264; https://www.trialregister.nl/trial/9264 International Registered Report Identifier (IRRID): PRR1-10.2196/28600 %M 34477561 %R 10.2196/28600 %U https://www.researchprotocols.org/2021/9/e28600 %U https://doi.org/10.2196/28600 %U http://www.ncbi.nlm.nih.gov/pubmed/34477561 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e28849 %T Implementing Home Office Work at a Large Psychiatric University Hospital in Switzerland During the COVID-19 Pandemic: Field Report %A Krückl,Jana Sophia %A Moeller,Julian %A Gaupp,Rainer %A Meier,Christoph E %A Roth,Carl Bénédict %A Lang,Undine Emmi %A Huber,Christian G %+ University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, Basel, 4002, Switzerland, 41 61 325 52 00, jana.krueckl@upk.ch %K home office %K psychiatry %K employees %K mental health %K depression %K anxiety %K stress factors %K Patient Health Questionnaire %K PHQ-2 %K General Anxiety Disorder %K GAD-2 %K PHQ-D %K COVID-19 %K pandemic %D 2021 %7 1.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic in 2020, psychiatric hospitals all over the world had to adapt their services to the prevailing governmental regulations. As a consequence, home office use and telepsychiatry boomed. Objective: The purpose of this study was to evaluate the potential of home office use, its adoption, and the association of home office use with employees’ mental health in a large psychiatric university hospital in Switzerland. Methods: We obtained and analyzed home office implementation and use data from the psychiatric university hospital’s information technology services. We also conducted a cross-sectional web-based survey to assess the employees’ attitudes toward the clinic’s crisis management during the COVID-19 pandemic in early 2020. Part of this web-based survey consisted of questions about home office use between March and June 2020, attitudes toward home office implementation, and mental health. Three mental health measures assessed depressive symptoms (Patient Health Questionnaire [PHQ]–2), anxiety (General Anxiety Disorder [GAD]–2), and stress factors (stress module of the PHQ-D); a cut-off score ≥3 was used for the PHQ-2 and GAD-2. Results: Of the 200 participating employees, 69 reported that they had worked from home at least partially (34.5%). Home office use differed significantly across professional groups (χ162=72.72, P≤.001, n=200). Employees experienced neither depressive symptoms (mean 0.76, SD 1.14) nor anxiety (mean 0.70, SD 1.03). The employees reported minor psychosocial stressors (mean 2.83, SD 2.92). The number of reported stress factors varied significantly across groups with different levels of home office use (χ42=9.72, P=.04). Conclusions: In general, home office implementation appears to be feasible for large psychiatric hospitals, however, it is not equally feasible for all professional groups. Professional groups that require personal contact with patients and technical or manual tasks must work onsite. Further evaluation of home office use in psychiatric hospitals up to the development of clinics that function merely online will follow in future research. The situation created by the COVID-19 pandemic served as a stepping stone to promote home office use and should be used to improve employees’ work–life balance, to save employers costs and foster other benefits. %M 34115606 %R 10.2196/28849 %U https://mental.jmir.org/2021/9/e28849 %U https://doi.org/10.2196/28849 %U http://www.ncbi.nlm.nih.gov/pubmed/34115606 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26223 %T Factors That Help and Hinder the Implementation of Digital Depression Prevention Programs: School-Based Cross-sectional Study %A Beames,Joanne R %A Johnston,Lara %A O'Dea,Bridianne %A Torok,Michelle %A Christensen,Helen %A Boydell,Katherine M %A Werner-Seidler,Aliza %+ Black Dog Institute, University of New South Wales, Hospital Road, Randwick, 2031, Australia, 61 2 9382 ext 8776, j.beames@blackdog.org.au %K secondary school %K depression %K prevention %K digital %K barrier %K facilitator %K teacher %K counselor %K principal %K student %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital prevention programs that are delivered in a school environment can inoculate young people against depression. However, little is known about the school-based factors that help and hinder the implementation of these programs. Staff members are integral for supporting mental health programs in schools and are likely to have a wealth of expertise and knowledge about the factors that affect implementation. Objective: The primary objective of this study was to explore the barriers and facilitators to implementing a digital depression prevention program in Australian secondary schools with teachers, counselors, and principals. The secondary objective was to explore variations in these factors across different school contexts, including the school type (government or nongovernment), location (capital city, regional/or rural areas), and socioeconomic status (SES) (low, medium, high). Methods: This quantitative cross-sectional survey study assessed the barriers and facilitators to implementing a hypothetical digital prevention program in Australian schools. The survey was taken by 97 teachers (average age 38.3 years), 93 counselors (average age 39.5 years), and 11 principals (average age 50.9 years) across Australia between November 2017 and July 2018. Results: A range of barriers and facilitators relating to logistics and resources, staff support, and program factors were endorsed by the surveyed staff. Consistent with prior research, common barriers included a lack of time and resources (ie, staff and rooms). These barriers were particularly evident in government, rural/regional, and low socioeconomic schools. Other barriers were specific to digital delivery, including privacy issues and a lack of clarity around staff roles and responsibilities. Facilitators included upskilling staff through training, embedding the program into the curriculum, and other program factors including universal delivery, screening of students’ mental health, and clear referral pathways. Knowledge about the program efficacy was also perceived as important by a large proportion of the respondents. Conclusions: The digital depression prevention program was perceived as suitable for use within different schools in Australia, although certain factors need to be considered to enable effective implementation. Logistics and resources, support, and program factors were identified as particularly important for school-based implementation. To maximize the effectiveness in delivering digital programs, implementation may need to be tailored to the staff roles and school types. %M 34448701 %R 10.2196/26223 %U https://www.jmir.org/2021/8/e26223 %U https://doi.org/10.2196/26223 %U http://www.ncbi.nlm.nih.gov/pubmed/34448701 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e30098 %T Telemental Health For Youth With Chronic Illnesses: Systematic Review %A Lau,Nancy %A Colt,Susannah F %A Waldbaum,Shayna %A O'Daffer,Alison %A Fladeboe,Kaitlyn %A Yi-Frazier,Joyce P %A McCauley,Elizabeth %A Rosenberg,Abby R %+ Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, 1920 Terry Ave, Seattle, WA, 98101, United States, 1 206 884 0569, nancy.lau@seattlechildrens.org %K telehealth care %K mental health %K psychosocial issues %K psychiatry %K psychology %K child %K chronic disease %D 2021 %7 27.8.2021 %9 Review %J JMIR Ment Health %G English %X Background: Children, adolescents, and young adults with chronic conditions experience difficulties coping with disease-related stressors, comorbid mental health problems, and decreased quality of life. The COVID-19 pandemic has led to a global mental health crisis, and telemental health has necessarily displaced in-person care. However, it remains unknown whether such remote interventions are feasible or efficacious. We aimed to fill this research-practice gap. Objective: In this systematic review, we present a synthesis of studies examining the feasibility and efficacy of telemental health interventions for youth aged ≤25 years with chronic illnesses. Methods: PubMed, Embase, Web of Science, PsycInfo, and Cochrane Database of Systematic Reviews were searched from 2008 to 2020. We included experimental, quasiexperimental, and observational studies of telemental health interventions designed for children, adolescents, and young adults aged ≤25 years with chronic illnesses, in which feasibility or efficacy outcomes were measured. Only English-language publications in peer-reviewed journals were included. We excluded studies of interventions for caregivers or health care providers, mental health problems not in the context of a chronic illness, disease and medication management, and prevention programs for healthy individuals. Results: We screened 2154 unique study records and 109 relevant full-text articles. Twelve studies met the inclusion criteria, and they represented seven unique telemental health interventions. Five of the studies included feasibility outcomes and seven included efficacy outcomes. All but two studies were pilot studies with relatively small sample sizes. Most interventions were based on cognitive behavioral therapy and problem-solving therapy. The subset of studies examining intervention feasibility concluded that telemental health interventions were appropriate, acceptable, and satisfactory to patients and their parents. Technology did not create barriers in access to care. For the subset of efficacy studies, evidence in support of the efficacy of telemental health was mixed. Significant heterogeneity in treatment type, medical diagnoses, and outcomes precluded a meta-analysis. Conclusions: The state of the science for telemental health interventions designed for youth with chronic illnesses is in a nascent stage. Early evidence supports the feasibility of telehealth-based delivery of traditional in-person interventions. Few studies have assessed efficacy, and current findings are mixed. Future research should continue to evaluate whether telemental health may serve as a sustainable alternative to in-person care after the COVID pandemic. %M 34448724 %R 10.2196/30098 %U https://mental.jmir.org/2021/8/e30098 %U https://doi.org/10.2196/30098 %U http://www.ncbi.nlm.nih.gov/pubmed/34448724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e26119 %T Distant Supervision for Mental Health Management in Social Media: Suicide Risk Classification System Development Study %A Fu,Guanghui %A Song,Changwei %A Li,Jianqiang %A Ma,Yue %A Chen,Pan %A Wang,Ruiqian %A Yang,Bing Xiang %A Huang,Zhisheng %+ School of Health Sciences, Wuhan University, Wuchang District, Wuhan, 430072, China, 86 15902731922, 00009312@whu.edu.cn %K deep learning %K distant supervision %K mental health %K crisis prevention %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based social media provides common people with a platform to express their emotions conveniently and anonymously. There have been nearly 2 million messages in a particular Chinese social media data source, and several thousands more are generated each day. Therefore, it has become impossible to analyze these messages manually. However, these messages have been identified as an important data source for the prevention of suicide related to depression disorder. Objective: We proposed in this paper a distant supervision approach to developing a system that can automatically identify textual comments that are indicative of a high suicide risk. Methods: To avoid expensive manual data annotations, we used a knowledge graph method to produce approximate annotations for distant supervision, which provided a basis for a deep learning architecture that was built and refined by interactions with psychology experts. There were three annotation levels, as follows: free annotations (zero cost), easy annotations (by psychology students), and hard annotations (by psychology experts). Results: Our system was evaluated accordingly and showed that its performance at each level was promising. By combining our system with several important psychology features from user blogs, we obtained a precision of 80.75%, a recall of 75.41%, and an F1 score of 77.98% for the hardest test data. Conclusions: In this paper, we proposed a distant supervision approach to develop an automatic system that can classify high and low suicide risk based on social media comments. The model can therefore provide volunteers with early warnings to prevent social media users from committing suicide. %M 34435964 %R 10.2196/26119 %U https://www.jmir.org/2021/8/e26119 %U https://doi.org/10.2196/26119 %U http://www.ncbi.nlm.nih.gov/pubmed/34435964 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e29419 %T The Persistence of the Impact of COVID-19–Related Distress, Mood Inertia, and Loneliness on Mental Health During a Postlockdown Period in Germany: An Ecological Momentary Assessment Study %A Haucke,Matthias %A Liu,Shuyan %A Heinzel,Stephan %+ Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, Berlin, Germany, 49 30450517002, siyan908@hotmail.com %K COVID-19 %K outbreaks %K epidemics %K pandemics %K psychological responses and emotional well-being %K ecological momentary assessment %K risk and protective factors %K low incidence and restrictions %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The first wave of the COVID-19 pandemic in early 2020 increased mental health problems globally. However, little is known about mental health problems during a low-incidence period of the pandemic without strict public health measures. Objective: We aim to investigate whether COVID-19–related risk factors for mental health problems persist beyond lockdown measures. We targeted a vulnerable population that is at risk of developing low mental health and assessed their daily dynamics of mood and emotion regulation after a strict lockdown. Methods: During a postlockdown period in Germany (between August 8, 2020, and November 1, 2020), we conducted an ecological momentary assessment with 131 participants who experienced at least mild COVID-19–related distress and loneliness. To estimate negative mood inertia, we built a lag-1 three-level autoregressive model. Results: We found that information exposure and active daily COVID-19 cases did not have an impact on negative mood amid a postlockdown period. However, there was a day-to-day carryover effect of negative mood. In addition, worrying about COVID-19, feeling restricted by COVID-19, and feeling lonely increased negative mood. Conclusions: The mental health of a vulnerable population is still challenged by COVID-19–related stressors after the lifting of a strict lockdown. This study highlights the need to protect mental health during postpandemic periods. %M 34347622 %R 10.2196/29419 %U https://mental.jmir.org/2021/8/e29419 %U https://doi.org/10.2196/29419 %U http://www.ncbi.nlm.nih.gov/pubmed/34347622 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e27379 %T Integration of Digital Tools Into Community Mental Health Care Settings That Serve Young People: Focus Group Study %A Knapp,Ashley A %A Cohen,Katherine %A Nicholas,Jennifer %A Mohr,David C %A Carlo,Andrew D %A Skerl,Joshua J %A Lattie,Emily G %+ Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, Chicago, IL, 60611, United States, 1 312 503 3751, Ashley.knapp@northwestern.edu %K digital mental health %K treatment %K young people %K children %K adolescents %K community mental health care %K mobile phone %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital mental health tools have substantial potential to be easily integrated into people’s lives and fundamentally impact public health. Such tools can extend the reach and maximize the impact of mental health interventions. Before implementing digital tools in new settings, it is critical to understand what is important to organizations and individuals who will implement and use these tools. Given that young people are highly familiar with technology and many mental health concerns emerge in childhood and adolescence, it is especially crucial to understand how digital tools can be integrated into settings that serve young people. Objective: This study aims to learn about considerations and perspectives of community behavioral health care providers on incorporating digital tools into their clinical care for children and adolescents. Methods: Data were analyzed from 5 focus groups conducted with clinicians (n=37) who work with young people at a large community service organization in the United States. This organization provides care to more than 27,000 people annually, most of whom are of low socioeconomic status. The transcripts were coded using thematic analysis. Results: Clinicians first provided insight into the digital tools they were currently using in their treatment sessions with young people, such as web-based videos and mood-tracking apps. They explained that their main goals in using these tools were to help young people build skills, facilitate learning, and monitor symptoms. Benefits were expressed, such as engagement of adolescents in treatment, along with potential challenges (eg, accessibility and limited content) and developmental considerations (eg, digital devices getting taken away as punishment). Clinicians discussed their desire for a centralized digital platform that securely connects the clinician, young person, and caregivers. Finally, they offered several considerations for integrating digital tools into mental health care, such as setting up expectations with clients and the importance of human support. Conclusions: Young people have unique considerations related to complex accessibility patterns and technology expectations that may not be observed when adults are the intended users of mental health technologies. Therefore, these findings provide critical insights to inform the development of future tools, specifically regarding connectivity, conditional restraints (eg, devices taken away as punishment and school restrictions), expectations of users from different generations, and the blended nature in which digital tools can support young people. %M 34420928 %R 10.2196/27379 %U https://mental.jmir.org/2021/8/e27379 %U https://doi.org/10.2196/27379 %U http://www.ncbi.nlm.nih.gov/pubmed/34420928 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e24393 %T Development of a Mobile App to Support Self-management of Anxiety and Depression in African American Women: Usability Study %A McCall,Terika %A Ali,Muhammad Osama %A Yu,Fei %A Fontelo,Paul %A Khairat,Saif %+ Center for Medical Informatics, Yale School of Medicine, 300 George Street, Suite 501, New Haven, CT, 06511, United States, 1 203 737 5379, terika.mccall@yale.edu %K African Americans %K women %K mental health %K anxiety %K depression %K telemedicine %K mHealth %K mobile applications %K digital health %K user-centered design %K mobile phone %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety and depressive disorders are the most common mental health conditions among African American women. Despite the need for mental health care, African American women significantly underuse mental health services. Previous mobile health studies revealed significant improvements in anxiety or depressive symptoms after intervention. The use of mobile apps offers the potential to eliminate or mitigate barriers for African American women who are seeking access to mental health services and resources. Objective: This study aims to evaluate the usability of the prototype of an app that is designed for supporting the self-management of anxiety and depression in African American women. Methods: Individual usability testing sessions were conducted with 15 participants in Chapel Hill, North Carolina. Cognitive walkthrough and think-aloud protocols were used to evaluate the user interface. Eye-tracking glasses were used to record participants’ visual focus and gaze path as they performed the tasks. The Questionnaire for User Interface Satisfaction was administered after each session to assess the participants’ acceptance of the app. Results: Participants rated the usability of the prototype positively and provided recommendations for improvement. The average of the mean scores for usability assessments (ie, overall reactions to the software, screen, terminology and app information, learning, and app capabilities) ranged from 7.2 to 8.8 on a scale of 0-9 (low to high rating) for user tasks. Most participants were able to complete each task with limited or no assistance. Design recommendations included improving the user interface by adding graphics and color, adding a tutorial for first-time users, curating a list of Black women therapists within the app, adding details about tracking anxiety and depression in the checkup graphs, informing users that they can use the talk-to-text feature for journal entries to reduce burden, relabeling the mental health information icon, monitoring for crisis support, and improving clickthrough sequencing. Conclusions: This study provides a better understanding of user experience with an app tailored to support the management of anxiety and depression for African American women, which is an underserved group. As African American women have high rates of smartphone ownership, there is a great opportunity to use mobile technology to provide access to needed mental health services and resources. Future work will include incorporating feedback from usability testing and focus group sessions to refine and develop the app further. The updated app will undergo iterative usability testing before launching the pilot study to evaluate the feasibility and acceptability of the prototype. %M 34133313 %R 10.2196/24393 %U https://formative.jmir.org/2021/8/e24393 %U https://doi.org/10.2196/24393 %U http://www.ncbi.nlm.nih.gov/pubmed/34133313 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26369 %T The Experience of Key Stakeholders During the Implementation and Use of Trauma Therapy via Digital Health for Military, Veteran, and Public Safety Personnel: Qualitative Thematic Analysis %A Smith-MacDonald,Lorraine %A Jones,Chelsea %A Sevigny,Phillip %A White,Allison %A Laidlaw,Alexa %A Voth,Melissa %A Mikolas,Cynthia %A Heber,Alexandra %A Greenshaw,Andrew J %A Brémault-Phillips,Suzette %+ Heroes in Mind, Advocacy and Research Consortium (HiMARC), Faculty of Rehabilitation Medicine, University of Alberta, 1-94 Corbett Hall, 8205 - 114 Street, Edmonton, AB, T6G 2G4, Canada, 1 7804920404, cweiman@ualberta.ca %K trauma %K mental health %K telemedicine %K therapy %K rehabilitation %K digital health %K psychotherapy %K military %K veteran %K first responder %K public safety personnel %K teletherapy %K psychotherapy %K telepsychiatry %K mobile phone %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Exposure to occupational stressors and potentially psychologically traumatic events experienced by public safety personnel (eg, paramedics, police, fire, and correctional officers), military members, and veterans can lead to the development of posttraumatic stress injuries and other mental health disorders. Providing emergency services during COVID-19 has intensified the challenges. Owing to COVID-19 restrictions, mental health service providers offering support to these populations have had to rapidly pivot to use digital versus in-person methods of service delivery. Objective: This paper aims to explore the experience of mental health service providers regarding digital health service delivery, including the current state of digital mental health service delivery, barriers to and facilitators of the use of digital health for mental health service delivery experienced during the pandemic, and recommendations for implementing and integrating digital health into regular mental health service delivery. Methods: This embedded mixed-methods study included questionnaires and focus groups with key stakeholders (N=31) with knowledge and experience in providing mental health services. Data analysis included descriptive, quantitative, and qualitative thematic analyses. Results: The following three themes emerged: being forced into change, daring to deliver mental health services using digital health, and future possibilities offered by digital health. In each theme, participants’ responses reflected their perceptions of service providers, organizations, and clients. The findings offer considerations regarding for whom and at what point in treatment digital health delivery is appropriate; recommendations for training, support, resources, and guidelines for digitally delivering trauma therapy; and a better understanding of factors influencing mental health service providers’ perceptions and acceptance of digital health for mental health service delivery. Conclusions: The results indicate the implementation of digital health for mental health service delivery to military members, public safety personnel, and veterans. As the COVID-19 pandemic continues, remote service delivery methods for trauma therapy are urgently needed to support the well-being of those who have served and continue to serve. %M 34387549 %R 10.2196/26369 %U https://formative.jmir.org/2021/8/e26369 %U https://doi.org/10.2196/26369 %U http://www.ncbi.nlm.nih.gov/pubmed/34387549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e20678 %T Artificial Intelligence–Based Chatbot for Anxiety and Depression in University Students: Pilot Randomized Controlled Trial %A Klos,Maria Carolina %A Escoredo,Milagros %A Joerin,Angela %A Lemos,Viviana Noemí %A Rauws,Michiel %A Bunge,Eduardo L %+ Interdisciplinary Center for Research in Health and Behavioral Sciences (CIICSAC), Universidad Adventista del Plata (UAP)., National Scientific and Technical Research Council (CONICET)., 25 de Mayo 99, Libertador San Martín, Entre Ríos, 3103, Argentina, 54 3435064263, mcarolinaklos@gmail.com %K artificial intelligence %K chatbots %K conversational agents %K mental health %K anxiety %K depression %K college students %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Artificial intelligence–based chatbots are emerging as instruments of psychological intervention; however, no relevant studies have been reported in Latin America. Objective: The objective of the present study was to evaluate the viability, acceptability, and potential impact of using Tess, a chatbot, for examining symptoms of depression and anxiety in university students. Methods: This was a pilot randomized controlled trial. The experimental condition used Tess for 8 weeks, and the control condition was assigned to a psychoeducation book on depression. Comparisons were conducted using Mann-Whitney U and Wilcoxon tests for depressive symptoms, and independent and paired sample t tests to analyze anxiety symptoms. Results: The initial sample consisted of 181 Argentinian college students (158, 87.2% female) aged 18 to 33. Data at week 8 were provided by 39 out of the 99 (39%) participants in the experimental condition and 34 out of the 82 (41%) in the control group. On an average, 472 (SD 249.52) messages were exchanged, with 116 (SD 73.87) of the messages sent from the users in response to Tess. A higher number of messages exchanged with Tess was associated with positive feedback (F2,36=4.37; P=.02). No significant differences between the experimental and control groups were found from the baseline to week 8 for depressive and anxiety symptoms. However, significant intragroup differences demonstrated that the experimental group showed a significant decrease in anxiety symptoms; no such differences were observed for the control group. Further, no significant intragroup differences were found for depressive symptoms. Conclusions: The students spent a considerable amount of time exchanging messages with Tess and positive feedback was associated with a higher number of messages exchanged. The initial results show promising evidence for the usability and acceptability of Tess in the Argentinian population. Research on chatbots is still in its initial stages and further research is needed. %M 34092548 %R 10.2196/20678 %U https://formative.jmir.org/2021/8/e20678 %U https://doi.org/10.2196/20678 %U http://www.ncbi.nlm.nih.gov/pubmed/34092548 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e26348 %T Validity of the Aktibipo Self-rating Questionnaire for the Digital Self-assessment of Mood and Relapse Detection in Patients With Bipolar Disorder: Instrument Validation Study %A Anýž,Jiří %A Bakštein,Eduard %A Dally,Andrea %A Kolenič,Marián %A Hlinka,Jaroslav %A Hartmannová,Tereza %A Urbanová,Kateřina %A Correll,Christoph U %A Novák,Daniel %A Španiel,Filip %+ National Insitute of Mental Health, Topolová 748, Klecany, 250 67, Czech Republic, 420 283 088 409, jiri.anyz@nudz.cz %K bipolar disorder %K symptom monitoring %K ecological mood assessment %K relapse detection %K mobile application %K mobile phone %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Self-reported mood is a valuable clinical data source regarding disease state and course in patients with mood disorders. However, validated, quick, and scalable digital self-report measures that can also detect relapse are still not available for clinical care. Objective: In this study, we aim to validate the newly developed ASERT (Aktibipo Self-rating) questionnaire—a 10-item, mobile app–based, self-report mood questionnaire consisting of 4 depression, 4 mania, and 2 nonspecific symptom items, each with 5 possible answers. The validation data set is a subset of the ongoing observational longitudinal AKTIBIPO400 study for the long-term monitoring of mood and activity (via actigraphy) in patients with bipolar disorder (BD). Patients with confirmed BD are included and monitored with weekly ASERT questionnaires and monthly clinical scales (Montgomery-Åsberg Depression Rating Scale [MADRS] and Young Mania Rating Scale [YMRS]). Methods: The content validity of the ASERT questionnaire was assessed using principal component analysis, and the Cronbach α was used to assess the internal consistency of each factor. The convergent validity of the depressive or manic items of the ASERT questionnaire with the MADRS and YMRS, respectively, was assessed using a linear mixed-effects model and linear correlation analyses. In addition, we investigated the capability of the ASERT questionnaire to distinguish relapse (YMRS≥15 and MADRS≥15) from a nonrelapse (interepisode) state (YMRS<15 and MADRS<15) using a logistic mixed-effects model. Results: A total of 99 patients with BD were included in this study (follow-up: mean 754 days, SD 266) and completed an average of 78.1% (SD 18.3%) of the requested ASERT assessments (completion time for the 10 ASERT questions: median 24.0 seconds) across all patients in this study. The ASERT depression items were highly associated with MADRS total scores (P<.001; bootstrap). Similarly, ASERT mania items were highly associated with YMRS total scores (P<.001; bootstrap). Furthermore, the logistic mixed-effects regression model for scale-based relapse detection showed high detection accuracy in a repeated holdout validation for both depression (accuracy=85%; sensitivity=69.9%; specificity=88.4%; area under the receiver operating characteristic curve=0.880) and mania (accuracy=87.5%; sensitivity=64.9%; specificity=89.9%; area under the receiver operating characteristic curve=0.844). Conclusions: The ASERT questionnaire is a quick and acceptable mood monitoring tool that is administered via a smartphone app. The questionnaire has a good capability to detect the worsening of clinical symptoms in a long-term monitoring scenario. %M 34383689 %R 10.2196/26348 %U https://mental.jmir.org/2021/8/e26348 %U https://doi.org/10.2196/26348 %U http://www.ncbi.nlm.nih.gov/pubmed/34383689 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e25650 %T A Compassion-Focused Ecological Momentary Intervention for Enhancing Resilience in Help-Seeking Youth: Uncontrolled Pilot Study %A Rauschenberg,Christian %A Boecking,Benjamin %A Paetzold,Isabell %A Schruers,Koen %A Schick,Anita %A van Amelsvoort,Thérèse %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 621 1703 1930, ulrich.reininghaus@zi-mannheim.de %K mental health %K adolescent psychopathology %K digital interventions %K mobile health %K self-compassion %K ecological momentary assessment %K mobile phone %D 2021 %7 5.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital interventions offer new avenues for low-threshold prevention and treatment in young people. Ecological momentary interventions (EMIs) represent a powerful approach that allows for adaptive, real-time, and real-world delivery of intervention components in daily life by real-time processing of ecological momentary assessment (EMA) data. Compassion-focused interventions (CFIs) may be particularly amenable to translation into an EMI to strengthen emotional resilience and modify putative risk mechanisms, such as stress sensitivity, in the daily lives of young help-seeking individuals. Objective: This study aims to investigate the feasibility, safety, and initial therapeutic effects of a novel, accessible, transdiagnostic, ecological momentary CFI for improving emotional resilience to stress (EMIcompass). Methods: In this uncontrolled pilot study, help-seeking youth with psychotic, depressive, or anxiety symptoms were offered the EMIcompass intervention in addition to treatment as usual. The EMIcompass intervention consisted of a 3-week EMI (including enhancing, consolidating, and EMA-informed interactive tasks) administered through a mobile health app and three face-to-face sessions with a trained psychologist intended to provide guidance and training on the CFI exercises presented in the app (ie, training session, follow-up booster session, and review session). Results: In total, 10 individuals (mean age 20.3 years, SD 3.8; range 14-25) were included in the study. Most (8/10, 80%) participants were satisfied and reported a low burden of app usage. No adverse events were observed. In approximately one-third of all EMAs, individuals scored high on stress, negative affect, or threat anticipation during the intervention period, resulting in real-time, interactive delivery of the CFI intervention components in addition to weekly enhancing and daily consolidating tasks. Although the findings should be interpreted with caution because of the small sample size, reduced stress sensitivity, momentary negative affect, and psychotic experiences, along with increased positive affect, were found at postintervention and the 4-week follow-up. Furthermore, reductions in psychotic, anxiety, and depressive symptoms were found (r=0.30-0.65). Conclusions: Our findings provide evidence on the feasibility and safety of the EMIcompass intervention for help-seeking youth and lend initial support to beneficial effects on stress sensitivity and mental health outcomes. An exploratory randomized controlled trial is warranted to establish the feasibility and preliminary evidence of its efficacy. %M 34383687 %R 10.2196/25650 %U https://mental.jmir.org/2021/8/e25650 %U https://doi.org/10.2196/25650 %U http://www.ncbi.nlm.nih.gov/pubmed/34383687 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e28360 %T Mental Health and the Perceived Usability of Digital Mental Health Tools Among Essential Workers and People Unemployed Due to COVID-19: Cross-sectional Survey Study %A Mata-Greve,Felicia %A Johnson,Morgan %A Pullmann,Michael D %A Friedman,Emily C %A Griffith Fillipo,Isabell %A Comtois,Katherine A %A Arean,Patricia %+ Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 206 616 2129, parean@uw.edu %K digital health %K COVID-19 %K essential worker %K unemployed %K usability %K user burden %K mental health %K e-mental health %K survey %K distress %D 2021 %7 5.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: COVID-19 has created serious mental health consequences for essential workers or people who have become unemployed as a result of the pandemic. Digital mental health tools have the potential to address this problem in a timely and efficient manner. Objective: The purpose of this study was to document the extent of digital mental health tool (DMHT) use by essential workers and those unemployed due to COVID-19, including asking participants to rate the usability and user burden of the DMHT they used most to cope. We also explored which aspects and features of DMHTs were seen as necessary for managing stress during a pandemic by having participants design their own ideal DMHT. Methods: A total of 2000 people were recruited from an online research community (Prolific) to complete a one-time survey about mental health symptoms, DMHT use, and preferred digital mental health features. Results: The final sample included 1987 US residents that identified as either an essential worker or someone who was unemployed due to COVID-19. Almost three-quarters of the sample (1479/1987, 74.8%) reported clinically significant emotional distress. Only 14.2% (277/1957) of the sample used a DMHT to cope with stress associated with COVID-19. Of those who used DMHTs to cope with COVID-19, meditation apps were the most common (119/261, 45.6%). Usability was broadly in the acceptable range, although participants unemployed due to COVID-19 were less likely to report user burden with DMHTs than essential workers (t198.1=–3.89, P<.001). Individuals with emotional distress reported higher financial burden for their DMHT than nondistressed individuals (t69.0=–3.21, P=.01). When the sample was provided the option to build their own DMHT, the most desired features were a combination of mindfulness/meditation (1271/1987, 64.0%), information or education (1254/1987, 63.1%), distraction tools (1170/1987, 58.9%), symptom tracking for mood and sleep (1160/1987, 58.4%), link to mental health resources (1140/1987, 57.4%), and positive psychology (1131/1986, 56.9%). Subgroups by employment, distress, and previous DMHT use status had varied preferences. Of those who did not use a DMHT to cope with COVID-19, most indicated that they did not consider looking for such a tool to help with coping (1179/1710, 68.9%). Conclusions: Despite the potential need for DMHTs, this study found that the use of such tools remains similar to prepandemic levels. This study also found that regardless of the level of distress or even past experience using an app to cope with COVID-19, it is possible to develop a COVID-19 coping app that would appeal to a majority of essential workers and unemployed persons. %M 34081592 %R 10.2196/28360 %U https://mental.jmir.org/2021/8/e28360 %U https://doi.org/10.2196/28360 %U http://www.ncbi.nlm.nih.gov/pubmed/34081592 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e30813 %T Smartphone Delivery of Cognitive Behavioral Therapy for Postintensive Care Syndrome-Family: Protocol for a Pilot Study %A Petrinec,Amy B %A Hughes,Joel W %A Zullo,Melissa D %A Wilk,Cindy %A George,Richard L %+ College of Nursing, Kent State University, Henderson Hall, 1375 University Esplanade, Kent, OH, 44242, United States, 1 3307152987, apetrine@kent.edu %K postintensive care syndrome-family %K mobile health app %K cognitive behavioral therapy %K mobile phone %D 2021 %7 4.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Family members of critically ill patients experience symptoms of postintensive care syndrome-family (PICS-F), including anxiety, depression, and posttraumatic stress disorder. Postintensive care syndrome-family reduces the quality of life of the families of critically ill patients and may impede the recovery of such patients. Cognitive behavioral therapy has become a first-line nonpharmacological treatment of many psychological symptoms and disorders, including anxiety, depression, and posttraumatic stress. With regard to managing mild-to-moderate symptoms, the delivery of cognitive behavioral therapy via mobile technology without input from a clinician has been found to be feasible and well accepted, and its efficacy rivals that of face-to-face therapy. Objective: The purpose of our pilot study is to examine the efficacy of using a smartphone mobile health (mHealth) app to deliver cognitive behavioral therapy and diminish the severity and prevalence of PICS-F symptoms in family members of critically ill patients. Methods: For our pilot study, 60 family members of critically ill patients will be recruited. A repeated-measures longitudinal study design that involves the randomization of participants to 2 groups (the control and intervention groups) will be used. The intervention group will receive cognitive behavioral therapy, which will be delivered via a smartphone mHealth app. Bandura’s social cognitive theory and an emphasis on mental health self-efficacy form the theoretical framework of the study. Results: Recruitment for the study began in August 2020. Data collection and analysis are expected to be completed by March 2022. Conclusions: The proposed study represents a novel approach to the treatment of PICS-F symptoms and is an extension of previous work conducted by the research team. The study will be used to plan a fully powered randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04316767; https://clinicaltrials.gov/ct2/show/NCT04316767 International Registered Report Identifier (IRRID): DERR1-10.2196/30813 %M 34346900 %R 10.2196/30813 %U https://www.researchprotocols.org/2021/8/e30813 %U https://doi.org/10.2196/30813 %U http://www.ncbi.nlm.nih.gov/pubmed/34346900 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26852 %T Patients’ Experiences of Using a Self-help App for Posttraumatic Stress Disorder: Qualitative Study %A Riisager,Lisa H G %A Christensen,Anne Bryde %A Scharff,Frederik Bernt %A Arendt,Ida-Marie T P %A Ismail,Israa %A Lau,Marianne Engelbrecht %A Moeller,Stine Bjerrum %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 25300977, lisagr@health.sdu.dk %K app %K PTSD %K mHealth %K qualitative analysis %K patient experience %K posttraumatic stress disorder %K thematic analysis %K smartphone %K intervention %K mobile phone %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Posttraumatic stress disorder (PTSD) is a common disorder that requires more treatment options. Mobile health (mHealth) app interventions are promising for patients with PTSD, as they can provide easily accessible support, strategies, and information. However, knowledge about mHealth interventions is sparse and primarily based on quantitative studies. Objective: The aim of this study is to qualitatively explore the experiences of patients with PTSD with regard to using an mHealth app as a stand-alone intervention before commencing psychotherapeutic treatment. Methods: We conducted semistructured interviews with 14 participants 6 weeks after they received the app. The participants were all referred to PTSD treatment and were waiting to commence psychotherapeutic treatment. During this waiting time, the participants had no contact with the health staff. Interviews were transcribed and were analyzed using thematic analysis. Results: A total of 3 themes were identified—the use of app, being a patient, and the overall evaluation of the app. The use of the app was described with the subtheme of habits, and the theme of being a patient included the subthemes of having negative experiences with the app and being a part of a research project. The use of the app encompassed how psychological factors and technical problems could interfere with the use of the app. The theme of being a patient depicted that the waiting time before starting treatment was long, and a subgroup of patients experienced feeling worse during this time, which they partly attributed to using the app. Several suggestions for change have been described in the overall evaluation of the app. Conclusions: The findings in this study revealed that emotional arousal influenced the use of the app and that it was difficult for participants to establish a habit of using the app, thus reflecting the importance of supporting habit formation when implementing an mHealth app in mental health care services. This study makes an important contribution to the field of mHealth research, as it revealed that some participants had negative experiences resulting from using the app, thus reflecting the potential harm of having an mHealth app without the support of a clinician. It is therefore recommended to use a blended care treatment or an approach in which mental health care professionals prescribe an mHealth app for relevant patients to avoid increased suicidal risk. %M 34346896 %R 10.2196/26852 %U https://formative.jmir.org/2021/8/e26852 %U https://doi.org/10.2196/26852 %U http://www.ncbi.nlm.nih.gov/pubmed/34346896 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27436 %T Determining Acceptance of e-Mental Health Interventions in Digital Psychodiabetology Using a Quantitative Web-Based Survey: Cross-sectional Study %A Damerau,Mirjam %A Teufel,Martin %A Musche,Venja %A Dinse,Hannah %A Schweda,Adam %A Beckord,Jil %A Steinbach,Jasmin %A Schmidt,Kira %A Skoda,Eva-Maria %A Bäuerle,Alexander %+ Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg Essen, Virchowstr. 174, Essen, 45147, Germany, 49 201 438755 228, mirjam.damerau@uni-due.de %K e-mental health %K acceptance %K UTAUT %K mental health %K diabetes %K e-mental health intervention %K psychodiabetology %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes is a very common chronic disease that exerts massive physiological and psychological burdens on patients. The digitalization of mental health care has generated effective e-mental health approaches, which offer an indubitable practical value for patient treatment. However, before implementing and optimizing e-mental health tools, their acceptance and underlying barriers and resources should be first determined for developing and establishing effective patient-oriented interventions. Objective: This study aims to assess the acceptance of e-mental health interventions among patients with diabetes and explore its underlying barriers and resources. Methods: A cross-sectional study was conducted in Germany from April 9, 2020, to June 15, 2020, through a web-based survey for which patients were recruited via web-based diabetes channels. The eligibility requirements were adult age (18 years or older), a good command of the German language, internet access, and a diagnosis of diabetes. Acceptance was measured using a modified questionnaire, which was based on the well-established Unified Theory of Acceptance and Use of Technology (UTAUT) and assessed health-related internet use, acceptance of e-mental health interventions, and its barriers and resources. Mental health was measured using validated and established instruments, namely the Generalized Anxiety Disorder Scale-7, Patient Health Questionnaire-2, and Distress Thermometer. In addition, sociodemographic and medical data regarding diabetes were collected. Results: Of the 340 participants who started the survey, 261 (76.8%) completed it and the final sample comprised 258 participants with complete data sets. The acceptance of e-mental health interventions in patients with diabetes was overall moderate (mean 3.02, SD 1.14). Gender and having a mental disorder had a significant influence on acceptance (P<.001). In an extended UTAUT regression model (UTAUT predictors plus sociodemographics and mental health variables), distress (β=.11; P=.03) as well as the UTAUT predictors performance expectancy (β=.50; P<.001), effort expectancy (β=.15; P=.001), and social influence (β=.28; P<.001) significantly predicted acceptance. The comparison between an extended UTAUT regression model (13 predictors) and the UTAUT-only regression model (performance expectancy, effort expectancy, social influence) revealed no significant difference in explained variance (F10,244=1.567; P=.12). Conclusions: This study supports the viability of the UTAUT model and its predictors in assessing the acceptance of e-mental health interventions among patients with diabetes. Three UTAUT predictors reached a notable amount of explained variance of 75% in the acceptance, indicating that it is a very useful and efficient method for measuring e-mental health intervention acceptance in patients with diabetes. Owing to the close link between acceptance and use, acceptance-facilitating interventions focusing on these three UTAUT predictors should be fostered to bring forward the highly needed establishment of effective e-mental health interventions in psychodiabetology. %M 34328429 %R 10.2196/27436 %U https://formative.jmir.org/2021/7/e27436 %U https://doi.org/10.2196/27436 %U http://www.ncbi.nlm.nih.gov/pubmed/34328429 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e26796 %T A Mobile Peer Intervention for Preventing Mental Health and Substance Use Problems in Adolescents: Protocol for a Randomized Controlled Trial (The Mind Your Mate Study) %A Birrell,Louise %A Furneaux-Bate,Ainsley %A Chapman,Cath %A Newton,Nicola C %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6, Jane Foss Russell Building, G02, Camperdown, Sydney, 2006, Australia, 61 8627 6904, ainsley.furneaux-bate@sydney.edu.au %K prevention %K mental health %K substance use %K peer support %K depression %K anxiety %K help-seeking %K mobile phone %D 2021 %7 30.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Anxiety, mood, and substance use disorders have significant social and economic impacts, which are largely attributable to their early age of onset and chronic disabling course. Therefore, it is critical to intervene early to prevent chronic and debilitating trajectories. Objective: This paper describes the study protocol of a CONSORT (Consolidated Standards of Reporting Trials)-compliant randomized controlled trial for evaluating the effectiveness of the Mind your Mate program, a mobile health (mHealth) peer intervention that aims to prevent mental health (focusing on anxiety and depression) and substance use problems in adolescents. Methods: Participants will consist of approximately 840 year 9 or year 10 students (60 students per grade per school) from 14 New South Wales high schools in Sydney, Australia. Schools will be recruited from a random selection of independent and public schools across the New South Wales Greater Sydney Area by using publicly available contact details. The intervention will consist of 1 introductory classroom lesson and a downloadable mobile app that will be available for use for 12 months. Schools will be randomly allocated to receive either the mHealth peer intervention or a waitlist control (health education as usual). All students will be given web-based self-assessments at baseline and at 6- and 12-month follow-ups. The primary outcomes of the trial will be the self-reported use of alcohol and drugs, anxiety and depression symptoms, knowledge about mental health and substance use, motives for not drinking, and willingness to seek help. Secondary outcomes will include positive well-being, the quality of life, and the impact of the COVID-19 pandemic. Analyses will be conducted using mixed-effects linear regression analyses for normally distributed data and mixed-effects logistic regression analyses for categorical data. Results: The Mind your Mate study was funded by an Australian Rotary Health Bruce Edwards Postdoctoral Research Fellowship from 2019 to 2022. Some of the development costs for the Mind your Mate intervention came from a seed funding grant from the Brain and Mind Centre of the University of Sydney. The enrollment of schools began in July 2020; 12 of 14 schools were enrolled at the time of submission. Baseline assessments are currently underway, and the first results are expected to be submitted for publication in 2022. Conclusions: The Mind your Mate study will generate vital new knowledge about the effectiveness of a peer support prevention strategy in real-world settings for the most common mental disorders in youth. If effective, this intervention will constitute a scalable, low-cost prevention strategy that has significant potential to reduce the impact of mental and substance use disorders. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000753954; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379738&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/26796 %M 34328426 %R 10.2196/26796 %U https://www.researchprotocols.org/2021/7/e26796 %U https://doi.org/10.2196/26796 %U http://www.ncbi.nlm.nih.gov/pubmed/34328426 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 7 %P e26187 %T Tele–Mental Health for Reaching Out to Patients in a Time of Pandemic: Provider Survey and Meta-analysis of Patient Satisfaction %A Mazziotti,Raffaele %A Rutigliano,Grazia %+ Department of Pathology, University of Pisa, via Savi, 10, Pisa, 56126, Italy, 39 3496117744, grazia.rutigliano.gr@gmail.com %K telepsychiatry %K telepsychology %K e-mental health %K document clustering %K survey %K COVID-19 %K access to care %K patient satisfaction %K mental health %K tele–mental health %K review %K telemedicine %K satisfaction %K access %D 2021 %7 29.7.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic threatened to impact mental health by disrupting access to care due to physical distance measures and the unexpected pressure on public health services. Tele–mental health was rapidly implemented to deliver health care services. Objective: The aims of this study were (1) to present state-of-the-art tele–mental health research, (2) to survey mental health providers about care delivery during the pandemic, and (3) to assess patient satisfaction with tele–mental health. Methods: Document clustering was applied to map research topics within tele–mental health research. A survey was circulated among mental health providers. Patient satisfaction was investigated through a meta-analysis of studies that compared satisfaction scores between tele–mental health and face-to-face interventions for mental health disorders, retrieved from Web of Knowledge and Scopus. Hedges g was used as the effect size measure, and effect sizes were pooled using a random-effect model. Sources of heterogeneity and bias were examined. Results: Evidence on tele–mental health has been accumulating since 2000, especially regarding service implementation, depressive or anxiety disorders, posttraumatic stress disorder, and special populations. Research was concentrated in a few countries. The survey (n=174 respondents from Italy, n=120 international) confirmed that, after the onset of COVID-19 outbreak, there was a massive shift from face-to-face to tele–mental health delivery of care. However, respondents held skeptical views about tele–mental health and did not feel sufficiently trained and satisfied. Meta-analysis of 29 studies (n=2143) showed that patients would be equally satisfied with tele–mental health as they are with face-to-face interventions (Hedges g=−0.001, 95% CI −0.116 to 0.114, P=.98, Q=43.83, I2=36%, P=.03) if technology-related issues were minimized. Conclusions: Mental health services equipped with tele–mental health will be better able to cope with public health crises. Both providers and patients need to be actively engaged in digitization, to reshape their reciprocal trust around technological innovations. %M 34114956 %R 10.2196/26187 %U https://mental.jmir.org/2021/7/e26187 %U https://doi.org/10.2196/26187 %U http://www.ncbi.nlm.nih.gov/pubmed/34114956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e23029 %T A Brief Intervention to Increase Uptake and Adherence of an Internet-Based Program for Depression and Anxiety (Enhancing Engagement With Psychosocial Interventions): Randomized Controlled Trial %A Batterham,Philip J %A Calear,Alison L %A Sunderland,Matthew %A Kay-Lambkin,Frances %A Farrer,Louise M %A Christensen,Helen %A Gulliver,Amelia %+ Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Rd, Acton, Canberra, 2601, Australia, 61 02612 ext 51031, philip.batterham@anu.edu.au %K implementation %K mental health %K adherence %K uptake %K engagement-facilitation intervention %K internet %K randomized controlled trial %D 2021 %7 27.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychosocial, self-guided, internet-based programs are effective in treating depression and anxiety. However, the community uptake of these programs is poor. Recent approaches to increasing engagement (defined as both uptake and adherence) in internet-based programs include brief engagement facilitation interventions (EFIs). However, these programs require evaluation to assess their efficacy. Objective: The aims of this hybrid implementation effectiveness trial are to examine the effects of a brief internet-based EFI presented before an internet-based cognitive behavioral therapy self-help program (myCompass 2) in improving engagement (uptake and adherence) with that program (primary aim), assess the relative efficacy of the myCompass 2 program, and determine whether greater engagement was associated with improved efficacy (greater reduction in depression or anxiety symptoms) relative to the control (secondary aim). Methods: A 3-arm randomized controlled trial (N=849; recruited via social media) assessed the independent efficacy of the EFI and myCompass 2. The myCompass 2 program was delivered with or without the EFI; both conditions were compared with an attention control condition. The EFI comprised brief (5 minutes), tailored audio-visual content on a series of click-through linear webpages. Results: Uptake was high in all groups; 82.8% (703/849) of participants clicked through the intervention following the pretest survey. However, the difference in uptake between the EFI + myCompass 2 condition (234/280, 83.6%) and the myCompass 2 alone condition (222/285, 77.9%) was not significant (n=565; χ21=29.2; P=.09). In addition, there was no significant difference in the proportion of participants who started any number of modules (1-14 modules) versus those who started none between the EFI + myCompass 2 (214/565, 37.9%) and the myCompass 2 alone (210/565, 37.2%) conditions (n=565; χ21<0.1; P=.87). Finally, there was no significant difference between the EFI + myCompass 2 and the myCompass 2 alone conditions in the number of modules started (U=39366.50; z=−0.32; P=.75) or completed (U=39494.0; z=−0.29; P=.77). The myCompass 2 program was not found to be efficacious over time for symptoms of depression (F4,349.97=1.16; P=.33) or anxiety (F4,445.99=0.12; P=.98). However, planned contrasts suggested that myCompass 2 may have been effective for participants with elevated generalized anxiety disorder symptoms (F4,332.80=3.50; P=.01). Conclusions: This brief internet-based EFI did not increase the uptake of or adherence to an existing internet-based program for depression and anxiety. Individuals’ motivation to initiate and complete internet-based self-guided interventions is complex and remains a significant challenge for self-guided interventions. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001565235; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375839 %M 34313595 %R 10.2196/23029 %U https://www.jmir.org/2021/7/e23029 %U https://doi.org/10.2196/23029 %U http://www.ncbi.nlm.nih.gov/pubmed/34313595 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e29159 %T Use of Telemedicine in Depression Care by Physicians: Scoping Review %A Echelard,Jean-François %+ Faculty of Medicine, Université de Montréal, 2900 Edouard Montpetit Blvd, Montreal, QC, H3T 1J4, Canada, 1 (514) 343 6111, jfechelard@hotmail.com %K telemedicine %K telepsychiatry %K depression %K mental health %K videoconferencing %D 2021 %7 26.7.2021 %9 Review %J JMIR Form Res %G English %X Background: Depression is a common disorder, and it creates burdens on people’s mental and physical health as well as societal costs. Although traditional in-person consultations are the usual mode of caring for patients with depression, telemedicine may be well suited to psychiatric assessment and management. Telepsychiatry can be defined as the use of information and communication technologies such as videoconferencing and telephone calls for the care of psychopathologies. Objective: This review aims to evaluate the extent and nature of the existing literature on the use of telemedicine for the care of depression by physicians. This review also aims to examine the effects and perceptions regarding this virtual care and determine how it compares to traditional in-person care. Methods: The Arksey and O’Malley framework and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines were followed. Relevant articles were identified through a search of three databases (MEDLINE, Cochrane Database of Systematic Reviews, and PsycArticles) on October 11, 2020. The search terms were “(virtual OR telemedicine OR teleconsultation* OR telehealth OR phone* OR webcam* OR telepsychiatry) AND (depress*)”. Eligibility criteria were applied to select studies about the use of telemedicine for the care of patients with depression specifically by physicians. An Excel file (Microsoft Corporation) was used to chart data from all included articles. Results: The search resulted in the identification of 28 articles, and all 13 nonreview studies were analyzed in detail. Most nonreview studies were conducted in the United States during the last decade. Most telemedicine programs were led by psychiatrists, and the average study population size was 135. In all applicable studies, telepsychiatry tended to perform at least as well as in-person care regarding improvement in depression severity, patient satisfaction, quality of life, functioning, cost-effectiveness, and most other perceptions and variables. Cultural sensitivity and collaborative care were part of the design of some telemedicine programs. Conclusions: Additional randomized, high-quality studies are recommended to evaluate various outcomes of the use of telemedicine for depression care, including depression variables, perceptions, health care outcomes and other outcomes. Studies should be conducted in various clinical contexts, including primary care. Telepsychiatry is a promising modality of care for patients suffering from depression. %M 34309571 %R 10.2196/29159 %U https://formative.jmir.org/2021/7/e29159 %U https://doi.org/10.2196/29159 %U http://www.ncbi.nlm.nih.gov/pubmed/34309571 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27865 %T Acceptability and Feasibility of the Transfer of Face-to-Face Group Therapy to Online Group Chats in a Psychiatric Outpatient Setting During the COVID-19 Pandemic: Longitudinal Observational Study %A Scholl,Julia %A Kohls,Elisabeth %A Görges,Frauke %A Steinbrecher,Marc %A Baldofski,Sabrina %A Moessner,Markus %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Semmelweisstraße 10, Haus 13, Leipzig, 04103, Germany, 49 3419724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K online %K group chats %K COVID-19 pandemic %K psychiatric outpatient setting %K online interventions %K e-mental health %K COVID-19 %K pandemic %K mental health %K psychoeducation %K online chat %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: At the height of the COVID-19 pandemic, several mental health care providers were obliged to shut down outpatient services, including group therapy and psychoeducational sessions. The lockdown in many countries is a serious threat to people’s mental well-being, especially for individuals with severe mental illnesses. Discontinued outpatient treatments and disruption of daily routines are considered to be risk factors for destabilization of patients with mental illness. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of a group chat program to replace cancelled face-to-face group sessions in an outpatient psychiatric department. Methods: Participants (N=33) were recruited in the outpatient department of a large university medical center in Leipzig, Germany. Former face-to-face group participants were invited to take part in a therapist-guided group-chat for 4 weeks (8 sessions) and were asked to evaluate the program via self-administered standardized questionnaires at baseline (T0, preintervention), after every chat session (T1), and posttreatment (T2, after 4-6 weeks). The chat groups were specific to the following mental disorder diagnoses and based on the same therapeutic principles and techniques as the former face-to-face groups: anxiety, depression, obsessive-compulsive disorder, and adult attention-deficit/hyperactivity disorder (ADHD). Sociodemographic measures, attitudes toward the COVID-19 pandemic, depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), treatment credibility/expectancy (Credibility Expectancy Questionnaire), and participants’ satisfaction (Client Satisfaction Questionnaire-8 [ZUF-8]) were measured. Results: Participants joined an average of 5 out of 8 offered chat sessions. Participation rates in the respective groups were highest in the ADHD group (8.6/11, 78%) and lowest in the anxiety group (3.7/9, 41%). The overall preintervention level of depressive symptoms was moderate and showed a slight, nonsignificant improvement at posttreatment (T0: mean 10.7, SD 5.5; T2: mean 10.2, SD 5.5). A similar result was observed regarding quality of life (T0: median 41.7-68.8; T2: median 50-70.3). Treatment credibility and expectancy scores were medium-high (T0: meancredibility 18.1, SD 3.8; meanexpectancy 11.2, SD 5.1; T2: meancredibility 17.1, SD 4.8; meanexpectancy 10.3, SD 5.8). Further, significant correlations were detected between posttreatment expectancy score and posttreatment PHQ-9 score (r=–0.41, P=.02), posttreatment physical quality of life (r=0.54, P=.001), and posttreatment psychological quality of life (r=0.53, P=.002). Overall, participants’ satisfaction with the program was very high, both after chat sessions and at posttreatment (ZUF-8: mean score 20.6, SD 1.0). Of all participants, a majority (27/31, 87%) rated the program as excellent/good and indicated they would recommend the group chat program to a friend in need of similar help (23/31, 74%). Conclusions: A therapist-guided group chat program to substitute outpatient group setting treatment during the COVID-19 lockdown was shown to be feasible, usable, and highly acceptable for participants. Web-based programs such as this one provide an easy-to-implement tool to successfully stabilize participants during a difficult time, such as the COVID-19 pandemic. Trial Registration: German Clinical Trials Register DRKS00021527; https://tinyurl.com/3btyxc2r %M 34161252 %R 10.2196/27865 %U https://formative.jmir.org/2021/7/e27865 %U https://doi.org/10.2196/27865 %U http://www.ncbi.nlm.nih.gov/pubmed/34161252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25926 %T Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial %A Mhende,Josephine %A Bell,Sharrill A %A Cottrell-Daniels,Cherell %A Luong,Jackie %A Streiff,Micah %A Dannenfelser,Mark %A Hayat,Matthew J %A Spears,Claire Adams %+ Georgia State University, 140 Decatur Street, Suite 400, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K acceptability %K addiction %K African American %K cessation %K COVID-19 %K feasibility %K income %K low socioeconomic status %K mHealth %K mindfulness %K minority %K smoking %K SMS %K text messaging %K treatment %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of .39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. Conclusions: Engagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms. %M 33999835 %R 10.2196/28055 %U https://formative.jmir.org/2021/6/e28055 %U https://doi.org/10.2196/28055 %U http://www.ncbi.nlm.nih.gov/pubmed/33999835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27132 %T Proof-of-Concept Support for the Development and Implementation of a Digital Assessment for Perinatal Mental Health: Mixed Methods Study %A Martin-Key,Nayra Anna %A Spadaro,Benedetta %A Schei,Thea Sofie %A Bahn,Sabine %+ Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge, CB3 0AS, United Kingdom, 44 1223 334151, sb209@cam.ac.uk %K COM-B %K COVID-19 %K digital mental health %K maternal mental health %K paternal mental health %K perinatal mental health %K mental health %K support %K development %K implementation %K assessment %K mother %K women %D 2021 %7 4.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Perinatal mental health symptoms commonly remain underdiagnosed and undertreated in maternity care settings in the United Kingdom, with outbreaks of disease, like the COVID-19 pandemic, further disrupting access to adequate mental health support. Digital technologies may offer an innovative way to support the mental health needs of women and their families throughout the perinatal period, as well as assist midwives in the recognition of perinatal mental health concerns. However, little is known about the acceptability and perceived benefits and barriers to using such technologies. Objective: The aim of this study was to conduct a mixed methods evaluation of the current state of perinatal mental health care provision in the United Kingdom, as well as users’ (women and partners) and midwives’ interest in using a digital mental health assessment throughout the perinatal period. Methods: Women, partners, and midwives were recruited to participate in the study, which entailed completing an online survey. Quantitative data were explored using descriptive statistics. Open-ended response data were first investigated using thematic analysis. Resultant themes were then mapped onto the components of the Capability, Opportunity, and Motivation Behavior model and summarized using descriptive statistics. Results: A total of 829 women, 103 partners, and 90 midwives participated in the study. The provision of adequate perinatal mental health care support was limited, with experiences varying significantly across respondents. There was a strong interest in using a digital mental health assessment to screen, diagnose, and triage perinatal mental health concerns, particularly among women and midwives. The majority of respondents (n=781, 76.42%) expressed that they would feel comfortable or very comfortable using or recommending a digital mental health assessment. The majority of women and partners showed a preference for in-person consultations (n=417, 44.74%), followed by a blended care approach (ie, both in-person and online consultations) (n=362, 38.84%), with fewer participants preferring online-only consultations (n=120, 12.88%). Identified benefits and barriers mainly related to physical opportunity (eg, accessibility), psychological capability (eg, cognitive skills), and automatic motivation (eg, emotions). Conclusions: This study provides proof-of-concept support for the development and implementation of a digital mental health assessment to inform clinical decision making in the assessment of perinatal mental health concerns in the United Kingdom. %M 34033582 %R 10.2196/27132 %U https://www.jmir.org/2021/6/e27132 %U https://doi.org/10.2196/27132 %U http://www.ncbi.nlm.nih.gov/pubmed/34033582 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e25199 %T Validation of Visual and Auditory Digital Markers of Suicidality in Acutely Suicidal Psychiatric Inpatients: Proof-of-Concept Study %A Galatzer-Levy,Isaac %A Abbas,Anzar %A Ries,Anja %A Homan,Stephanie %A Sels,Laura %A Koesmahargyo,Vidya %A Yadav,Vijay %A Colla,Michael %A Scheerer,Hanne %A Vetter,Stefan %A Seifritz,Erich %A Scholz,Urte %A Kleim,Birgit %+ Research and Development, AiCure, 19 W 24th St, 11th Floor, New York, NY, 10010, United States, 1 6463015037, vidya.koesmahargyo@aicure.com %K digital phenotyping %K digital biomarkers %K digital health %K depression %K suicidal ideation %K digital markers %K digital %K facial %K suicide %K suicide risk %K visual %K auditory %D 2021 %7 3.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Multiple symptoms of suicide risk have been assessed based on visual and auditory information, including flattened affect, reduced movement, and slowed speech. Objective quantification of such symptomatology from novel data sources can increase the sensitivity, scalability, and timeliness of suicide risk assessment. Objective: We aimed to examine measurements extracted from video interviews using open-source deep learning algorithms to quantify facial, vocal, and movement behaviors in relation to suicide risk severity in recently admitted patients following a suicide attempt. Methods: We utilized video to quantify facial, vocal, and movement markers associated with mood, emotion, and motor functioning from a structured clinical conversation in 20 patients admitted to a psychiatric hospital following a suicide risk attempt. Measures were calculated using open-source deep learning algorithms for processing facial expressivity, head movement, and vocal characteristics. Derived digital measures of flattened affect, reduced movement, and slowed speech were compared to suicide risk with the Beck Scale for Suicide Ideation controlling for age and sex, using multiple linear regression. Results: Suicide severity was associated with multiple visual and auditory markers, including speech prevalence (β=−0.68, P=.02, r2=0.40), overall expressivity (β=−0.46, P=.10, r2=0.27), and head movement measured as head pitch variability (β=−1.24, P=.006, r2=0.48) and head yaw variability (β=−0.54, P=.06, r2=0.32). Conclusions: Digital measurements of facial affect, movement, and speech prevalence demonstrated strong effect sizes and linear associations with the severity of suicidal ideation. %M 34081022 %R 10.2196/25199 %U https://www.jmir.org/2021/6/e25199 %U https://doi.org/10.2196/25199 %U http://www.ncbi.nlm.nih.gov/pubmed/34081022 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 5 %P e24567 %T Using Digital Tools to Engage Patients With Psychosis and Their Families in Research: Survey Recruitment and Completion in an Early Psychosis Intervention Program %A Polillo,Alexia %A Voineskos,Aristotle N %A Foussias,George %A Kidd,Sean A %A Sav,Andreea %A Hawley,Steve %A Soklaridis,Sophie %A Stergiopoulos,Vicky %A Kozloff,Nicole %+ Centre for Addiction and Mental Health, 1025 Queen Street West, B1-4345, Toronto, ON, M6J 1H1, Canada, 1 416 535 8501, n.kozloff@mail.utoronto.ca %K digital %K online %K psychosis %K schizophrenia %K early psychosis intervention %K surveys %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Barriers to recruiting and retaining people with psychosis and their families in research are well-established, potentially biasing clinical research samples. Digital research tools, such as online platforms, mobile apps, and text messaging, have the potential to address barriers to research by facilitating remote participation. However, there has been limited research on leveraging these technologies to engage people with psychosis and their families in research. Objective: The objective of this study was to assess the uptake of digital tools to engage patients with provisional psychosis and their families in research and their preferences for different research administration methods. Methods: This study used Research Electronic Data Capture (REDCap)—a secure web-based platform with built-in tools for data collection and storage—to send web-based consent forms and surveys on service engagement via text message or email to patients and families referred to early psychosis intervention services; potential participants were also approached or reminded about the study in person. We calculated completion rates and timing using remote and in-person methods and compensation preferences. Results: A total of 447 patients with provisional psychosis and 187 of their family members agreed to receive the web-based consent form, and approximately half of the patients (216/447, 48.3%) and family members (109/187, 58.3%) consented to participate in the survey. Most patients (182/229, 79.5%) and family members (75/116, 64.7%) who completed the consent form did so remotely, with more family members (41/116, 35.3%) than patients (47/229, 20.5%) completing it in person. Of those who consented, 77.3% (167/216) of patients and 72.5% (79/109) of family members completed the survey, and most did the survey remotely. Almost all patients (418/462, 90.5%) and family members (174/190, 91.6%) requested to receive the consent form and survey by email, and only 4.1% (19/462) and 3.2% (6/190), respectively, preferred text message. Just over half of the patients (91/167, 54.5%) and family members (42/79, 53.2%) preferred to receive electronic gift cards from a coffee shop as study compensation. Most surveys were completed on weekdays between 12 PM and 6 PM. Conclusions: When offered the choice, most participants with psychosis and their families chose remote administration methods, suggesting that digital tools may enhance research recruitment and participation in this population, particularly in the context of the COVID-19 global pandemic. %M 34057421 %R 10.2196/24567 %U https://mental.jmir.org/2021/5/e24567 %U https://doi.org/10.2196/24567 %U http://www.ncbi.nlm.nih.gov/pubmed/34057421 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26989 %T Use of a Self-guided Computerized Cognitive Behavioral Tool During COVID-19: Evaluation Study %A Detweiler Guarino,Isadora %A Cowan,Devin R %A Fellows,Abigail M %A Buckey,Jay C %+ Space Medicine Innovations Laboratory, Geisel School of Medicine at Dartmouth, One Medical Center Drive, Lebanon, NH, 03756, United States, 1 603 650 6012, Jay.C.Buckey.Jr@dartmouth.edu %K computerized cognitive behavioral therapy %K interactive media %K COVID-19 %K computer-based therapy %K usability %K acceptability %K cognitive behavioral therapy %K therapy %K effectiveness %K digital health %K depression %K stress %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based programs can help provide accessible and inexpensive behavioral health care to those in need; however, the evaluation of these interventions has been mostly limited to controlled trials. Data regarding patterns of use and effectiveness of self-referred, open-access online interventions are lacking. We evaluated an online-based treatment designed to address stress, depression, and conflict management, the Dartmouth PATH Program, in a freely available and self-guided format during the COVID-19 pandemic. Objective: The primary aim is to determine users’ levels of stress and depression, and the nature of problems and triggers they reported during the COVID-19 pandemic. A secondary objective is to assess the acceptability and usability of the PATH content and determine whether such a program would be useful as a stand-alone open-access resource. The final objective is understanding the high dropout rates associated with online behavioral programs by contrasting the use pattern and program efficacy of individuals who completed session one and did not return to the program with those who came back to complete more sessions. Methods: Cumulative anonymous data from 562 individuals were analyzed. Stress triggers, stress responses, and reported problems were analyzed using qualitative analysis techniques. Scores on usability and acceptability questionnaires were evaluated using the sign test and Wilcoxon signed rank test. Mixed-effects linear modeling was used to evaluate changes in stress and depression over time. Results: A total of 2484 users registered from April through October 2020, most of whom created an account without initiating a module. A total of 562 individuals started the program and were considered in the data analysis. The most common stress triggers individuals reported involved either conflicts with family or spouses and work or workload. The most common problems addressed in the mood module were worry, anxiousness, or stress and difficulty concentrating or procrastination. The attrition rate was high with 13% (21/156) completing the conflict module, 17% (50/289) completing session one of the mood module, and 14% (16/117) completing session one of the stress module. Usability and acceptability scores for the mood and stress modules were significantly better than average. In those who returned to complete sessions, symptoms of stress showed a significant improvement over time (P=.03), and there was a significant decrease in depressive symptoms over all time points (P=.01). Depression severity decreased on average by 20% (SD 35.2%; P=.60) between sessions one and two. Conclusions: Conflicts with others, worry, and difficulty concentrating were some of the most common problems people used the programs to address. Individuals who completed the modules indicated improvements in self-reported stress and depression symptoms. Users also found the modules to be effective and rated the program highly for usability and acceptability. Nevertheless, the attrition rate was very high, as has been found with other freely available online-based interventions. Trial Registration: ClinicalTrials.gov NCT02726061; https://clinicaltrials.gov/ct2/show/NCT02726061 %M 33973856 %R 10.2196/26989 %U https://formative.jmir.org/2021/5/e26989 %U https://doi.org/10.2196/26989 %U http://www.ncbi.nlm.nih.gov/pubmed/33973856 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e18261 %T A Clinician-Controlled Just-in-time Adaptive Intervention System (CBT+) Designed to Promote Acquisition and Utilization of Cognitive Behavioral Therapy Skills in Bulimia Nervosa: Development and Preliminary Evaluation Study %A Juarascio,Adrienne %A Srivastava,Paakhi %A Presseller,Emily %A Clark,Kelsey %A Manasse,Stephanie %A Forman,Evan %+ Center for Weight, Eating and Lifestyle Science, Drexel University, 3141 Chestnut Street, Stratton Hall, Suite 232, Philadelphia, PA, 19104, United States, 1 2678156511, ps887@drexel.edu %K eating disorders %K telemedicine %K mobile phone %K smartphone %K technology %K cognitive behavioral therapy %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cognitive behavioral therapy (CBT) for bulimia nervosa (BN) is most effective when patients demonstrate adequate skill utilization (ie, the frequency with which a patient practices or uses therapeutic skills) and skill acquisition (ie, the ability to successfully perform a skill learned in treatment). However, rates of utilization and acquisition of key treatment skills (eg, regular eating, urge management skills, and mood management skills) by the end of the treatment are frequently low; as a result, outcomes from CBT for BN are affected. Just-in-time adaptive interventions (JITAIs) may improve skill acquisition and utilization by delivering real-time interventions during algorithm-identified opportunities for skill practice. Objective: In this manuscript, we describe a newly developed JITAI system called CBT+ that is designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation. We also present feasibility, acceptability, and preliminary outcomes data from a small proof-of-concept pilot trial (n=5 patients and n=3 clinicians) designed to identify opportunities for iterative development of CBT+ ahead of a larger ongoing randomized controlled trial. Methods: A total of 5 individuals with BN received 16 sessions of outpatient CBT for BN while using the CBT+ app. Data were collected from patients and clinicians to evaluate the feasibility (eg, app use and user adherence), acceptability (eg, qualitative patient and clinician feedback, including usefulness ratings of CBT+ on a 6-point Likert scale ranging from 1=extremely useless to 6=extremely useful), and preliminary outcomes (eg, improvements in skill utilization and acquisition and BN symptoms) of the CBT+ system. Results: Patients reported that CBT+ was a relatively low burden (eg, quick and easy-to-use self-monitoring interface), and adherence to in-app self-monitoring was high (mean entries per day 3.13, SD 1.03). JITAIs were perceived as useful by both patients (median rating 5/6) and clinicians (median rating 5/6) for encouraging the use of CBT skills. Large improvements in CBT skills and clinically significant reductions in BN symptoms were observed post treatment. Although preliminary findings indicated that the CBT+ system was acceptable to most patients and clinicians, the overall study dropout was relatively high (ie, 2/5, 40% patients), which could indicate some moderate concerns regarding feasibility. Conclusions: CBT+, the first-ever JITAI system designed to facilitate the acquisition and utilization of CBT for BN treatment skills when used as a treatment augmentation, was shown to be feasible and acceptable. The results indicate that the CBT+ system should be subjected to more rigorous evaluations with larger samples and should be considered for wider implementation if found effective. Areas for iterative improvement of the CBT+ system ahead of a randomized controlled trial are also discussed. %M 34057416 %R 10.2196/18261 %U https://formative.jmir.org/2021/5/e18261 %U https://doi.org/10.2196/18261 %U http://www.ncbi.nlm.nih.gov/pubmed/34057416 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 5 %P e25528 %T Initial Training for Mental Health Peer Support Workers: Systematized Review and International Delphi Consultation %A Charles,Ashleigh %A Nixdorf,Rebecca %A Ibrahim,Nashwa %A Meir,Lion Gai %A Mpango,Richard S %A Ngakongwa,Fileuka %A Nudds,Hannah %A Pathare,Soumitra %A Ryan,Grace %A Repper,Julie %A Wharrad,Heather %A Wolf,Philip %A Slade,Mike %A Mahlke,Candelaria %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, Jubilee Campus, University of Nottingham Innovation Park, Triumph Road, Nottingham, , United Kingdom, 44 (0)115 7484303, ashleigh.charles@nottingham.ac.uk %K peer support work %K peer support worker training %K Delphi consultation %K mental health %K mobile phone %D 2021 %7 27.5.2021 %9 Review %J JMIR Ment Health %G English %X Background: Initial training is essential for the mental health peer support worker (PSW) role. Training needs to incorporate recent advances in digital peer support and the increase of peer support work roles internationally. There is a lack of evidence on training topics that are important for initial peer support work training and on which training topics can be provided on the internet. Objective: The objective of this study is to establish consensus levels about the content of initial training for mental health PSWs and the extent to which each identified topic can be delivered over the internet. Methods: A systematized review was conducted to identify a preliminary list of training topics from existing training manuals. Three rounds of Delphi consultation were then conducted to establish the importance and web-based deliverability of each topic. In round 1, participants were asked to rate the training topics for importance, and the topic list was refined. In rounds 2 and 3, participants were asked to rate each topic for importance and the extent to which they could be delivered over the internet. Results: The systematized review identified 32 training manuals from 14 countries: Argentina, Australia, Brazil, Canada, Chile, Germany, Ireland, the Netherlands, Norway, Scotland, Sweden, Uganda, the United Kingdom, and the United States. These were synthesized to develop a preliminary list of 18 topics. The Delphi consultation involved 110 participants (49 PSWs, 36 managers, and 25 researchers) from 21 countries (14 high-income, 5 middle-income, and 2 low-income countries). After the Delphi consultation (round 1: n=110; round 2: n=89; and round 3: n=82), 20 training topics (18 universal and 2 context-specific) were identified. There was a strong consensus about the importance of five topics: lived experience as an asset, ethics, PSW well-being, and PSW role focus on recovery and communication, with a moderate consensus for all other topics apart from the knowledge of mental health. There was no clear pattern of differences among PSW, manager, and researcher ratings of importance or between responses from participants in countries with different resource levels. All training topics were identified with a strong consensus as being deliverable through blended web-based and face-to-face training (rating 1) or fully deliverable on the internet with moderation (rating 2), with none identified as only deliverable through face-to-face teaching (rating 0) or deliverable fully on the web as a stand-alone course without moderation (rating 3). Conclusions: The 20 training topics identified can be recommended for inclusion in the curriculum of initial training programs for PSWs. Further research on web-based delivery of initial training is needed to understand the role of web-based moderation and whether web-based training better prepares recipients to deliver web-based peer support. %M 34042603 %R 10.2196/25528 %U https://mental.jmir.org/2021/5/e25528 %U https://doi.org/10.2196/25528 %U http://www.ncbi.nlm.nih.gov/pubmed/34042603 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24417 %T Recorded Mental Health Recovery Narratives as a Resource for People Affected by Mental Health Problems: Development of the Narrative Experiences Online (NEON) Intervention %A Slade,Mike %A Rennick-Egglestone,Stefan %A Llewellyn-Beardsley,Joy %A Yeo,Caroline %A Roe,James %A Bailey,Sylvia %A Smith,Roger Andrew %A Booth,Susie %A Harrison,Julian %A Bhogal,Adaresh %A Penas Morán,Patricia %A Hui,Ada %A Quadri,Dania %A Robinson,Clare %A Smuk,Melanie %A Farkas,Marianne %A Davidson,Larry %A van der Krieke,Lian %A Slade,Emily %A Bond,Carmel %A Nicholson,Joe %A Grundy,Andrew %A Charles,Ashleigh %A Hare-Duke,Laurie %A Pollock,Kristian %A Ng,Fiona %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, University of Nottingham Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 409326, stefan.egglestone@nottingham.ac.uk %K narratives %K storytelling %K intervention development %K mental health %K online intervention %K patient involvement %K narrative medicine %K internet %K recovery %K mobile phone %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The internet enables sharing of narratives about health concerns on a substantial scale, and some digital health narratives have been integrated into digital health interventions. Narratives describing recovery from health problems are a focus of research, including those presented in recorded (eg, invariant) form. No clinical trial has been conducted on a web-based intervention providing access to a collection of Recorded Recovery Narratives (RRNs). Objective: This study presents knowledge produced through the development of the Narrative Experiences Online (NEON) Intervention, a web-based intervention incorporating the algorithmic recommendation of RRNs. Methods: Knowledge was gathered through knowledge integration (KI) activities. KI1 synthesized previous studies to produce the NEON Impact Model describing how accessing RRNs produces health-related outcomes. KI2 developed curation principles for the NEON Collection of RRNs through consultation with the NEON Lived Experience Advisory Panel and the curation of a preliminary collection. KI3 identified harm minimization strategies for the NEON Intervention through consultation with the NEON International Advisory Board and Lived Experience Advisory Panel. The NEON Intervention was finalized through 2 research studies (RS). In RS1, mental health service users (N=40) rated the immediate impact of randomly presented narratives to validate narrative feedback questions used to inform the recommendation algorithm. In RS2, mental health service users (n=25) were interviewed about their immediate response to a prototype of the NEON Intervention and trial procedures and then were interviewed again after 1 month of use. The usability and acceptability of the prototype and trial procedures were evaluated and refinements were made. Results: KI1 produced the NEON Impact Model, which identifies moderators (recipient and context), mechanisms of connection (reflection, comparison, learning, and empathy), processes (identification of change from narrative structure or content and internalization of observed change), and outcomes (helpful and unhelpful). KI2 identified 22 curation principles, including a mission to build a large, heterogeneous collection to maximize opportunities for connection. KI3 identified seven harm minimization strategies, including content warnings, proactive and reactive blocking of narratives, and providing resources for the self-management of emotional distress. RS1 found variation in the impact of narratives on different participants, indicating that participant-level feedback on individual narratives is needed to inform a recommender system. The order of presentation did not predict narrative feedback. RS2 identified amendments to web-based trial procedures and the NEON Intervention. Participants accessed some narratives multiple times, use reduced over the 4-week period, and narrative feedback was provided for 31.8% (105/330) of narrative accesses. Conclusions: RRNs can be integrated into web-based interventions. Evaluating the NEON Intervention in a clinical trial is feasible. The mixed methods design for developing the NEON Intervention can guide its extension to other clinical populations, the design of other web-based mental health interventions, and the development of narrative-based interventions in mental health. %M 34042595 %R 10.2196/24417 %U https://formative.jmir.org/2021/5/e24417 %U https://doi.org/10.2196/24417 %U http://www.ncbi.nlm.nih.gov/pubmed/34042595 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e27772 %T Determining the Efficacy of Electronic Cognitive Behavioral Therapy for Generalized Anxiety Disorder Compared to Pharmaceutical Interventions: Protocol for a Quasi-Experimental Study %A Alavi,Nazanin %A Stephenson,Callum %A Yang,Megan %A Shirazi,Amirhossein %A Shao,Yijia %A Kumar,Anchan %A Yee,Caitlin S %A Miller,Shadé %A Stefatos,Anthi %A Gholamzadehmir,Maedeh %A Abbaspour,Zara %A Patel,Archana %A Patel,Charmy %A Reshetukha,Taras %A Omrani,Mohsen %A Groll,Dianne %+ Department of Psychiatry, Queen's University, Hotel Dieu Hospital, 166 Brock Street, Kingston, ON, K7L 5G2, Canada, 1 6135443310, nazanin.alavi@queensu.ca %K eHealth %K mental health %K anxiety %K generalized anxiety disorder %K cognitive behavioral therapy %K psychotherapy %K online %K internet %K electronic %K virtual %K mental health care %D 2021 %7 27.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Generalized anxiety disorder (GAD) is an extremely prevalent and debilitating mental health disorder. Currently, the gold standard treatment for GAD is cognitive behavioral therapy (CBT) and/or pharmacotherapy. The most common medications used to treat GAD are selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors. While CBT is the gold standard treatment for GAD, it is costly, time-consuming, and often inaccessible. Fortunately, the electronic delivery of CBT (e-CBT) has emerged as a promising solution to address these barriers. e-CBT has shown to offer comparable results to in-person CBT while improving accessibility for patients and time efficiency for clinicians. Objective: This study aims to investigate the treatment efficacy of e-CBT compared to and in conjunction with pharmacotherapy for GAD. Methods: This study will use a quasi-experimental design to allow patients the freedom to choose which treatment modality they would like to receive. Participants with a diagnosis of GAD will be enrolled in 1 of 3 possible treatment arms: (1) e-CBT, (2) medication, or (3) a combination of e-CBT and medication. The e-CBT program will include a 12-week psychotherapy program delivered through the Online Psychotherapy Tool—a secure, cloud-based, digital mental health platform. The treatment efficacy of e-CBT will be compared with that of medication alone and medication in combination with e-CBT. Results: The study received ethics approval in April 2019 and participant recruitment began in June 2019. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 146 participants (e-CBT: n=53; medication: n=49; combination: n=44) have been recruited. Data collection is expected to conclude by June 2021, and data analysis is expected to be completed by October 2021. Linear regression (for continuous outcomes) and binomial regression (for categorical outcomes) analysis will be conducted using interpretive qualitative methods. Conclusions: If either the efficacy of e-CBT is shown to be comparable to that of medication or the effects of both treatments are augmented when used in tandem, these findings could have major implications on the mental health care system. e-CBT is a more accessible and affordable treatment that could increase mental health care capacity 4-fold if proven viable. Trial Registration: ClinicalTrials.gov NCT04478526; https://clinicaltrials.gov/ct2/show/NCT04478526 International Registered Report Identifier (IRRID): DERR1-10.2196/27772 %M 33857917 %R 10.2196/27772 %U https://www.researchprotocols.org/2021/5/e27772 %U https://doi.org/10.2196/27772 %U http://www.ncbi.nlm.nih.gov/pubmed/33857917 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e24623 %T The Differential Effects of Social Media on Depressive Symptoms and Suicidal Ideation Among the Younger and Older Adult Population in Hong Kong During the COVID-19 Pandemic: Population-Based Cross-sectional Survey Study %A Yang,Xue %A Yip,Benjamin H K %A Mak,Arthur D P %A Zhang,Dexing %A Lee,Eric K P %A Wong,Samuel Y S %+ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, School of Public Health Building, Prince of Wales Hospital, 30-32 Ngan Shing Street, Shatin, New Territories, Hong Kong, Hong Kong, 852 2252 8488, yeungshanwong@cuhk.edu.hk %K social media %K depression %K suicidal ideation %K social loneliness %K posttraumatic stress %K suicide %K mental health %K COVID-19 %K loneliness %K age %K mediation %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media has become a ubiquitous part of daily life during the COVID-19 pandemic isolation. However, the role of social media use in depression and suicidal ideation of the general public remains unclear. Related empirical studies were limited and reported inconsistent findings. Little is known about the potential underlying mechanisms that may illustrate the relationship between social media use and depression and suicidal ideation during the COVID-19 pandemic. Objective: This study tested the mediation effects of social loneliness and posttraumatic stress disorder (PTSD) symptoms on the relationship between social media use and depressive symptoms and suicidal ideation, as well as the moderation effect of age on the mediation models. Methods: We administered a population-based random telephone survey in May and June 2020, when infection control measures were being vigorously implemented in Hong Kong. A total of 1070 adults (658 social media users and 412 nonusers) completed the survey. Structural equation modeling (SEM) and multigroup SEM were conducted to test the mediation and moderation effects. Results: The weighted prevalence of probable depression was 11.6%; 1.6% had suicidal ideation in the past 2 weeks. Both moderated mediation models of depressive symptoms (χ262=335.3; P<.05; comparative fit index [CFI]=0.94; nonnormed fit index [NNFI]=0.92; root mean square error of approximation [RMSEA]=0.06) and suicidal ideation (χ234=50.8; P<.05; CFI=0.99; NNFI=0.99; RMSEA=0.02) showed acceptable model fit. There was a significantly negative direct effect of social media use on depressive symptoms among older people (β=–.07; P=.04) but not among younger people (β=.04; P=.55). The indirect effect via PTSD symptoms was significantly positive among both younger people (β=.09; P=.02) and older people (β=.10; P=.01). The indirect effect via social loneliness was significant among older people (β=–.01; P=.04) but not among younger people (β=.01; P=.31). The direct effect of social media use on suicidal ideation was not statistically significant in either age group (P>.05). The indirect effects via PTSD symptoms were statistically significant among younger people (β=.02; P=.04) and older people (β=.03; P=.01). Social loneliness was not a significant mediator between social media use and suicidal ideation among either age group (P>.05). Conclusions: Social media may be a “double-edged sword” for psychosocial well-being during the COVID-19 pandemic, and its roles vary across age groups. The mediators identified in this study can be addressed by psychological interventions to prevent severe mental health problems during and after the COVID-19 pandemic. %M 33835937 %R 10.2196/24623 %U https://publichealth.jmir.org/2021/5/e24623 %U https://doi.org/10.2196/24623 %U http://www.ncbi.nlm.nih.gov/pubmed/33835937 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25078 %T Changes in Perceived Stress Following a 10-Week Digital Mindfulness-Based Stress Reduction Program: Retrospective Study %A Venkatesan,Aarathi %A Krymis,Holly %A Scharff,Jenny %A Waber,Art %+ Vida Health, 100 Montgomery St #750, San Francisco, CA, 94104, United States, 1 (415) 989 1017, aarathi.venkatesan@vida.com %K perceived stress %K health coaching %K digital mental health intervention %K digital therapeutics %K mobile phone %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As the need for effective scalable interventions for mental health conditions such as depression, anxiety, and stress has grown, the digital delivery of mindfulness-based stress reduction (MBSR) has gained interest as a promising intervention in this domain. Objective: This study aims to evaluate the changes in perceived stress following a 10-week digital MBSR program that combined an app-based digital program with weekly one-on-one remote sessions with a health coach. Methods: This study used a retrospective, observational design. A total of 229 participants with moderate-to-high perceived stress scores as assessed by the Perceived Stress Scale (PSS)-10 enrolled in the 10-week Vida Health MBSR program. The program included weekly remote sessions with a certified health coach and digital content based on concepts fundamental to mindfulness practice. The PSS-10 was used to evaluate perceived stress. Of the 229 participants, 131 (57.2%) were considered program completers and provided at least one follow-up PSS-10. A secondary analysis examined the changes in stress scores at 6 months. This analysis was restricted to participants who had been enrolled in the program for at least 6 months (n=121). To account for random and fixed effects, linear mixed effects modeling was used to assess changes in stress scores over time. An intention-to-treat approach was used to evaluate the changes in perceived stress across the entire study cohort, including those who were lost to follow-up. In addition, a reliable change index was computed to evaluate the changes in scores from the baseline. Results: The findings revealed a significant positive association between program time and stress reduction (B=−0.365; P<.001) at 12 weeks. We observed an average reduction in stress scores of 3.17 points (95% CI −3.93 to −2.44) by program week 6 and 4.86 points (95% CI −5.86 to −3.85) by program week 12. Overall, 83.2% (109/131) of participants showed a reduction in stress scores by week 12, with 40.5% (53/131) of participants showing reliable improvement at 12 weeks and 47.8% (56/131) of participants showing a shift to a lower stress level category (ie, moderate-to-low stress). The intention-to-treat analysis revealed a significant, although attenuated, reduction in stress scores at 12 weeks (B=−0.23; P<.001). Participants who completed more lessons had an increased likelihood of moving down at least one stress level category (odds ratio 1.512, 95% CI 1.056 to 2.166; P=.02). In assessing medium-term outcomes, among participants who had completed at least 6 months in the program, 48.8% (59/121) of members provided a 6-month assessment. We observed a significant reduction in stress scores at 6 months (t58=10.24; P<.001), with 61% (36/59) of participants showing reliable improvement. Conclusions: The findings of this retrospective, observational study suggest that a blended, digital mindfulness-based intervention may support program uptake and meaningful, sustained reduction in stress outcomes. %M 34032571 %R 10.2196/25078 %U https://formative.jmir.org/2021/5/e25078 %U https://doi.org/10.2196/25078 %U http://www.ncbi.nlm.nih.gov/pubmed/34032571 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e27868 %T Evidence of Human-Level Bonds Established With a Digital Conversational Agent: Cross-sectional, Retrospective Observational Study %A Darcy,Alison %A Daniels,Jade %A Salinger,David %A Wicks,Paul %A Robinson,Athena %+ Woebot Health, 650 Fifth Street, San Francisco, CA, , United States, 1 851694777, alison@woebothealth.com %K conversational agents %K mobile mental health %K chatbots %K depression %K anxiety %K digital health %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There are far more patients in mental distress than there is time available for mental health professionals to support them. Although digital tools may help mitigate this issue, critics have suggested that technological solutions that lack human empathy will prevent a bond or therapeutic alliance from being formed, thereby narrowing these solutions’ efficacy. Objective: We aimed to investigate whether users of a cognitive behavioral therapy (CBT)–based conversational agent would report therapeutic bond levels that are similar to those in literature about other CBT modalities, including face-to-face therapy, group CBT, and other digital interventions that do not use a conversational agent. Methods: A cross-sectional, retrospective study design was used to analyze aggregate, deidentified data from adult users who self-referred to a CBT-based, fully automated conversational agent (Woebot) between November 2019 and August 2020. Working alliance was measured with the Working Alliance Inventory-Short Revised (WAI-SR), and depression symptom status was assessed by using the 2-item Patient Health Questionnaire (PHQ-2). All measures were administered by the conversational agent in the mobile app. WAI-SR scores were compared to those in scientific literature abstracted from recent reviews. Results: Data from 36,070 Woebot users were included in the analysis. Participants ranged in age from 18 to 78 years, and 57.48% (20,734/36,070) of participants reported that they were female. The mean PHQ-2 score was 3.03 (SD 1.79), and 54.67% (19,719/36,070) of users scored over the cutoff score of 3 for depression screening. Within 5 days of initial app use, the mean WAI-SR score was 3.36 (SD 0.8) and the mean bond subscale score was 3.8 (SD 1.0), which was comparable to those in recent studies from the literature on traditional, outpatient, individual CBT and group CBT (mean bond subscale scores of 4 and 3.8, respectively). PHQ-2 scores at baseline weakly correlated with bond scores (r=−0.04; P<.001); however, users with depression and those without depression had high bond scores of 3.45. Conclusions: Although bonds are often presumed to be the exclusive domain of human therapeutic relationships, our findings challenge the notion that digital therapeutics are incapable of establishing a therapeutic bond with users. Future research might investigate the role of bonds as mediators of clinical outcomes, since boosting the engagement and efficacy of digital therapeutics could have major public health benefits. %M 33973854 %R 10.2196/27868 %U https://formative.jmir.org/2021/5/e27868 %U https://doi.org/10.2196/27868 %U http://www.ncbi.nlm.nih.gov/pubmed/33973854 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e18096 %T Usability and Acceptance of Wearable Biosensors in Forensic Psychiatry: Cross-sectional Questionnaire Study %A de Looff,Pieter Christiaan %A Nijman,Henk %A Didden,Robert %A Noordzij,Matthijs L %+ Behavioural Science Institute, Radboud University, Postbus 9104, Nijmegen, Netherlands, 31 030 2256405, peterdelooff@gmail.com %K forensic psychiatry %K wearable biosensors %K intellectual disabilities %K usability %K acceptance %K continuous use %K emotion regulation %K behavior regulation %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of wearable biosensor devices for monitoring and coaching in forensic psychiatric settings yields high expectations for improved self-regulation of emotions and behavior in clients and staff members. More so, if clients have mild intellectual disabilities (IQ 50-85), they might benefit from these biosensors as they are easy to use in everyday life, which ensures that clients can practice with the devices in multiple stress and arousal-inducing situations. However, research on (continuous) use and acceptance of biosensors in forensic psychiatry for clients with mild intellectual disabilities and their caretakers is scarce. Although wearable biosensors show promise for health care, recent research showed that the acceptance and continuous use of wearable devices in consumers is not as was anticipated, probably due to low expectations. Objective: The main goal of this study was to investigate the associations between and determinants of the expectation of usability, the actual experienced usability, and the intention for continuous use of biosensors. Methods: A total of 77 participants (31 forensic clients with mild intellectual disabilities and 46 forensic staff members) participated in a 1-week trial. Preceding the study, we selected 4 devices thought to benefit the participants in domains of self-regulation, physical health, or sleep. Qualitative and quantitative questionnaires were used that explored the determinants of usability, acceptance, and continuous use of biosensors. Questionnaires consisted of the System Usability Scale, the Technology Acceptance Model questionnaire, and the extended expectation confirmation model questionnaire. Results: Only the experienced usability of the devices was associated with intended continuous use. Forensic clients scored higher on acceptance and intention for continuous use than staff members. Moderate associations were found between usability with acceptance and continuous use. Staff members showed stronger associations between usability and acceptance (r=.80, P<.001) and usability and continuous use (r=.79, P<.001) than clients, who showed more moderate correlations between usability and acceptance (r=.46, P=.01) and usability and continuous use (r=.52, P=.003). The qualitative questionnaires in general indicated that the devices were easy to use and gave clear information. Conclusions: Contrary to expectations, it was the actual perceived usability of wearing a biosensor that was associated with continuous use and to a much lesser extent the expectancy of usability. Clients scored higher on acceptance and intention for continuous use, but associations between usability and both acceptance and continuous use were markedly stronger in staff members. This study provides clear directions on how to further investigate these associations. For example, whether this is a true effect or due to a social desirability bias in the client group must be investigated. Clients with mild intellectual disabilities might benefit from the ease of use of these devices and their continuing monitoring and coaching apps. For these clients, it is especially important to develop easy-to-use biosensors with a minimum requirement on cognitive capacity to increase usability, acceptance, and continuous use. %M 33970115 %R 10.2196/18096 %U https://formative.jmir.org/2021/5/e18096 %U https://doi.org/10.2196/18096 %U http://www.ncbi.nlm.nih.gov/pubmed/33970115 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26294 %T Perception of Mental Health Care Professionals in Saudi Arabia on Computerized Cognitive Behavioral Therapy: Observational Cross-sectional Study %A AlHadi,Ahmad N %A Alammari,Khawla A %A Alsiwat,Lojain J %A Alhaidri,Nojood E %A Alabdulkarim,Nouf H %A Altwaijri,Nouf A %A AlSohaili,Shamma A %+ Department of Psychiatry, College of Medicine, King Saud University, PO Box 2925, Riyadh, 11461, Saudi Arabia, 966 118066346, alhadi@ksu.edu.sa %K CBT %K iCBT %K cCBT %K knowledge %K attitude %K mental health care professionals %K computer usage %K psychotherapy %K therapy %K cognitive behavioral therapy %K health care worker %K perception %K Saudi Arabia %K preference %K mental health %D 2021 %7 3.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health disorders are common in Saudi Arabia with a 34% lifetime prevalence. Cognitive behavioral therapy (CBT), a type of psychotherapy, is an evidence-based intervention for the majority of mental disorders. Although the demand for CBT is increasing, unfortunately, there are few therapists available to meet this demand and the therapy is expensive. Computerized cognitive behavioral therapy (cCBT) is a new modality that can help fill this gap. Objective: We aimed to measure the knowledge of cCBT among mental health care professionals in Saudi Arabia, and to evaluate their attitudes and preferences toward cCBT. Methods: This quantitative observational cross-sectional study used a convenience sample, selecting mental health care professionals working in the tertiary hospitals of Saudi Arabia. The participants received a self-administered electronic questionnaire through data collectors measuring their demographics, knowledge, and attitudes about cCBT, and their beliefs about the efficacy of using computers in therapy. Results: Among the 121 participating mental health care professionals, the mean age was 36.55 years and 60.3% were women. Most of the participants expressed uncertainty and demonstrated a lack of knowledge regarding cCBT. However, the majority of participants indicated a positive attitude toward using computers in therapy. Participants agreed with the principles of cCBT, believed in its efficacy, and were generally confident in using computers. Among the notable results, participants having a clinical license and with cCBT experience had more knowledge of cCBT. The overall attitude toward cCBT was not affected by demographic or work-related factors. Conclusions: Mental health care professionals in Saudi Arabia need more education and training regarding cCBT; however, their attitude toward its use and their comfort in using computers in general show great promise. Further research is needed to assess the acceptance of cCBT by patients in Saudi Arabia, in addition to clinical trials measuring its effectiveness in the Saudi population. %M 33938810 %R 10.2196/26294 %U https://formative.jmir.org/2021/5/e26294 %U https://doi.org/10.2196/26294 %U http://www.ncbi.nlm.nih.gov/pubmed/33938810 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26939 %T Exploring the Role of Persuasive Design in Unguided Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Adults: Systematic Review, Meta-analysis, and Meta-regression %A McCall,Hugh C %A Hadjistavropoulos,Heather D %A Sundström,Christopher Richard Francis %+ Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK, S4S 0A2, Canada, 1 306 585 4111, hugh.c.mccall@gmail.com %K ICBT %K internet %K depression %K anxiety %K persuasive design %K eHealth %D 2021 %7 29.4.2021 %9 Review %J J Med Internet Res %G English %X Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective treatment that can overcome barriers to mental health care. Various research groups have suggested that unguided ICBT (ie, ICBT without therapist support) and other eHealth interventions can be designed to enhance user engagement and thus outcomes. The persuasive systems design framework captures most design recommendations for eHealth interventions, but there is little empirical evidence that persuasive design is related to clinical outcomes in unguided ICBT. Objective: This study aims to provide an updated meta-analysis of randomized controlled trials of unguided ICBT for depression and anxiety, describe the frequency with which various persuasive design principles are used in such interventions, and use meta-regression to explore whether a greater number of persuasive design elements predicts efficacy in unguided ICBT for depression and anxiety. Methods: We conducted a systematic review of 5 databases to identify randomized controlled trials of unguided ICBT for depression and anxiety. We conducted separate random effects meta-analyses and separate meta-regressions for depression and anxiety interventions. Each meta-regression included 2 steps. The first step included, as a predictor, whether each intervention was transdiagnostic. For the meta-regression of ICBT for depression, the first step also included the type of control condition. The number of persuasive design principles identified for each intervention was added as a predictor in the second step to reveal the additional variance in effect sizes explained by persuasive design. Results: Of the 4471 articles we identified in our search, 46 (1.03%) were eligible for inclusion in our analyses. Our meta-analyses showed effect sizes (Hedges g) ranging from 0.22 to 0.31 for depression interventions, depending on the measures taken to account for bias in the results. We found a mean effect size of 0.45 (95% CI 0.33-0.56) for anxiety interventions, with no evidence that the results were inflated by bias. Included interventions were identified as using between 1 and 13 persuasive design principles, with an average of 4.95 (SD 2.85). The meta-regressions showed that a greater number of persuasive design principles predicted greater efficacy in ICBT for depression (R2 change=0.27; B=0.04; P=.02) but not anxiety (R2 change=0.05; B=0.03; P=.17). Conclusions: These findings show wide variability in the use of persuasive design in unguided ICBT for depression and anxiety and provide preliminary support for the proposition that more persuasively designed interventions are more efficacious, at least in the treatment of depression. Further research is needed to clarify the role of persuasive design in ICBT. %M 33913811 %R 10.2196/26939 %U https://www.jmir.org/2021/4/e26939 %U https://doi.org/10.2196/26939 %U http://www.ncbi.nlm.nih.gov/pubmed/33913811 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25279 %T Investigating the Use of Electronic Well-being Diaries Completed Within a Psychoeducation Program for University Students: Longitudinal Text Analysis Study %A Linton,Myles-Jay Anthony %A Jelbert,Sarah %A Kidger,Judi %A Morris,Richard %A Biddle,Lucy %A Hood,Bruce %+ Population Health Sciences, Bristol Medical School, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, United Kingdom, 44 1173314380, mj.linton@bristol.ac.uk %K psychoeducation %K diary %K students %K text analysis %K wellbeing %K science of happiness %K university %K emotional tone %K e-mental health %K mobile phone %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychoeducation has the potential to support students experiencing distress and help meet the demand for support; however, there is a need to understand how these programs are experienced. Web-based diaries are a useful activity for psychoeducation because of their therapeutic benefits, ability to capture naturalistic data relevant to well-being, and appropriateness for text analysis methods. Objective: This study aims to examine how university students use electronic diaries within a psychoeducation program designed to enhance mental well-being. Methods: The Science of Happiness course was administered to 154 undergraduate students in a university setting (the United Kingdom). Diaries were collected from the students for 9 weeks. Baseline well-being data were collected using the Short Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS). The percentage of negative and positive emotion words used in diaries (emotional tone) and use of words from five life domains (social, work, money, health, and leisure) were calculated using the Linguistic Inquiry and Word Count 2015 software. Random effects (generalized least squares) regression models were estimated to examine whether time, diary characteristics, demographics, and baseline well-being predict the emotional tone of diaries. Results: A total of 149 students participated in the diary study, producing 1124 individual diary entries. Compliance with the diary task peaked in week 1 (n=1041, 92.62%) and was at its lowest in week 3 (n=807, 71.81%). Compared with week 1, diaries were significantly more positive in their emotional tone during week 5 (mean difference 23.90, 95% CI 16.89-30.90) and week 6 (mean difference 26.62, 95% CI 19.35-33.88) when students were tasked with writing about gratitude and their strengths. Across weeks, moderate and high baseline SWEMWBS scores were associated with a higher percentage of positive emotion words used in diaries (increases compared with students scoring low in SWEMWBS were 5.03, 95% CI 0.08-9.98 and 7.48, 95% CI 1.84-13.12, respectively). At week 1, the diaries of students with the highest levels of baseline well-being (82.92, 95% CI 73.08-92.76) were more emotionally positive on average than the diaries of students with the lowest levels of baseline well-being (59.38, 95% CI 51.02-67.73). Diaries largely focused on the use of social words. The emotional tone of diary entries was positively related to the use of leisure (3.56, 95% CI 2.28-4.85) and social words (0.74, 95% CI 0.21-1.27), and inversely related to the use of health words (−1.96, 95% CI −3.70 to −0.22). Conclusions: We found evidence for short-term task-specific spikes in the emotional positivity of web-based diary entries and recommend future studies examine the possibility of long-term impacts on the writing and well-being of students. With student well-being strategies in mind, universities should value and encourage leisure and social activities. %M 33885373 %R 10.2196/25279 %U https://www.jmir.org/2021/4/e25279 %U https://doi.org/10.2196/25279 %U http://www.ncbi.nlm.nih.gov/pubmed/33885373 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25773 %T Development of a Resource Guide to Support the Engagement of Mental Health Providers and Patients With Digital Health Tools: Multimethod Study %A Strudwick,Gillian %A McLay,David %A Lo,Brian %A Shin,Hwayeon Danielle %A Currie,Leanne %A Thomson,Nicole %A Maillet,Éric %A Strong,Vanessa %A Miller,Alanna %A Shen,Nelson %A Campbell,Janis %+ Centre for Addiction and Mental Health, 1001 Queen St W, Toronto, ON, M6J 1H4, Canada, 1 416 535 8501 ext 39333, gillian.strudwick@camh.ca %K digital health %K mental health %K psychiatry %K COVID-19 %K nursing informatics %K health informatics %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As mental illness continues to affect 1 in 5 individuals, and the need for support has increased during the COVID-19 pandemic, the promise of digital mental health tools remains largely unrealized due to a lack of uptake by patients and providers. Currently, most efforts on supporting the uptake of digital mental health tools remain fragmented across organizations and geography. There is a critical need to synthesize these efforts in order to provide a coordinated strategy of supporting the adoption of digital mental health tools. Objective: The specific aim of this project is to develop a web-based resource document to support the engagement of mental health providers and patients in the use of digital mental health tools. Methods: The web-based resource was developed using a multimethod approach. A grey literature review was conducted in 2019 to identify relevant toolkits that are available in the public domain. This was supplemented with an environmental scan where individuals with expertise in the development, acquisition, implementation, and evaluation of digital mental health tools were invited to contribute additional tools or documents not identified in the grey literature search. An engagement workshop was held with stakeholders to explore how the resource document should be developed and delivered. These findings were collectively used to develop the final iteration of the resource document. Results: Based on a gray literature review and environmental scan with 27 experts, 25 resources were identified and included in the resource guide. These resources were developed for patients and providers by organizations from 5 countries. An engagement workshop was held with 14 stakeholders, and barriers related to cultural sensitivity, sustainability, and accessibility of the toolkit were identified. The final iteration of the resource document was developed by the research team using findings from the gray literature review, environmental scan, and engagement workshop. The contents of the 45-page resource guide are directed at mental health care providers, administrators, and patients (inclusive of families and caregivers). Conclusions: The use of a multimethod approach led to the development of a resource guide that builds on existing evidence on digital mental health tools and was co-designed with stakeholders and end-users. The resource guide is now publicly available online for free and is being promoted through digital health and mental health websites. Future work should explore how this document can be integrated into clinical care delivery and pathways. %M 33885374 %R 10.2196/25773 %U https://www.jmir.org/2021/4/e25773 %U https://doi.org/10.2196/25773 %U http://www.ncbi.nlm.nih.gov/pubmed/33885374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21678 %T Chatbot-Based Assessment of Employees’ Mental Health: Design Process and Pilot Implementation %A Hungerbuehler,Ines %A Daley,Kate %A Cavanagh,Kate %A Garcia Claro,Heloísa %A Kapps,Michael %+ Vitalk, TNH Health, R. Pais Leme, 215 - Sala 2504, Pinheiros, São Paulo, 05424-150, Brazil, 55 11963883018, drkatedaley@gmail.com %K chatbot %K conversational agent %K online %K digital health %K mobile phone %K mental health %K workplace %K work stress %K survey %K response rate %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Stress, burnout, and mental health problems such as depression and anxiety are common, and can significantly impact workplaces through absenteeism and reduced productivity. To address this issue, organizations must first understand the extent of the difficulties by mapping the mental health of their workforce. Online surveys are a cost-effective and scalable approach to achieve this but typically have low response rates, in part due to a lack of interactivity. Chatbots offer one potential solution, enhancing engagement through simulated natural human conversation and use of interactive features. Objective: The aim of this study was to explore if a text-based chatbot is a feasible approach to engage and motivate employees to complete a workplace mental health assessment. This paper describes the design process and results of a pilot implementation. Methods: A fully automated chatbot (“Viki”) was developed to evaluate employee risks of suffering from depression, anxiety, stress, insomnia, burnout, and work-related stress. Viki uses a conversation style and gamification features to enhance engagement. A cross-sectional analysis was performed to gain first insights of a pilot implementation within a small to medium–sized enterprise (120 employees). Results: The response rate was 64.2% (77/120). In total, 98 employees started the assessment, 77 of whom (79%) completed it. The majority of participants scored in the mild range for anxiety (20/40, 50%) and depression (16/28, 57%), in the moderate range for stress (10/22, 46%), and at the subthreshold level for insomnia (14/20, 70%) as defined by their questionnaire scores. Conclusions: A chatbot-based workplace mental health assessment seems to be a highly engaging and effective way to collect anonymized mental health data among employees with response rates comparable to those of face-to-face interviews. %M 33881403 %R 10.2196/21678 %U https://formative.jmir.org/2021/4/e21678 %U https://doi.org/10.2196/21678 %U http://www.ncbi.nlm.nih.gov/pubmed/33881403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25468 %T Potential Correlates of Internet Gaming Disorder Among Indonesian Medical Students: Cross-sectional Study %A Siste,Kristiana %A Hanafi,Enjeline %A Sen,Lee Thung %A Wahjoepramono,Petra Octavian Perdana %A Kurniawan,Andree %A Yudistiro,Ryan %+ Faculty of Medicine, Universitas Pelita Harapan, Siloam Hospitals, Jl Siloam No 6, Tangerang, 15811, Indonesia, 62 811971169, petra.wahjoepramono@uph.edu %K internet gaming disorder %K medical students %K psychopathology %K temperament %K risk factors %D 2021 %7 19.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet gaming disorder has been a controversial topic for nearly a decade. Although internet addiction has been studied in medical students, there is a paucity of evidence regarding internet gaming disorder. Previous studies in Indonesia explored only the prevalence rate and characteristics. Objective: This study aimed to determine the prevalence rate of internet gaming disorder and correlations between internet gaming disorder, temperament, and psychopathology among Indonesian medical students. Methods: A cross-sectional study was performed from August 2019 to September 2019 using total and convenience sampling at a private university and a public university, respectively. The study variables were measured using the Indonesian version of the 10-item Internet Gaming Disorder Test, the Temperament and Character Inventory, and the Symptoms Checklist 90. Chi-square and logistic regression analyses were conducted to examine the relationships between demographic factors, temperament, psychopathology, and the presence of internet gaming disorder. Results: Among the 639 respondents, the prevalence rate of internet gaming disorder was 2.03% (n=13), with a mean age of 20.23 (SD 0.13) years and an average gaming duration of 19.0 (SD 0.96) hours/week. Up to 71.2% respondents played using their mobile phones, and respondents with internet gaming disorder reported experiencing all psychopathologies assessed, except phobic anxiety. Bivariate analysis demonstrated that internet gaming disorder was associated with gender, gaming duration, gaming community affiliation, and 9 out of 10 domains of psychopathology. In a logistic regression model, internet gaming disorder was correlated with weekly gaming hours ≥20 hours (odds ratio [OR] 4.21, 95% CI 1.08-16.38, P=.04). Conclusions: These findings suggest that the prevalence of internet gaming disorder among medical students in Jakarta, Indonesia is similar to that in other populations of Asian countries. The predisposing factor for internet gaming disorder was weekly gaming duration, while other demographic, temperament, and psychopathology variables acted as probable moderators. Strategies should, therefore, be developed and integrated into medical curriculum to screen and aid individuals with these predisposing factors. %M 33871379 %R 10.2196/25468 %U https://www.jmir.org/2021/4/e25468 %U https://doi.org/10.2196/25468 %U http://www.ncbi.nlm.nih.gov/pubmed/33871379 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e25545 %T Effects of a Digital Mental Health Program on Perceived Stress in Adolescents Aged 13-17 Years: Protocol for a Randomized Controlled Trial %A Boucher,Eliane M %A Ward,Haley E %A Stafford,Julia L %A Parks,Acacia C %+ Happify Health, 51 East 12th Street, 5th Floor, New York, NY, 10003, United States, 1 432 258 5233, eliane@happify.com %K digital intervention %K adolescents %K stress management %K mental health %K mobile phone %D 2021 %7 19.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Stress is an important transdiagnostic risk factor in adolescence and predicts a host of physical and psychological problems in adolescence and adulthood. Adolescence is also a developmental stage in which people may be more sensitive or reactive to stress. Indeed, research has shown that adolescents report high levels of stress, particularly when enrolled in school. However, adolescents report engaging in few, if any, stress management techniques. Consequently, the development of effective programs to help address adolescent stress is particularly important. To date, most stress management programs for adolescents are delivered within schools, and the evidence for such programs is mixed. Furthermore, most of these programs rely on traditional stress management techniques rather than incorporating methods to address the underlying negative cognitive processes, such as rumination, that may contribute to or exacerbate the effects of perceived stress. Objective: The aim of this study is to test the short-term effects of a digital mental health program designed for adolescents aged 13-17 years on perceived stress and rumination. Methods: This is a randomized controlled trial in which adolescents between the ages of 13 and 17 years, with elevated levels of perceived stress and brooding, will be randomly assigned to complete 8 weeks of a digital mental health program (Happify for Teens) or to a corresponding wait-list control group. The study will take place over 3 months, including the 8-week intervention period and 1-month postintervention follow-up. The primary outcome, perceived stress, along with secondary and exploratory outcomes (ie, brooding, optimism, sleep disturbance, and loneliness) will be assessed via self-report at baseline, 4 weeks, 8 weeks, and 12 weeks to compare changes in these outcomes across conditions. Results: Recruitment is expected to begin in the second quarter of 2021, with a target sample size of 800 participants (400 per condition). Participants will begin the study as they are recruited and will finish in waves, with the first wave of data expected 8 weeks after recruitment begins and the final wave of data expected by the end of the third quarter of 2021. Conclusions: Although school-based stress management programs for adolescents are common, research suggests that they may be limited in their reach and more effective for school-based stress than other types of stress. This trial will be one of the first attempts to examine the potential benefits of a digital mental health program on adolescents to address stress along with negative cognitive processes such as rumination. If successful, this would help introduce a more scalable alternative to school-based programs that offers adolescents greater privacy while also providing insight into novel ways to target adolescent mental health more generally. Trial Registration: ClinicalTrials.gov NCT04567888; https://clinicaltrials.gov/ct2/show/NCT04567888 International Registered Report Identifier (IRRID): PRR1-10.2196/25545 %M 33871377 %R 10.2196/25545 %U https://www.researchprotocols.org/2021/4/e25545 %U https://doi.org/10.2196/25545 %U http://www.ncbi.nlm.nih.gov/pubmed/33871377 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e25731 %T Virtual Reality–Based Psychotherapy in Social Anxiety Disorder: fMRI Study Using a Self-Referential Task %A Hur,Ji-Won %A Shin,Hyemin %A Jung,Dooyoung %A Lee,Heon-Jeong %A Lee,Sungkil %A Kim,Gerard J %A Cho,Chung-Yean %A Choi,Seungmoon %A Lee,Seung-Moo %A Cho,Chul-Hyun %+ Department of Psychiatry, College of Medicine, Chungnam National University, 82 Munhwa-ro, Jung-gu, Daejeon, 35015, Republic of Korea, 82 44 995 4775, david0203@gmail.com %K virtual reality %K VR %K social anxiety %K social phobia %K exposure therapy %K fMRI %K unctional magnetic resonance imaging %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although it has been well demonstrated that the efficacy of virtual reality therapy for social anxiety disorder is comparable to that of traditional cognitive behavioral therapy, little is known about the effect of virtual reality on pathological self-referential processes in individuals with social anxiety disorder. Objective: We aimed to determine changes in self-referential processing and their neural mechanisms following virtual reality treatment. Methods: We recruited participants with and without a primary diagnosis of social anxiety disorder to undergo clinical assessments (Social Phobia Scale and Post-Event Rumination Scale) and functional magnetic resonance imaging (fMRI) scans. Participants with social anxiety disorder received virtual reality–based exposure treatment for 6 sessions starting immediately after baseline testing. After the sixth session, participants with social anxiety disorder completed follow-up scans during which they were asked to judge whether a series of words (positive, negative, neutral) was relevant to them. Results: Of 25 individuals with social anxiety disorder who participated in the study, 21 completed the sessions and follow-up; 22 control individuals also participated. There were no significant differences in age (P=.36), sex (P=.71), or handedness (P=.51) between the groups. Whole-brain analysis revealed that participants in the social anxiety disorder group had increased neural responses during positive self-referential processing in the medial temporal and frontal cortexes compared with those in the control group. Participants in the social anxiety disorder group also showed increased left insular activation and decreased right middle frontal gyrus activation during negative self-referential processing. After undergoing virtual reality–based therapy, overall symptoms of the participants with social anxiety disorder were reduced, and these participants exhibited greater activity in a brain regions responsible for self-referential and autobiographical memory processes while viewing positive words during postintervention fMRI scans. Interestingly, the greater the blood oxygen level dependent changes related to positive self-referential processing, the lower the tendency to ruminate on the negative events and the lower the social anxiety following the virtual reality session. Compared with that at baseline, higher activation was also found within broad somatosensory areas in individuals with social anxiety disorder during negative self-referential processing following virtual reality therapy. Conclusions: These fMRI findings might reflect the enhanced physiological and cognitive processing in individuals with social anxiety disorder in response to self-referential information. They also provide neural evidence of the effect of virtual reality exposure therapy on social anxiety and self-derogation. %M 33851931 %R 10.2196/25731 %U https://mental.jmir.org/2021/4/e25731 %U https://doi.org/10.2196/25731 %U http://www.ncbi.nlm.nih.gov/pubmed/33851931 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21127 %T Brief Interventions via Electronic Health Record Messaging for Population-Based Suicide Prevention: Mixed Methods Pilot Study %A Whiteside,Ursula %A Richards,Julie %A Simon,Gregory E %+ NowMattersNow.org, 1645 140th Ave NE, Suite A41053, Bellevue, WA, 98005, United States, 1 206 679 6349, ursulawhiteside@gmail.com %K suicide %K suicide prevention %K dialectical behavior therapy %K caring message %K web-based %K NowMattersNow.org %K prevention %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: New opportunities to create and evaluate population-based selective prevention programs for suicidal behavior are emerging in health care settings. Standard depression severity measures recorded in electronic medical records (EMRs) can be used to identify patients at risk for suicide and suicide attempt, and promising interventions for reducing the risk of suicide attempt in at-risk populations can be adapted for web-based delivery in health care. Objective: This study aims to evaluate a pilot of a psychoeducational program, focused on developing emotion regulation techniques via a web-based dialectical behavior therapy (DBT) skills site, including four DBT skills, and supported by secure message coaching, including elements of caring messages. Methods: Patients were eligible based on the EMR-documented responses to the Patient Health Questionnaire indicating suicidal thoughts. We measured feasibility via the proportion of invitees who opened program invitations, visited the web-based consent form page, and consented; acceptability via qualitative feedback from participants about the DBT program; and engagement via the proportion of invitees who began DBT skills as well as the number of website visits for DBT skills and the degree of site engagement. Results: A total of 60 patients were invited to participate. Overall, 93% (56/60) of the patients opened the invitation and 43% (26/60) consented to participate. DBT skills website users visited the home page on an average of 5.3 times (SD 6.0). Procedures resulted in no complaints and some participant feedback emphasizing the usefulness of DBT skills. Conclusions: This study supports the potential of using responses to patient health questionnaires in EMRs to identify a high-risk population and offer key elements of caring messages and DBT adapted for a low-intensity intervention. A randomized trial evaluating the effectiveness of this program is now underway (ClinicalTrials.gov: NCT02326883). %M 33843599 %R 10.2196/21127 %U https://formative.jmir.org/2021/4/e21127 %U https://doi.org/10.2196/21127 %U http://www.ncbi.nlm.nih.gov/pubmed/33843599 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e26562 %T Technology-Based Psychological Interventions for Young Adults With Early Psychosis and Cannabis Use Disorder: Qualitative Study of Patient and Clinician Perspectives %A Tatar,Ovidiu %A Abdel-Baki,Amal %A Tra,Christophe %A Mongeau-Pérusse,Violaine %A Arruda,Nelson %A Kaur,Navdeep %A Landry,Vivianne %A Coronado-Montoya,Stephanie %A Jutras-Aswad,Didier %+ Research Center, Centre Hospitalier de l’Université de Montréal (CRCHUM), 900 St-Denis Street Viger Tower, 5th floor, room R05.740, Montreal, QC, H2X 1P1, Canada, 1 514 890 8000 ext 35703, didier.jutras-aswad@umontreal.ca %K psychology %K intervention %K cannabis misuse %K cannabis use disorder %K young adult %K clinician %K psychosis %K schizophrenia %K dual diagnosis %K qualitative %K acceptability %K technology-based %K telemedicine %K mHealth %K digital health %K eHealth %K application %K smartphone %K mobile phone %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The persistence of cannabis use disorder (CUD) in young adults with first-episode psychosis (FEP) is associated with poor clinical and functional outcomes. Face-to-face psychological interventions are effective in treating CUD. However, their use in early intervention services (EISs) for psychosis is inconsistent because of barriers, including high workload and heterogeneity in training of clinicians and lack of motivation for treatment among patients. Tailoring new technology-based psychological interventions (TBPIs) to overcome these barriers is necessary to ensure their optimal acceptability. Objective: The aim of this study is twofold: to explore psychological intervention practices and intervention targets that are relevant for treating CUD in individuals with early psychosis and to explore factors related to the development and implementation of a technology-assisted psychological intervention. Methods: A total of 10 patients undergoing treatment for FEP and CUD in EISs participated in a focus group in June 2019. Semistructured individual interviews were conducted with 10 clinicians working in first-episode clinics in the province of Québec, Canada. A hybrid inductive-deductive approach was used to analyze data. For the deductive analysis, we used categories of promoting strategies found in the literature shown to increase adherence to web-based interventions for substance use (ie, tailoring, reminders, delivery strategies, social support, and incentives). For the inductive analysis, we identified new themes through an iterative process of reviewing the data multiple times by two independent reviewers. Results: Data were synthesized into five categories of factors that emerged from data collection, and a narrative synthesis of commonalities and differences between patient and clinician perspectives was produced. The categories included attitudes and beliefs related to psychological interventions (eg, behavioral stage of change), strategies for psychological interventions (eg, motivational interviewing, cognitive behavioral therapy, psychoeducation, stress management), incentives (eg, contingency management), general interest in TBPIs (eg, facilitators and barriers of TBPIs), and tailoring of TBPIs (eg, application needs and preferences, outcome measures of interest for clinicians). Conclusions: This study provides a comprehensive portrait of the multifaceted needs and preferences of patients and clinicians related to TBPIs. Our results can inform the development of smartphone- or web-based psychological interventions for CUD in young adults with early psychosis. %M 33818397 %R 10.2196/26562 %U https://formative.jmir.org/2021/4/e26562 %U https://doi.org/10.2196/26562 %U http://www.ncbi.nlm.nih.gov/pubmed/33818397 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27121 %T Computer Mouse Movements as an Indicator of Work Stress: Longitudinal Observational Field Study %A Banholzer,Nicolas %A Feuerriegel,Stefan %A Fleisch,Elgar %A Bauer,Georg Friedrich %A Kowatsch,Tobias %+ Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Weinbergstr 56/58, Zurich, 8092, Switzerland, 41 799129133, tkowatsch@ethz.ch %K work stress %K psychological stress %K stress indicator %K computer mouse movements %K human-computer interactions %D 2021 %7 2.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Work stress affects individual health and well-being. These negative effects could be mitigated through regular monitoring of employees’ stress. Such monitoring becomes even more important as the digital transformation of the economy implies profound changes in working conditions. Objective: The goal of this study was to investigate the association between computer mouse movements and work stress in the field. Methods: We hypothesized that stress is associated with a speed-accuracy trade-off in computer mouse movements. To test this hypothesis, we conducted a longitudinal field study at a large business organization, where computer mouse movements from regular work activities were monitored over 7 weeks; the study included 70 subjects and 1829 observations. A Bayesian regression model was used to estimate whether self-reported acute work stress was associated with a speed-accuracy trade-off in computer mouse movements. Results: There was a negative association between stress and the two-way interaction term of mouse speed and accuracy (mean −0.32, 95% highest posterior density interval −0.58 to −0.08), which means that stress was associated with a speed-accuracy trade-off. The estimated association was not sensitive to different processing of the data and remained negative after controlling for the demographics, health, and personality traits of subjects. Conclusions: Self-reported acute stress is associated with computer mouse movements, specifically in the form of a speed-accuracy trade-off. This finding suggests that the regular analysis of computer mouse movements could indicate work stress. %M 33632675 %R 10.2196/27121 %U https://www.jmir.org/2021/4/e27121 %U https://doi.org/10.2196/27121 %U http://www.ncbi.nlm.nih.gov/pubmed/33632675 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24727 %T Correlations Between Facial Expressivity and Apathy in Elderly People With Neurocognitive Disorders: Exploratory Study %A Zeghari,Radia %A König,Alexandra %A Guerchouche,Rachid %A Sharma,Garima %A Joshi,Jyoti %A Fabre,Roxane %A Robert,Philippe %A Manera,Valeria %+ Cognition Behaviour Technology Research Unit, Memory Center, Université Côte d’Azur, 10 Rue Molière, Nice, France, 33 4 92 03 47 66, radia.zeghari@univ-cotedazur.fr %K apathy %K action units %K assessment %K ICT %K facial video analysis %K neurocognitive disorders %K neurocognitive %K facial analysis %D 2021 %7 31.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Neurocognitive disorders are often accompanied by behavioral symptoms such as anxiety, depression, and/or apathy. These symptoms can occur very early in the disease progression and are often difficult to detect and quantify in nonspecialized clinical settings. Objective: We focus in this study on apathy, one of the most common and debilitating neuropsychiatric symptoms in neurocognitive disorders. Specifically, we investigated whether facial expressivity extracted through computer vision software correlates with the severity of apathy symptoms in elderly subjects with neurocognitive disorders. Methods: A total of 63 subjects (38 females and 25 males) with neurocognitive disorder participated in the study. Apathy was assessed using the Apathy Inventory (AI), a scale comprising 3 domains of apathy: loss of interest, loss of initiation, and emotional blunting. The higher the scale score, the more severe the apathy symptoms. Participants were asked to recall a positive and a negative event of their life, while their voice and face were recorded using a tablet device. Action units (AUs), which are basic facial movements, were extracted using OpenFace 2.0. A total of 17 AUs (intensity and presence) for each frame of the video were extracted in both positive and negative storytelling. Average intensity and frequency of AU activation were calculated for each participant in each video. Partial correlations (controlling for the level of depression and cognitive impairment) were performed between these indexes and AI subscales. Results: Results showed that AU intensity and frequency were negatively correlated with apathy scale scores, in particular with the emotional blunting component. The more severe the apathy symptoms, the less expressivity in specific emotional and nonemotional AUs was displayed from participants while recalling an emotional event. Different AUs showed significant correlations depending on the sex of the participant and the task’s valence (positive vs negative story), suggesting the importance of assessing male and female participants independently. Conclusions: Our study suggests the interest of employing computer vision-based facial analysis to quantify facial expressivity and assess the severity of apathy symptoms in subjects with neurocognitive disorders. This may represent a useful tool for a preliminary apathy assessment in nonspecialized settings and could be used to complement classical clinical scales. Future studies including larger samples should confirm the clinical relevance of this kind of instrument. %M 33787499 %R 10.2196/24727 %U https://formative.jmir.org/2021/3/e24727 %U https://doi.org/10.2196/24727 %U http://www.ncbi.nlm.nih.gov/pubmed/33787499 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25810 %T Development of Coaching Support for LiveWell: A Smartphone-Based Self-Management Intervention for Bipolar Disorder %A Dopke,Cynthia A %A McBride,Alyssa %A Babington,Pamela %A Jonathan,Geneva K %A Michaels,Tania %A Ryan,Chloe %A Duffecy,Jennifer %A Mohr,David C %A Goulding,Evan H %+ Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, 303 E Chicago Ave., Suite 7-102, Chicago, IL, 60611, United States, 1 3125031189, e-goulding@fsm.northwestern.edu %K human support %K adherence %K self-management %K behavior change %K mHealth %K bipolar disorder %D 2021 %7 24.3.2021 %9 Viewpoint %J JMIR Form Res %G English %X Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to recurrence of episodes, long episode durations, and persistence of interepisode symptoms. While adding psychotherapy to pharmacotherapy improves outcomes, the availability of adjunctive psychotherapy is limited. To extend the accessibility and functionality of psychotherapy for bipolar disorder, we developed LiveWell, a smartphone-based self-management intervention. Unfortunately, many mental health technology interventions suffer from high attrition rates, with users rapidly failing to maintain engagement with the intervention technology. Human support reduces this commonly observed engagement problem but does not consistently improve clinical and recovery outcomes. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, timing of delivery, and the training and supervision for coaching support of the LiveWell technology. This support includes clearly defined and structured roles that aim to encourage the use of the technology, self-management strategies, and communication with care providers. A clear division of labor is established between the coaching support roles and the intervention technology to allow lay personnel to serve as coaches and thereby maximize accessibility to the LiveWell intervention. %M 33759798 %R 10.2196/25810 %U https://formative.jmir.org/2021/3/e25810 %U https://doi.org/10.2196/25810 %U http://www.ncbi.nlm.nih.gov/pubmed/33759798 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23137 %T Key Variables for Effective eHealth Designs for Individuals With and Without Mental Health Disorders: 2^12-4 Fractional Factorial Experiment %A Rotondi,Armando J %A Grady,Jonathan %A Hanusa,Barbara H %A Haas,Gretchen L %A Spring,Michael R %A Abebe,Kaleab Z %A Luther,James %A Gurklis,John %+ Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Health Care System, Department of Veterans Affairs, Research Office Bld, (151R-U), University Drive C, Pittsburgh, PA, 15240, United States, 1 412 360 2369, armandorotondi1@gmail.com %K schizophrenia %K severe mental illness %K eHealth %K eHealth design %K website %K usability %K website design %K website usability %K fractional factorial design %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth applications not only offer the potential to increase service convenience and responsiveness but also expand the ability to tailor services to improve relevance, engagement, and use. To achieve these goals, it is critical that the designs are intuitive. Limited research exists on designs that work for those with a severe mental illness (SMI), many of whom have difficulty traveling for treatments, reject or infrequently seek treatment, and tend to discontinue treatments for significant periods. Objective: This study aims to evaluate the influence of 12 design variables (eg, navigational depth, reading level, and use of navigational lists) on the usability of eHealth application websites for those with and without SMI. Methods: A 212-4 fractional factorial experiment was used to specify the designs of 256 eHealth websites. This approach systematically varied the 12 design variables. The final destination contents of all websites were identical, and only the designs of the navigational pages varied. The 12 design elements were manipulated systematically to allow the assessment of combinations of design elements rather than only one element at a time. Of the 256 websites, participants (n=222) sought the same information on 8 randomly selected websites. Mixed effect regressions, which accounted for the dependency of the 8 observations within participants, were used to test for main effects and interactions on the ability and time to find information. Classification and regression tree analyses were used to identify effects among the 12 variables on participants’ abilities to locate information, for the sample overall and each of the 3 diagnostic groups of participants (schizophrenia spectrum disorder [SSD], other mental illnesses, and no mental illness). Results: The best and worst designs were identified for each of these 4 groups. The depth of a website’s navigation, that is, the number of screens users needed to navigate to find the desired content, had the greatest influence on usability (ability to find information) and efficiency (time to find information). The worst performing designs for those with SSD had a 9% success rate, and the best had a 51% success rate: the navigational designs made a 42% difference in usability. For the group with other mental illnesses, the design made a 50% difference, and for those with no mental illness, a 55% difference was observed. The designs with the highest usability had several key design similarities, as did those with the poorest usability. Conclusions: It is possible to identify evidence-based strategies for designing eHealth applications that result in significantly better performance. These improvements in design benefit all users. For those with SSD or other SMIs, there are designs that are highly effective. Both the best and worst designs have key similarities but vary in some characteristics. %M 33759796 %R 10.2196/23137 %U https://www.jmir.org/2021/3/e23137 %U https://doi.org/10.2196/23137 %U http://www.ncbi.nlm.nih.gov/pubmed/33759796 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e26355 %T Designing an mHealth Intervention for People With Visible Differences Based on Acceptance and Commitment Therapy: Participatory Study Gaining Stakeholders’ Input %A Zucchelli,Fabio %A Donnelly,Olivia %A Rush,Emma %A Smith,Harriet %A Williamson,Heidi %A , %+ The Centre for Appearance Research, University of the West of England, Frenchay Campus, Coldharbour Lane, Bristol, BS16 1QY, United Kingdom, 44 11732 83882, fabio.zucchelli@uwe.ac.uk %K mobile health %K acceptance and commitment therapy %K appearance %K qualitative %K participatory design %K mobile phone %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Given their growing popularity, mobile health (mHealth) apps may offer a viable method of delivering psychological interventions for people with an atypical appearance (ie, visible difference) who struggle with appearance-related distress. Acceptance and Commitment Therapy (ACT), a third-wave cognitive behavioral approach, has been used effectively in mHealth and is being increasingly applied clinically to common psychosocial difficulties associated with visible differences. We planned to design an ACT-based mHealth intervention (ACT It Out) for this population. Objective: The aim of this study is to gain key stakeholder input from user representatives and psychological clinicians to optimize the intervention’s design for future development and uptake. To do so, we explored considerations relating to mHealth as a delivery platform for adults with visible differences and elicited stakeholders’ design preferences and ideas based on initial author-created content. Methods: Within a participatory design framework, we used a mix of qualitative methods, including usability sessions and a focus group in a face-to-face workshop, and interviews and textual feedback collected remotely, all analyzed using template analysis. A total of 6 user representatives and 8 clinicians were recruited for this study. Results: Our findings suggest that there are likely to be strengths and challenges of mHealth as an intervention platform for the study population, with key concerns being user safeguarding and program adherence. Participants expressed design preferences toward relatable human content, interactive and actionable features, flexibility of use, accessibility, and engaging content. Conclusions: The findings offer valuable design directions for ACT It Out and related interventions, emphasizing the need to carefully guide users through the intervention while acknowledging the limited time and space that mHealth affords. %M 33759791 %R 10.2196/26355 %U https://formative.jmir.org/2021/3/e26355 %U https://doi.org/10.2196/26355 %U http://www.ncbi.nlm.nih.gov/pubmed/33759791 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 3 %P e21115 %T The Moderating Role of Coping Mechanisms and Being an e-Sport Player Between Psychiatric Symptoms and Gaming Disorder: Online Survey %A Bányai,Fanni %A Zsila,Ágnes %A Kökönyei,Gyöngyi %A Griffiths,Mark D %A Demetrovics,Zsolt %A Király,Orsolya %+ Centre of Excellence in Responsible Gaming, University of Gibraltar, Europa Point Campus, Europa Point, Gibraltar, GX111AA, Gibraltar, 36 30 976 1097, zsolt.demetrovics@unigib.edu.gi %K gaming disorder %K esports %K professional gaming %K video games %K coping skills %K psychiatric symptoms %K psychiatry %K mental health %K gaming %D 2021 %7 23.3.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The emerging popularity of playing video games (gaming) as a hobby and as a professional sport raises awareness about both the benefits and possible downsides of the activity. Although a healthy and passionate hobby for most, a minority of gamers experience addiction-like symptoms and are considered to have gaming disorder (GD). GD has previously been found to be related to aversive conditions, such as depression or anxiety, as well as putatively maladaptive coping strategies. Objective: The aim of this study is twofold: to explore the moderating effect of different coping strategies and type of video game usage (professional [e-sport] or recreational) on the relationship between psychiatric symptoms and GD. Methods: A sample of 3476 gamers (n=3133, 90.13% males; mean age 23.20, SD 6.48 years) was recruited via the website and social networking site of the most popular gaming magazine in Hungary (GameStar). Results: The main effect of psychiatric symptoms was moderate to large in all models, whereas the moderation effects were significant (P<.001) for 4 out of 8 coping strategies (ie, self-blame/self-distraction, denial, emotional/social support, and active coping). However, the explained variance of the models only increased negligibly (from 0.3% to 0.5%) owing to the moderation effect. The direction of the moderations was as expected (ie, putatively maladaptive strategies were associated with more GD symptoms when the level of psychiatric symptoms was high, while putatively adaptive strategies were associated with less). Furthermore, no considerable moderation effect of the player type (recreational vs professional players) was found on the association between psychiatric symptoms and GD (β=.04; P=.02; 0.1% change in the explained variance). Conclusions: Future studies should be designed to better understand coping-related mechanisms in the context of video gaming and GD. %M 33755024 %R 10.2196/21115 %U https://mental.jmir.org/2021/3/e21115 %U https://doi.org/10.2196/21115 %U http://www.ncbi.nlm.nih.gov/pubmed/33755024 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e24799 %T Internet-Based Individualized Cognitive Behavioral Therapy for Shift Work Sleep Disorder Empowered by Well-Being Prediction: Protocol for a Pilot Study %A Ito-Masui,Asami %A Kawamoto,Eiji %A Sakamoto,Ryota %A Yu,Han %A Sano,Akane %A Motomura,Eishi %A Tanii,Hisashi %A Sakano,Shoko %A Esumi,Ryo %A Imai,Hiroshi %A Shimaoka,Motomu %+ Departments of Molecular and Pathobiology and Cell Adhesion Biology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu City, Mie, 514-8507, Japan, 81 59 232 5036, a_2.uk@mac.com %K shift work sleep disorders %K health care workers %K wearable sensors %K shift work %K sleep disorder %K medical safety %K safety issue %K shift workers %K sleep %K safety %K cognitive behavioral therapy %K CBT %K online intervention %K pilot study %K machine learning %K well-being %D 2021 %7 18.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Shift work sleep disorders (SWSDs) are associated with the high turnover rates of nurses, and are considered a major medical safety issue. However, initial management can be hampered by insufficient awareness. In recent years, it has become possible to visualize, collect, and analyze the work-life balance of health care workers with irregular sleeping and working habits using wearable sensors that can continuously monitor biometric data under real-life settings. In addition, internet-based cognitive behavioral therapy for psychiatric disorders has been shown to be effective. Application of wearable sensors and machine learning may potentially enhance the beneficial effects of internet-based cognitive behavioral therapy. Objective: In this study, we aim to develop and evaluate the effect of a new internet-based cognitive behavioral therapy for SWSD (iCBTS). This system includes current methods such as medical sleep advice, as well as machine learning well-being prediction to improve the sleep durations of shift workers and prevent declines in their well-being. Methods: This study consists of two phases: (1) preliminary data collection and machine learning for well-being prediction; (2) intervention and evaluation of iCBTS for SWSD. Shift workers in the intensive care unit at Mie University Hospital will wear a wearable sensor that collects biometric data and answer daily questionnaires regarding their well-being. They will subsequently be provided with an iCBTS app for 4 weeks. Sleep and well-being measurements between baseline and the intervention period will be compared. Results: Recruitment for phase 1 ended in October 2019. Recruitment for phase 2 has started in October 2020. Preliminary results are expected to be available by summer 2021. Conclusions: iCBTS empowered with well-being prediction is expected to improve the sleep durations of shift workers, thereby enhancing their overall well-being. Findings of this study will reveal the potential of this system for improving sleep disorders among shift workers. Trial Registration: UMIN Clinical Trials Registry UMIN000036122 (phase 1), UMIN000040547 (phase 2); https://tinyurl.com/dkfmmmje, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046284 International Registered Report Identifier (IRRID): DERR1-10.2196/24799 %M 33626497 %R 10.2196/24799 %U https://www.researchprotocols.org/2021/3/e24799 %U https://doi.org/10.2196/24799 %U http://www.ncbi.nlm.nih.gov/pubmed/33626497 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e18348 %T e-Mental Health Program Usage Patterns in Randomized Controlled Trials and in the General Public to Inform External Validity Considerations: Sample Groupings Using Cluster Analyses %A Sanatkar,Samineh %A Baldwin,Peter %A Huckvale,Kit %A Christensen,Helen %A Harvey,Samuel %+ Black Dog Institute, The University of New South Wales Sydney, Hospital Road, Randwick, 2031, Australia, 61 9382 4368, s.sanatkar@unsw.edu.au %K e-mental health %K engagement patterns %K external validity %K randomized controlled trial %K community sample %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Randomized controlled trials (RCTs) with vigorous study designs are vital for determining the efficacy of treatments. Despite the high internal validity attributed to RCTs, external validity concerns limit the generalizability of results to the general population. Bias can be introduced, for example, when study participants who self-select into a trial are more motivated to comply with study conditions than are other individuals. These external validity considerations extend to e-mental health (eMH) research, especially when eMH tools are designed for public access and provide minimal or no supervision. Objective: Clustering techniques were employed to identify engagement profiles of RCT participants and community users of a self-guided eMH program. This exploratory approach inspected actual, not theorized, RCT participant and community user engagement patterns. Both samples had access to the eMH program over the same time period and received identical usage recommendations on the eMH program website. The aim of this study is to help gauge expectations of similarities and differences in usage behaviors of an eMH tool across evaluation and naturalistic contexts. Methods: Australian adults signed up to myCompass, a self-guided online treatment program created to reduce mild to moderate symptoms of negative emotions. They did so either by being part of an RCT onboarding (160/231, 69.6% female) or by accessing the program freely on the internet (5563/8391, 66.30% female) between October 2011 and October 2012. During registration, RCT participants and community users provided basic demographic information. Usage metrics (number of logins, trackings, and learning activities) were recorded by the system. Results: Samples at sign-up differed significantly in age (P=.003), with community users being on average 3 years older (mean 41.78, SD 13.64) than RCT participants (mean 38.79, SD 10.73). Furthermore, frequency of program use was higher for RCT participants on all usage metrics compared to community users through the first 49 days after registration (all P values <.001). Two-step cluster analyses revealed 3 user groups in the RCT sample (Nonstarters, 10-Timers, and 30+-Timers) and 2 user groups in the community samples (2-Timers and 20-Timers). Groups seemed comparable in patterns of use but differed in magnitude, with RCT participant usage groups showing more frequent engagement than community usage groups. Only the high-usage group among RCT participants approached myCompass usage recommendations. Conclusions: Findings suggested that external validity concerns of RCT designs may arise with regards to the predicted magnitude of eMH program use rather than overall usage styles. Following up RCT nonstarters may help provide unique insights into why individuals choose not to engage with an eMH program despite generally being willing to participate in an eMH evaluation study. Overestimating frequency of engagement with eMH tools may have theoretical implications and potentially impact economic considerations for plans to disseminate these tools to the general public. %M 33704070 %R 10.2196/18348 %U https://www.jmir.org/2021/3/e18348 %U https://doi.org/10.2196/18348 %U http://www.ncbi.nlm.nih.gov/pubmed/33704070 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e24534 %T The Impact of a Web-Based Mindfulness, Nutrition, and Physical Activity Platform on the Health Status of First-Year University Students: Protocol for a Randomized Controlled Trial %A Trottier,Claire F %A Lieffers,Jessica R L %A Johnson,Steven T %A Mota,João F %A Gill,Roshni K %A Prado,Carla M %+ Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, 2-004 Li Ka Shing Centre for Health and Innovation, 8602 - 112 Street, Edmonton, AB, T6G 2R3, Canada, 1 780 492 7934, cprado@ualberta.ca %K internet-based intervention %K wellness programs %K dietary intake %K physical activity %K mindfulness %K quality of life %K randomized controlled trial %D 2021 %7 10.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: First-year university students are at an increased risk for developing mental health issues and a poor nutritional status. Self-care plays an essential role in optimizing mental health and can prevent or manage stress, anxiety, and depression. Web-based self-monitoring of diet and physical activity can lead to similar or improved health outcomes compared with conventional methods. Such tools are also popular among university students. Objective: The primary aim of this 12-week randomized controlled trial is to assess the impact of a web-based wellness platform on perceived stress among first-year university students. The secondary aim is to assess the effects of the platform on diet quality. The exploratory objectives are to explore the effects of the platform on body composition, health-related quality of life, mindfulness, mental well-being, and physical activity. Methods: A total of 97 first-year undergraduate students were randomized to either the intervention (n=48) or control (n=49) group. The intervention consisted of access to a web-based platform called My Viva Plan (MVP), which aims to support healthy living by focusing on the topics of mindfulness, nutrition, and physical activity. The platform is fully automated and guided by the principles of cognitive behavioral theory. Participants in the intervention group were instructed to use the MVP as frequently as possible over 12 weeks. The control group did not receive access to MVP. Perceived stress was assessed using the Stress Indicators Questionnaire at baseline, week 6, and week 12. Three-day food records were used to analyze the dietary intake at baseline and week 12. Health-related quality of life, mindfulness, mental well-being, and physical activity questionnaires were completed at baseline, week 6, and week 12. Body composition was assessed at baseline and week 12. Study assessments were completed in person at baseline and week 12 and electronically at week 6. Results: Study recruitment started in August 2018, with batch enrollment for students registered in the fall (September 2018 to December 2018) and winter (January 2019 to April 2019) academic terms at the University of Alberta, Edmonton, Alberta. Conclusions: This study is the first to explore the impact of a web-based platform designed to promote health and wellness on perceived stress and diet quality among first-year university students. Trial Registration: ClinicalTrials.gov NCT03579264; https://clinicaltrials.gov/ct2/show/NCT03579264. International Registered Report Identifier (IRRID): DERR1-10.2196/24534 %M 33688844 %R 10.2196/24534 %U https://www.researchprotocols.org/2021/3/e24534 %U https://doi.org/10.2196/24534 %U http://www.ncbi.nlm.nih.gov/pubmed/33688844 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e17438 %T Opportunities and Challenges for Digital Social Prescribing in Mental Health: Questionnaire Study %A Patel,Shivani %A Craigen,Gerry %A Pinto da Costa,Mariana %A Inkster,Becky %+ South London and Maudsley NHS Trust, Denmark Hill, London, United Kingdom, 44 3228 6000 ext 1234, shivaninpatel183@gmail.com %K mental health %K technology %K psychiatry %K mobile phone %D 2021 %7 9.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The concept of digital social prescription usually refers to social prescriptions that are facilitated by using technology. Tools that enable such digital social prescriptions may be beneficial in recommending nonmedical activities to people with mental illness. As these tools are still somewhat novel and emerging, little is known about their potential advantages and disadvantages. Objective: The objective of this study is to identify the potential opportunities and challenges that may arise from digital social prescriptions. Methods: We developed a qualitative questionnaire that was disseminated through social media (Facebook and Twitter). A purposive sample targeting digital mental health experts and nonexperts was approached. The questionnaire asked participants’ views about digital social prescription; the core elements linked with a definition of digital social prescription; and the strengths, weaknesses, opportunities, and threats associated with digital social prescription. Results: Four core elements were recommended to define the concept of digital social prescription: digital, facilitate, user, and social. The main strength identified was the possibility to rapidly start using digital social prescription tools, which were perceived as cost-effective. The main weaknesses were their poor adherence and difficulties with using such tools. The main opportunities were an increased access to social prescription services and the prevention of serious mental illness. The main threats were certain groups being disadvantaged, patients being subject to unintended negative consequences, and issues relating to confidentiality and data protection. Conclusions: Although digital social prescriptions may be able to effectively augment the social prescriptions, a careful consideration of practical challenges and data ethics is imperative in the design and implementation of such technologies. %M 33687338 %R 10.2196/17438 %U https://www.jmir.org/2021/3/e17438 %U https://doi.org/10.2196/17438 %U http://www.ncbi.nlm.nih.gov/pubmed/33687338 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e26168 %T Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol %A Lewis,Matthew %A Palmer,Victoria J %A Kotevski,Aneta %A Densley,Konstancja %A O'Donnell,Meaghan L %A Johnson,Caroline %A Wohlgezogen,Franz %A Gray,Kathleen %A Robins-Browne,Kate %A Burchill,Luke %+ Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 4th Floor, Clinical Sciences Building, Parkville, 3050, Australia, 61 3 8344 7161, blj@unimelb.edu.au %K mental health %K mobile applications %K COVID-19 %K health personnel %K experience-based co-design %K impact %K evaluation %K digital interventions %K app %K intervention %K health care worker %K design %K delivery %K support %D 2021 %7 9.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has highlighted the importance of health care workers’ mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. Objective: RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. Methods: The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. Results: The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. Conclusions: The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. International Registered Report Identifier (IRRID): DERR1-10.2196/26168 %M 33635823 %R 10.2196/26168 %U https://www.researchprotocols.org/2021/3/e26168 %U https://doi.org/10.2196/26168 %U http://www.ncbi.nlm.nih.gov/pubmed/33635823 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e23613 %T Development of a Web-Based Intervention Course to Promote Students’ Well-Being and Studying in Universities: Protocol for an Experimental Study Design %A Asikainen,Henna %A Katajavuori,Nina %+ Faculty of Educational Sciences, University of Helsinki, Viikinkaari 9, PO Box 59, Helsinki, 00014, Finland, 358 445532494, henna.asikainen@helsinki.fi %K approaches to learning %K psychological flexibility %K well-being %K online intervention tool %K peer support %K reflection %D 2021 %7 9.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The decline in the well-being among university students well as increasing dropouts has become a serious issue in universities around the world. Thus, effective ways to support students’ well-being and their ability to study are highly needed. Objective: The purpose of this study was to build an intervention course for university students, which promotes both students’ well-being as well as their learning and study skills, and to describe the experimental study design that explores the effects of this intervention course. Methods: Research has shown that psychological flexibility has a great effect on the well-being as well as the study skills of students pursuing higher education. The basis of our intervention course was to promote psychological flexibility and students’ study skills with the help of peer support and reflection. Results: This course was offered as a voluntary course to all the students at the University of Helsinki twice during the academic year 2020-2021. The first course was from October to December and the second course was from January to March. This course was advertised in fall 2020 through social media and by different student organizations and program leaders at different faculties of the University of Helsinki. As of October 2020, we enrolled 566 students comprising 310 students for the course in fall 2020 and 256 students for the course in spring 2021. Of the 256 students who enrolled in the second course, 170 students voluntarily participated in this study and they answered the questionnaires, including all the measures, simultaneously with the participants in the first group and thus served as the control group. The effect of this course will be measured with multiple data, including questionnaire data, reflective journals, and physiological data of well-being with a longitudinal experimental design. This research very strictly follows the ethical guidelines drawn up by the Finnish National Board on Research Integrity. We expect to publish the results of this study in fall 2021 at the latest. Conclusions: We argue that a web-based, 8-week intervention course, which promotes both student well-being and their study skills, is a good way to support students pursuing higher education, and both aspects should be considered when supporting university students. International Registered Report Identifier (IRRID): DERR1-10.2196/23613 %M 33687336 %R 10.2196/23613 %U https://www.researchprotocols.org/2021/3/e23613 %U https://doi.org/10.2196/23613 %U http://www.ncbi.nlm.nih.gov/pubmed/33687336 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22950 %T Older Adult Peer Support Specialists’ Age-Related Contributions to an Integrated Medical and Psychiatric Self-Management Intervention: Qualitative Study of Text Message Exchanges %A Mbao,Mbita %A Collins-Pisano,Caroline %A Fortuna,Karen %+ Dartmouth College, Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States, 1 603 722 5727, karen.L.Fortuna@dartmouth.edu %K older adults %K peer support %K self-management %K mobile technology %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X 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 adult peer support specialists” is increasingly using technology to deliver peer support services to address both the mental health and physical health needs of middle-aged and older adults with a diagnosis of a serious mental illness. Objective: This exploratory qualitative study examined older adult peer support specialists’ text message exchanges with middle-aged and older adults with a diagnosis of a serious mental illness and their nonmanualized age-related contributions to a standardized integrated medical and psychiatric self-management intervention. Methods: Older adult peer support specialists exchanged text messages with middle-aged and older adults with a diagnosis of a serious mental illness as part of a 12-week standardized integrated medical and psychiatric self-management smartphone intervention. Text message exchanges between older adult peer support specialists (n=3) and people with serious mental illnesses (n=8) were examined (mean age 68.8 years, SD 4.9 years). A total of 356 text messages were sent between older adult peer support specialists and service users with a diagnosis of a serious mental illness. Older adult peer support specialists sent text messages to older participants’ smartphones between 8 AM and 10 PM on weekdays and weekends. Results: Five themes emerged from text message exchanges related to older adult peer support specialists’ age-related contributions to integrated self-management, including (1) using technology to simultaneously manage mental health and physical health issues; (2) realizing new coping skills in late life; (3) sharing roles as parents and grandparents; (4) wisdom; and (5) sharing lived experience of difficulties with normal age-related changes (emerging). Conclusions: Older adult peer support specialists’ lived experience of aging successfully with a mental health challenge may offer an age-related form of peer support that may have implications for promoting successful aging in older adults with a serious mental illness. %M 33650979 %R 10.2196/22950 %U https://formative.jmir.org/2021/3/e22950 %U https://doi.org/10.2196/22950 %U http://www.ncbi.nlm.nih.gov/pubmed/33650979 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e17993 %T A Rest Quality Metric Using a Cluster-Based Analysis of Accelerometer Data and Correlation With Digital Medicine Ingestion Data: Algorithm Development %A Heidary,Zahra %A Cochran,Jeffrey M %A Peters-Strickland,Timothy %A Knights,Jonathan %+ Otsuka Pharmaceutical Development & Commercialization, Inc, 508 Carnegie Center Dr, Princeton, NJ, 08540, United States, 1 609 524 6788, jeffrey.cochran@otsuka-us.com %K serious mental illness %K rest quality %K actimetry %K behavioral health %K digital medicine %K accelerometer %K medication adherence %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adherence to medication regimens and patient rest are two important factors in the well-being of patients with serious mental illness. Both of these behaviors are traditionally difficult to record objectively in unsupervised populations. Objective: A digital medicine system that provides objective time-stamped medication ingestion records was used by patients with serious mental illness. Accelerometer data from the digital medicine system was used to assess rest quality and thus allow for investigation into correlations between rest and medication ingestion. Methods: Longest daily rest periods were identified and then evaluated using a k-means clustering algorithm and distance metric to quantify the relative quality of patient rest during these periods. This accelerometer-derived quality-of-rest metric, along with other accepted metrics of rest quality, such as duration and start time of the longest rest periods, was compared to the objective medication ingestion records. Overall medication adherence classification based on rest features was not performed due to a lack of patients with poor adherence in the sample population. Results: Explorations of the relationship between these rest metrics and ingestion did seem to indicate that patients with poor adherence experienced relatively low quality of rest; however, patients with better adherence did not necessarily exhibit consistent rest quality. This sample did not contain sufficient patients with poor adherence to draw more robust correlations between rest quality and ingestion behavior. The correlation of temporal outliers in these rest metrics with daily outliers in ingestion time was also explored. Conclusions: This result demonstrates the ability of digital medicine systems to quantify patient rest quality, providing a framework for further work to expand the participant population, compare these rest metrics to gold-standard sleep measurements, and correlate these digital medicine biomarkers with objective medication ingestion data. %M 33650981 %R 10.2196/17993 %U https://formative.jmir.org/2021/3/e17993 %U https://doi.org/10.2196/17993 %U http://www.ncbi.nlm.nih.gov/pubmed/33650981 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18172 %T Co-Designing a Mobile App to Improve Mental Health and Well-Being: Focus Group Study %A Alqahtani,Felwah %A Winn,Andrea %A Orji,Rita %+ Faculty of Computer Science, Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada, 1 9027892230, Felwah.alqahtani@dal.ca %K mental health %K mobile app %K focus groups %K design recommendation %K mobile phone %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent advances in mobile technology have created opportunities to develop mobile apps to aid and assist people in achieving various health and wellness goals. Mental health apps hold significant potential to assist people affected by various mental health issues at any time they may need it, considering the ubiquitous nature of mobile phones. However, there is a need for research to explore and understand end users’ perceptions, needs, and concerns with respect to such technologies. Objective: The aim of this paper is to explore the opinions, perceptions, preferences, and experiences of people who have experienced some form of mental health issues based on self-diagnosis to inform the design of a next-generation mental health app that would be substantially more engaging and effective than the currently available apps to improve mental health and well-being. Methods: We conducted six focus group sessions with people who had experienced mental health issues based on self-diagnosis (average age 26.7 years, SD 23.63; 16/32, 50% male; 16/32, 50% female). We asked participants about their experiences with mental health issues and their viewpoints regarding two existing mental health apps (the Happify app and the Self-Help Anxiety Management app). Finally, participants were engaged in a design session where they each sketched a design for their ideal mental health and well-being mobile app. Results: Our findings revealed that participants used strategies to deal with their mental health issues: doing something to distract themselves from their current negative mood, using relaxation exercises and methods to relieve symptoms, interacting with others to share their issues, looking for an external source to solve their problems, and motivating themselves by repeating motivational sentences to support themselves or by following inspirational people. Moreover, regarding the design of mental health apps, participants identified that general design characteristics; personalization of the app, including tracking and feedback, live support, and social community; and providing motivational content and relaxation exercises are the most important features that users want in a mental health app. In contrast, games, relaxation audio, the Google map function, personal assistance to provide suggestions, goal setting, and privacy preservation were surprisingly the least requested features. Conclusions: Understanding end users’ needs and concerns about mental health apps will inform the future design of mental health apps that are useful to and used by many people. %M 33635281 %R 10.2196/18172 %U https://formative.jmir.org/2021/2/e18172 %U https://doi.org/10.2196/18172 %U http://www.ncbi.nlm.nih.gov/pubmed/33635281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22393 %T Awareness and Potential Impacts of the Medicalization of Internet Gaming Disorder: Cross-sectional Survey Among Adolescents in China %A Yu,Yanqiu %A Li,Ji-Bin %A Lau,Joseph T F %+ Center for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince Whales Hospital, Sha Tin, Hong Kong, Hong Kong, 852 22528727, jlau@cuhk.edu.hk %K gaming disorder %K ICD-11 %K high-risk subgroups %K disease awareness %K medicalization %K internet gaming %K awareness %K impact %K adolescent %K young adult %K China %K game %K disorder %K ICD %D 2021 %7 24.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The Eleventh Revision of International Classification of Diseases (ICD-11) newly listed gaming disorder, including internet gaming disorder (IGD), as a disease. The level of awareness and potential positive and negative impacts of this medicalization among adolescents were unknown. Objective: This study investigated the levels, associated factors, and potential positive and negative impacts of awareness of the medicalization of IGD among adolescents in China. Methods: In a cross-sectional survey, 1343 middle school students in Guangzhou, China, self-administered an anonymous questionnaire in classrooms (October to December 2019). Three risk subgroups were identified: those who scored ≥5 items in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition checklist (IGD-S), those who self-perceived having IGD currently (IGD-PC), and those who self-perceived having IGD within 12 months (IGD-P12M). Results: Of the internet gamers, 48.3% (460/952) were aware of the medicalization of IGD; they were more likely to belong to the IGD-P12M/IGD-S risk subgroups. Within the IGD-PC/IGD-P12M (but not IGD-S) risk subgroups, IGD medicalization awareness was positively associated with favorable outcomes (reduced internet gaming time in the past 12 months, seeking help from professionals if having IGD, and fewer maladaptive cognitions). After being briefed about the ICD-11 inclusion of IGD, 54.2% (516/952) and 32.8% (312/952) expressed that it would lead to the reduction of gaming time and help-seeking behaviors, respectively; however, 17.9% (170/952), 21.5% (205/952), 15.9% (151/952), and 14.5% (138/952) perceived self-doubt for being diseased, stronger pressure from family members, negative emotional responses, and labeling effect, respectively. With a few exceptions, such perceived positive or negative impacts were stronger among the IGD-S, IGD-PC, and IGD-P12M risk subgroups. Conclusions: The exploratory study shows that the medicalization of IGD may have benefits that need maximization and potentially harmful effects that need minimization. Future studies should test the efficacies of health promotion that increases IGD medicalization awareness. %M 33625362 %R 10.2196/22393 %U https://www.jmir.org/2021/2/e22393 %U https://doi.org/10.2196/22393 %U http://www.ncbi.nlm.nih.gov/pubmed/33625362 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25870 %T The Building Educators’ Skills in Adolescent Mental Health Training Program for Secondary School Educators: Protocol for a Cluster Randomized Controlled Trial %A Parker,Belinda L %A Chakouch,Cassandra %A Subotic-Kerry,Mirjana %A Batterham,Philip J %A Mackinnon,Andrew %A Newby,Jill M %A Whitton,Alexis E %A McGoldrick,Janey %A Cockayne,Nicole %A O'Dea,Bridianne %+ Black Dog Institute, Prince of Wales Hospital, Hospital Road, Randwick, 2031, Australia, 61 290659057, belinda.parker@blackdog.org.au %K mental health training %K schools %K teachers %K educators %K mental health %K student mental health %K secondary school %D 2021 %7 24.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Australia, secondary school educators are well positioned to recognize mental illness among students and provide support. However, many report that they lack the knowledge and confidence to do so, and few mental health training programs available for educators are evidence based. To address this gap, the Black Dog Institute (BDI) developed a web-based training program (Building Educators’ Skills in Adolescent Mental Health [BEAM]) that aims to improve mental health knowledge, confidence, and helping behaviors among secondary school educators in leadership positions. A pilot study of the training program found it to be positively associated with increased confidence and helping behaviors among educators and reduced personal psychological distress. An adequately powered randomized controlled trial (RCT) is needed. Objective: The primary objective of this cluster RCT is to evaluate the effectiveness of the BEAM program for improving educators’ confidence in managing student mental health. The trial will also evaluate the effect of the BEAM program in increasing educators’ frequency of providing help to students and improving their mental health knowledge and reducing educators’ psychological distress and stigma toward students with mental health issues. Methods: The target sample size is 234 educators from 47 secondary schools across New South Wales, Australia. Four waves of recruitment and enrollment into the trial are planned. Schools will participate in one wave only and will be randomized to the intervention or waitlist control conditions. Participants from the same school will be assigned to the same condition. Assessments will be conducted at baseline, posttest (10 weeks after baseline), and follow-up (22 weeks after baseline) using the BDI eHealth research platform. Intervention participants will receive access to the BEAM program for 10 weeks upon completion of baseline, and the control condition will receive access for 10 weeks upon completion of the follow-up assessment. Results: Recruitment for this trial began on July 21, 2020, with the first baseline assessments occurring on August 17, 2020. To date, 295 participants from 71 schools have completed baseline. Due to the unexpected success of recruitment in the first 3 waves, the final fourth wave has been abandoned. Intervention participants are currently receiving the program, with follow-up due for completion in March 2021. Conclusions: This is one of the first RCTs to examine the effectiveness of a web-based adolescent mental health training program for Australian secondary school educators in leadership positions. If found to be effective, this training program will offer a sustainable and scalable delivery method for upskilling educators in caring for students’ mental health. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12620000876998; https://covid-19.cochrane.org/studies/crs-14669208 International Registered Report Identifier (IRRID): DERR1-10.2196/25870 %M 33625374 %R 10.2196/25870 %U https://www.researchprotocols.org/2021/2/e25870 %U https://doi.org/10.2196/25870 %U http://www.ncbi.nlm.nih.gov/pubmed/33625374 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e19004 %T A Perspective on Client-Psychologist Relationships in Videoconferencing Psychotherapy: Literature Review %A Cataldo,Francesco %A Chang,Shanton %A Mendoza,Antonette %A Buchanan,George %+ School of Computing and Information Systems, University Of Melbourne, Parkville, VIC, Melbourne, 3010, Australia, 61 444 574 920, fcataldo@student.unimelb.edu.au %K videoconference %K psychotherapy %K professional-patient relations %K client-psychologist relationships %K therapeutic alliance %K telehealth %K mobile phone %D 2021 %7 19.2.2021 %9 Review %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic, people have been encouraged to maintain social distance. Technology helps people schedule meetings as remote videoconferencing sessions rather than face-to-face interactions. Psychologists are in high demand because of an increase in stress as a result of COVID-19, and videoconferencing provides an opportunity for mental health clinicians to treat current and new referrals. However, shifting treatment from face-to-face to videoconferencing is not simple: both psychologists and clients miss in-person information cues, including body language. Objective: This review proposes a new theoretical framework to guide the design of future studies examining the impact of a computer as a mediator of psychologist-client relationships and the influence of videoconferencing on the relationship process. Methods: We conducted a literature review including studies focused on communication and key concepts of the therapeutic relationship and therapeutic alliance. Results: Studies have reported that clients are generally satisfied with videoconference therapy in terms of the relationship with their therapists and the establishment of the therapeutic alliance. Conversely, studies indicate that psychologists continue to highlight difficulties in establishing the same quality of therapeutic relationship and therapeutic alliance. The contrasting experiences might underlie the differences in the type of emotional and cognitive work required by both actors in any therapy session; furthermore, the computer seems to take part in their interaction not only as a vehicle to transmit messages but also as an active part of the communication. A new model of interaction and relationship is proposed, taking into account the presence of the computer, along with further hypotheses. Conclusions: It is important to consider the computer as having an active role in the client-psychologist relationship; thus, it is a third party to the communication that either assists or interferes with the interaction between psychologists and clients. %M 33605891 %R 10.2196/19004 %U http://mental.jmir.org/2021/2/e19004/ %U https://doi.org/10.2196/19004 %U http://www.ncbi.nlm.nih.gov/pubmed/33605891 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e20329 %T Induction of Efficacy Expectancies in an Ambulatory Smartphone-Based Digital Placebo Mental Health Intervention: Randomized Controlled Trial %A Stalujanis,Esther %A Neufeld,Joel %A Glaus Stalder,Martina %A Belardi,Angelo %A Tegethoff,Marion %A Meinlschmidt,Gunther %+ Department of Clinical Psychology and Cognitive Behavioral Therapy, International Psychoanalytic University Berlin, Stromstraße 1, Berlin, 10555, Germany, 49 30 300117 710, gunther.meinlschmidt@ipu-berlin.de %K digital placebo effect %K efficacy expectancies %K ecological momentary assessment %K mHealth %K mobile phone %K placebo effect %K randomized controlled trial %K smartphone-based intervention %D 2021 %7 17.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is certain evidence on the efficacy of smartphone-based mental health interventions. However, the mechanisms of action remain unclear. Placebo effects contribute to the efficacy of face-to-face mental health interventions and may also be a potential mechanism of action in smartphone-based interventions. Objective: This study aimed to investigate whether different types of efficacy expectancies as potential factors underlying placebo effects could be successfully induced in a smartphone-based digital placebo mental health intervention, ostensibly targeting mood and stress. Methods: We conducted a randomized, controlled, single-blinded, superiority trial with a multi-arm parallel design. Participants underwent an Android smartphone-based digital placebo mental health intervention for 20 days. We induced prospective efficacy expectancies via initial instructions on the purpose of the intervention and retrospective efficacy expectancies via feedback on the success of the intervention at days 1, 4, 7, 10, and 13. A total of 132 healthy participants were randomized to a prospective expectancy–only condition (n=33), a retrospective expectancy–only condition (n=33), a combined expectancy condition (n=34), or a control condition (n=32). As the endpoint, we assessed changes in efficacy expectancies with the Credibility Expectancy Questionnaire, before the intervention and on days 1, 7, 14, and 20. For statistical analyses, we used a random effects model for the intention-to-treat sample, with intervention day as time variable and condition as two factors: prospective expectancy (yes vs no) and retrospective expectancy (yes vs no), allowed to vary over participant and intervention day. Results: Credibility (β=−1.63; 95% CI −2.37 to −0.89; P<.001) and expectancy (β=−0.77; 95% CI −1.49 to −0.05; P=.04) decreased across the intervention days. For credibility and expectancy, we found significant three-way interactions: intervention day×prospective expectancy×retrospective expectancy (credibility: β=2.05; 95% CI 0.60-3.50; P=.006; expectancy: β=1.55; 95% CI 0.14-2.95; P=.03), suggesting that efficacy expectancies decreased least in the combined expectancy condition and the control condition. Conclusions: To our knowledge, this is the first empirical study investigating whether efficacy expectancies can be successfully induced in a specifically designed placebo smartphone-based mental health intervention. Our findings may pave the way to diminish or exploit digital placebo effects and help to improve the efficacy of digital mental health interventions. Trial Registration: Clinicaltrials.gov NCT02365220; https://clinicaltrials.gov/ct2/show/NCT02365220. %M 33594991 %R 10.2196/20329 %U http://mhealth.jmir.org/2021/2/e20329/ %U https://doi.org/10.2196/20329 %U http://www.ncbi.nlm.nih.gov/pubmed/33594991 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e23960 %T Developmental Assets of Adolescents and Young Adults With Chronic Illness and Comorbid Depression: Qualitative Study Using YouTube %A Zheng,Katherine %A George,Maureen %A Roehlkepartain,Eugene %A Santelli,John %A Bruzzese,Jean-Marie %A Smaldone,Arlene %+ The Feinberg School of Medicine, Center for Education in Health Sciences, Northwestern University, 633 N Saint Clair St, 20th Floor, Chicago, IL, 60605, United States, 1 6032036736, katzheng1@gmail.com %K adolescent development %K chronic disease %K depression %K developmental assets %K positive youth development %K YouTube %D 2021 %7 16.2.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Developmental assets provide a framework for optimizing development among adolescents but have not been studied in adolescents with chronic illness and comorbid depression, which is a group at risk for poor health outcomes. YouTube postings provide valuable insights to understand this understudied population. Objective: This study aims to explore asset development from the perspectives of adolescents and young adults (AYAs) with chronic illness and comorbid depression. Methods: YouTube was searched using 12 chronic illnesses (eg, diabetes) coupled with “depression” as keywords. Videos were included if they were uploaded by AYAs aged between 11 and 29 years and discussed living with chronic illness and depression during adolescence. Video transcripts were coded deductively for 40 internal and external assets that constitute the Developmental Assets Framework. Categories not captured by deductive coding were identified using conventional content analysis. Categories and their respective assets were labeled as being discussed either negatively or positively. Results: In total, 31 videos from 16 AYAs met the inclusion criteria. A total of 7 asset categories, support, constructive use of time, boundaries and expectations (external assets), identity, commitment to learning, positive values, and social competence (internal assets), reflecting 25 (13 internal; 12 external) assets, were discussed. Internal assets, particularly relating to identity, were commonly discussed by AYAs either in a negative way or fluctuated between positive and negative perspectives. Conclusions: In this sample of AYAs with chronic illness and comorbid depression, internal assets were commonly discussed in a negative way. Future research is needed to better understand how assets develop and if the Developmental Assets Framework adequately represents the experiences of this population. %M 33591288 %R 10.2196/23960 %U http://mental.jmir.org/2021/2/e23960/ %U https://doi.org/10.2196/23960 %U http://www.ncbi.nlm.nih.gov/pubmed/33591288 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e19532 %T Technology-Enabled Reform in a Nontraditional Mental Health Service for Eating Disorders: Participatory Design Study %A Milton,Alyssa Clare %A Hambleton,Ashlea %A Dowling,Mitchell %A Roberts,Anna Elizabeth %A Davenport,Tracey %A Hickie,Ian %+ University of Sydney, Rm 04.12, Brain and Mind Centre, Sydney, 2050, Australia, 61 0404839897, Tracey.Davenport@sydney.edu.au %K eating disorders %K body image %K mental health %K technology %K co-design %K participatory design %K service reform %K consumer engagement %D 2021 %7 16.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The recent Australian National Agenda for Eating Disorders highlights the role technology can play in improving accessibility and service development through web-based prevention, early access pathways, self-help, and recovery assistance. However, engagement with the eating disorders community to co-design, build, and evaluate these much-needed technology solutions through participatory design processes has been lacking and, until recently, underresourced. Objective: This study aims to customize and configure a technology solution for a nontraditional (web-based, phone, email) mental health service that provides support for eating disorders and body image issues through the use of participatory design processes. Methods: Participants were recruited chiefly through the Butterfly National Helpline 1800 ED HOPE (Butterfly’s National Helpline), an Australian-wide helpline supporting anyone concerned by an eating disorder or body image issue. Participants included individuals with lived experience of eating disorders and body image issues, their supportive others (such as family, health professionals, support workers), and staff of the Butterfly Foundation. Participants took part in participatory design workshops, running up to four hours, which were held nationally in urban and regional locations. The workshop agenda followed an established process of discovery, evaluation, and prototyping. Workshop activities included open and prompted discussion, reviewing working prototypes, creating descriptive artifacts, and developing user journeys. Workshop artifacts were used in a knowledge translation process, which identified key learnings to inform user journeys, user personas, and the customization and configuration of the InnoWell Platform for Butterfly’s National Helpline. Further, key themes were identified using thematic techniques and coded in NVivo 12 software. Results: Six participatory design workshops were held, of which 45 participants took part. Participants highlighted that there is a critical need to address some of the barriers to care, particularly in regional and rural areas. The workshops highlighted seven overarching qualitative themes: identified barriers to care within the current system; need for people to be able to access the right care anywhere, anytime; recommendations for the technological solution (ie, InnoWell Platform features and functionality); need for communication, coordination, and integration of a technological solution embedded in Butterfly’s National Helpline; need to consider engagement and tone within the technological solution; identified challenges and areas to consider when implementing a technological solution in the Helpline; and potential outcomes of the technological solution embedded in the Helpline relating to system and service reform. Ultimately, this technology solution should ensure that the right care is provided to individuals the first time. Conclusions: Our findings highlight the value of actively engaging stakeholders in participatory design processes for the customization and configuration of new technologies. End users can highlight the critical areas of need, which can be used as a catalyst for reform through the implementation of these technologies in nontraditional services. %M 33591283 %R 10.2196/19532 %U http://www.jmir.org/2021/2/e19532/ %U https://doi.org/10.2196/19532 %U http://www.ncbi.nlm.nih.gov/pubmed/33591283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e23200 %T Evaluation of a Blended Relapse Prevention Program for Anxiety and Depression in General Practice: Qualitative Study %A Krijnen-de Bruin,Esther %A Geerlings,Jasmijn A %A Muntingh,Anna DT %A Scholten,Willemijn D %A Maarsingh,Otto R %A van Straten,Annemieke %A Batelaan,Neeltje M %A van Meijel,Berno %+ Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute, De Boelelaan 1117, Amsterdam, Netherlands, 31 884662683, esther.krijnendebruin@inholland.nl %K relapse prevention %K anxiety disorder %K depressive disorder %K eHealth %K general practice %K qualitative research %D 2021 %7 16.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing studies have yet to investigate the perspectives of patients and professionals concerning relapse prevention programs for patients with remitted anxiety or depressive disorders in primary care. User opinions should be considered when optimizing the use and implementation of interventions. Objective: This study aimed to evaluate the GET READY relapse prevention programs for patients with remitted anxiety or depressive disorders in general practice. Methods: Semistructured interviews (N=26) and focus group interviews (N=2) with patients and mental health professionals (MHPs) in the Netherlands were performed. Patients with remitted anxiety or depressive disorders and their MHPs who participated in the GET READY study were interviewed individually. Findings from the interviews were tested in focus group interviews with patients and MHPs. Data were analyzed using thematic analysis. Results: Participants were positive about the program because it created awareness of relapse risks. Lack of motivation, lack of recognizability, lack of support from the MHP, and symptom severity (too low or too high) appeared to be limiting factors in the use of the program. MHPs play a crucial role in motivating and supporting patients in relapse prevention. The perspectives of patients and MHPs were largely in accordance, although they had different perspectives concerning responsibilities for taking initiative. Conclusions: The implementation of the GET READY program was challenging. Guidance from MHPs should be offered for relapse prevention programs based on eHealth. Both MHPs and patients should align their expectations concerning responsibilities in advance to ensure optimal usage. Usage of blended relapse prevention programs may be further enhanced by diagnosis-specific programs and easily accessible support from MHPs. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-019-2034-6 %M 33591277 %R 10.2196/23200 %U http://formative.jmir.org/2021/2/e23200/ %U https://doi.org/10.2196/23200 %U http://www.ncbi.nlm.nih.gov/pubmed/33591277 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25363 %T Exposure to COVID-19-Related Information and its Association With Mental Health Problems in Thailand: Nationwide, Cross-sectional Survey Study %A Mongkhon,Pajaree %A Ruengorn,Chidchanok %A Awiphan,Ratanaporn %A Thavorn,Kednapa %A Hutton,Brian %A Wongpakaran,Nahathai %A Wongpakaran,Tinakon %A Nochaiwong,Surapon %+ Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, 239, Suthep Road, Chiang Mai, 50200, Thailand, 66 899973365, surapon.nochaiwong@gmail.com %K coronavirus %K COVID-19 %K insomnia %K mental health %K social media %K depression %K anxiety %K stress %K psychosocial problem %D 2021 %7 12.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a negative impact on both the physical and mental health of individuals worldwide. Evidence regarding the association between mental health problems and information exposure among Thai citizens during the COVID-19 outbreak is limited. Objective: This study aimed to explore the relationship between information exposure and mental health problems during the COVID-19 pandemic in Thailand. Methods: Between April 21 and May 4, 2020, we conducted a cross-sectional, nationwide online survey of the general population in Thailand. We categorized the duration of exposure to COVID-19-related information as follows: <1 h/day (reference group), 1-2 h/day, and ≥3 h/day. Mental health outcomes were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the Perceived Stress Scale-10, and the Insomnia Severity Index for symptoms of depression, anxiety, perceived stress, and insomnia, respectively. Multivariable logistic regression models were used to evaluate the relationship between information exposure and the risk of developing the aforementioned symptoms. An ancillary analysis using multivariable multinomial logistic regression models was also conducted to assess the possible dose-response relationship across the severity strata of mental health problems. Results: Of the 4322 eligible participants, 4004 (92.6%) completed the online survey. Of them, 1481 (37.0%), 1644 (41.1%), and 879 (22.0%) participants were exposed to COVID-19-related information for less than 1 hour per day, 1 to 2 hours per day, or 3 or more hours per day, respectively. The major source of information related to the COVID-19 pandemic was social media (95.3%), followed by traditional media (68.7%) and family members (34.9%). Those exposed to information for 3 or more hours per day had a higher risk of developing symptoms of depression (adjusted odds ratio [OR] 1.35, 95% CI 1.03-1.76; P=.03), anxiety (adjusted OR 1.88, 95% CI 1.43-2.46; P<.001), and insomnia (adjusted OR 1.52, 95% CI 1.17-1.97; P=.001) than people exposed to information for less than 1 hour per day. Meanwhile, people exposed to information for 1 to 2 hours per day were only at risk of developing symptoms of anxiety (adjusted OR 1.35, 95% CI 1.08-1.69; P=.008). However, no association was found between information exposure and the risk of perceived stress. In the ancillary analysis, a dose-response relationship was observed between information exposure of 3 or more hours per day and the severity of mental health problems. Conclusions: These findings suggest that social media is the main source of COVID-19-related information. Moreover, people who are exposed to information for 3 or more hours per day are more likely to develop psychological problems, including depression, anxiety, and insomnia. Longitudinal studies investigating the long-term effects of COVID-19-related information exposure on mental health are warranted. %M 33523828 %R 10.2196/25363 %U http://www.jmir.org/2021/2/e25363/ %U https://doi.org/10.2196/25363 %U http://www.ncbi.nlm.nih.gov/pubmed/33523828 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e24703 %T Effectiveness of Smartphone-Based Cognitive Behavioral Therapy Among Patients With Major Depression: Systematic Review of Health Implications %A Hrynyschyn,Robert %A Dockweiler,Christoph %+ Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Health and Nursing Science, Campus Virchow Klinikum, Berlin, 13353, Germany, 49 30 450 529 124, robert.hrynyschyn@charite.de %K mobile health %K depression %K cognitive behavioral therapy %K systematic review %K mobile phone %D 2021 %7 10.2.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Depression is often associated with rapid changes in mood and quality of life that persist for a period of 2 weeks. Despite medical innovations, there are problems in the provision of care. Long waiting times for treatment and high recurrence rates of depression cause enormous costs for health care systems. At the same time, comprehensive limitations in physical, psychological, and social dimensions are observed for patients with depression, which significantly reduce their quality of life. In addition to patient-specific limitations, undersupply and inappropriate health care have been determined. For this reason, new forms of care are discussed. Smartphone-based therapy is considered to have great potential due to its reach and easy accessibility. Low socioeconomic groups, which are always difficult to reach for public health interventions, can now be accessed due to the high dispersion of smartphones. There is still little information about the impact and mechanisms of smartphone-based therapy on depression. In a systematic literature review, the health implications of smartphone-based therapy were presented in comparison with standard care. Objective: The objective of this review was to identify and summarize the existing evidence regarding smartphone-based cognitive behavioral therapy for patients with depression and to present the health implications of smartphone-based cognitive behavioral therapy of considered endpoints. Methods: A systematic literature review was conducted to identify relevant studies by means of inclusion and exclusion criteria. For this purpose, the PubMed and Psyndex databases were systematically searched using a search syntax. The endpoints of depressive symptoms, depression-related anxiety, self-efficacy or self-esteem, and quality of life were analyzed. Identified studies were evaluated for study quality and risk of bias. After applying the inclusion and exclusion criteria, 8 studies were identified. Results: The studies examined in this review reported contradictory results regarding the investigated endpoints. In addition, due to clinical and methodological heterogeneity, it was difficult to derive evident results. All included studies reported effects on depressive symptoms. The other investigated endpoints were only reported by isolated studies. Only 50% (4/8) of the studies reported effects on depression-related anxiety, self-efficacy or self-esteem, and quality of life. Conclusions: No clear implications of smartphone-based cognitive behavioral therapy could be established. Evidence for the treatment of depression using smartphone-based cognitive behavioral therapy is limited. Additional research projects are needed to demonstrate the effects of smartphone-based cognitive behavioral therapy in the context of evidence-based medicine and to enable its translation into standard care. Participatory technology development might help to address current problems in mobile health intervention studies. %M 33565989 %R 10.2196/24703 %U http://mhealth.jmir.org/2021/2/e24703/ %U https://doi.org/10.2196/24703 %U http://www.ncbi.nlm.nih.gov/pubmed/33565989 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 2 %P e21700 %T Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review %A Köhnen,Moritz %A Dreier,Mareike %A Seeralan,Tharanya %A Kriston,Levente %A Härter,Martin %A Baumeister,Harald %A Liebherz,Sarah %+ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistr 52, Hamburg, 20246, Germany, 49 407410 ext 57705, m.koehnen@uke.de %K internet %K telephone %K psychotherapy %K depression %K depressive disorder %K systematic review %K mobile phone %D 2021 %7 10.2.2021 %9 Review %J JMIR Ment Health %G English %X Background: Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. Objective: This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. Methods: Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. Results: Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. Conclusions: Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028042 %M 33565981 %R 10.2196/21700 %U https://mental.jmir.org/2021/2/e21700 %U https://doi.org/10.2196/21700 %U http://www.ncbi.nlm.nih.gov/pubmed/33565981 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21737 %T Development and Feasibility of a Digital Acceptance and Commitment Therapy–Based Intervention for Generalized Anxiety Disorder: Pilot Acceptability Study %A Hemmings,Nicola R %A Kawadler,Jamie M %A Whatmough,Rachel %A Ponzo,Sonia %A Rossi,Alessio %A Morelli,Davide %A Bird,Geoffrey %A Plans,David %+ Department of Organizational Psychology, Birkbeck University of London, Malet St, London, WC1E 7HX, United Kingdom, 44 7716362200, nhemmi01@mail.bbk.ac.uk %K anxiety %K depression %K acceptance and commitment therapy %K person-based approach %K mHealth %K mental health %K digital %K remote %K smartphone %K mobile phone %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Generalized anxiety disorder (GAD) is characterized by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD. Objective: This paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing well-being app platform, BioBase. A pilot feasibility study evaluating acceptability and usability is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study. Methods: Phase 1 applied the person-based approach (creation of guiding principles, intervention design objectives, and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for 2 weeks. Self-report questionnaires were obtained at baseline and posttreatment. The primary outcome was psychological flexibility (Acceptance and Action Questionnaire-II [AAQ-II]) as this is the aim of ACT. Mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) and symptoms of anxiety (7-item Generalized Anxiety Disorder Assessment [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were also assessed. Posttreatment usability was assessed via self-report measures (System Usability Scale [SUS]) in addition to interviews that further explored feasibility of the digital intervention in this sample. Results: The app-based therapeutic was well received. Of 13 participants, 10 (77%) completed the treatment. Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful, and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline (P=.03 and .008 for GAD-7 and PHQ-9, respectively). Participants had higher psychological flexibility and well-being scores at exit, although these were not significantly different from baseline (P=.11 and .55 for AAQ-II and WEMWBS, respectively). Conclusions: This ACT prototype within BioBase is an acceptable and feasible digital intervention in reducing symptoms of anxiety and depression. This study suggests that this intervention warrants a larger feasibility study in adults with GAD. %M 33560232 %R 10.2196/21737 %U https://formative.jmir.org/2021/2/e21737 %U https://doi.org/10.2196/21737 %U http://www.ncbi.nlm.nih.gov/pubmed/33560232 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e14378 %T A Brief Mobile-Augmented Suicide Prevention Intervention for People With Psychotic Disorders in Transition From Acute to Ongoing Care: Protocol for a Pilot Trial %A Depp,Colin %A Ehret,Blaire %A Villa,Jennifer %A Perivoliotis,Dimitri %A Granholm,Eric %+ Department of Psychiatry, University of California, San Diego, 9500 Gilman Dr, La Jolla, CA, 92093-0603, United States, 1 858 822 4251, cdepp@ucsd.edu %K prevention %K mental health services %K psychosis %K technology %D 2021 %7 8.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: People with serious mental illnesses (SMIs) are at exceptionally high risk for lifetime suicidal ideation and behavior compared with the general population. The transition period between urgent evaluation and ongoing care could provide an important setting for brief suicide-specific interventions for SMIs. To address this concern, this trial, SafeTy and Recovery Therapy (START), involves a brief suicide-specific cognitive behavioral intervention for SMIs that is augmented with mobile phone interactions. Objective: The primary aim of this pilot trial is to evaluate the feasibility, acceptability, and preliminary effectiveness of the intervention. Methods: A 6-month pilot trial with 70 participants with a diagnosis of bipolar disorder, schizophrenia or schizoaffective disorder, and current active suicidal ideation were randomized to START or START with mobile augmentation. START consists of 4 weekly sessions addressing early warning signs and triggers, symptoms influencing suicidal thinking, and social relationships. Recovery planning is followed by biweekly telephone coaching. START with mobile augmentation includes personalized automated cognitive behavioral therapy scripts that build from in-person content. Participants were evaluated at baseline, 4 weeks (end of in-person sessions), 12 weeks (end of telephone coaching), and 24 weeks. In addition to providing point estimates of feasibility and acceptability, the primary outcome of the trial was the change in severity of suicidal ideation as measured with the Scale for Suicide Ideation (SSI) and secondary outcome included the rate of outpatient engagement. Results: The trial is ongoing. Feasibility and acceptability across conditions will be assessed using t tests or Mann-Whitney tests or chi-square tests. The reduction of SSI over time will be assessed using hierarchical linear models. Conclusions: The design considerations and results of this trial may be informative for adapted suicide prevention in psychotic disorders in applied community settings. Trial Registration: ClinicalTrials.gov NCT03198364; http://clinicaltrials.gov/ct2/show/NCT03198364 International Registered Report Identifier (IRRID): DERR1-10.2196/14378 %M 33555265 %R 10.2196/14378 %U https://www.researchprotocols.org/2021/2/e14378 %U https://doi.org/10.2196/14378 %U http://www.ncbi.nlm.nih.gov/pubmed/33555265 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e21207 %T Optimizing the Context of Support to Improve Outcomes of Internet-Based Self-help in Individuals With Depressive Symptoms: Protocol for a Randomized Factorial Trial %A Bur,Oliver Thomas %A Krieger,Tobias %A Moritz,Steffen %A Klein,Jan Philipp %A Berger,Thomas %+ Department of Clinical Psychology and Psychotherapy, University of Bern, Fabrikstrasse 8, Bern, 3012, Switzerland, 41 31 631 54 13, oliver.bur@psy.unibe.ch %K depression %K self-help %K adherence %K internet-based intervention %K factorial design %K problem-solving therapy %K online %K mental health %K multiphase optimization strategy %K digital health %D 2021 %7 2.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Internet-based self-help interventions for individuals with depressive symptoms, in which the main component is often a web-based self-help program, have been shown to be efficacious in many controlled trials. However, there are also trials on self-help programs showing no significant effect when delivered in routine care, and some studies report high dropout and low adherence rates. Research suggests that these findings do not emerge primarily due to the specific content of a self-help program. It seems more important how a program is embedded in the context of human and automated support before and during the use of a self-help program. Objective: This study aims to better understand the effects of 4 supportive contextual factors on outcomes of and adherence to a web-based self-help program for depressive symptoms. In a factorial experiment, 2 of 4 supportive factors, for which there is evidence for their role on outcomes and adherence, are realized during the intervention—personal guidance and automated email reminders. The other 2 factors are realized before the intervention—a diagnostic interview and a preintervention module aimed at increasing the motivation to use the program with motivational interviewing techniques. Methods: The study is a full factorial randomized trial. Adults with mild to moderate depressive symptoms (Patient Health Questionnaire–9 score: 5-14) are recruited from the community through the internet and conventional media. All participants receive access to a web-based self-help program based on problem-solving therapy. They are randomized across 4 experimental factors, each reflecting the presence versus absence of a supportive factor (guidance, automated reminders, diagnostic interview, preintervention module) resulting in a 16-condition balanced factorial design. The primary outcome is depressive symptoms at 10 weeks post assessment. Secondary outcomes include adherence to the program, anxiety, stress, health-related quality of life, possible negative effects, and treatment satisfaction. Potential moderators and mediators (eg, treatment expectancy, problem-solving skills, working alliance with the study team) will also be investigated. Results: Ethical approval was received on January 20, 2020. The study was initiated in February 2020, and 240 participants have been enrolled in the study as of November 1, 2020. Recruitment for a total of 255 participants is ongoing. Data collection is expected to be completed by May 2021. Conclusions: A better understanding of relevant supportive factors in the dissemination of web-based interventions is necessary to improve outcomes of and adherence to web-based self-help programs. This study may inform health care systems and guide decisions to optimize the implementation context of web-based self-help programs for depressive symptoms. Trial Registration: ClinicalTrials.gov NCT04318236; https://clinicaltrials.gov/ct2/show/NCT04318236 International Registered Report Identifier (IRRID): DERR1-10.2196/21207 %M 33528377 %R 10.2196/21207 %U http://www.researchprotocols.org/2021/2/e21207/ %U https://doi.org/10.2196/21207 %U http://www.ncbi.nlm.nih.gov/pubmed/33528377 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e21585 %T Evaluating the Effectiveness of an E-Mental Health Intervention for People Living in Lebanon: Protocol for Two Randomized Controlled Trials %A van 't Hof,Edith %A Heim,Eva %A Abi Ramia,Jinane %A Burchert,Sebastian %A Cornelisz,Ilja %A Cuijpers,Pim %A El Chammay,Rabih %A Harper Shehadeh,Melissa %A Noun,Philip %A Smit,Filip %A van Klaveren,Chris %A van Ommeren,Mark %A Zoghbi,Edwina %A Carswell,Kenneth %+ Department of Mental Health and Substance Use, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland, 31 641692545, edithvanhof@gmail.com %K e-mental health %K psychological interventions %K guided-self-help %K global mental health %K adversity %K Lebanon %K Syrians %D 2021 %7 28.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The lack of availability of evidence-based services for people exposed to adversity globally has led to the development of psychological interventions with features that will likely make them more scalable. The evidence for the efficacy of e-mental health from high-income countries is compelling, and the use of these interventions could be a way to increase the coverage of evidence-based psychological interventions in low- and middle-income countries. Step-by-Step is a brief (5-session) intervention proposed by the World Health Organization as an innovative approach to reducing the suffering and disability associated with depression. Objective: This study aims to evaluate the effectiveness and cost-effectiveness of a locally adapted version of Step-by-Step with Syrian nationals (trial 1) and Lebanese nationals and other populations residing in Lebanon (trial 2). Methods: This Step-by-Step trial involves 2 parallel, two-armed, randomized controlled trials comparing the e-intervention Step-by-Step to enhanced care as usual in participants with depressive symptoms and impaired functioning. The randomized controlled trials are designed and powered to detect effectiveness in 2 populations: Syrians in Lebanon (n=568) and other people residing in Lebanon (n=568; Lebanese nationals and other populations resident in Lebanon). The primary outcomes are depressive symptomatology (measured with the Patient Health Questionnaire-9) and functioning (measured with the World Health Organization Disability Assessment Scale 2.0). Secondary outcomes include anxiety symptoms, posttraumatic stress disorder symptoms, personalized measures of psychosocial problems, subjective well-being, and economic effectiveness. Participants are mainly recruited through online advertising. Additional outreach methods will be used if required, for example through dissemination of information through partner agencies and organizations. They can access the intervention on a computer, tablet, and mobile phone through a hybrid app. Step-by-Step has 5 sessions, and users are guided by trained nonspecialist “e-helpers” providing phone-based or message-based support for around 15 minutes a week. Results: The trials were funded in 2018. The study protocol was last verified June 20, 2019 (WHO ERC.0002797) and registered with ClinicalTrials.gov (NCT03720769). The trials started recruitment as of December 9, 2019, and all data collection was completed in December 2020. Conclusions: The Step-by-Step trials will provide evidence about the effectiveness of an e-mental health intervention in Lebanon. If the intervention proves to be effective, this will inform future scale-up of this and similar interventions in Lebanon and in other settings across the world. Trial Registration: ClinicalTrials.gov NCT03720769; https://clinicaltrials.gov/ct2/show/NCT03720769 International Registered Report Identifier (IRRID): DERR1-10.2196/21585 %M 33507158 %R 10.2196/21585 %U http://www.researchprotocols.org/2021/1/e21585/ %U https://doi.org/10.2196/21585 %U http://www.ncbi.nlm.nih.gov/pubmed/33507158 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 1 %P e25456 %T It Is Time to REACT: Opportunities for Digital Mental Health Apps to Reduce Mental Health Disparities in Racially and Ethnically Minoritized Groups %A Friis-Healy,Elsa A %A Nagy,Gabriela A %A Kollins,Scott H %+ Department of Psychiatry and Behavioral Services, Duke University School of Medicine, 2608 Erwin Road, Durham, NC, 27705, United States, 1 919 681 0014, eaf23@duke.edu %K digital health %K app %K public mental health %K health disparities %K COVID-19 %K pandemic %K mental health %K disparity %K behavior %D 2021 %7 26.1.2021 %9 Viewpoint %J JMIR Ment Health %G English %X The behavioral health toll of the COVID-19 pandemic and systemic racism has directed increased attention to the potential of digital health as a way of improving access to and quality of behavioral health care. However, as the pandemic continues to widen health disparities in racially and ethnically minoritized groups, concerns arise around an increased reliance on digital health technologies exacerbating the digital divide and reinforcing rather than mitigating systemic health inequities in communities of color. As funding for digital mental health continues to surge, we offer five key recommendations on how the field can “REACT” to ensure the development of approaches that increase health equity by increasing real-world evidence, educating consumers and providers, utilizing adaptive interventions to optimize care, creating for diverse populations, and building trust. Recommendations highlight the need to take a strengths-based view when designing for racially and ethnically diverse populations and embracing the potential of digital approaches to address complex challenges. %M 33406050 %R 10.2196/25456 %U http://mental.jmir.org/2021/1/e25456/ %U https://doi.org/10.2196/25456 %U http://www.ncbi.nlm.nih.gov/pubmed/33406050 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e24662 %T Association Between Care Utilization and Anxiety Outcomes in an On-Demand Mental Health System: Retrospective Observational Study %A Kunkle,Sarah %A Yip,Manny %A Hunt,Justin %A Ξ,Watson %A Udall,Dana %A Arean,Patricia %A Nierenberg,Andrew %A Naslund,John A %+ Ginger, 116 New Montgomery Street, San Francisco, CA, United States, 1 7175197355, sarah@ginger.io %K mental health %K digital health %K anxiety %K telehealth %K virtual care %K utilization %K outcome %K retrospective %K observational %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Anxiety is an extremely prevalent condition, and yet, it has received notably less attention than depression and other mental health conditions from a research, clinical, and public health perspective. The COVID-19 pandemic has only exacerbated growing concerns about the burden of anxiety due to the confluence of physical health risks, economic stressors, social isolation, and general disruption of daily activities. Objective: This study examines differences in anxiety outcomes by care modality (coaching, teletherapy and telepsychiatry, and combined care) within an on-demand mental health system. We also explore the association between levels of engagement within each care modality and odds of improvement in symptoms of anxiety. Methods: We conducted a retrospective observational study of individuals who accessed Ginger, an on-demand mental health system. Data were collected from 1611 Ginger members between January 1, 2018, and December 31, 2019. We used logistic regression to assess the association between care modality and improvement in anxiety symptoms. Within each modality, we assessed the association between level of engagement and improvement. Results: Of 1611 Ginger members, 761 (47.0%) experienced a decrease in anxiety symptoms, as measured by a change from a positive to a negative 2-item Generalized Anxiety Disorder (GAD-2) screen. Among members who still screened positive at follow-up (865/1611, 53%), a total of 192 members (11.9%) experienced a clinically significant score reduction in the full GAD-7 (ie, a score reduction of >5 points), even though their GAD-2 scores were still positive. All modalities showed increased odds of improvement compared to those who were not engaged with coaching or clinical services (“app-only”). Higher GAD-7 intake scores were also associated with decreased odds of improvement. Conclusions: This study found increased odds of anxiety improvement for all care modalities compared to those who did not engage in care, with larger effect sizes for higher utilization within all care modalities. Additionally, there is a promising observation that those engaged in combined care (teletherapy and text-based coaching) had the greatest odds of anxiety improvement. Future directions include more detailed classifications of utilization patterns and an exploration of explanations and solutions for lower-utilization members. %M 33496679 %R 10.2196/24662 %U http://formative.jmir.org/2021/1/e24662/ %U https://doi.org/10.2196/24662 %U http://www.ncbi.nlm.nih.gov/pubmed/33496679 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e20557 %T Understanding eHealth Cognitive Behavioral Therapy Targeting Substance Use: Realist Review %A Shams,Farhud %A Wong,James S H %A Nikoo,Mohammadali %A Outadi,Ava %A Moazen-Zadeh,Ehsan %A Kamel,Mostafa M %A Song,Michael Jae %A Jang,Kerry L %A Krausz,Reinhard Michael %+ Institute of Mental Health, Department of Psychiatry, University of British Columbia, 430-5950 University Boulevard, David Strangway Bldg, Vancouver, BC, V6T 1Z3, Canada, 1 6478345370, f.shams@hotmail.de %K eHealth CBT %K substance use %K realist review %K eHealth mechanisms %K opioid crisis %D 2021 %7 21.1.2021 %9 Review %J J Med Internet Res %G English %X Background: There is a growing body of evidence regarding eHealth interventions that target substance use disorders. Development and funding decisions in this area have been challenging, due to a lack of understanding of what parts of an intervention work in which context. Objective: We conducted a realist review of the literature on electronic cognitive behavioral therapy (eCBT) programs for substance use with the goal of answering the following realist question: “How do different eCBT interventions for substance use interact with different contexts to produce certain outcomes?” Methods: A literature search of published and gray literature on eHealth programs targeting substance use was conducted. After data extraction, in order to conduct a feasible realist review in a timely manner, the scope had to be refined further and, ultimately, only included literature focusing on eCBT programs targeting substance use. We synthesized the available evidence from the literature into Context-Mechanism-Outcome configurations (CMOcs) in order to better understand when and how programs work. Results: A total of 54 papers reporting on 24 programs were reviewed. Our final results identified eight CMOcs from five unique programs that met criteria for relevance and rigor. Conclusions: Five strategies that may be applied to future eCBT programs for substance use are discussed; these strategies may contribute to a better understanding of mechanisms and, ultimately, may help design more effective solutions in the future. Future research on eCBT programs should try to understand the mechanisms of program strategies and how they lead to outcomes in different contexts. %M 33475520 %R 10.2196/20557 %U http://www.jmir.org/2021/1/e20557/ %U https://doi.org/10.2196/20557 %U http://www.ncbi.nlm.nih.gov/pubmed/33475520 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e23771 %T Technology Enabled Clinical Care (TECC): Protocol for a Prospective Longitudinal Cohort Study of Smartphone-Augmented Mental Health Treatment %A Rauseo-Ricupero,Natali %A Torous,John %+ Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Rabb Building, Boston, MA, 02446, United States, 1 617 667 6700, jtorous@bidmc.harvard.edu %K mental health care %K access %K multi-language %K smartphone %K app %K quality improvement %K protocol %K mental health %K treatment %K acceptability %K efficacy %K COVID-19 %D 2021 %7 14.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Even before COVID-19, there has been an urgent need to expand access to and quality of mental health care. This paper introduces an 8-week treatment protocol to realize that vision—Technology Enabled Clinical Care (TECC). TECC offers innovation in clinical assessment, monitoring, and interventions for mental health. TECC uses the mindLAMP app to enable digital phenotyping, clinical communication, and smartphone-based exercises that will augment in-person or telehealth virtual visits. TECC exposes participants to an array of evidence-based treatments (cognitive behavioral therapy, dialectical behavior therapy, acceptance and commitment therapy) introduced through clinical sessions and then practiced through interactive activities provided through a smartphone app called mindLAMP. Objective: TECC will test the feasibility of providing technology-enabled mental health care within an outpatient clinic; explore the practicality for providing this care to individuals with limited English proficiency; and track anxiety, depression, and mood symptoms for participants to measure the effectiveness of the TECC design. Methods: The TECC study will assess the acceptability and efficacy of this care model in 50 participants as compared to an age- and gender-matched cohort of patients presenting with similar clinical severity of depression, anxiety, or psychotic symptoms. Participants will be recruited from clinics in the Metro Boston area. Aspects of TECC will be conducted in both Spanish and English to ensure wide access to care for multiple populations. Results: The results of the TECC study will be used to support or adapt this model of care and create training resources to ensure its dissemination. The study results will be posted on ClinicalTrials.gov, with primary outcomes related to changes in mood, anxiety, and stress, and secondary outcomes related to engagement, alliance, and satisfaction. Conclusions: TECC combines new digital mental health technology with updated clinical protocols and workflows designed to ensure patients can benefit from innovation in digital mental health. Supporting multiple languages, TECC is designed to ensure digital health equity and highlights how mobile health can bridge, not expand, gaps in care for underserved populations. International Registered Report Identifier (IRRID): PRR1-10.2196/23771 %M 33296869 %R 10.2196/23771 %U https://www.researchprotocols.org/2021/1/e23771 %U https://doi.org/10.2196/23771 %U http://www.ncbi.nlm.nih.gov/pubmed/33296869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e13770 %T Mobile App–Based Self-Report Questionnaires for the Assessment and Monitoring of Bipolar Disorder: Systematic Review %A Chan,Eric C %A Sun,Yuting %A Aitchison,Katherine J %A Sivapalan,Sudhakar %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Center, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7802332709, echantai@ualberta.ca %K mobile apps %K mental health %K bipolar disorder %K smartphone %K cell phone %D 2021 %7 8.1.2021 %9 Review %J JMIR Form Res %G English %X Background: Bipolar disorder is a chronic, progressive illness characterized by recurrent episodes of mania and depression. Self-report scales have historically played a significant role in the monitoring of bipolar symptoms. However, these tools rely on episodic memory, which can be unreliable and do not allow the clinician to monitor brief episodic symptoms or the course of symptoms over shorter periods of time. Mobile app–based questionnaires have been suggested as a tool to improve monitoring of patients with bipolar disorder. Objective: This paper aims to determine the feasibility and validity of mobile app–based self-report questionnaires. Methods: We performed a systematic review of the literature according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The PubMed, PsycInfo, Web of Science, Ovid MEDLINE, and EMBASE databases were searched for papers published in English that assessed adherence to and the validity of mobile app–based self-report questionnaires. Relevant studies published from database creation to May 22, 2020, were identified, and results examining the validity of and rates of adherence to app-based self-report questionnaires are reported. Results: A total of 13 records were identified for inclusion in this review. Of these studies, 4 assessed the concurrent validity of mobile app–based self-report tools, with the majority of findings indicating significant associations between data collected using these tools and the Young Mania Rating Scale, Hamilton Depression Rating Scale-17, or Montgomery-Åsberg Depression Rating Scale (P<.001 to P=.24). Three studies comparing the variability or range of symptoms between patients with bipolar disorder and healthy controls suggested that these data are capable of differentiating between known groups. Two studies demonstrated statistically significant associations between data collected via mobile app–based self-report tools and instruments assessing other clinically important factors. Adherence rates varied across the studies examined. However, good adherence rates (>70%) were observed in all but 1 study using a once-daily assessment. There was a wide range of adherence rates observed in studies using twice-daily assessments (42%-95%). Conclusions: These findings suggest that mobile app–based self-report tools are valid in the assessment of symptoms of mania and depression in euthymic patients with bipolar disorder. Data collected using these tools appear to differ between patients with bipolar disorder and healthy controls and are significantly associated with other clinically important measures. It is unclear at this time whether these tools can be used to detect acute episodes of mania or depression in patients with bipolar disorder. Adherence data indicate that patients with bipolar disorder show good adherence to self-report assessments administered daily for the duration of the study periods evaluated. %M 33416510 %R 10.2196/13770 %U https://formative.jmir.org/2021/1/e13770 %U https://doi.org/10.2196/13770 %U http://www.ncbi.nlm.nih.gov/pubmed/33416510 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 12 %P e17341 %T Associations Among Internet Addiction, Genetic Polymorphisms, Family Functioning, and Psychopathological Risk: Cross-Sectional Exploratory Study %A Cerniglia,Luca %A Cimino,Silvia %A Marzilli,Eleonora %A Pascale,Esterina %A Tambelli,Renata %+ International Telematic University Uninettuno, Corso Vittorio Emanuele II, 39, Rome, 00186, Italy, 39 06679201, l.cerniglia@uninettunouniversity.net %K internet addiction %K mobile phones %K family functioning %K depression %K anxiety %K avoidant personality %K MAO-A %K 5-HTTPR %K DRD4 %K DAT1 %D 2020 %7 24.12.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: International research has emphasized that youths are at higher risk for the onset of internet addiction (IA), but studies investigating biological, psychological, and social factors associated with this condition are limited. Objective: This study aims to investigate the possible association between IA and genetic polymorphisms in monoamine oxidase A (MAO-A), serotonin-transporter (5-HTTPR), dopamine receptor (DRD4), and dopamine transporter (DAT1) genes by considering the role played by the perception of young adults in their family functioning and their depression, anxiety, and avoidant personality problems. Methods: In a sample of 104 male and female young adults aged between 19 and 23 years (mean age 21.87, SD 2.29 years) recruited from universities in the central southern part of Italy, we addressed the presence of IA using the Young criteria of the IA test. Moreover, the perception of young adults of their family functioning and their psychopathological symptoms were assessed through the Family Assessment Device (FAD) and the Adult Self-Report, respectively. Results: We found no significant association between IA and any genetic polymorphisms, neither among males or females. Young adults with IA reported significantly higher scores in the subscale of FAD affective responsiveness (AR; P=.01) and in depressive problems (P=.02), anxiety problems (P=.009), and avoidant personality problems (P=.003) than those in the control group. Results of mediation analyses showed a mediation role played by depressive symptoms (B=0.99; 95% CI 0.22 to 1.97) and avoidant personality problems (B=1.09; 95% CI 0.32 to 2.05) of young adults on the relationship between the FAD, AR, and IA. Finally, this relationship was moderated by the genotype of the 5-HTTLPR (P<.001), DAT1 (P<.001), and MAO-A (P<.001) genes in young adults. Conclusions: This exploratory study supports the recent evidence on the mutual relationship among biological, individual, and social risk factors associated with IA in young adulthood. Our findings may have important clinical implications for the development of prevention and treatment programs. %M 33361057 %R 10.2196/17341 %U http://mental.jmir.org/2020/12/e17341/ %U https://doi.org/10.2196/17341 %U http://www.ncbi.nlm.nih.gov/pubmed/33361057 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e15293 %T Detection of Suicidality Among Opioid Users on Reddit: Machine Learning–Based Approach %A Yao,Hannah %A Rashidian,Sina %A Dong,Xinyu %A Duanmu,Hongyi %A Rosenthal,Richard N %A Wang,Fusheng %+ Stony Brook University, 2313D Computer Science, Stony Brook, NY, 11794, United States, 1 631 632 2594, fusheng.wang@stonybrook.edu %K opioid epidemic %K opioid-related disorders %K suicide %K social media %K machine learning %K deep learning %K natural language processing %D 2020 %7 27.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, both suicide and overdose rates have been increasing. Many individuals who struggle with opioid use disorder are prone to suicidal ideation; this may often result in overdose. However, these fatal overdoses are difficult to classify as intentional or unintentional. Intentional overdose is difficult to detect, partially due to the lack of predictors and social stigmas that push individuals away from seeking help. These individuals may instead use web-based means to articulate their concerns. Objective: This study aimed to extract posts of suicidality among opioid users on Reddit using machine learning methods. The performance of the models is derivative of the data purity, and the results will help us to better understand the rationale of these users, providing new insights into individuals who are part of the opioid epidemic. Methods: Reddit posts between June 2017 and June 2018 were collected from r/suicidewatch, r/depression, a set of opioid-related subreddits, and a control subreddit set. We first classified suicidal versus nonsuicidal languages and then classified users with opioid usage versus those without opioid usage. Several traditional baselines and neural network (NN) text classifiers were trained using subreddit names as the labels and combinations of semantic inputs. We then attempted to extract out-of-sample data belonging to the intersection of suicide ideation and opioid abuse. Amazon Mechanical Turk was used to provide labels for the out-of-sample data. Results: Classification results were at least 90% across all models for at least one combination of input; the best classifier was convolutional neural network, which obtained an F1 score of 96.6%. When predicting out-of-sample data for posts containing both suicidal ideation and signs of opioid addiction, NN classifiers produced more false positives and traditional methods produced more false negatives, which is less desirable for predicting suicidal sentiments. Conclusions: Opioid abuse is linked to the risk of unintentional overdose and suicide risk. Social media platforms such as Reddit contain metadata that can aid machine learning and provide information at a personal level that cannot be obtained elsewhere. We demonstrate that it is possible to use NNs as a tool to predict an out-of-sample target with a model built from data sets labeled by characteristics we wish to distinguish in the out-of-sample target. %M 33245287 %R 10.2196/15293 %U http://www.jmir.org/2020/11/e15293/ %U https://doi.org/10.2196/15293 %U http://www.ncbi.nlm.nih.gov/pubmed/33245287 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e15149 %T Health Personnel’s Perceived Usefulness of Internet-Based Interventions for Parents of Children Younger Than 5 Years: Cross-Sectional Web-Based Survey Study %A Størksen,Hege Therese %A Haga,Silje Marie %A Slinning,Kari %A Drozd,Filip %+ Department for Infant Mental Health, Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, Oslo, 0484, Norway, 47 95972822, hege.storksen@r-bup.no %K internet %K parent support %K children %K mental health %K acceptability %K health care services %D 2020 %7 18.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Approximately 10%-15% of children struggle with different socioemotional and psychological difficulties in infancy and early childhood. Thus, health service providers should have access to mental health interventions that can reach more parents than traditional face-to-face interventions. However, despite increasing evidence on the efficacy of internet-based mental health interventions, the pace in transferring such interventions to health care has been slow. One of the major suggested barriers to this may be the health personnel’s attitudes to perceived usefulness of internet-based interventions. Objective: The purpose of this study was to examine health professionals’ perceived usefulness of internet-based mental health interventions and to identify the key areas that they consider new internet-based services to be useful. Methods: Between May and September 2018, 2884 leaders and practitioners of infant and child health services were recruited to a cross-sectional web-based survey through the following channels: (1) existing email addresses from the Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, course database, (2) an official mailing list to infant and child health services, (3) social media, or (4) other recruitment channels. Respondents filled in background information and were asked to rate the usefulness of internet-based interventions for 12 different infant and child mental health problem areas based on the broad categories from the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC:0-5). Perceived usefulness was assessed with 1 global item: “How often do you think internet-based self-help programs can be useful for following infant and child mental health problems in your line of work?” The answers were scored on a 4-point scale ranging from 0 (never) to 3 (often). Results: The participants reported that they sometimes or often perceived internet-based interventions as useful for different infant and child mental health problems (scale of 0-3, all means>1.61). Usefulness of internet-based interventions was rated acceptable for sleep problems (mean 2.22), anxiety (mean 2.09), and social withdrawal and shyness (mean 2.07), whereas internet-based interventions were rated as less useful for psychiatric problems such as obsessive behaviors (mean 1.89), developmental disorders (mean 1.91), or trauma (mean 1.61). Further, there were a few but small differences in perceived usefulness between service leaders and practitioners (all effect sizes<0.32, all P<.02) and small-to-moderate differences among daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics (all effect sizes<0.69, all P<.006). Conclusions: Internet-based interventions for different infant and child mental health problems within services such as daycare centers, well-baby clinics, municipal child welfare services, and child and adolescent mental health clinics are sometimes or often perceived as useful. These encouraging findings can support the continued exploration of internet-based mental health interventions as a way to improve parental support. %M 33206058 %R 10.2196/15149 %U http://mental.jmir.org/2020/11/e15149/ %U https://doi.org/10.2196/15149 %U http://www.ncbi.nlm.nih.gov/pubmed/33206058 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 11 %P e24245 %T Shaping Blended Care: Adapting an Instrument to Support Therapists in Using eMental Health %A Kip,Hanneke %A Wentzel,Jobke %A Kelders,Saskia M %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7500 AE, Netherlands, 31 53 489 9180, h.kip@utwente.nl %K eHealth %K blended care %K implementation science %K participatory development %K forensic psychiatry %K mobile phone %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Although eMental health interventions, especially when delivered in a blended way, have great potential to improve the quality and efficiency of mental health care, their use in practice lags behind expectations. The Fit for Blended Care (FfBC) instrument was developed to support therapists and clients in shaping blended care in a way that optimally fits their needs. However, this existing version cannot be directly applied to specific branches of mental health care as it is too broad and generic. Objective: The goal of this study is to adapt the existing FfBC instrument to fit a specific, complex setting—forensic mental health care—by means of participatory development with therapists. Methods: The participatory process was divided into 4 phases and was executed by a project team consisting of 1 manager, 3-5 therapists, and 1 researcher. In phase 1, general requirements for the adaptation of the existing instrument were discussed in 2 focus groups with the project team. In phase 2, patient-related factors that influence the use of an existing web-based intervention were elicited through semistructured interviews with all 18 therapists working at an outpatient clinic. In phase 3, multiple focus groups with the project teams were held to create the first version of the adapted FfBC instrument. In phase 4, a digital prototype of the instrument was used with 8 patients, and the experiences of the 4 therapists were discussed in a focus group. Results: In phase 1, it became clear that the therapists’ main requirement was to develop a much shorter instrument with a few items, in which the content was specifically tailored to the characteristics of forensic psychiatric outpatients. The interviews showed a broad range of patient-related factors, of which 5 were used in the instrument: motivation for blended treatment; writing about thoughts, feelings, and behavior; conscientiousness; psychosocial problems; and social support. In addition, a part of the instrument was focused on the practical necessary preconditions that patients should fill by themselves before the treatment was developed. The use of the web-based prototype of the instrument in treatment resulted in overall positive experiences with the content; however, therapists indicated that the items should be formulated in a more patient-centered way to encourage their involvement in discussing the factors. Conclusions: The participatory, iterative process of this study resulted in an adapted version of the FfBC instrument that fits the specific forensic context and supports shared decision making. In general, the adaptiveness of the instrument is important: its content and implementation should fit the type of care, the organization, and eHealth intervention. To adapt the instrument to other contexts, the guidelines described in this paper can be followed. %M 33185559 %R 10.2196/24245 %U http://mental.jmir.org/2020/11/e24245/ %U https://doi.org/10.2196/24245 %U http://www.ncbi.nlm.nih.gov/pubmed/33185559 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e19171 %T Instagram as a Window to Societal Perspective on Mental Health, Gender, and Race: Observational Pilot Study %A Utter,Kierstin %A Waineo,Eva %A Bell,Capricia M %A Quaal,Harrison L %A Levine,Diane L %+ Department of Internal Medicine, Wayne State University School of Medicine, Suite 2E, 4201 St Antoine, Detroit, MI, 48201, United States, 1 313 993 7835, DLLevine@med.wayne.edu %K mental health %K Instagram %K social media %K stigma %K gender %K race %K depression %D 2020 %7 27.10.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Gender and race are known to impact attitudes toward mental health topics and help-seeking behavior. Men and minorities are more likely to cite stigma as a reason for not seeking help for mental health concerns, which is of particular relevance given the high rate of suicide in men and challenges of historic proportion currently facing minority communities. Instagram provides a platform to discuss mental health, though a lack of male and minority representation may further alienate these populations. Objective: We aimed to investigate whether men and nonwhite individuals are underrepresented in Instagram photos tagged with #mentalhealth (compared to photos tagged with #health) to better understand how gender and race-based representations are manifested on this popular social media platform and discuss the implications. Methods: Three investigators of different genders and racial backgrounds met on nine different days via teleconference to analyze a total of 215 publicly available Instagram photos tagged with #mentalhealth and 215 with #health. These photos were generated using Instagram’s search function, and search results were sorted by most recently published at the time of data collection. For each photo, the three investigators recorded their observations about the gender (male versus female) and race (white versus nonwhite versus racially unclassifiable) of subjects featured in the photo, which they did not discuss with other investigators. Chi-squared analysis was performed on each investigator’s data set to compare the frequency of male versus female and white versus nonwhite subjects identified in each hashtag category. Kappa interrater agreement was calculated for each investigator pair, category (gender or race), and hashtag. Results: All three investigators observed significantly more female as compared to male subjects in photos tagged with #mentalhealth (X2=14.4, P<.001 for all investigators) while observing no significant difference between numbers of male and female subjects in photos tagged with #health (X2=1.533, P=.22; X2=1.241, P=.27; X2=0.096, P=.76). All three investigators identified significantly more white than nonwhite subjects in photos tagged with both #health and #mentalhealth (X2 values range from 11.912 to 98.927, P<.001 for all). Kappa interrater agreement revealed almost perfect agreement for gender (kappa=0.908-0.992) with the agreement for race ranging from 0.614 to 0.822, depending on hashtag and rater pair. Conclusions: Women are featured more frequently than men in Instagram photos tagged with #mentalhealth. The topic of #health, meanwhile, is not gendered this way. Low visibility of mental health among men may both represent and exacerbate existing stigma and barriers to care. White subjects are featured significantly more frequently than nonwhite subjects in photos tagged with both #mentalhealth and #health. Directed interventions using the Instagram platform may be indicated to increase the visibility of underrepresented groups and break the cycle of stigma. %M 33107831 %R 10.2196/19171 %U http://mental.jmir.org/2020/10/e19171/ %U https://doi.org/10.2196/19171 %U http://www.ncbi.nlm.nih.gov/pubmed/33107831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18447 %T Experiences of Serving and Ex-Serving Members With the PTSD Coach Australia App: Mixed Methods Study %A Shakespeare-Finch,Jane %A Alichniewicz,Karolina K %A Strodl,Esben %A Brown,Kelly %A Quinn,Catherine %A Hides,Leanne %A White,Angela %A Gossage,Gabrial %A Poerio,Loretta %A Batras,Dimitri %A Jackson,Samantha %A Styles,Jess %A Kavanagh,David %+ Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, 4059, Australia, 61 0731384932, j.shakespeare-finch@qut.edu.au %K PTSD %K stress disorders, posttraumatic %K self-management %K evaluation, qualitative %K health, veterans %K armed forces personnel %D 2020 %7 8.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: PTSD Coach Australia is an app for serving and ex-serving defense members and was adapted for the Australian context in 2013 from PTSD Coach, which was created in the United States. Objective: This study aimed to provide a user-centered evaluation of the app from the perspective of serving and ex-serving members of the Australian Defence Force. Methods: Qualitative data were collected in response to questions to participants in 1 of 5 workshops (n=29) or in telephone interviews (n=24). Quantitative data were collected using the user version of Mobile Apps Rating Scale (uMARS). Results: Analysis of the qualitative data demonstrated mixed support for the app. While some people found it extremely useful, especially as an adjunct to therapy, others pointed out limitations and cautioned against the app potentially triggering symptoms in people with PTSD. This perceived risk was usually found to stem from frustration with the app’s functionality rather than its content. Participants spoke about the helpful and unhelpful aspects of the app and barriers to its use and made suggestions for improvement. Many participants encouraged its continued use and highlighted the need for it to be promoted more broadly, as many were not aware of it until they were invited to participate in this research. Conclusions: PTSD Coach Australia was seen in a positive light by some participants, but others thought it had too much text and the potential to trigger a traumatic response in users with PTSD. A need to update the app was also a common comment as was the need to increase awareness of the app’s existence. %M 33030438 %R 10.2196/18447 %U https://www.jmir.org/2020/10/e18447 %U https://doi.org/10.2196/18447 %U http://www.ncbi.nlm.nih.gov/pubmed/33030438 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e16450 %T User Experience and Effects of an Individually Tailored Transdiagnostic Internet-Based and Mobile-Supported Intervention for Anxiety Disorders: Mixed-Methods Study %A Weisel,Kiona K %A Zarski,Anna-Carlotta %A Berger,Thomas %A Krieger,Tobias %A Moser,Christian T %A Schaub,Michael P %A Görlich,Dennis %A Berking,Matthias %A Ebert,David D %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg, Nägelsbachstraße 25a, Erlangen, Germany, 49 (0)9131 ext 8567570, kiona.weisel@fau.de %K transdiagnostic %K anxiety %K depression %K tailored %K internet intervention %D 2020 %7 16.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet interventions have been shown to be effective in treating anxiety disorders. Most interventions to date focus on single disorders and disregard potential comorbidities. Objective: The aim of this mixed-methods study was to investigate feasibility, user experience, and effects of a newly developed individually tailored transdiagnostic guided internet intervention for anxiety disorders. Methods: This study is an uncontrolled, within-group, baseline, postintervention pilot trial with an embedded qualitative and quantitative process and effect evaluation. In total, 49 adults with anxiety disorders (generalized anxiety disorder n=20, social phobia n=19, agoraphobia without panic n=12, panic with agoraphobia n=6, panic without agoraphobia n=4, subclinical depression n=41) received access to the 7-session intervention. We examined motivation and expectations, intervention use, user experience, impact, and modification requests. Qualitative data were assessed using semistructured interviews and analyzed by qualitative content analysis. Quantitative outcomes included symptom severity of anxiety and depression (Hamilton Anxiety Rating Scale [HAM-A], Quick Item Inventory of Depressive Symptomatology clinician rating [QIDS-C]), diagnostic status in clinical interviews (Mini International Neuropsychiatric Interview [MINI]), and web-based self-reports (Generalized Anxiety Disorder–7 [GAD-7], Center for Epidemiological Studies Depression Scale [CES-D], Beck Anxiety Inventory [BAI], Panic and Agoraphobia Scale [PAS], Social Phobia Scale [SPS], Patient Health Questionnaire–9 [PHQ-9]) at baseline and postassessment. Quantitative data was analyzed by comparing within-group means expressed as Cohen d. Results: Anxiety symptom severity (HAM-A d=1.19) and depressive symptoms (QIDS-C d=0.42) improved significantly, and 54% (21/39) no longer were diagnosed as having any anxiety disorder. The main positive effects were the general improvement of disease burden and attentiveness to feelings and risk situations while the main negative effects experienced were lack of change in disease burden and symptom deterioration. The most prevalent reasons for participation were the advantages of online treatment, symptom burden, and openness toward online treatment. Helpful factors included support, psychoeducation and practicing strategies in daily life; the main hindering factors were too little individualization and being overwhelmed by the content and pace. Conclusions: The intervention was found to be feasible and results show preliminary data indicating potential efficacy for improving anxiety and depression. The next step should be the evaluation within a randomized controlled trial. Concerning intervention development, it was found that future interventions should emphasize individualization even more in order to further improve the fit to individual characteristics, preferences, and needs. %M 32936085 %R 10.2196/16450 %U http://www.jmir.org/2020/9/e16450/ %U https://doi.org/10.2196/16450 %U http://www.ncbi.nlm.nih.gov/pubmed/32936085 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e18458 %T Compensatory Social Networking Site Use, Family Support, and Depression Among College Freshman: Three-Wave Panel Study %A Zhou,Mingjie %A Li,Fugui %A Wang,Yanhong %A Chen,Shuang %A Wang,Kexin %+ College of Media and International Culture, Zhejiang University, Main Teaching Building, 4th Fl., Hangzhou, 310007, China, 86 18611897400, wangkexin0809@zju.edu.cn %K freshmen %K introversion %K compensatory use of SNS %K depression %K family support %K social media %D 2020 %7 2.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Freshmen were found to use social networking sites (SNS) as a useful medium to effectively adjust to college life, which hints at a tendency to resort to SNS for social compensation. However, the compensatory use of SNS is usually problematic. Objective: This study explores why a subgroup of freshmen developed depressive symptoms while socially adjusting to college by investigating the antecedent role of introversion, the explanatory role of compensatory use of SNS, and the protective role of perceived family support. The study is among the first to point out the relevance of the compensatory use of SNS in explaining the indirect association between introversion and depression with a longitudinal design. Methods: A 3-wave panel sample of freshmen (N=1137) is used to examine the moderated mediation model. Results: We found that introversion at Wave 1 positively predicted compensatory use of SNS at Wave 2 and subsequently increased depression at Wave 3 (unstandardized B=0.07, SE 0.02, P<.001, 95% CI 0.04-0.10; unstandardized B=0.09, SE 0.01, P<.001, 95% CI 0.06-0.12). The moderated mediation model further examined the buffering role of perceived family support within the link between introversion and compensatory SNS use (index=0.0031, SE 0.0015, 95% CI 0.0003-0.0062). Unexpectedly, we found that family support in Wave 1 decreased compensatory SNS use for less introverted freshmen in Wave 2 and further decreased depression in Wave 3. Conclusions: Unexpectedly, our findings uncover an enhancing effect, rather than a buffering effect, of family support by embedding its effect within the relationship between introversion and compensatory SNS use. Appreciating the differences in the casual pathways for freshmen with different levels of introversion clarifies how SNS affect young adults' lives. %M 32795999 %R 10.2196/18458 %U https://www.jmir.org/2020/9/e18458 %U https://doi.org/10.2196/18458 %U http://www.ncbi.nlm.nih.gov/pubmed/32795999 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19950 %T Connected Mental Health: Systematic Mapping Study %A Drissi,Nidal %A Ouhbi,Sofia %A Janati Idrissi,Mohammed Abdou %A Fernandez-Luque,Luis %A Ghogho,Mounir %+ Department of Computer Science and Software Engineering, United Arab Emirates University, College of Information Technology, United Arab Emirates University, Al Ain, 15551, United Arab Emirates, 971 37135568, sofia.ouhbi@uaeu.ac.ae %K mental health %K connected health %K eHealth %K mobile health %K telehealth %K mHealth %K mobile phone %K health informatics %K review %K interdisciplinary research %K information technology %K information systems %D 2020 %7 28.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Although mental health issues constitute an increasing global burden affecting a large number of people, the mental health care industry is still facing several care delivery barriers such as stigma, education, and cost. Connected mental health (CMH), which refers to the use of information and communication technologies in mental health care, can assist in overcoming these barriers. Objective: The aim of this systematic mapping study is to provide an overview and a structured understanding of CMH literature available in the Scopus database. Methods: A total of 289 selected publications were analyzed based on 8 classification criteria: publication year, publication source, research type, contribution type, empirical type, mental health issues, targeted cohort groups, and countries where the empirically evaluated studies were conducted. Results: The results showed that there was an increasing interest in CMH publications; journals were the main publication channels of the selected papers; exploratory research was the dominant research type; advantages and challenges of the use of technology for mental health care were the most investigated subjects; most of the selected studies had not been evaluated empirically; depression and anxiety were the most addressed mental disorders; young people were the most targeted cohort groups in the selected publications; and Australia, followed by the United States, was the country where most empirically evaluated studies were conducted. Conclusions: CMH is a promising research field to present novel approaches to assist in the management, treatment, and diagnosis of mental health issues that can help overcome existing mental health care delivery barriers. Future research should be shifted toward providing evidence-based studies to examine the effectiveness of CMH solutions and identify related issues. %M 32857055 %R 10.2196/19950 %U http://www.jmir.org/2020/8/e19950/ %U https://doi.org/10.2196/19950 %U http://www.ncbi.nlm.nih.gov/pubmed/32857055 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17675 %T Modeling Early Gambling Behavior Using Indicators from Online Lottery Gambling Tracking Data: Longitudinal Analysis %A Challet-Bouju,Gaëlle %A Hardouin,Jean-Benoit %A Thiabaud,Elsa %A Saillard,Anaïs %A Donnio,Yann %A Grall-Bronnec,Marie %A Perrot,Bastien %+ Addictology and Psychiatry Department, Centre Hospitalier Universitaire de Nantes, Hôpital Saint Jacques, 85 rue Saint Jacques, Nantes, 44093, France, 33 253482532, gaelle.bouju@chu-nantes.fr %K gambling %K internet %K trajectory %K latent class analysis %K growth mixture modeling %K gambling tracking data %K early detection %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals who gamble online may be at risk of gambling excessively, but internet gambling also provides a unique opportunity to monitor gambling behavior in real environments which may allow intervention for those who encounter difficulties. Objective: The objective of this study was to model the early gambling trajectories of individuals who play online lottery. Methods: Anonymized gambling‐related records of the initial 6 months of 1152 clients of the French national lottery who created their internet gambling accounts between September 2015 and February 2016 were analyzed using a two-step approach that combined growth mixture modeling and latent class analysis. The analysis was based upon behavior indicators of gambling activity (money wagered and number of gambling days) and indicators of gambling problems (breadth of involvement and chasing). Profiles were described based upon the probabilities of following the trajectories that were identified for the four indicators, and upon several covariates (age, gender, deposits, type of play, net losses, voluntary self-exclusion, and Playscan classification—a responsible gambling tool that provides each player with a risk assessment: green for low risk, orange for medium risk and red for high risk). Net losses, voluntary self-exclusion, and Playscan classification were used as external verification of problem gambling. Results: We identified 5 distinct profiles of online lottery gambling. Classes 1 (56.8%), 2 (14.8%) and 3 (13.9%) were characterized by low to medium gambling activity and low values for markers of problem gambling. They displayed low net losses, did not use the voluntary self-exclusion measure, and were classified predominantly with green Playscan tags (range 90%-98%). Class 4 (9.7%) was characterized by medium to high gambling activity, played a higher breadth of game types (range 1-6), and had zero to few chasing episodes. They had high net losses but were classified with green (66%) or orange (25%) Playscan tags and did not use the voluntary self-exclusion measure. Class 5 (4.8%) was characterized by medium to very high gambling activity, played a higher breadth of game types (range 1-17), and had a high number of chasing episodes (range 0-5). They experienced the highest net losses, the highest proportion of orange (32%) and red (39%) tags within the Playscan classification system and represented the only class in which voluntary self-exclusion was present. Conclusions: Classes 1, 2, 3 may be considered to represent recreational gambling. Class 4 had higher gambling activity and higher breadth of involvement and may be representative of players at risk for future gambling problems. Class 5 stood out in terms of much higher gambling activity and breadth of involvement, and the presence of chasing behavior. Individuals in classes 4 and 5 may benefit from early preventive measures. %M 32254041 %R 10.2196/17675 %U http://www.jmir.org/2020/8/e17675/ %U https://doi.org/10.2196/17675 %U http://www.ncbi.nlm.nih.gov/pubmed/32254041 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17560 %T Associations of Internet Addiction Severity With Psychopathology, Serious Mental Illness, and Suicidality: Large-Sample Cross-Sectional Study %A Guo,Wanjun %A Tao,Yujie %A Li,Xiaojing %A Lin,Xia %A Meng,Yajing %A Yang,Xia %A Wang,Huiyao %A Zhang,Yamin %A Tang,Wanjie %A Wang,Qiang %A Deng,Wei %A Zhao,Liansheng %A Ma,Xiaohong %A Li,Mingli %A Chen,Ting %A Xu,Jiajun %A Li,Jing %A Hao,Wei %A Lee,Sing %A Coid,Jeremy W %A Greenshaw,Andrew J %A Li,Tao %+ Mental Health Center and Psychiatric Laboratory, State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, 28 Dianxin South Street, Chengdu, Sichuan, China, 86 18980601817, xuntao26@hotmail.com %K internet %K addiction %K psychopathology %K suicidality %K serious mental illness %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet addiction has become a major global concern and a burden on mental health. However, there is a lack of consensus on its link to mental health outcomes. Objective: The aim of this study was to investigate the associations between internet addiction severity and adverse mental health outcomes. Methods: First-year undergraduates enrolled at Sichuan University during September 2015, 2016, 2017, and 2018 were invited to participate in the current study survey, 85.13% (31,659/37,187) of whom fully responded. Young’s 20-item Internet Addiction Test, Patient Health Questionnaire-15, Patient Health Questionnaire-9, Symptom Checklist 90, Six-Item Kessler Psychological Distress Scale, and Suicidal Behaviors Questionnaire-Revised were used to evaluate internet addiction, four psychopathologies (high somatic symptom severity, clinically significant depression, psychoticism, and paranoia), serious mental illness, and lifetime suicidality. Results: The prevalence of students with mild, moderate, and severe internet addiction was 37.93% (12,009/31,659), 6.33% (2003/31,659), and 0.20% (63/31,659), respectively. The prevalence rates of high somatic symptom severity, clinically significant depression, psychoticism, paranoid ideation, and serious mental illness were 6.54% (2072/31,659), 4.09% (1294/31,659), 0.51% (160/31,659), 0.52% (165/31,659), and 1.88% (594/31,659), respectively, and the lifetime prevalence rates of suicidal ideation, suicidal plan, and suicidal attempt were 36.31% (11,495/31,659), 5.13% (1624/31,659), and 1.00% (315/31,659), respectively. The prevalence rates and odds ratios (ORs) of the four psychopathologies and their comorbidities, screened serious mental illness, and suicidalities in the group without internet addiction were much lower than the average levels of the surveyed population. Most of these metrics in the group with mild internet addiction were similar to or slightly higher than the average rates; however, these rates sharply increased in the moderate and severe internet addiction groups. Among the four psychopathologies, clinically significant depression was most strongly associated with internet addiction after adjusting for the confounding effects of demographics and other psychopathologies, and its prevalence increased from 1.01% (178/17,584) in the students with no addiction to 4.85% (582/12,009), 24.81% (497/2,003), and 58.73% (37/63) in the students with mild, moderate, and severe internet addiction, respectively. The proportions of those with any of the four psychopathologies increased from 4.05% (713/17,584) to 11.72% (1408/12,009), 36.89% (739/2003), and 68.25% (43/63); those with lifetime suicidal ideation increased from 24.92% (4382/17,584) to 47.56% (5711/12,009), 67.70% (1356/2003), and 73.02% (46/63); those with a suicidal plan increased from 2.59% (456/17,584) to 6.77% (813/12,009), 16.72% (335/2003), and 31.75% (20/63); and those with a suicidal attempt increased from 0.50% (88/17,584) to 1.23% (148/12,009), 3.54% (71/2003), and 12.70% (8/63), respectively. Conclusions: Moderate and severe internet addiction were strongly associated with a broad group of adverse mental health outcomes, including somatic symptoms that are the core features of many medical illnesses, although clinically significant depression showed the strongest association. This finding supports the illness validity of moderate and severe internet addiction in contrast to mild internet addiction. These results are important for informing health policymakers and service suppliers from the perspective of resolving the overall human health burden in the current era of “Internet Plus” and artificial intelligence. %M 32780029 %R 10.2196/17560 %U https://www.jmir.org/2020/8/e17560 %U https://doi.org/10.2196/17560 %U http://www.ncbi.nlm.nih.gov/pubmed/32780029 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16961 %T Perceived Effectiveness and Motivations for the Use of Web-Based Mental Health Programs: Qualitative Study %A Eccles,Heidi %A Nannarone,Molly %A Lashewicz,Bonnie %A Attridge,Mark %A Marchand,Alain %A Aiken,Alice %A Ho,Kendall %A Wang,Jianli %+ Work & Mental Health Research Unit, The Institute of Mental Health Research, University of Ottawa, Room 5404, 1145 Carling Ave, Ottawa, ON, K1Z7K4, Canada, 1 6137226521, jianli.wang@theroyal.ca %K prevention %K mental health %K depression %K cognitive behavioral therapy %K motivators %K perceived effectiveness %K internet-based intervention %K interview %D 2020 %7 31.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The prevalence of depression is high and has been stable despite increased treatment, research, and dissemination. People encounter barriers to seeking traditional mental health services, which could be mitigated by using web-based prevention methods. Objective: This study aims to understand what people at high risk for depression perceive as effective aspects of web-based mental health programs and what motivates people at high risk for depression to use web-based mental health programs. Methods: We conducted an inductive content analysis using telephone interview data from 77 participants at high risk for depression who were recruited from 2 randomized controlled trials (RCTs). Participants from the first RCT were working men who had been randomly assigned to 1 of the following 3 groups: control group, who had access to general depression information from a website called BroMatters; intervention group 1, who had access to the BroMatters website along with the associated BroHealth web-based mental health program; and intervention group 2, who had access to the BroMatters website, the BroHealth web-based mental health program, and telephone sessions with a life coach. Participants from the second RCT were men and women who had been assigned to the intervention group, who received access to the HardHat web-based mental health program, or the control group, who only received access to the HardHat web-based mental health program following completion of the RCT. Participants for this inductive content analysis study were recruited from the intervention groups in both RCTs. Two groups of participants (n=41 and n=20) were recruited from the BroHealth RCT, and a third group comprised 16 participants that were recruited from the HardHat RCT. Results: We generated four categories regarding the perceived effectiveness of web-based programs and five categories related to what motivates the use of web-based programs. Participants identified awareness, program medium and functionality, program content, and coaches as categories related to the effectiveness of the programs. Categories of motivators to use web-based programs included providing reminders or incentives, promotion of the programs, providing appropriate medium and functionality, appropriate content, and perceived need. The final category related to motivators reflects perceptions of participants who were either unsure about what motivates them or believed that there is no way to motivate use. Conclusions: Conflicting evidence was obtained regarding the perceived effectiveness of aspects of the content and functionality of web-based programs. In general, web-based mental health programs were perceived to help increase mental health awareness, especially when it includes live access to a coach. However, the results also revealed that it is difficult to motivate people to begin using web-based mental health programs. Strategies that may motivate the use of such programs include perceived personal need, effective promotion, providing incentives and reminders, and improving functionality. %M 32735216 %R 10.2196/16961 %U http://www.jmir.org/2020/7/e16961/ %U https://doi.org/10.2196/16961 %U http://www.ncbi.nlm.nih.gov/pubmed/32735216 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e14915 %T Mobile Mental Health Apps in China: Systematic App Store Search %A Yin,Huifang %A Wardenaar,Klaas J %A Wang,Yuhao %A Wang,Nan %A Chen,Wenjin %A Zhang,Yan %A Xu,Guangming %A Schoevers,Robert A %+ Tianjin Anding Hospital, No 13, Liulin Road, Hexi district, Tianjin, China, 86 15122997716, xugm@ymail.com %K smartphone %K app %K mobile mental health %K mental illness %K mental health problem %K China %D 2020 %7 27.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphones have become ubiquitous in China, offering a promising way to deliver mental health interventions; however, little is known about the current use and characteristics of smartphone apps for mental health. Objective: The purpose of this study was to gain insight into mobile mental health apps available in China as of December 2018. Methods: A systematic search was conducted to identify and evaluate the most downloaded apps from iOS and Android platforms. Apps were categorized according to their main purpose and downloaded to evaluate their content. Each app’s affiliation, cost, target users, information security, and evidence-based nature were evaluated. Results: Of the 172 unique apps that were identified, there were 37 apps (21.5%) for psychological counseling, 50 apps (29.1%) for assessment, 12 apps (7.0%) to relieve stress, 24 apps (14.0%) for psychoeducation, and 49 (28.4%) multipurpose apps (ie, a combination of counseling and assessment). Most apps were developed for adults in the general population (166/172, 96.5%), rather than for psychiatric patients. App-based counseling was mostly provided by psychologists, and of the assessed apps, only 40% (70/172) used evidence-based scales to assess mental health problems such as anxiety or depressed mood. Guided meditation was used as the main technique in stress-relieving apps. Conclusions: Many apps contained useful and evidence-based elements, such as good quality information, validated measurements, and useful meditation methods; however, for mobile apps to contribute significantly to mental health care in China, considerable challenges remain, including the need for more patient-focused apps that can actually take on the role of a health care provider. In addition, efficacy studies are needed. %M 32716301 %R 10.2196/14915 %U https://www.jmir.org/2020/7/e14915 %U https://doi.org/10.2196/14915 %U http://www.ncbi.nlm.nih.gov/pubmed/32716301 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e14958 %T An Integrative Model for the Effectiveness of Biofeedback Interventions for Anxiety Regulation: Viewpoint %A Weerdmeester,Joanneke %A van Rooij,Marieke MJW %A Engels,Rutger CME %A Granic,Isabela %+ Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, Netherlands, 31 243612076, j.weerdmeester@psych.ru.nl %K biofeedback %K neurofeedback %K anxiety %K appraisal %K mechanisms %K mental health %K eHealth %K video games %K wearable technology %K review %K mobile phone %D 2020 %7 23.7.2020 %9 Viewpoint %J J Med Internet Res %G English %X Biofeedback has shown to be a promising tool for the treatment of anxiety; however, several theoretical as well as practical limitations have prevented widespread adaptation until now. With current technological advances and the increasing interest in the use of self-monitoring technology to improve mental health, we argue that this is an ideal time to launch a new wave of biofeedback training. In this viewpoint paper, we reflect on the current state of biofeedback training, including the more traditional techniques and mechanisms that have been thought to explain the effectiveness of biofeedback such as the integration of operant learning and meditation techniques, and the changes in interoceptive awareness and physiology. Subsequently, we propose an integrative model that includes a set of cognitive appraisals as potential determinants of adaptive trajectories within biofeedback training such as growth mindset, self-efficacy, locus of control, and threat-challenge appraisals. Finally, we present a set of detailed guidelines based on the integration of our model with the mechanics and mechanisms offered by emerging interactive technology to encourage a new phase of research and implementation using biofeedback. There is a great deal of promise for future biofeedback interventions that harness the power of wearables and video games, and that adopt a user-centered approach to help people regulate their anxiety in a way that feels engaging, personal, and meaningful. %M 32706654 %R 10.2196/14958 %U https://www.jmir.org/2020/7/e14958 %U https://doi.org/10.2196/14958 %U http://www.ncbi.nlm.nih.gov/pubmed/32706654 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e14865 %T Habits and Attitudes of Video Gaming and Information Technology Use in People with Schizophrenia: Cross-Sectional Survey %A Choi,William TH %A Yu,Dan KS %A Wong,Terry %A Lantta,Tella %A Yang,Min %A Välimäki,Maritta %+ Department of Nursing Science, Faculty of Medicine, University of Turku, ICT-City, A-wing, 5th floor, Joukahaisenkatu 3–5, Turku, 20520, Finland, 358 29 450 236, maritta.valimaki@polyu.edu.hk %K video gaming %K internet %K information technology %K schizophrenia %D 2020 %7 22.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Information technology and video gaming have potential advantages in the treatment of schizophrenia. However, information regarding the habits and attitudes related to internet use and video gaming in people with schizophrenia is limited. Objective: The aim of this study was to explore the habits and attitudes regarding video gaming and information technology usage and their associated factors in people with schizophrenia in Hong Kong. Methods: In this cross-sectional survey, service users with schizophrenia were recruited from 6 halfway hostels and 7 integrated centers for mental wellness in Hong Kong. A 79-item self-report questionnaire was utilized to explore the habits of internet use and video gaming in these people with schizophrenia. The attitude toward video gaming was assessed using the Gaming Attitudes, Motivations, and Experiences Scales. Of the 148 individuals in a convenience sample who were invited to participate in this study, 110 willingly participated (a response rate of 74.3%). The data were analyzed using descriptive statistics, a two-tailed independent t test, Pearson correlation, and principal analysis with 3 methods of rotation (varimax, equimax, and promax). Results: Most participants (100/110, 90.9%) had access to the internet and half of them (54/110, 49.1%) used the internet daily mostly to watch videos (66/110, 60.0%) or read news or books, etc (42/110, 38.2%). One-third of the participants (36/110, 32.7%) used the internet to play web-based games, and most of them (88/110, 80.0%) had played a video game in the past year. The most favorable gaming platforms were cellular phones (43/88, 49%) followed by computers (19/88, 22%) and arcade cabinets (6/88, 7%). The most favorable game genre was action games (34/145, 23.4%). Those who had a bachelor’s degree or higher scored lower in social interaction than those with a lower education level (P=.03). Those who played video games daily scored higher in the category of story than those who did not play daily (t86=2.03, P=.05). The most popular gaming category was autonomy and the least popular categories were violent catharsis and violent reward. Two motives, “social playing” and “evasive playing,” were formed to describe the characteristics of playing video games. Conclusions: Our data showed a high internet utilization rate among people with schizophrenia in Hong Kong. Only a few of them used the internet to search for health-related information. Our study also exemplified the unique habits of gaming among the participants. Health care professionals could utilize video games to engage people with schizophrenia and promote coping with stress and provide social skills training to such people with schizophrenia. Identification of the gaming attitudes can contribute to the development of serious games for the schizophrenic population. Further investigation is vital for the promotion of mental health through web-based platforms. %M 32459646 %R 10.2196/14865 %U http://www.jmir.org/2020/7/e14865/ %U https://doi.org/10.2196/14865 %U http://www.ncbi.nlm.nih.gov/pubmed/32459646 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16021 %T Effectiveness and Safety of Using Chatbots to Improve Mental Health: Systematic Review and Meta-Analysis %A Abd-Alrazaq,Alaa Ali %A Rababeh,Asma %A Alajlani,Mohannad %A Bewick,Bridgette M %A Househ,Mowafa %+ College of Science and Engineering, Hamad Bin Khalifa University, Liberal Arts and Sciences Building, Education City, Ar Rayyan, Doha, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K chatbots %K conversational agents %K mental health %K mental disorders %K depression %K anxiety %K effectiveness %K safety %D 2020 %7 13.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The global shortage of mental health workers has prompted the utilization of technological advancements, such as chatbots, to meet the needs of people with mental health conditions. Chatbots are systems that are able to converse and interact with human users using spoken, written, and visual language. While numerous studies have assessed the effectiveness and safety of using chatbots in mental health, no reviews have pooled the results of those studies. Objective: This study aimed to assess the effectiveness and safety of using chatbots to improve mental health through summarizing and pooling the results of previous studies. Methods: A systematic review was carried out to achieve this objective. The search sources were 7 bibliographic databases (eg, MEDLINE, EMBASE, PsycINFO), the search engine “Google Scholar,” and backward and forward reference list checking of the included studies and relevant reviews. Two reviewers independently selected the studies, extracted data from the included studies, and assessed the risk of bias. Data extracted from studies were synthesized using narrative and statistical methods, as appropriate. Results: Of 1048 citations retrieved, we identified 12 studies examining the effect of using chatbots on 8 outcomes. Weak evidence demonstrated that chatbots were effective in improving depression, distress, stress, and acrophobia. In contrast, according to similar evidence, there was no statistically significant effect of using chatbots on subjective psychological wellbeing. Results were conflicting regarding the effect of chatbots on the severity of anxiety and positive and negative affect. Only two studies assessed the safety of chatbots and concluded that they are safe in mental health, as no adverse events or harms were reported. Conclusions: Chatbots have the potential to improve mental health. However, the evidence in this review was not sufficient to definitely conclude this due to lack of evidence that their effect is clinically important, a lack of studies assessing each outcome, high risk of bias in those studies, and conflicting results for some outcomes. Further studies are required to draw solid conclusions about the effectiveness and safety of chatbots. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42019141219; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019141219 %M 32673216 %R 10.2196/16021 %U http://www.jmir.org/2020/7/e16021/ %U https://doi.org/10.2196/16021 %U http://www.ncbi.nlm.nih.gov/pubmed/32673216 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18220 %T Effectiveness of a Transdiagnostic Guided Internet-Delivered Protocol for Emotional Disorders Versus Treatment as Usual in Specialized Care: Randomized Controlled Trial %A González-Robles,Alberto %A Díaz-García,Amanda %A García-Palacios,Azucena %A Roca,Pablo %A Ramos-Quiroga,Josep Antoni %A Botella,Cristina %+ Department of Basic and Clinical Psychology, and Psychobiology, Universitat Jaume I, Sos Baynat Avenue, Campus del Riu Sec, Research II Building, Labpsitec, Castellón de la Plana, 12071, Spain, 34 964387646 ext 7646, vrobles@uji.es %K transdiagnostic %K internet %K cognitive behavioral therapy %K emotional disorders %K depression %K anxiety %K specialized care %D 2020 %7 7.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Anxiety disorders and depression (emotional disorders) are highly prevalent mental disorders. Extensive empirical evidence supports the efficacy of cognitive behavioral therapy (CBT) for the treatment of these disorders. However, there are still some barriers related to their dissemination and implementation, which make it difficult for patients to receive these treatments, especially in public health care settings where resources are limited. Recent advances in improving CBT dissemination encompass different perspectives. One is the transdiagnostic approach, which offers treatment protocols that can be used for a range of emotional disorders. Another approach is the use of the internet to reach a larger number of people who could benefit from CBT. Objective: This study aimed to analyze the effectiveness and acceptability of a transdiagnostic internet-delivered protocol (EmotionRegulation) with human and automated guidance in patients from public specialized mental health care settings. Methods: A 2-armed randomized controlled trial (RCT) was conducted to compare the effectiveness of EmotionRegulation with treatment as usual (TAU) in specialized mental health care. In all, 214 participants were randomly assigned to receive either EmotionRegulation (n=106) or TAU (n=108). Measurement assessments were conducted at pre- and postintervention and at a 3-month follow-up. Results: The results revealed the superiority of EmotionRegulation over TAU on measures of depression (d=0.41), anxiety (d=0.35), and health-related quality of life (d=−0.45) at posttreatment, and these gains were maintained at the 3-month follow-up. Furthermore, the results for expectations and opinions showed that EmotionRegulation was well accepted by participants. Conclusions: EmotionRegulation was more effective than TAU for the treatment of emotional disorders in the Spanish public mental health system. The implications of this RCT, limitations, and suggestions for future research are discussed. Trial Registration: ClinicalTrials.gov NCT02345668; https://clinicaltrials.gov/ct2/show/NCT02345668 %M 32673226 %R 10.2196/18220 %U https://www.jmir.org/2020/7/e18220 %U https://doi.org/10.2196/18220 %U http://www.ncbi.nlm.nih.gov/pubmed/32673226 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18723 %T Blended Care-Cognitive Behavioral Therapy for Depression and Anxiety in Real-World Settings: Pragmatic Retrospective Study %A Lungu,Anita %A Jun,Janie Jihee %A Azarmanesh,Okhtay %A Leykin,Yan %A Chen,Connie E-Jean %+ Lyra Health, 287 Lorton Avenue, Burlingame, CA, 94010, United States, 1 6505673136, anita@lyrahealth.com %K cognitive behavior therapy %K blended psychotherapy %K dissemination %K implementation %K depression %K anxiety/anxiety disorders %K internet %K web based %K video psychotherapy %D 2020 %7 6.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The past few decades saw considerable advances in research and dissemination of evidence-based psychotherapies, yet available treatment resources are not able to meet the high need for care for individuals suffering from depression or anxiety. Blended care psychotherapy, which combines the strengths of therapist-led and internet interventions, can narrow this gap and be clinically effective and efficient, but has rarely been evaluated outside of controlled research settings. Objective: This study evaluated the effectiveness of a blended care intervention (video-based cognitive behavior therapy and internet intervention) under real-world conditions. Methods: This is a pragmatic retrospective cohort analysis of 385 participants with clinical range depression and/or anxiety symptoms at baseline, measured using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), who enrolled in blended care psychotherapy treatment. Participants resided in the United States and had access to the blended care intervention as a mental health benefit offered through their employers. Levels of depression and anxiety were tracked throughout treatment. Hierarchical linear modeling was used to examine the change in symptoms over time. The effects of age, gender, and providers on participants’ symptom change trajectories were also evaluated. Paired sample t-tests were also conducted, and rates of positive clinical change and clinically significant improvement were calculated. Results: The average depression and anxiety symptoms at 6 weeks after the start of treatment were 5.94 and 6.57, respectively. There were significant linear effects of time on both symptoms of depression and anxiety (β=–.49, P<.001 and β=–.64, P<.001). The quadratic effect was also significant for both symptoms of depression and anxiety (β=.04, P<.001 for both), suggesting a decelerated decrease in symptoms over time. Approximately 73% (n=283) of all 385 participants demonstrated reliable improvement, and 83% (n=319) recovered on either the PHQ-9 or GAD-7 measures. Large effect sizes were observed on both symptoms of depression (Cohen d=1.08) and of anxiety (d=1.33). Conclusions: Video blended care cognitive behavioral therapy interventions can be effective and efficient in treating symptoms of depression and anxiety in real-world conditions. Future research should investigate the differential and interactive contribution of the therapist-led and digital components of care to patient outcomes to optimize care. %M 32628120 %R 10.2196/18723 %U https://www.jmir.org/2020/7/e18723 %U https://doi.org/10.2196/18723 %U http://www.ncbi.nlm.nih.gov/pubmed/32628120 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17570 %T Young People’s Experience of a Long-Term Social Media–Based Intervention for First-Episode Psychosis: Qualitative Analysis %A Valentine,Lee %A McEnery,Carla %A O’Sullivan,Shaunagh %A Gleeson,John %A Bendall,Sarah %A Alvarez-Jimenez,Mario %+ Orygen, 35 Poplar Rd, Parkville, 3052, Australia, 61 0417398175, lee.valentine@orygen.org.au %K social media %K social networking %K youth %K young adult %K psychotic disorders %K mHealth %K qualitative research %D 2020 %7 26.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital mental health interventions present a unique opportunity to address the lack of social connection and loneliness experienced by young people with first-episode psychosis (FEP). The first generation of digital interventions, however, is associated with high attrition rates. Social media presents an opportunity to target this issue. A new generation of digital intervention has harnessed the popularity of social media to both promote engagement and foster social connectedness in youth mental health interventions. Despite their potential, little is known about how young people engage with, and experience, social media–based interventions as well as the optimal design, implementation, and management needed to ensure young people with psychosis receive benefit. Objective: This study aimed to explore how young people engage with, and experience, a long-term social media–based mental health intervention designed to address social functioning in individuals with FEP. Methods: This qualitative study was based on 12 interviews with young people who used Horyzons, a long-term social media–based mental health intervention, as part of a previous randomized controlled trial. A semistructured phenomenological interview guide with open-ended questions was used to explore young people’s subjective experience of the intervention. All interviews were recorded and transcribed verbatim. Data were analyzed using interpretative phenomenological analysis. Results: A total of 4 superordinate themes emerged during the analysis including (1) shared experience as the catalyst for a cocreated social space, (2) the power of peer support, (3) an upbeat environment, and (4) experiences that interrupt being in Horyzons. Conclusions: We found that Horyzon’s therapeutic social network fostered a connection and an understanding among young people. It also aided in the creation of an embodied experience that afforded young people with FEP a sense of self-recognition and belonging over the long term. However, although we found that most young people had strong positive experiences of a social connection on Horyzons, we also found that they experienced significant barriers that could substantively interrupt their ability to use the platform. We found that social anxiety, paranoia, internalized stigma, lack of autonomy, and social protocol confusion interfered with young people’s usage of the platform. From a design perspective, digital interventions are flexible and thus equipped to begin addressing these implications by providing customizable and personalized treatment options that account for varying levels of social connection and psychological need that could otherwise interrupt young people’s usage of social media–based interventions. %M 32384056 %R 10.2196/17570 %U https://www.jmir.org/2020/6/e17570 %U https://doi.org/10.2196/17570 %U http://www.ncbi.nlm.nih.gov/pubmed/32384056 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e17224 %T Mental Health–Related Behaviors and Discussions Among Young Adults: Analysis and Classification %A Rivas,Ryan %A Shahbazi,Moloud %A Garett,Renee %A Hristidis,Vagelis %A Young,Sean %+ Department of Computer Science and Engineering, University of California, Riverside, 363 Winston Chung Hall, 900 University Ave, Riverside, CA, United States, 1 9518272838, rriva002@ucr.edu %K social media %K data analysis %K supervised machine learning %K universities %K students %D 2020 %7 29.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There have been recurring reports of web-based harassment and abuse among adolescents and young adults through anonymous social networks. Objective: This study aimed to explore discussions on the popular anonymous social network Yik Yak related to social and mental health messaging behaviors among college students, including cyberbullying, to provide insights into mental health behaviors on college campuses. Methods: From April 6, 2016, to May 7, 2016, we collected anonymous conversations posted on Yik Yak at 19 universities in 4 different states and performed statistical analyses and text classification experiments on a subset of these messages. Results: We found that prosocial messages were 5.23 times more prevalent than bullying messages. The frequency of cyberbullying messages was positively associated with messages seeking emotional help. We found significant geographic variation in the frequency of messages offering supportive vs bullying messages. Across campuses, bullying and political discussions were positively associated. We also achieved a balanced accuracy of over 0.75 for most messaging behaviors and topics with a support vector machine classifier. Conclusions: Our results show that messages containing data about students’ mental health–related attitudes and behaviors are prevalent on anonymous social networks, suggesting that these data can be mined for real-time analysis. This information can be used in education and health care services to better engage with students, provide insight into conversations that lead to cyberbullying, and reach out to students who need support. %M 32469317 %R 10.2196/17224 %U http://www.jmir.org/2020/5/e17224/ %U https://doi.org/10.2196/17224 %U http://www.ncbi.nlm.nih.gov/pubmed/32469317 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16210 %T Mediating Effect of Internet Addiction on the Relationship Between Individualism and Cyberbullying: Cross-Sectional Questionnaire Study %A Arpaci,Ibrahim %A Abdeljawad,Thabet %A Baloğlu,Mustafa %A Kesici,Şahin %A Mahariq,Ibrahim %+ Department of Computer Education and Instructional Technology, Tokat Gaziosmanpasa University, Faculty of Education, Tokat, 60250, Turkey, 90 356 252 16 16, ibrahimarpaci@gmail.com %K vertical individualism %K horizontal individualism %K cyberbullying %K internet addiction %D 2020 %7 28.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Among a variety of dynamics that may have effects on internet-related behaviors, cultural orientation is particularly important. Previous studies suggest that individualism is a strong determinant of certain behaviors. In addition, findings suggest that vertical individualism may lead to the development of more tolerance for addiction and aggression on the internet. Objective: This study aimed to investigate whether vertical individualism has significant positive effects on cyberbullying and internet addiction and whether horizontal individualism has significant negative effects on cyberbullying and internet addiction. A theoretical model was specified to test the relationships among vertical versus horizontal individualism, cyberbullying, and internet addiction. Methods: A total of 665 college students were selected using a convenience sampling method and willingly participated in the study. Participants’ ages ranged from 17 to 19 years (mean 17.94 years, SD 1.12 years). Of the group, 462 were women (462/665, 69.5%), and 203 were men (203/665, 30.5%). Study majors represented were mathematics (113/665, 17%), sciences (102/665, 15.3%), instructional technology (99/665, 14.9%), psychology (98/665, 14.7%), and others (253/665, 38.1%). Self-report instruments were used to measure vertical/horizontal individualism, cyberbullying, and internet addiction. Results: Results show a significant positive effect of vertical individualism (effect size 0.10) and significant negative effect of horizontal individualism (effect size –0.12) on cyberbullying. In addition, the direct effect of vertical individualism on internet addiction was significant (effect size 0.28), but the direct effect of horizontal individualism was not (effect size –0.05). Internet addiction had a significant direct effect on cyberbullying (effect size 0.39) as well as an intervening effect on the relationship between vertical individualism and cyberbullying. Results also indicate significant gender differences in cultural patterns and internet addiction. Conclusions: The findings suggest that horizontal and vertical individualism have significant effects on internet addiction. The findings also suggest that vertical individualists are more vulnerable to internet addiction. Further, the findings indicate a significant relationship between internet addiction and cyberbullying. %M 32463369 %R 10.2196/16210 %U http://www.jmir.org/2020/5/e16210/ %U https://doi.org/10.2196/16210 %U http://www.ncbi.nlm.nih.gov/pubmed/32463369 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 5 %P e14835 %T Evaluation of Electronic Mental Health Implementation in Northern Territory Services Using the Integrated “Promoting Action on Research Implementation in Health Services” Framework: Qualitative Study %A Raphiphatthana,Buaphrao %A Sweet,Michelle %A Puszka,Stefanie %A Whitty,Megan %A Dingwall,Kylie %A Nagel,Tricia %+ Menzies School of Health Research, Charles Darwin University, Casuarina, 0810, Australia, 61 0889468478, buaphrao.raphiphatthana@menzies.edu.au %K eHealth %K implementation science %K health care delivery %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Electronic mental health is a promising strategy to bridge the treatment gap in mental health care. Training workshops have been delivered to service providers working with Aboriginal and Torres Strait Islander people at a primary health care level to raise awareness and knowledge of electronic mental health approaches. Objective: This study aimed to understand service providers’ perspectives and experiences of electronic mental health adoption. More specifically, it aimed to use the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to further identify and understand how different factors facilitate or impede electronic mental health uptake within primary health care settings providing services to Aboriginal and Torres Strait Islander people. Methods: Qualitative interviews were conducted with 57 service providers working with Aboriginal and Torres Strait Islander people, who had undergone electronic mental health training workshops. Results: Several factors related to innovation (electronic mental health approach), recipients (service providers as an individual and as a team), and context (local, organizational, and external contexts) were found to influence electronic mental health uptake. Particularly, organizational readiness, in terms of information technology resources and infrastructure, policies, workforce and culture, and processes to mandate electronic mental health use, were found to be significant impediments to electronic mental health utilization. These findings led to the development of a three-phase implementation strategy that aims to enhance electronic mental health adoption by addressing organizational readiness before and post electronic mental health training. Conclusions: The i-PARIHS provides a useful determinant framework that deepens our understanding of how different factors impede or facilitate electronic mental health adoption in this setting. This insight was used to develop a practical and comprehensive implementation strategy to enhance the utilization of electronic mental health approaches within primary health care settings, involving three phases: pretraining consultations, training workshops, and post-training follow-up support. %M 32452812 %R 10.2196/14835 %U http://mental.jmir.org/2020/5/e14835/ %U https://doi.org/10.2196/14835 %U http://www.ncbi.nlm.nih.gov/pubmed/32452812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e15817 %T A Cross-Cultural Comparison of an Extended Planned Risk Information Seeking Model on Mental Health Among College Students: Cross-Sectional Study %A Niu,Zhaomeng %A Willoughby,Jessica Fitts %A Mei,Jing %A Li,Shaochun %A Hu,Pengwei %+ AI for Healthcare, IBM Research, 19 Zhonguancun Software Park, 8 Dong Bei Wang Xi Lu, Haidian Qu,, Beijing, 100085, China, 86 10 58748625, hupwei@cn.ibm.com %K information seeking behavior %K mental health %K cross-cultural comparison %D 2020 %7 11.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Approximately 42.5 million adults have been affected by mental illness in the United States in 2013, and 173 million people have been affected by a diagnosable psychiatric disorder in China. An increasing number of people tend to seek health information on the Web, and it is important to understand the factors associated with individuals’ mental health information seeking. Identifying factors associated with mental health information seeking may influence the disease progression of potential patients. The planned risk information seeking model (PRISM) was developed in 2010 by integrating multiple information seeking models including the theory of planned behavior. Few studies have replicated PRISM outside the United States and no previous study has examined mental health as a personal risk in different cultures. Objective: This study aimed to test the planned risk information seeking model (PRISM) in China and the United States with a chronic disease, mental illness, and two additional factors, ie, media use and cultural identity, among college students. Methods: Data were collected in both countries using the same online survey through a survey management program (Qualtrics). In China, college instructors distributed the survey link among university students, and it was also posted on a leading social media site called Sina Weibo. In the United States, the data were collected in a college-wide survey pool in a large Northwestern university. Results: The final sample size was 235 for the Chinese sample and 241 for the US sample. Media use was significantly associated with mental health information–seeking intentions in the Chinese sample (P<.001), and cultural identity was significantly associated with intentions in both samples (China: P=.02; United States: P<.001). The extended PRISM had a better model fit than the original PRISM. Conclusions: Cultural identity and media use should be considered when evaluating the process of mental health information seeking or when designing interventions to address mental health information seeking. %M 32441654 %R 10.2196/15817 %U http://www.jmir.org/2020/5/e15817/ %U https://doi.org/10.2196/15817 %U http://www.ncbi.nlm.nih.gov/pubmed/32441654 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16468 %T The Mediator Roles of Problematic Internet Use and Perceived Stress Between Health Behaviors and Work-Life Balance Among Internet Users in Germany and China: Web-Based Cross-Sectional Study %A Gao,Lingling %A Gan,Yiqun %A Whittal,Amanda %A Yan,Song %A Lippke,Sonia %+ School of Psychological Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, 5 Yiheyuan Rd, Haidian District, Beijing, China, 86 10 62757271, ygan@pku.edu.cn %K healthy lifestyle %K work-life balance %K internet %K healthy diet %K exercise %K culture %D 2020 %7 11.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Work-life balance is associated with health behaviors. In the face of digitalization, understanding this link requires a theory-based investigation of problematic internet use and perceived stress, which are so far unknown. Objective: On the basis of the compensatory carry-over action model, this study aimed to determine whether problematic internet use and perceived stress mediate the relationship between health behaviors and work-life balance in two groups of internet users from different environments (residents in Germany and China). We also investigated whether the place of residence was a moderator. Methods: An online questionnaire (N=877) was administered to residents from Germany (n=374) and China (n=503) in 3 languages (German, English, and Chinese). Moderated mediation analyses were run with health behaviors as the independent variable, work-life balance as the dependent variable, problematic internet use and perceived stress as the mediator variables, and place of residence as a potential moderator. Results: On a mean level, individuals in Germany reported less problematic internet use and more health behaviors than individuals in China; however, they also had lower work-life balance and higher perceived stress. Results showed that health behaviors seem to be directly related to work-life balance in both groups. Among the residents of Germany, a partial mediation was revealed (β=.13; P=.01), whereas among the residents of China, a full mediation was found (β=.02; P=.61). The mediator role of perceived stress was compared with problematic internet use in all the serial models and the parallel model. Residence moderated the relationship between health behaviors and work-life balance: The interrelation between health behaviors and work-life balance was stronger in Germany (β=.19; P<.001) than in China (β=.11; P=.01) when controlling for other variables. Conclusions: The findings of this study are in line with the compensatory carry-over action model. To promote work-life balance, individuals should perform health behaviors to help overcome problematic internet use and perceived stress. Both problematic internet use and perceived stress mediated health behaviors and work-life balance partially in German study participants and fully in Chinese study participants. %M 32391798 %R 10.2196/16468 %U https://www.jmir.org/2020/5/e16468 %U https://doi.org/10.2196/16468 %U http://www.ncbi.nlm.nih.gov/pubmed/32391798 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15568 %T Mental Health Therapy Protocols and eHealth Design: Focus Group Study %A van Dooren,Marierose M M %A Visch,Valentijn %A Spijkerman,Renske %A Goossens,Richard H M %A Hendriks,Vincent M %+ Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 15 27 87660, m.m.m.vandooren@tudelft.nl %K eHealth design %K mental health care %K personalization %K protocol %K youth addiction care %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic health (eHealth) programs are often based on protocols developed for the original face-to-face therapies. However, in practice, therapists and patients may not always follow the original therapy protocols. This form of personalization may also interfere with the intended implementation and effects of eHealth interventions if designers do not take these practices into account. Objective: The aim of this explorative study was to gain insights into the personalization practices of therapists and patients using cognitive behavioral therapy, one of the most commonly applied types of psychotherapy, in a youth addiction care center as a case context. Methods: Focus group discussions were conducted asking therapists and patients to estimate the extent to which a therapy protocol was followed and about the type and reasons for personalization of a given therapy protocol. A total of 7 focus group sessions were organized involving therapists and patients. We used a commonly applied protocol for cognitive behavioral therapy as a therapy protocol example in youth mental health care. The first focus group discussions aimed at assessing the extent to which patients (N=5) or therapists (N=6) adapted the protocol. The second focus group discussions aimed at estimating the extent to which the therapy protocol is applied and personalized based on findings from the first focus groups to gain further qualitative insight into the reasons for personalization with groups of therapists and patients together (N=7). Qualitative data were analyzed using thematic analysis. Results: Therapists used the protocol as a “toolbox” comprising different therapy tools, and personalized the protocol to enhance the therapeutic alliance and based on their therapy-provision experiences. Therapists estimated that they strictly follow 48% of the protocol, adapt 30%, and replace 22% by other nonprotocol therapeutic components. Patients personalized their own therapy to conform the assignments to their daily lives and routines, and to reduce their levels of stress and worry. Patients estimated that 29% of the provided therapy had been strictly followed by the therapist, 48% had been adjusted, and 23% had been replaced by other nonprotocol therapeutic components. Conclusions: A standard cognitive behavioral therapy protocol is not strictly and fully applied but is mainly personalized. Based on these results, the following recommendations for eHealth designers are proposed to enhance alignment of eHealth to therapeutic practice and implementation: (1) study and copy at least the applied parts of a protocol, (2) co-design eHealth with therapists and patients so they can allocate the components that should be open for user customization, and (3) investigate if components of the therapy protocol that are not applied should remain part of the eHealth applied. To best generate this information, we suggest that eHealth designers should collaborate with therapists, patients, protocol developers, and mental health care managers during the development process. %M 32374271 %R 10.2196/15568 %U https://formative.jmir.org/2020/5/e15568 %U https://doi.org/10.2196/15568 %U http://www.ncbi.nlm.nih.gov/pubmed/32374271 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e14940 %T Mediation Effect of Suicide-Related Social Media Use Behaviors on the Association Between Suicidal Ideation and Suicide Attempt: Cross-Sectional Questionnaire Study %A Liu,Xingyun %A Huang,Jiasheng %A Yu,Nancy Xiaonan %A Li,Qing %A Zhu,Tingshao %+ Institute of Psychology, Chinese Academy of Sciences, No 16, Lincui Road, Beijing, , China, 86 15010965509, tszhu@psych.ac.cn %K suicidal ideation %K suicide %K attempted %K social media %K suicide-related social media use behaviors %D 2020 %7 28.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A limited number of studies have examined the differences in suicide-related social media use behaviors between suicide ideators and suicide attempters or have sought to elucidate how these social media usage behaviors contributed to the transition from suicidal ideation to suicide attempt. Objective: Suicide attempts can be acquired through suicide-related social media use behaviors. This study aimed to propose 3 suicide-related social media use behaviors (ie, attending to suicide information, commenting on or reposting suicide information, or talking about suicide) based on social cognitive theory, which proposes that successive processes governing behavior transition include attentional, retention, production, and motivational processes. Methods: We aimed to examine the mediating role of suicide-related social media use behaviors in Chinese social media users with suicidal risks. A sample of 569 Chinese social media users with suicidal ideation completed measures on suicidal ideation, suicide attempt, and suicide-related social media use behaviors. Results: The results demonstrated that suicide attempters showed a significantly higher level of suicidal ideation (t563.64=5.04; P<.001; two-tailed) and more suicide-related social media use behaviors, which included attending to suicide information (t567=1.94; P=.05; two-tailed), commenting on or reposting suicide information (t567=2.12; P=.03; two-tailed), or talking about suicide (t542.22=5.12; P<.001; two-tailed). Suicidal ideation also affected suicide attempts through the mediational chains. Conclusions: Our findings thus support the social cognitive theory, and there are implications for population-based suicide prevention that can be achieved by identifying behavioral signals. %M 32343249 %R 10.2196/14940 %U http://www.jmir.org/2020/4/e14940/ %U https://doi.org/10.2196/14940 %U http://www.ncbi.nlm.nih.gov/pubmed/32343249 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16470 %T A Comparison of the Psycholinguistic Styles of Schizophrenia-Related Stigma and Depression-Related Stigma on Social Media: Content Analysis %A Li,Ang %A Jiao,Dongdong %A Liu,Xiaoqian %A Zhu,Tingshao %+ Institute of Psychology, Chinese Academy of Sciences, No 16 Lincui Rd, Chaoyang District, Beijing, 100101, China, 86 150 1096 5509, tszhu@psych.ac.cn %K stigma %K schizophrenia %K depression %K psycholinguistic analysis %K social media %D 2020 %7 21.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Stigma related to schizophrenia is considered to be the primary focus of antistigma campaigns. Accurate and efficient detection of stigma toward schizophrenia in mass media is essential for the development of targeted antistigma interventions at the population level. Objective: The purpose of this study was to examine the psycholinguistic characteristics of schizophrenia-related stigma on social media (ie, Sina Weibo, a Chinese microblogging website), and then to explore whether schizophrenia-related stigma can be distinguished from stigma toward other mental illnesses (ie, depression-related stigma) in terms of psycholinguistic style. Methods: A total of 19,224 schizophrenia- and 15,879 depression-related Weibo posts were collected and analyzed. First, a human-based content analysis was performed on collected posts to determine whether they reflected stigma or not. Second, by using Linguistic Inquiry and Word Count software (Simplified Chinese version), a number of psycholinguistic features were automatically extracted from each post. Third, based on selected key features, four groups of classification models were established for different purposes: (a) differentiating schizophrenia-related stigma from nonstigma, (b) differentiating a certain subcategory of schizophrenia-related stigma from other subcategories, (c) differentiating schizophrenia-related stigma from depression-related stigma, and (d) differentiating a certain subcategory of schizophrenia-related stigma from the corresponding subcategory of depression-related stigma. Results: In total, 26.22% of schizophrenia-related posts were labeled as stigmatizing posts. The proportion of posts indicating depression-related stigma was significantly lower than that indicating schizophrenia-related stigma (χ21=2484.64, P<.001). The classification performance of the models in the four groups ranged from .71 to .92 (F measure). Conclusions: The findings of this study have implications for the detection and reduction of stigma toward schizophrenia on social media. %M 32314969 %R 10.2196/16470 %U http://www.jmir.org/2020/4/e16470/ %U https://doi.org/10.2196/16470 %U http://www.ncbi.nlm.nih.gov/pubmed/32314969 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e17330 %T Patients’ Perspective on Mental Health Specialist Video Consultations in Primary Care: Qualitative Preimplementation Study of Anticipated Benefits and Barriers %A Bleyel,Caroline %A Hoffmann,Mariell %A Wensing,Michel %A Hartmann,Mechthild %A Friederich,Hans-Christoph %A Haun,Markus W %+ Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, Heidelberg, D-69120, Germany, 49 622156 ext 38396, markus.haun@med.uni-heidelberg.de %K telemedicine %K remote consultation %K implementation %K primary health care %K mental health services %K thematic analysis %K integrated behavioral health %K health services research %D 2020 %7 20.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to limited access to specialist services, most patients with common mental disorders (depression or anxiety, or both) usually receive treatment in primary care. More recently, innovative technology-based care models (eg, video consultations) have been proposed to facilitate access to specialist services. Against this background, the PROVIDE (Improving Cross-Sectoral Collaboration Between Primary and Psychosocial Care: An Implementation Study on Video Consultations) project aims to improve the provision of psychosocial care through implementing video consultations integrated into routine primary care. Objective: From the patients’ perspective, this qualitative preimplementation study explored (1) anticipated benefits from and (2) barriers to implementing mental health specialist video consultations embedded in primary care services and (3) prerequisites for interacting with therapists via video consultations. Methods: Using a purposive (ie, stratified) sampling strategy, we recruited 13 patients from primary care practices and a tertiary care hospital (psychosomatic outpatient clinic) for one-off semistructured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking. Results: Overall, we derived 3 key themes and 10 subthemes. Participants identified specific benefits in 2 areas: the accessibility of mental health specialist care (shorter waiting times: 11/13, 85%; lower threshold for seeking specialist mental health care: 6/13, 46%; shorter travel distances: 3/13, 23%); and the environment in primary care (familiar travel modalities, premises, and employees: 5/13, 38%). The main barriers to the implementation of mental health video consultations from the patients’ perspective were the lack of face-to-face contact (13/13, 100%) and technical challenges (12/13, 92%). Notably, participants’ prerequisites for interacting with therapists (12/13, 92%) did not seem to differ much from those concerning face-to-face contacts. Conclusions: Mental health service users mostly welcomed mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly valued the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations and to ensure optimal resemblance to face-to-face settings (eg, by training therapists in consistently reacting to nonverbal cues). Trial Registration: German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one %M 32310139 %R 10.2196/17330 %U http://www.jmir.org/2020/4/e17330/ %U https://doi.org/10.2196/17330 %U http://www.ncbi.nlm.nih.gov/pubmed/32310139 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e16526 %T Exploring the Factors Influencing Consumers to Voluntarily Reward Free Health Service Contributors in Online Health Communities: Empirical Study %A Zhou,Junjie %A Liu,Fang %A Zhou,Tingting %+ China Life Property & Casualty Insurance Company Limited, No 16 Jinrong Street, Beijing, China, 86 1066190179, liu-fang@chinalife-p.com.cn %K telemedicine %K health services %K social media %K reward %K social interaction %K social support %K pay-what-you-want %D 2020 %7 14.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Rewarding health knowledge and health service contributors with money is one possible approach for the sustainable provision of health knowledge and health services in online health communities (OHCs); however, the reasons why consumers voluntarily reward free health knowledge and health service contributors are still underinvestigated. Objective: This study aimed to address the abovementioned gap by exploring the factors influencing consumers’ voluntary rewarding behaviors (VRBs) toward contributors of free health services in OHCs. Methods: On the basis of prior studies and the cognitive-experiential self-theory (CEST), we incorporated two health service content–related variables (ie, informational support and emotional support) and two interpersonal factors (ie, social norm compliance and social interaction) and built a proposed model. We crawled a dataset from a Chinese OHC for mental health, coded it, extracted nine variables, and tested the model with a negative binomial model. Results: The data sample included 2148 health-related questions and 12,133 answers. The empirical results indicated that the effects of informational support (β=.168; P<.001), emotional support (β=.463; P<.001), social norm compliance (β=.510; P<.001), and social interaction (β=.281; P<.001) were significant. The moderating effects of social interaction on informational support (β=.032; P=.02) and emotional support (β=−.086; P<.001) were significant. The moderating effect of social interaction on social norm compliance (β=.014; P=.38) was insignificant. Conclusions: Informational support, emotional support, social norm compliance, and social interaction positively influence consumers to voluntarily reward free online health service contributors. Social interaction enhances the effect of informational support but weakens the effect of emotional support. This study contributes to the literature on knowledge sharing in OHCs by exploring the factors influencing consumers’ VRBs toward free online health service contributors and contributes to the CEST literature by verifying that the effects of experiential and rational systems on individual behaviors can vary while external factors change. %M 32286231 %R 10.2196/16526 %U http://www.jmir.org/2020/4/e16526/ %U https://doi.org/10.2196/16526 %U http://www.ncbi.nlm.nih.gov/pubmed/32286231 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e15033 %T Assessing Real-Time Moderation for Developing Adaptive Mobile Health Interventions for Medical Interns: Micro-Randomized Trial %A NeCamp,Timothy %A Sen,Srijan %A Frank,Elena %A Walton,Maureen A %A Ionides,Edward L %A Fang,Yu %A Tewari,Ambuj %A Wu,Zhenke %+ Department of Statistics, University of Michigan, 1085 South University Ave, Ann Arbor, MI, 48109, United States, 1 7346474820, tnecamp@umich.edu %K mobile health %K digital health %K smartphone %K mobile phone %K wearable devices %K ecological momentary assessment %K depression %K mood %K physical activity %K sleep %K moderator variables %D 2020 %7 31.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals in stressful work environments often experience mental health issues, such as depression. Reducing depression rates is difficult because of persistently stressful work environments and inadequate time or resources to access traditional mental health care services. Mobile health (mHealth) interventions provide an opportunity to deliver real-time interventions in the real world. In addition, the delivery times of interventions can be based on real-time data collected with a mobile device. To date, data and analyses informing the timing of delivery of mHealth interventions are generally lacking. Objective: This study aimed to investigate when to provide mHealth interventions to individuals in stressful work environments to improve their behavior and mental health. The mHealth interventions targeted 3 categories of behavior: mood, activity, and sleep. The interventions aimed to improve 3 different outcomes: weekly mood (assessed through a daily survey), weekly step count, and weekly sleep time. We explored when these interventions were most effective, based on previous mood, step, and sleep scores. Methods: We conducted a 6-month micro-randomized trial on 1565 medical interns. Medical internship, during the first year of physician residency training, is highly stressful, resulting in depression rates several folds higher than those of the general population. Every week, interns were randomly assigned to receive push notifications related to a particular category (mood, activity, sleep, or no notifications). Every day, we collected interns’ daily mood valence, sleep, and step data. We assessed the causal effect moderation by the previous week’s mood, steps, and sleep. Specifically, we examined changes in the effect of notifications containing mood, activity, and sleep messages based on the previous week’s mood, step, and sleep scores. Moderation was assessed with a weighted and centered least-squares estimator. Results: We found that the previous week’s mood negatively moderated the effect of notifications on the current week’s mood with an estimated moderation of −0.052 (P=.001). That is, notifications had a better impact on mood when the studied interns had a low mood in the previous week. Similarly, we found that the previous week’s step count negatively moderated the effect of activity notifications on the current week’s step count, with an estimated moderation of −0.039 (P=.01) and that the previous week’s sleep negatively moderated the effect of sleep notifications on the current week’s sleep with an estimated moderation of −0.075 (P<.001). For all three of these moderators, we estimated that the treatment effect was positive (beneficial) when the moderator was low, and negative (harmful) when the moderator was high. Conclusions: These findings suggest that an individual’s current state meaningfully influences their receptivity to mHealth interventions for mental health. Timing interventions to match an individual’s state may be critical to maximizing the efficacy of interventions. Trial Registration: ClinicalTrials.gov NCT03972293; http://clinicaltrials.gov/ct2/show/NCT03972293 %M 32229469 %R 10.2196/15033 %U http://www.jmir.org/2020/3/e15033/ %U https://doi.org/10.2196/15033 %U http://www.ncbi.nlm.nih.gov/pubmed/32229469 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e18047 %T Affect-Focused Psychodynamic Internet-Based Therapy for Adolescent Depression: Randomized Controlled Trial %A Lindqvist,Karin %A Mechler,Jakob %A Carlbring,Per %A Lilliengren,Peter %A Falkenström,Fredrik %A Andersson,Gerhard %A Johansson,Robert %A Edbrooke-Childs,Julian %A Dahl,Hanne-Sofie J %A Lindert Bergsten,Katja %A Midgley,Nick %A Sandell,Rolf %A Thorén,Agneta %A Topooco,Naira %A Ulberg,Randi %A Philips,Björn %+ Department of Psychology, Stockholm University, SE-106 91, Stockholm, Sweden, 46 (0)8 16 20 10, bjorn.philips@psychology.su.se %K depressive disorder %K adolescents %K psychodynamic %K internet-based treatment %K treatment outcome %K mobile phone %D 2020 %7 30.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescent depression is one of the largest health issues in the world and there is a pressing need for effective and accessible treatments. Objective: This trial examines whether affect-focused internet-based psychodynamic therapy (IPDT) with therapist support is more effective than an internet-based supportive control condition on reducing depression in adolescents. Methods: The trial included 76 adolescents (61/76, 80% female; mean age 16.6 years), self-referred via an open access website and fulfilling criteria for major depressive disorder. Adolescents were randomized to 8 weeks of IPDT (38/76, 50%) or supportive control (38/76, 50%). The primary outcome was self-reported depressive symptoms, measured with the Quick Inventory of Depressive Symptomatology for Adolescents (QIDS-A17-SR). Secondary outcomes were anxiety severity, emotion regulation, self-compassion, and an additional depression measure. Assessments were made at baseline, postassessment, and at 6 months follow-up, in addition to weekly assessments of the primary outcome measure as well as emotion regulation during treatment. Results: IPDT was significantly more effective than the control condition in reducing depression (d=0.82, P=.01), the result of which was corroborated by the second depression measure (d=0.80, P<.001). IPDT was also significantly more effective in reducing anxiety (d=0.78, P<.001) and increasing emotion regulation (d=0.97, P<.001) and self-compassion (d=0.65, P=.003). Significantly more patients in the IPDT group compared to the control group met criteria for response (56% vs 21%, respectively) and remission (35% vs 8%, respectively). Results on depression and anxiety symptoms were stable at 6 months follow-up. On average, participants completed 5.8 (SD 2.4) of the 8 modules. Conclusions: IPDT may be an effective intervention to reduce adolescent depression. Further research is needed, including comparisons with other treatments. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 16206254; http://www.isrctn.com/ISRCTN16206254 %M 32224489 %R 10.2196/18047 %U http://www.jmir.org/2020/3/e18047/ %U https://doi.org/10.2196/18047 %U http://www.ncbi.nlm.nih.gov/pubmed/32224489 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e17208 %T A Mobile Health Intervention for Mental Health Promotion Among University Students: Randomized Controlled Trial %A Bendtsen,Marcus %A Müssener,Ulrika %A Linderoth,Catharina %A Thomas,Kristin %+ Linköping University, 581 83 Linköping, Linköping, Sweden, 46 13282546, kristin.thomas@liu.se %K mHealth %K positive mental health %K university students %K randomized controlled trial %D 2020 %7 20.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: High positive mental health, including the ability to cope with the normal stresses of life, work productively, and be able to contribute to one’s community, has been associated with various health outcomes. The role of positive mental health is therefore increasingly recognized in national mental health promotion programs and policies. Mobile health (mHealth) interventions could be a cost-effective way to disseminate positive psychological interventions to the general population. Objective: The aim of this study was to estimate the effect of a fully automated mHealth intervention on positive mental health, and anxiety and depression symptomology among Swedish university students using a randomized controlled trial design. Methods: A 2-arm, single-blind (researchers), parallel-groups randomized controlled trial with an mHealth positive psychology program intervention group and a relevant online mental health information control group was employed to estimate the effect of the novel intervention. Participants were recruited using digital advertising through student health care centers in Sweden. Inclusion criteria were (1) university students, (2) able to read and understand Swedish, (3) and have access to a mobile phone. Exclusion criteria were high positive mental health, as assessed by the Mental Health Continuum Short Form (MHC-SF), or high depression and anxiety symptomology, as assessed by the Hospital Anxiety Depression Scale (HADS). The primary outcome was positive mental health (MHC-SF), and the secondary outcomes were depression and anxiety symptomatology (HADS). The subscales of MHC-SF were also analyzed as exploratory outcomes. Outcomes were measured 3 months after randomization through questionnaires completed on the participants’ mobile phones. Results: A total of 654 participants (median age 25 years), including 510 (78.0%) identifying as female, were randomized to either the intervention (n=348) or control group (n=306). At follow-up, positive mental health was significantly higher in the intervention group compared with the control group (incidence rate ratio [IRR]=1.067, 95% CI 1.024-1.112, P=.002). For both depression and anxiety symptomatology, the intervention group showed significantly lower scores at follow-up compared with the control group (depression: IRR=0.820, 95% CI 0.714-0.942, P=.005; anxiety: IRR=0.899, 95% CI 0.840-0.962, P=.002). Follow-up rates were lower than expected (58.3% for primary outcomes and 52.3% for secondary outcomes); however, attrition analyses did not identify any systematic attrition with respect to baseline variables. Conclusions: The mHealth intervention was estimated to be superior to usual care in increasing positive mental health among university students. A protective effect of the intervention was also found on depressive and anxiety symptoms. These findings demonstrate the feasibility of using an automated mobile phone format to enhance positive mental health, which offers promise for the use of mHealth solutions in public mental health promotion. Trial Registration: International Standard Randomized Controlled Trial Registry ISRCTN54748632; http://www.isrctn.com/ISRCTN54748632 %M 32196462 %R 10.2196/17208 %U http://mhealth.jmir.org/2020/3/e17208/ %U https://doi.org/10.2196/17208 %U http://www.ncbi.nlm.nih.gov/pubmed/32196462 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 3 %P e13118 %T Impact of the Use of Electronic Health Tools on the Psychological and Emotional Well-Being of Electronic Health Service Users (The Seventh Tromsø Study - Part 3): Population-Based Questionnaire Study %A Budrionis,Andrius %A Wynn,Rolf %A Marco-Ruiz,Luis %A Yigzaw,Kassaye Yitbarek %A Bergvik,Svein %A Oyeyemi,Sunday Oluwafemi %A Bellika,Johan Gustav %+ Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Postboks 6050 Langnes, Tromsø, 9037, Norway, 47 95748049, johan.gustav.bellika@ehealthresearch.no %K eHealth %K telemedicine %K health information %K Tromsø study %K health-related internet use %K emotions %K effect %K anxious %K confused %K knowledgeable %K reassured %D 2020 %7 5.3.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health (eHealth) has been described as a silver bullet for addressing how challenges of the current health care system may be solved by technological solutions in future strategies and visions for modern health care. However, the evidence of its effects on service quality and cost effectiveness remains unclear. In addition, patients’ psychological and emotional reactions to using eHealth tools are rarely addressed by the scientific literature. Objective: This study aimed to assess how the psychological and emotional well-being of eHealth service users is affected by the use of eHealth tools. Methods: We analyzed data from a population-based survey in Norway, conducted in the years 2015-2016 and representing 10,604 eHealth users aged over 40 years, to identify how the use of eHealth tools was associated with feeling anxious, confused, knowledgeable, or reassured. Associations between these four emotional outcomes and the use of four types of eHealth services (Web search engines, video search engines, health apps, and social media) were analyzed using logistic regression models. Results: The use of eHealth tools made 72.41% (6740/9308) of the participants feel more knowledgeable and 47.49% (4421/9308) of the participants feel more reassured about their health status. However, 25.69% (2392/9308) reported feeling more anxious and 27.88% (2595/9308) reported feeling more confused using eHealth tools. A high level of education and not having a full-time job were associated with positive reactions and emotions (feeling more knowledgeable and reassured), whereas low self-reported health status and not having enough friends who could provide help and support predicted negative reactions and emotions (ie, feeling anxious and confused). Overall, the positive emotional effects of eHealth use (feeling knowledgeable and reassured) were relatively more prevalent among users aged over 40 years than the negative emotional effects (ie, feeling anxious and confused). About one-fourth of eHealth users reported being more confused and anxious after using eHealth services. Conclusions: The search for health information on the internet can be motivated by a range of factors and needs (not studied in this study), and people may experience a range of reactions and feelings following health information searching on the Web. Drawing on prior studies, we categorized reactions as positive and negative reactions. Some participants had negative reactions, which is challenging to resolve and should be taken into consideration by eHealth service providers when designing services (ie, including concrete information about how users can get more help and support). There is a need for more studies examining a greater range of reactions to online health information and factors that might predict negative reactions to health information on the Web. %M 32134396 %R 10.2196/13118 %U https://www.jmir.org/2020/3/e13118 %U https://doi.org/10.2196/13118 %U http://www.ncbi.nlm.nih.gov/pubmed/32134396 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e15553 %T The Systematic Medical Appraisal Referral and Treatment Mental Health Project: Quasi-Experimental Study to Evaluate a Technology-Enabled Mental Health Services Delivery Model Implemented in Rural India %A Maulik,Pallab K %A Devarapalli,Siddhardha %A Kallakuri,Sudha %A Bhattacharya,Amritendu %A Peiris,David %A Patel,Anushka %+ George Insitute for Global Health, 311-312 Elegance Tower, New Delhi, 110025, India, 91 8800493204, pmaulik@georgeinstitute.org.in %K mental health services %K mHealth %K rural %K India %K mental disorders %K primary health care %D 2020 %7 27.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap. Objective: This study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders. Methods: A before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community antistigma campaign, with the training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression, and suicide risk using an electronic clinical decision support system. Results: In total, 900 of 22,046 (4.08%) adults screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 out of 900 (81.2%) reported visiting the doctor for their mental health symptoms, compared with 3.3% (30/900) at baseline (odds ratio 133.3, 95% CI 89.0 to 199.7; P<.001). Mean depression and anxiety scores were significantly lower postintervention compared with baseline from 13.4 to 3.1 (P<.001) and from 12.9 to 1.9 (P<.001), respectively. Conclusions: The intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomized controlled trial. %M 32130125 %R 10.2196/15553 %U http://www.jmir.org/2020/2/e15553/ %U https://doi.org/10.2196/15553 %U http://www.ncbi.nlm.nih.gov/pubmed/32130125 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16715 %T Effect of a WeChat-Based Intervention (Run4Love) on Depressive Symptoms Among People Living With HIV in China: Randomized Controlled Trial %A Guo,Yan %A Hong,Y Alicia %A Cai,Weiping %A Li,Linghua %A Hao,Yuantao %A Qiao,Jiaying %A Xu,Zhimeng %A Zhang,Hanxi %A Zeng,Chengbo %A Liu,Cong %A Li,Yiran %A Zhu,Mengting %A Zeng,Yu %A Penedo,Frank J %+ Department of Health Administration and Policy, College of Health and Human Services, George Mason University, 4400 University Dr MS 1J3, Fairfax, VA, United States, 1 7039931929, yhong22@gmu.edu %K HIV %K depression %K mHealth %K WeChat %K randomized controlled trial %D 2020 %7 11.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: People living with HIV (PLWH) have high rates of depressive symptoms. However, only a few effective mental health interventions exist for this vulnerable population. Objective: The aim of this study was to assess the efficacy of a WeChat-based intervention, Run4Love, with a randomized controlled trial among 300 people living with HIV and depression (PLWHD) in China. Methods: We recruited PLWH from the HIV outpatient clinic in South China. Participants were screened based on the Center for Epidemiologic Studies-Depression (CES-D) scale. Those who scored 16 or higher were eligible to participate. A total of 300 eligible patients were enrolled. After obtaining informed consent from the participants, completion of a baseline survey, and collection of participants’ hair samples for measuring cortisol, the participants were randomly assigned to an intervention or a control group in a 1:1 ratio. The intervention group received the Run4Love program, delivered via the popular social media app WeChat. Cognitive behavioral stress management courses and weekly reminders of exercise were delivered in a multimedia format. Participants’ progress was monitored with timely and tailored feedback. The control group received usual care and a brochure on nutrition for PLWH. Data were collected at 3, 6, and 9 months. The primary outcome was depression, which was measured by a validated instrument. Results: Participants in the intervention and control groups were comparable at baseline; about 91.3% (139/150), 88.3% (132/150), and 86.7% (130/150) participants completed the 3-, 6-, and 9-month follow-ups, respectively. At the 3-month follow-up, a significant reduction in CES-D score was observed in the intervention group (from 23.9 to 17.7 vs from 24.3 to 23.8; mean difference=−5.77, 95% CI −7.82 to −3.71; P<.001; standard effect size d=0.66). The mean changes in CES-D score from baseline to the 6- and 9-month follow-ups between the two groups remained statistically significant. No adverse events were reported. Conclusions: The WeChat-based mobile health (mHealth) intervention Run4Love significantly reduced depressive symptoms among PLWHD, and the effect was sustained. An app-based mHealth intervention could provide a feasible therapeutic option for many PLWHD in resource-limited settings. Further research is needed to assess generalizability and cost-effectiveness of this intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR-IPR-17012606; http://www.chictr.org.cn/showproj.aspx?proj=21019 (Archived by WebCite at https://www.webcitation.org/78Bw2vouF) %R 10.2196/16715 %U https://www.jmir.org/2020/2/e16715 %U https://doi.org/10.2196/16715 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 2 %P e15914 %T Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies %A Ospina-Pinillos,Laura %A Davenport,Tracey A %A Navarro-Mancilla,Alvaro Andres %A Cheng,Vanessa Wan Sze %A Cardozo Alarcón,Andrés Camilo %A Rangel,Andres M %A Rueda-Jaimes,German Eduardo %A Gomez-Restrepo,Carlos %A Hickie,Ian B %+ Brain and Mind Centre, Sydney, The University of Sydney, 94 Mallett Street, Camperdown, Sydney, 2050, Australia, 61 2 9351 0652, laura.ospinapinillos@sydney.edu.au %K Colombia %K telemedicine %K medical informatics %K eHealth %K mental health %K cultural characteristics %K cultural competency %K ethnic groups %K quality of health care %K community-based participatory research %K primary health care %K patient participation %K patient preference %K patient satisfaction %K consumer health information %K methods %K research design %D 2020 %7 6.2.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. Objective: Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). Methods: This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions. Results: A total of 2 co-design workshops were held with 18 users—young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions—young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. Conclusions: The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C—a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time. %R 10.2196/15914 %U https://mental.jmir.org/2020/2/e15914 %U https://doi.org/10.2196/15914 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e13201 %T Associations Between Affective States and Sexual and Health Status Among Men Who Have Sex With Men in China: Exploratory Study Using Social Media Data %A Zheng,Zhi-Wei %A Yang,Qing-Ling %A Liu,Zhong-Qi %A Qiu,Jia-Ling %A Gu,Jing %A Hao,Yuan-Tao %A Song,Chao %A Jia,Zhong-Wei %A Hao,Chun %+ Department of Medical Statistics, School of Public Health, Sun Yat-sen University, No 74, Zhongshan 2nd Road, Guangzhou, 510080, China, 86 13922750299, haochun@mail.sysu.edu.cn %K affect %K men who have sex with men %K sexual behaviors %K health status %K social media %D 2020 %7 31.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Affective states, including sentiment and emotion, are critical determinants of health. However, few studies among men who have sex with men (MSM) have examined sentiment and emotion specifically using real-time social media technologies. Moreover, the explorations on their associations with sexual and health status among MSM are limited. Objective: This study aimed to understand and examine the associations of affective states with sexual behaviors and health status among MSM using public data from the Blued (Blued International Inc) app. Methods: A total of 843,745 public postings of 377,610 MSM users located in Guangdong were saved from the Blued app by automatic screen capture. Positive affect, negative affect, sexual behaviors, and health status were measured using the Simplified Chinese Linguistic Inquiry and Word Count. Emotions, including joy, sadness, anger, fear, and disgust, were measured using the Weibo Basic Mood Lexicon. A positive sentiment score and a positive emotion score were also calculated. Univariate and multivariate linear regression models on the basis of a permutation test were used to assess the associations of affective states with sexual behaviors and health status. Results: A total of 5871 active MSM users and their 477,374 postings were finally selected. Both positive affect and positive emotions (eg, joy) peaked between 7 AM and 9 AM. Negative affect and negative emotions (eg, sadness and disgust) peaked between 2 AM and 4 AM. During that time, 25.1% (97/387) of negative postings were related to health and 13.4% (52/387) of negative postings were related to seeking social support. A multivariate analysis showed that the MSM who were more likely to post sexual behaviors were more likely to express positive affect (beta=0.3107; P<.001) and positive emotions (joy: beta=0.027; P<.001), as well as negative emotions (sadness: beta=0.0443; P<.001 and disgust: beta=0.0256; P<.001). They also had a higher positive sentiment score (beta=0.2947; P<.001) and a higher positive emotion score (beta=0.1612; P<.001). The MSM who were more likely to post their health status were more likely to express negative affect (beta=0.8088; P<.001) and negative emotions, including sadness (beta=0.0705; P<.001), anger (beta=0.0058; P<.001), fear (beta=0.0052; P<.001), and disgust (beta=0.3065; P<.001), and less likely to express positive affect (beta=−0.0224; P=.02). In addition, they had a lower positive sentiment score (beta=−0.8306; P<.001) and a lower positive emotion score (beta=−0.3743; P<.001). Conclusions: The MSM social media community mainly expressed their positive affect in the early morning and negative affect after midnight. Positive affective states were associated with being sexually active, whereas negative affective states were associated with health problems, mostly about mental health. Our finding suggests the potential to deliver different health-related intervention strategies (eg, psychological counseling and safe sex promotion) on a social media app according to the affective states of MSM in real time. %M 32012054 %R 10.2196/13201 %U http://www.jmir.org/2020/1/e13201/ %U https://doi.org/10.2196/13201 %U http://www.ncbi.nlm.nih.gov/pubmed/32012054 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e12599 %T Technological State of the Art of Electronic Mental Health Interventions for Major Depressive Disorder: Systematic Literature Review %A Burger,Franziska %A Neerincx,Mark A %A Brinkman,Willem-Paul %+ Delft University of Technology, van Mourik Broekmanweg 6, Delft, 2628XE, Netherlands, 31 0645340352, f.v.burger@tudelft.nl %K eHealth %K major depressive disorder %K technology %K systematic review %D 2020 %7 20.1.2020 %9 Review %J J Med Internet Res %G English %X Background: Electronic mental (e-mental) health care for depression aims to overcome barriers to and limitations of face-to-face treatment. Owing to the high and growing demand for mental health care, a large number of such information and communication technology systems have been developed in recent years. Consequently, a diverse system landscape formed. Objective: This literature review aims to give an overview of this landscape of e-mental health systems for the prevention and treatment of major depressive disorder, focusing on three main research questions: (1) What types of systems exist? (2) How technologically advanced are these systems? (3) How has the system landscape evolved between 2000 and 2017? Methods: Publications eligible for inclusion described e-mental health software for the prevention or treatment of major depressive disorder. Additionally, the software had to have been evaluated with end users and developed since 2000. After screening, 270 records remained for inclusion. We constructed a taxonomy concerning software systems, their functions, how technologized these were in their realization, and how systems were evaluated, and then, we extracted this information from the included records. We define here as functions any component of the system that delivers either treatment or adherence support to the user. For this coding process, an elaborate classification hierarchy for functions was developed yielding a total of 133 systems with 2163 functions. The systems and their functions were analyzed quantitatively, with a focus on technological realization. Results: There are various types of systems. However, most are delivered on the World Wide Web (76%), and most implement cognitive behavioral therapy techniques (85%). In terms of content, systems contain twice as many treatment functions as adherence support functions, on average. Furthermore, autonomous systems, those not including human guidance, are equally as technologized and have one-third less functions than guided ones. Therefore, lack of guidance is neither compensated with additional functions nor compensated by technologizing functions to a greater degree. Although several high-tech solutions could be found, the average system falls between a purely informational system and one that allows for data entry but without automatically processing these data. Moreover, no clear increase in the technological capabilities of systems showed in the field, between 2000 and 2017, despite a marked growth in system quantity. Finally, more sophisticated systems were evaluated less often in comparative trials than less sophisticated ones (OR 0.59). Conclusions: The findings indicate that when developers create systems, there is a greater focus on implementing therapeutic treatment than adherence support. Although the field is very active, as evidenced by the growing number of systems developed per year, the technological possibilities explored are limited. In addition to allowing developers to compare their system with others, we anticipate that this review will help researchers identify opportunities in the field. %M 31958063 %R 10.2196/12599 %U https://www.jmir.org/2020/1/e12599 %U https://doi.org/10.2196/12599 %U http://www.ncbi.nlm.nih.gov/pubmed/31958063 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e15592 %T A Web- and Mobile App–Based Mental Health Promotion Intervention Comparing Email, Short Message Service, and Videoconferencing Support for a Healthy Cohort: Randomized Comparative Study %A Renfrew,Melanie Elise %A Morton,Darren Peter %A Morton,Jason Kyle %A Hinze,Jason Scott %A Beamish,Peter James %A Przybylko,Geraldine %A Craig,Bevan Adrian %+ Lifestyle and Health Research Centre, Avondale University College, 582 Freemans Drive, Cooranbong, New South Wales, , Australia, 61 405445151, melrenfrew@gmail.com %K guidance %K health promotion %K eHealth %K short message service %K videoconferencing %D 2020 %7 6.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid increase in mental health disorders has prompted a call for greater focus on mental health promotion and primary prevention. Web- and mobile app–based interventions present a scalable opportunity. Little is known about the influence of human support on the outcomes of these interventions. Objective: This study aimed to compare the influence of 3 modes of human support on the outcomes (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing) of a 10-week, Web- and mobile app–based, lifestyle-focused mental health promotion intervention among a healthy adult cohort. Methods: Participants were recruited voluntarily using a combination of online and offline advertising. They were randomized, unblinded into 3 groups differentiated by human support mode: Group 1 (n=201): standard—fully automated emails (S); Group 2 (n=202): standard plus personalized SMS (S+pSMS); and Group 3 (n=202): standard plus weekly videoconferencing support (S+VCS), hosted by 1 trained facilitator. Participants accessed the intervention, including the questionnaire, on a Web-based learning management system or through a mobile app. The questionnaire, administered at pre- and postintervention, contained self-reported measures of mental well-being, including the “mental health” and “vitality” subscales from the Short Form Health Survey-36, Depression Anxiety and Stress Scale-21, Diener Satisfaction With Life Scale (SWLS), and Diener Flourishing Scale. Results: Of 605 potential participants, 458 (S: n=157, S+pSMS: n=163, and S+VCS: n=138) entered the study by completing registration and the preintervention questionnaire. At post intervention, 320 out of 458 participants (69.9%; S: n=103, S+pSMS: n=114, and S+VCS: n=103) completed the questionnaire. Significant within-group improvements were recorded from pre- to postintervention in all groups and in every outcome measure (P≤.001). No significant between-group differences were observed for outcomes in any measure: mental health (P=.77), vitality (P=.65), depression (P=.93), anxiety (P=.25), stress (P.57), SWLS (P=.65), and Flourishing Scale (P=.99). Adherence was not significantly different between groups for mean videos watched (P=.42) and practical activity engagement (P=.71). Participation in videoconference support sessions (VCSSs) was low; 37 out of 103 (35.9%) participants did not attend any VCSSs, and only 19 out of 103 (18.4%) attended 7 or more out of 10 sessions. Stratification within the S+VCS group revealed that those who attended 7 or more VCSSs experienced significantly greater improvements in the domains of mental health (P=.006; d=0.71), vitality (P=.005; d=0.73), depression (P=.04; d=0.54), and life satisfaction (P=.046; d=0.50) compared with participants who attended less than 7. Conclusions: A Web- and mobile app–based mental health promotion intervention enhanced domains of mental well-being among a healthy cohort, irrespective of human support. Low attendance at VCSSs hindered the ability to make meaningful between-group comparisons. Supplementing the intervention with VCSSs might improve outcomes when attendance is optimized. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): 12619001009101; http://www.anzctr.org.au/ACTRN12619001009101.aspx %M 31904578 %R 10.2196/15592 %U https://www.jmir.org/2020/1/e15592 %U https://doi.org/10.2196/15592 %U http://www.ncbi.nlm.nih.gov/pubmed/31904578 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e15644 %T Clinically Meaningful Use of Mental Health Apps and its Effects on Depression: Mixed Methods Study %A Zhang,Renwen %A Nicholas,Jennifer %A Knapp,Ashley A %A Graham,Andrea K %A Gray,Elizabeth %A Kwasny,Mary J %A Reddy,Madhu %A Mohr,David C %+ Department of Communication Studies, Northwestern University, 2240 Campus Dr, MTS Program, Evanston, IL, 60208, United States, 1 8479976596, alicezhang@u.northwestern.edu %K mHealth %K mobile apps %K mental health %K engagement %D 2019 %7 20.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: User engagement is key to the effectiveness of digital mental health interventions. Considerable research has examined the clinical outcomes of overall engagement with mental health apps (eg, frequency and duration of app use). However, few studies have examined how specific app use behaviors can drive change in outcomes. Understanding the clinical outcomes of more nuanced app use could inform the design of mental health apps that are more clinically effective to users. Objective: This study aimed to classify user behaviors in a suite of mental health apps and examine how different types of app use are related to depression and anxiety outcomes. We also compare the clinical outcomes of specific types of app use with those of generic app use (ie, intensity and duration of app use) to understand what aspects of app use may drive symptom improvement. Methods: We conducted a secondary analysis of system use data from an 8-week randomized trial of a suite of 13 mental health apps. We categorized app use behaviors through a mixed methods analysis combining qualitative content analysis and principal component analysis. Regression analyses were used to assess the association between app use and levels of depression and anxiety at the end of treatment. Results: A total of 3 distinct clusters of app use behaviors were identified: learning, goal setting, and self-tracking. Each specific behavior had varied effects on outcomes. Participants who engaged in self-tracking experienced reduced depression symptoms, and those who engaged with learning and goal setting at a moderate level (ie, not too much or not too little) also had an improvement in depression. Notably, the combination of these 3 types of behaviors, what we termed “clinically meaningful use,” accounted for roughly the same amount of variance as explained by the overall intensity of app use (ie, total number of app use sessions). This suggests that our categorization of app use behaviors succeeded in capturing app use associated with better outcomes. However, anxiety outcomes were neither associated with specific behaviors nor generic app use. Conclusions: This study presents the first granular examination of user interactions with mental health apps and their effects on mental health outcomes. It has important implications for the design of mobile health interventions that aim to achieve greater user engagement and improved clinical efficacy. %M 31859682 %R 10.2196/15644 %U http://www.jmir.org/2019/12/e15644/ %U https://doi.org/10.2196/15644 %U http://www.ncbi.nlm.nih.gov/pubmed/31859682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e16176 %T A Customized Social Network Platform (Kids Helpline Circles) for Delivering Group Counseling to Young People Experiencing Family Discord That Impacts Their Well-Being: Exploratory Study %A Campbell,Andrew %A Ridout,Brad %A Amon,Krestina %A Navarro,Pablo %A Collyer,Brian %A Dalgleish,John %+ Cyberpsychology Research Group, Faculty of Medicine & Health, The University of Sydney, Level 2, Charles Perkins Centre, Camperdown, 2006, Australia, 61 415280495, andrew.campbell@sydney.edu.au %K social media %K social networking %K online counseling %K family discord %K well-being %D 2019 %7 20.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: It has often been reported that young people are at high risk of mental health concerns, more so than at any other time in development over their life span. The situational factors that young people report as impacting their well-being are not addressed as often: specifically, family discord. Kids Helpline, a national service in Australia that provides free counseling online and by telephone to young people in distress, report that family discord and well-being issues are one of the major concerns reported by clients. In order to meet the preferences that young people seek when accessing counseling support, Kids Helpline has designed and trialed a custom-built social network platform for group counseling of young people experiencing family discord that impacts their well-being. Objective: In this exploratory study, we communicate the findings of Phase 1 of an innovative study in user and online counselor experience. This will lead to an iterative design for a world-first, purpose-built social network that will do the following: (1) increase reach and quality of service by utilizing a digital tool of preference for youth to receive peer-to-peer and counselor-to-peer support in a safe online environment and (2) provide the evidence base to document the best practice for online group counseling in a social network environment. Methods: The study utilized a participatory action research design. Young people aged 13-25 years (N=105) with mild-to-moderate depression or anxiety (not high risk) who contacted Kids Helpline were asked if they would like to trial the social networking site (SNS) for peer-to-peer and counselor-to-peer group support. Subjects were grouped into age cohorts of no more than one year above or below their reported age and assigned to groups of no more than 36 participants, in order to create a community of familiarity around age and problems experienced. Each group entered into an 8-week group counseling support program guided by counselors making regular posts and providing topic-specific content for psychoeducation and discussion. Counselors provided a weekly log of events to researchers; at 2-week intervals, subjects provided qualitative and quantitative feedback through open-ended questions and specific psychometric measures. Results: Qualitative results provided evidence of user support and benefits of the online group counseling environment. Counselors also reported benefits of the modality of therapy delivery. Psychometric scales did not report significance in changes of mood or affect. Counselors and users suggested improvements to the platform to increase user engagement. Conclusions: Phase 1 provided proof of concept for this mode of online counseling delivery. Users and counselors saw value in the model and innovation of the service. Phase 2 will address platform issues with changes to a new social network platform. Phase 2 will focus more broadly on mental health concerns raised by users and permit inclusion of a clinical population of young people experiencing depression and anxiety. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616000518460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370381 %M 31859671 %R 10.2196/16176 %U http://www.jmir.org/2019/12/e16176/ %U https://doi.org/10.2196/16176 %U http://www.ncbi.nlm.nih.gov/pubmed/31859671 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e13911 %T Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Trial %A Thabrew,Hiran %A D'Silva,Simona %A Darragh,Margot %A Goldfinch,Mary %A Meads,Jake %A Goodyear-Smith,Felicity %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Department of Psychological Medicine, University of Auckland, Level 12, Support Block, Auckland Hospital, 2 Park Road, Grafton, Auckland, 1142, New Zealand, 64 21402055, h.thabrew@auckland.ac.nz %K mass screening %K adolescents %K anxiety %K depression %K substance-related disorders %K primary health care %K school health services %K eHealth %D 2019 %7 3.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people. In New Zealand, screening for such problems is undertaken routinely only with year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, electronic tablet–based composite screener for identifying similar psychosocial issues to HEEADSSS Objective: This study aimed to compare the performance and acceptability of YouthCHAT with face-to-face HEEADSSS assessment among 13-year-old high school students. Methods: A counterbalanced randomized trial of YouthCHAT screening either before or after face-to-face HEEADSSS assessment was undertaken with 129 13-year-old New Zealand high school students of predominantly Māori and Pacific Island ethnicity. Main outcome measures were comparability of YouthCHAT and HEEADSSS completion times, detection rates, and acceptability to students and school nurses. Results: YouthCHAT screening was more than twice as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min; mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min 10 seconds]; P<.01) and detected more issues overall on comparable domains. For substance misuse and problems at home, both instruments were roughly comparable. YouthCHAT detected significantly more problems with eating or body image perception (70/110, 63.6% vs 25/110, 22.7%; P<.01), sexual health (24/110, 21.8% vs 10/110, 9.1%; P=.01), safety (65/110, 59.1% vs 17/110, 15.5%; P<.01), and physical inactivity (43/110, 39.1% vs 21/110, 19.1%; P<.01). HEEADSSS had a greater rate of detection for a broader set of mental health issues (30/110, 27%) than YouthCHAT (11/110, 10%; P=.001), which only assessed clinically relevant anxiety and depression. Assessment order made no significant difference to the duration of assessment or to the rates of YouthCHAT-detected positive screens for anxiety and depression. There were no significant differences in student acceptability survey results between the two assessments. Nurses identified that students found YouthCHAT easy to answer and that it helped students answer face-to-face questions, especially those of a sensitive nature. Difficulties encountered with YouthCHAT included occasional Wi-Fi connectivity and student literacy issues. Conclusions: This study provides preliminary evidence regarding the shorter administration time, detection rates, and acceptability of YouthCHAT as a school-based psychosocial screener for young people. Although further research is needed to confirm its effectiveness in other age and ethnic groups, YouthCHAT shows promise for aiding earlier identification and treatment of common psychosocial problems in young people, including possible use as part of an annual, school-based, holistic health check. Trial Registration: Australian New Zealand Clinical Trials Network Registry (ACTRN) ACTRN12616001243404p; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=371422. %M 31793890 %R 10.2196/13911 %U https://www.jmir.org/2019/12/e13911 %U https://doi.org/10.2196/13911 %U http://www.ncbi.nlm.nih.gov/pubmed/31793890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14728 %T Using Cluster Analysis to Explore Engagement and e-Attainment as Emergent Behavior in Electronic Mental Health %A Sanatkar,Samineh %A Baldwin,Peter Andrew %A Huckvale,Kit %A Clarke,Janine %A Christensen,Helen %A Harvey,Samuel %A Proudfoot,Judy %+ Black Dog Institute, School of Psychiatry, University of New South Wales, Hospital Road, Sydney 2031, , Australia, 61 2 9382 ext 4368, s.sanatkar@unsw.edu.au %K eHealth %K engagement %K adherence %K Web-based intervention %K depression %K anxiety %D 2019 %7 28.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In most e-mental health (eMH) research to date, adherence is defined according to a trial protocol. However, adherence to a study protocol may not completely capture a key aspect of why participants engage with eMH tools, namely, to achieve personal mental health goals. As a consequence, trial attrition reported as non-adherence or dropout may reflect e-attainment, the discontinuation of eMH engagement after personal goals have been met. Clarifying engagement patterns, such as e-attainment, and how these align with mental health trajectories, may help optimize eMH design and implementation science. Objective: This study aimed to use clustering techniques to identify real-world engagement profiles in a community of eMH users and examine if such engagement profiles are associated with different mental health outcomes. The novelty of this approach was our attempt to identify actual user engagement behaviors, as opposed to employing engagement benchmarks derived from a trial protocol. The potential of this approach is to link naturalistic behaviors to beneficial mental health outcomes, which would be especially informative when designing eMH programs for the general public. Methods: Between May 2013 and June 2018, Australian adults (N=43,631) signed up to myCompass, a self-guided eMH program designed to help alleviate mild to moderate symptoms of depression, anxiety, and stress. Recorded usage data included number of logins, frequency of mood tracking, number of started and completed learning activities, and number of tracking reminders set. A subset of users (n=168) completed optional self-assessment mental health questionnaires (Patient Health Questionnaire-9 item, PHQ-9; Generalized Anxiety Disorder Questionnaire-7 item, GAD-7) at registration and at 28 and 56 days after sign-up. Another subset of users (n=861) completed the PHQ-9 and GAD-7 at registration and at 28 days. Results: Two-step cluster analyses revealed 3 distinct usage patterns across both subsamples: moderates, trackers, and super users, signifying differences both in the frequency of use as well as differences in preferences for program functionalities. For both subsamples, repeated measures analysis of variances showed significant decreases over time in PHQ-9 and GAD-7 scores. Time-by-cluster interactions, however, did not yield statistical significance in both subsamples, indicating that clusters did not predict symptom reduction over time. Interestingly, users who completed the self-assessment questionnaires twice had slightly but significantly lower depression and anxiety levels at sign-up compared with users who completed the questionnaires a third time at 56 days. Conclusions: Findings suggested that although users engaged with myCompass in different but measurable ways, those different usage patterns evoked equivalent mental health benefits. Furthermore, the randomized controlled trial paradigm may unintentionally limit the scope of eMH engagement research by mislabeling early mental health goal achievers as dropouts. More detailed and naturalistic approaches to study engagement with eMH technologies may improve program design and, ultimately, program effectiveness. %M 31778115 %R 10.2196/14728 %U http://www.jmir.org/2019/11/e14728/ %U https://doi.org/10.2196/14728 %U http://www.ncbi.nlm.nih.gov/pubmed/31778115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e13873 %T Young People’s Online Help-Seeking and Mental Health Difficulties: Systematic Narrative Review %A Pretorius,Claudette %A Chambers,Derek %A Coyle,David %+ School of Computer Science, University College Dublin, Belfield, Dublin, Ireland, 353 017162818, claudette.pretorius@ucdconnect.ie %K internet %K help-seeking behavior %K youth %K mental health %K online behavior %K self-determination theory %K systematic review %D 2019 %7 19.11.2019 %9 Review %J J Med Internet Res %G English %X Background: Young people frequently make use of the internet as part of their day-to-day activities, and this has extended to their help-seeking behavior. Offline help-seeking is known to be impeded by a number of barriers including stigma and a preference for self-reliance. Online help-seeking may offer an additional domain where young people can seek help for mental health difficulties without being encumbered by these same barriers. Objective: The objective of this systematic literature review was to examine young peoples’ online help-seeking behaviors for mental health concerns. It aimed to summarize young peoples’ experiences and identify benefits and limitations of online help-seeking for this age group. It also examined the theoretical perspectives that have been applied to understand online help-seeking. Methods: A systematic review of peer-reviewed research papers from the following major electronic databases was conducted: PsycINFO, Cumulative Index of Nursing and Allied Health Literature, PubMed, Cochrane Library, Association for Computing Machinery Digital Library, and Institute of Electrical and Electronics Engineers Xplore. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. The search was conducted in August 2017. The narrative synthesis approach to reviews was used to analyze the existing evidence to answer the review questions. Results: Overall, 28 studies were included. The most common method of data collection was through the use of surveys. Study quality was moderate to strong. Text-based query via an internet search engine was the most commonly identified help-seeking approach. Social media, government or charity websites, live chat, instant messaging, and online communities were also used. Key benefits included anonymity and privacy, immediacy, ease of access, inclusivity, the ability to connect with others and share experiences, and a greater sense of control over the help-seeking journey. Online help-seeking has the potential to meet the needs of those with a preference for self-reliance or act as a gateway to further help-seeking. Barriers to help-seeking included a lack of mental health literacy, concerns about privacy and confidentiality, and uncertainty about the trustworthiness of online resources. Until now, there has been limited development and use of theoretical models to guide research on online help-seeking. Conclusions: Approaches to improving help-seeking by young people should consider the role of the internet and online resources as an adjunct to offline help-seeking. This review identifies opportunities and challenges in this space. It highlights the limited use of theoretical frameworks to help conceptualize online help-seeking. Self-determination theory and the help-seeking model provide promising starting points for the development of online help-seeking theories. This review discusses the use of these theories to conceptualize online help-seeking and identify key motivations and tensions that may arise when young people seek help online. %M 31742562 %R 10.2196/13873 %U http://www.jmir.org/2019/11/e13873/ %U https://doi.org/10.2196/13873 %U http://www.ncbi.nlm.nih.gov/pubmed/31742562 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e14754 %T Use of a Fully Automated Internet-Based Cognitive Behavior Therapy Intervention in a Community Population of Adults With Depression Symptoms: Randomized Controlled Trial %A Schure,Mark B %A Lindow,Janet C %A Greist,John H %A Nakonezny,Paul A %A Bailey,Sandra J %A Bryan,William L %A Byerly,Matthew J %+ Department of Health & Human Development, Montana State University, 305 Herrick Hall, Bozeman, MT, United States, 1 406 994 3248, mark.schure@montana.edu %K internet-based cognitive behavior therapy %K iCBT %K depression symptoms %K rural populations %K RCT %K randomized controlled trial %K CBT %D 2019 %7 18.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Although internet-based cognitive behavior therapy (iCBT) interventions can reduce depression symptoms, large differences in their effectiveness exist. Objective: The aim of this study was to evaluate the effectiveness of an iCBT intervention called Thrive, which was designed to enhance engagement when delivered as a fully automated, stand-alone intervention to a rural community population of adults with depression symptoms. Methods: Using no diagnostic or treatment exclusions, 343 adults with depression symptoms were recruited from communities using an open-access website and randomized 1:1 to the Thrive intervention group or the control group. Using self-reports, participants were evaluated at baseline and 4 and 8 weeks for the primary outcome of depression symptom severity and secondary outcome measures of anxiety symptoms, work and social adjustment, psychological resilience, and suicidal ideation. Results: Over the 8-week follow-up period, the intervention group (n=181) had significantly lower depression symptom severity than the control group (n=162; P<.001), with a moderate treatment effect size (d=0.63). Moderate to near-moderate effect sizes favoring the intervention group were observed for anxiety symptoms (P<.001; d=0.47), work/social functioning (P<.001; d=0.39), and resilience (P<.001; d=0.55). Although not significant, the intervention group was 45% less likely than the control group to experience increased suicidal ideation (odds ratio 0.55). Conclusions: These findings suggest that the Thrive intervention was effective in reducing depression and anxiety symptom severity and improving functioning and resilience among a mostly rural community population of US adults. The effect sizes associated with Thrive were generally larger than those of other iCBT interventions delivered as a fully automated, stand-alone intervention. Trial Registration: ClinicalTrials.gov NCT03244878; https://clinicaltrials.gov/ct2/show/NCT03244878 %M 31738173 %R 10.2196/14754 %U http://www.jmir.org/2019/11/e14754/ %U https://doi.org/10.2196/14754 %U http://www.ncbi.nlm.nih.gov/pubmed/31738173 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e13540 %T Qualitative Synthesis of Young People’s Experiences With Technology-Assisted Cognitive Behavioral Therapy: Systematic Review %A McCashin,Darragh %A Coyle,David %A O'Reilly,Gary %+ School of Psychology, University College Dublin, Belfield, Dublin, Dublin 4, Ireland, 353 1718363, darragh.mccashin@ucd.ie %K cognitive behavioral therapy %K systematic review %K qualitative research %K children %K mental health %K technology %K mHealth %K eHealth %D 2019 %7 12.11.2019 %9 Review %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy (CBT) for young people is increasingly being provided using technology-assisted formats. Although there is increasing evidence regarding the efficacy of such approaches, as illustrated by quantitative systematic reviews, the literature has also highlighted challenges with implementation factors, including high attrition rates and variable user engagement. Qualitative review methods can help to address the factors that impact young peoples’ experience of technology-assisted cognitive behavioral therapy (tech-assisted CBT) and, thus, enable us to better understand such implementation factors. To date, no such qualitative synthesis exists. Objective: The primary aim of this review was to systematically identify and synthesize the qualitative literature concerning the experiences of young people who have used tech-assisted CBT. Methods: This systematic review applied Thomas and Harden’s 2008 qualitative thematic synthesis approach. This involved line-by-line coding of the results sections of included studies and an inductive analysis on identified themes, followed by the generation of analytical themes through a process of iteration and interpretation of the descriptive themes. PsycINFO, ACM Digital Library, PubMed, EMBASE, and JMIR Publications databases were searched. The inclusion criteria were (1) studies involving school-aged young people over preschool age (6 years) but under the age of 18 years, (2) use of any form of tech-assisted CBT for any time period, (3) a stated focus of qualitative data to document the experiences of participants, and (4) studies published in English. The exclusion criteria were (1) interventions only provided face-to-face with no technological component, (2) only focused on the performance of the technology rather than participant experience, and (3) numerical data that sought to represent qualitative data. Results: A total of 14 studies were included in this review. Overall, these studies represented interventions for low mood and anxiety (n=10), trauma or self-harm (n=2), and physical difficulties (n=2). Overall, 5 analytical themes emerged on young people’s experiences with tech-assisted CBT: (1) helpfulness, (2) therapeutic process, (3) transferability, (4) gameplay experience, and (5) limitations. In addition, these analytical themes contained the following subthemes: positive experiences, tech-assisted CBT versus face-to-face CBT, understanding of a CBT model, process of change, skills development, application to everyday life settings, parental involvement, character relatedness, playability, negative experiences, and broad content. Conclusions: Overall, young people’s experiences with tech-assisted CBT were mostly positive. The use of gaming environments, relatable characters, concrete metaphors, and age-appropriate narratives contributed to these positive experiences. Evidence suggests that technology can help to mediate face-to-face relationships with therapists and help young people to understand the CBT model. Clear barriers also emerged, including over-reliance on reading and writing skills and dissatisfaction with overly generalized content and comparison with commercial technologies. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42018103388; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018103388 %M 31714251 %R 10.2196/13540 %U http://www.jmir.org/2019/11/e13540/ %U https://doi.org/10.2196/13540 %U http://www.ncbi.nlm.nih.gov/pubmed/31714251 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e13393 %T Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial %A Topooco,Naira %A Byléhn,Sandra %A Dahlström Nysäter,Ellen %A Holmlund,Jenny %A Lindegaard,Johanna %A Johansson,Sanna %A Åberg,Linnea %A Bergman Nordgren,Lise %A Zetterqvist,Maria %A Andersson,Gerhard %+ Department of Behavioural Sciences and Learning, Linköping University, Campus Valla, Linköping, SE-581 83, Sweden, 46 13281000, naira.topooco@liu.se %K adolescent %K depression %K cognitive behavioral therapy %K randomized controlled trial %K internet %K digital health %K technology %K mental health %K text messaging %K instant messaging %D 2019 %7 1.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is a common and serious problem among adolescents, but few seek or have access to therapy. Internet-delivered cognitive behavioral therapies (ICBTs), developed to increase treatment access, show promise in reducing depression. The inclusion of coach support in treatment is desired and may be needed. Objective: The aim of this study was to determine the efficacy of an ICBT protocol blended with weekly real-time therapist sessions via chat; blended treatment, for adolescent depression, including major depressive episode (MDE). The protocol has previously been evaluated in a controlled study. Methods: In a two-arm randomized controlled trial, adolescents 15 to 19 years of age were recruited through a community setting at the national level in Sweden (n=70) and allocated to either 8 weeks of treatment or to minimal attention control. Depression was assessed at baseline, at posttreatment, and at 12 months following treatment (in the intervention group). The primary outcome was self-reported depression level as measured with the Beck Depression Inventory II at posttreatment. The intervention was offered without the need for parental consent. Results: Over two weeks, 162 adolescents registered and completed the baseline screening. Eligible participants (n=70) were on average 17.5 years of age (SD 1.15), female (96%, 67/70), suffered from MDE (76%, 53/70), had no previous treatment experience (64%, 45/70), and reported guardian(s) to be aware about their depression state (71%, 50/70). The average intervention completion was 74% (11.8 of 16 modules and sessions). Following the treatment, ICBT participants demonstrated a significant decrease in depression symptoms compared with controls (P<.001), corresponding to a large between-group effect (intention-to-treat analysis: d=0.86, 95% CI 0.37-1.35; of completer analysis: d=0.99, 95% CI 0.48-1.51). A significant between-group effect was observed in the secondary depression outcome (P=.003); clinically significant improvement was found in 46% (16/35) of ICBT participants compared with 11% (4/35) in the control group (P=.001). Conclusions: The results are in line with our previous study, further demonstrating that adolescents with depression can successfully be engaged in and experience significant improvement following ICBT blended with therapist chat sessions. Findings on participants’ age and baseline depression severity are of interest in relation to used study methods. Trial Registration: ClinicalTrials.gov NCT02363205; https://clinicaltrials.gov/ct2/show/NCT02363205 %M 31682572 %R 10.2196/13393 %U https://www.jmir.org/2019/11/e13393 %U https://doi.org/10.2196/13393 %U http://www.ncbi.nlm.nih.gov/pubmed/31682572 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14366 %T Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study %A Allan,Stephanie %A Bradstreet,Simon %A Mcleod,Hamish %A Farhall,John %A Lambrou,Maria %A Gleeson,John %A Clark,Andrea %A , %A Gumley,Andrew %+ Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Fleming Pavilion, West of Scotland Science Park, Glasgow, G20 0XA, United Kingdom, 44 01412113939, andrew.gumley@glasgow.ac.uk %K psychosis %K self-management %K implementation science %D 2019 %7 24.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker–supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation—both within trials and beyond. Objective: Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods: To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders’ expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results: All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions: A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders’ previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration: ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262 %M 31651400 %R 10.2196/14366 %U https://www.jmir.org/2019/10/e14366 %U https://doi.org/10.2196/14366 %U http://www.ncbi.nlm.nih.gov/pubmed/31651400 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e13655 %T Improving the Course of Depressive Symptoms After Inpatient Psychotherapy Using Adjunct Web-Based Self-Help: Follow-Up Results of a Randomized Controlled Trial %A Zwerenz,Rüdiger %A Baumgarten,Carlotta %A Becker,Jan %A Tibubos,Ana %A Siepmann,Martin %A Knickenberg,Rudolf J %A Beutel,Manfred E %+ Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg-University, Untere Zahlbacher Str 8, Mainz, 55131, Germany, 49 61311 75981, ruediger.zwerenz@unimedizin-mainz.de %K depression %K mental health %K internet %K aftercare %K psychotherapy %K psychology, clinical %K inpatients %D 2019 %7 24.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: We recently showed in a randomized controlled trial that Web-based self-help as an adjunct improved the effectiveness of multimodal inpatient psychotherapy for depression. Objective: The aims of this study were (1) to determine whether a Web-based self-help adjunctive to multimodal inpatient psychotherapeutic treatment could also improve the course of depressive symptoms and (2) to identify predictors of residual depressive symptoms at follow-up. Methods: Overall, 229 patients were randomized either to the Web-based self-help intervention group (Deprexis) or an active control group (Web-based information about depression and depressive symptoms) in addition to multimodal inpatient psychotherapy. Participants in both groups were able to access their respective Web-based programs for 12 weeks, which meant that they typically had access after discharge from the inpatient unit (mean hospitalization duration: 40 days, T1). Follow-up was performed 6 months after study intake (T3). Results: At follow-up, participants of the Web-based self-help group had considerably lower symptom load regarding depressive symptoms (d=0.58) and anxiety (d=0.46) as well as a better quality of life (d=0.43) and self-esteem (d=0.31) than participants of the control group. Nearly 3 times as many participants of the intervention group compared with the control group achieved remission in accordance with less deterioration. The number needed to treat based on the Beck Depression Inventory-II (BDI-II) improved over time (T1: 7.84, T2: 7.09, and T3: 5.12). Significant outcome predictors were BDI at discharge and treatment group. Conclusions: Web-based self-help as an add-on to multimodal inpatient psychotherapy improved the short-term course of depressive symptoms beyond termination. Residual symptoms at discharge from inpatient treatment and utilization of the Web-based self-help were the major predictors of depressive symptoms at follow-up. Challenges and barriers (eg, costs, therapists’ concerns, or technical barriers) of adding Web-based interventions to inpatient treatment have to be addressed. Trial Registration: ClinicalTrials.gov NCT02196896; https://clinicaltrials.gov/ct2/show/NCT02196896. %M 31651403 %R 10.2196/13655 %U https://www.jmir.org/2019/10/e13655 %U https://doi.org/10.2196/13655 %U http://www.ncbi.nlm.nih.gov/pubmed/31651403 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14065 %T Development of the Therapeutic Alliance and its Association With Internet-Based Mindfulness-Based Cognitive Therapy for Distressed Cancer Patients: Secondary Analysis of a Multicenter Randomized Controlled Trial %A Bisseling,Else %A Cillessen,Linda %A Spinhoven,Philip %A Schellekens,Melanie %A Compen,Félix %A van der Lee,Marije %A Speckens,Anne %+ Radboudumc for Mindfulness, Department of Psychiatry, Radboud University Medical Center, 966/CvM, Postbus 9101, Nijmegen, 6500HB, Netherlands, 31 243615445, else.bisseling@radboudumc.nl %K therapeutic alliance %K telemedicine %K mindfulness %K cancer %K patient dropouts %D 2019 %7 18.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Mindfulness-based cognitive therapy (MBCT) is an evidence-based group-based psychological treatment in oncology, resulting in reduction of depressive and anxiety symptoms. Internet-based MBCT (eMBCT) has been found to be an effective alternative for MBCT. The therapeutic alliance (the bond between therapist and patient,) is known to have a significant impact on psychological treatment outcomes, including MBCT. A primary concern in the practice of eMBCT is whether a good therapeutic alliance can develop. Although evidence for the beneficial effect of therapist assistance on treatment outcome in internet-based interventions (IBIs) is accumulating, it is still unclear whether the therapeutic alliance is related to outcome in IBIs. Objective: This study aimed to (1) explore whether early therapeutic alliance predicts treatment dropout in MBCT or eMBCT, (2) compare the development of the therapeutic alliance during eMBCT and MBCT, and (3) examine whether early therapeutic alliance is a predictor of the reduction of psychological distress and the increase of mental well-being at posttreatment in both conditions. Methods: This study was part of a multicenter randomized controlled trial (n=245) on the effectiveness of MBCT or eMBCT for distressed cancer patients. The therapeutic alliance was measured at the start of week 2 (ie, early therapeutic alliance), week 5, and week 9. Outcome measures were psychological distress, measured with the Hospital Anxiety and Depression Scale, and mental well-being, measured with the Mental Health Continuum-Short Form. Results: The strength of early therapeutic alliance did not predict treatment dropout in MBCT or eMBCT (B=−.39; P=.21). Therapeutic alliance increased over time in both conditions (F2,90=16.46; Wilks λ=0.732; P<.001). This increase did not differ between eMBCT and MBCT (F1,91=0.114; P=.74). Therapeutic alliance at week 2 predicted a decrease in psychological distress (B=−.12; t114=−2.656; P=.01) and an increase in mental well-being (B=.23; t113=2.651; P=.01) at posttreatment. The relationship with reduction of psychological distress differed between treatments: a weaker early therapeutic alliance predicted higher psychological distress at posttreatment in MBCT but not in eMBCT (B=.22; t113=2.261; P=.03). Conclusions: A therapeutic alliance can develop in both eMBCT and MBCT. Findings revealed that the strength of early alliance did not predict treatment dropout. Furthermore, the level of therapeutic alliance predicted reduced psychological distress and increased mental well-being at posttreatment in both conditions. Interestingly, the strength of therapeutic alliance appeared to be more related to treatment outcome in group-based MBCT than in eMBCT. Trial Registration: ClinicalTrials.gov NCT02138513; https://clinicaltrials.gov/ct2/show/NCT02138513 %M 31628791 %R 10.2196/14065 %U https://www.jmir.org/2019/10/e14065 %U https://doi.org/10.2196/14065 %U http://www.ncbi.nlm.nih.gov/pubmed/31628791 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e11665 %T Analysis of the Recomposition of Norms and Representations in the Field of Psychiatry and Mental Health in the Age of Electronic Mental Health: Qualitative Study %A Morgiève,Margot %A Sebbane,Déborah %A De Rosario,Bianca %A Demassiet,Vincent %A Kabbaj,Soraya %A Briffault,Xavier %A Roelandt,Jean-Luc %+ World Health Organization Collaborating Centre for Research and Training in Mental Health, Établissement Public de Santé Mentale Lille Metropole, 211 rue Roger Salengro, 59260, Lille-Hellemmes, France, 33 620578776, deborah.sebbane6@gmail.com %K ehealth %K mental health %K psychiatry %K social representations %K focus group %K users %K caregivers %K qualitative analysis %K digital tools. %D 2019 %7 9.10.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: For the World Health Organization, electronic health (eHealth) is seen as an effective way to improve therapeutic practices and disease prevention in health. Digital tools lead to major changes in the field of mental medicine, but specific analyses are required to understand and accompany these changes. Objective: Our objective was to highlight the positions of the different stakeholders of the mental health care system on eHealth services and tools, as well as to establish professional and user group profiles of these positions and the uses of these services. Methods: In order to acquire the opinions and expectations of different categories of people, we carried out a qualitative study based on 10 focus groups (n=70, from 3-12 people per group) composed of: general practitioners, psychiatrists, psychologists, social workers, occupational therapists, nurses, caregivers, mental health services users, user representatives, and the general public. The analyses of focus group discussions were performed independently by four investigators through a common analysis grid. The constant comparative method was adopted within this framework. Results: The interviewees expressed different problems that new technologies engender in the field of mental health. What was previously strictly under the jurisdiction of physicians now tends to be fragmented and distributed over different groups and locations. New technologies reposition care in the field of domestic, rather than therapeutic, activities, and thus the conception of care as an autonomous activity in the subject’s life is questioned. The ideal of social autonomy through technology is part of the new logic of health democracy and empowerment, which is linked to a strong, contemporary aspiration to perform. Participants emphasized that there was the potential risk of a decrease in autonomy for the digitally engaged patient, while personal empowerment could become a set of obligations. Conclusions: This qualitative research highlights the heterogeneity of opinions among the groups and within each group. It suggests that opinions on electronic mental health devices are still far from being stabilized, and that a change management process should be set up to both regulate the development and facilitate the use of these tools. %M 31356151 %R 10.2196/11665 %U https://mental.jmir.org/2019/10/e11665 %U https://doi.org/10.2196/11665 %U http://www.ncbi.nlm.nih.gov/pubmed/31356151 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e14834 %T A Web-Based Intervention for Social Media Addiction Disorder Management in Higher Education: Quantitative Survey Study %A Dogan,Huseyin %A Norman,Helmi %A Alrobai,Amen %A Jiang,Nan %A Nordin,Norazah %A Adnan,Anita %+ Faculty of Education, Universiti Kebangsaan Malaysia, Jalan Reko, Bangi, 43600, Malaysia, 60 389216062, helmi.norman@ukm.edu.my %K Facebook addiction %K intervention features %K postgraduate education %K social media addiction %K obsessive-compulsive disorder (OCD) %K PLS-SEM analysis %D 2019 %7 2.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media addiction disorder has recently become a major concern and has been reported to have negative impacts on postgraduate studies, particularly addiction to Facebook. Although previous studies have investigated the effects of Facebook addiction disorder in learning settings, there still has been a lack of studies investigating the relationship between online intervention features for Facebook addiction focusing on postgraduate studies. Objective: In an attempt to understand this relationship, this study aimed to carry out an investigation on online intervention features for effective management of Facebook addiction in higher education. Methods: This study was conducted quantitatively using surveys and partial least square-structural equational modeling. The study involved 200 postgraduates in a Facebook support group for postgraduates. The Bergen Facebook Addiction test was used to assess postgraduates’ Facebook addiction level, whereas online intervention features were used to assess postgraduates’ perceptions of online intervention features for Facebook addiction, which are as follows: (1) self-monitoring features, (2) manual control features, (3) notification features, (4) automatic control features, and (5) reward features. Results: The study discovered six Facebook addiction factors (relapse, conflict, salience, tolerance, withdrawal, and mood modification) and five intervention features (notification, auto-control, reward, manual control, and self-monitoring) that could be used in the management of Facebook addiction in postgraduate education. The study also revealed that relapse is the most important factor and mood modification is the least important factor. Furthermore, findings indicated that notification was the most important intervention feature, whereas self-monitoring was the least important feature. Conclusions: The study’s findings (addiction factors and intervention features) could assist future developers and educators in the development of online intervention tools for Facebook addiction management in postgraduate education. %M 31579018 %R 10.2196/14834 %U https://www.jmir.org/2019/10/e14834 %U https://doi.org/10.2196/14834 %U http://www.ncbi.nlm.nih.gov/pubmed/31579018 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e14171 %T Family Separation and the Impact of Digital Technology on the Mental Health of Refugee Families in the United States: Qualitative Study %A Shah,Sayyed Fawad Ali %A Hess,Julia Meredith %A Goodkind,Jessica R %+ Department of Sociology, University of New Mexico, MSC05 3080, Albuquerque, NM, 87131, United States, 1 505 277 2501, jgoodkin@unm.edu %K refugees %K family separation %K mental health %K mobile phone %D 2019 %7 03.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Conflicts around the world have resulted in a record high number of refugees. Family separation is a critical factor that impacts refugee mental health. Thus, it is important to explore refugees’ ability to maintain contact with family members across the globe and the ways in which they attempt to do so. It is increasingly common for refugees to use information and communication technologies (ICTs), which include mobile phones, the internet, and social media sites, such as Facebook, WhatsApp, Skype, and Viber, for these purposes. Objective: The aim of this study was to explore refugees’ perceptions of the impact of communication through ICTs on their mental health, the exercise of agency by refugees within the context of ICT use, especially their communication with their families, and logistical issues that affect their access to ICTs in the United States. Methods: We used a constructivist grounded theory approach to analyze in-depth interviews of 290 adult refugee participants from different countries, who were enrolled in a randomized controlled trial of a community-based mental health intervention. Results: Analyses showed that communication through ICTs had differing impacts on the mental health of refugee participants. ICTs, as channels of communication between separated families, were a major source of emotional and mental well-being for a large number of refugee participants. However, for some participants, the communication process with separated family members through digital technology was mentally and emotionally difficult. The participants also discussed ways in which they hide adversities from their families through selective use of different ICTs. Several participants noted logistical and financial barriers to communicating with their families through ICTs. Conclusions: These findings are important in elucidating aspects of refugee agency and environmental constraints that need to be further explicated in theories related to ICT use as well as in providing insight for researchers and practitioners involved in efforts related to migration and mental health. %M 31482853 %R 10.2196/14171 %U https://www.jmir.org/2019/9/e14171/ %U https://doi.org/10.2196/14171 %U http://www.ncbi.nlm.nih.gov/pubmed/31482853 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13432 %T Internet-Based Cognitive Behavioral Therapy Among Psychologists in a Medical Setting: A Survey on Implementation %A IJzerman,Renée V H %A van der Vaart,Rosalie %A Evers,Andrea W M %+ Unit of Health, Medical and Neuropsychology, Faculty of Social and Behavioural Sciences, Leiden University, Wassenaarseweg 52, Leiden,, Netherlands, 31 715275083, r.v.h.ijzerman@fsw.leidenuniv.nl %K eHealth %K chronic care %K self-management %K implementation %K psychologists %K UTAUT %D 2019 %7 09.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) is an effective treatment for patients with a chronic somatic illness to improve self-management skills and to learn to adjust to their chronic disease and its impact on daily life. However, the implementation of iCBT in clinical practice is challenging. Objective: This study aimed to examine the current degree of implementation of iCBT among psychologists in a medical setting and discover determinants influencing the implementation of iCBT among nonusers. Methods: A Web-based survey, based on the Unified Theory of Acceptance and Use of Technology (UTAUT), was distributed among psychologists in a medical setting. The survey included questions regarding the current use of iCBT, intention to use iCBT in the future, and operationalized concepts of the UTAUT constructs, that is, performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Results: In total, 107 (24.8%) psychologists completed the survey. Of them, 16.8% have access to iCBT, 15.9% currently use iCBT, and 21.5% are expected to use iCBT within the next year. The constructs PE, EE, and SI together significantly influenced behavioral intention (BI; mean 3.9 [SD=0.8]) among nonusers (R2=0.490; F4.85=20.405; P<.001). Conclusions: In spite of an average to high BI, the current implementation of iCBT is rather low among psychologists in a medical setting. Further research should focus on reducing the gap between intention to use and actual use by focusing on influencing the predictive UTAUT constructs. %M 31400101 %R 10.2196/13432 %U https://www.jmir.org/2019/8/e13432/ %U https://doi.org/10.2196/13432 %U http://www.ncbi.nlm.nih.gov/pubmed/31400101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e14127 %T Using Participatory Design Methodologies to Co-Design and Culturally Adapt the Spanish Version of the Mental Health eClinic: Qualitative Study %A Ospina-Pinillos,Laura %A Davenport,Tracey %A Mendoza Diaz,Antonio %A Navarro-Mancilla,Alvaro %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, Shops 1-3, 66-70 Parramatta Road, Sydney, NSW, 2051, Australia, 61 028 627 6946, laura.ospinapinillos@sydney.edu.au %K telemedicine %K medical informatics %K eHealth %K mental health %K cultural characteristics %K cultural competency %K ethnic groups %K transients and migrants %K quality of health care %K international students %K Hispanics %K Latinos %K community-based participatory research %K primary health care %K patient participation %K patient preference %K patient satisfaction %K consumer health information %D 2019 %7 02.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The Mental Health eClinic (MHeC) aims to deliver best-practice clinical services to young people experiencing mental health problems by making clinical care accessible, affordable, and available to young people whenever and wherever they need it most. The original MHeC consists of home page with a visible triage system for those requiring urgent help; a online physical and mental health self-report assessment; a results dashboard; a booking and videoconferencing system; and the generation of a personalized well-being plan. Populations who do not speak English and reside in English-speaking countries are less likely to receive mental health care. In Australia, international students have been identified as disadvantaged compared with their peers; have weaker social support networks; and have higher rates of psychological distress. This scenario is acquiring significant relevance as Spanish-speaking migration is rapidly growing in Australia, and the mental health services for culturally and linguistically diverse populations are limited. Having a Spanish version (MHeC-S) of the Mental Health eClinic would greatly benefit these students. Objective: We used participatory design methodologies with users (young people aged 16-30 years, supportive others, and health professionals) to (1) conduct workshops with users to co-design and culturally adapt the MHeC; (2) inform the development of the MHeC-S alpha prototype; (3) test the usability of the MHeC-S alpha prototype; (4) translate, culturally adapt, and face-validate the MHeC-S self-report assessment; and (5) collect information to inform its beta prototype. Methods: A research and development cycle included several participatory design phases: co-design workshops; knowledge translation; language translation and cultural adaptation; and rapid prototyping and user testing of the MHeC-S alpha prototype. Results: We held 2 co-design workshops with 17 users (10 young people, 7 health professionals). A total of 15 participated in the one-on-one user testing sessions (7 young people, 5 health professionals, 3 supportive others). We collected 225 source documents, and thematic analysis resulted in 5 main themes (help-seeking barriers, technology platform, functionality, content, and user interface). A random sample of 106 source documents analyzed by 2 independent raters revealed almost perfect agreement for functionality (kappa=.86; P<.001) and content (kappa=.92; P<.001) and substantial agreement for the user interface (kappa=.785; P<.001). In this random sample, no annotations were coded for help-seeking barriers or the technology platform. Language was identified as the main barrier to getting medical or psychological services, and smartphones were the most-used device to access the internet. Acceptability was adequate for the prototype’s 5 main elements: home page and triage system, self-report assessment, dashboard of results, booking and video visit system, and personalized well-being plan. The data also revealed gaps in the alpha prototype, such as the need for tailored assessment tools and a greater integration with Spanish-speaking services and communities. Spanish-language apps and e-tools, as well as online mental health information, were lacking. Conclusions: Through a research and development process, we co-designed and culturally adapted, developed and user tested, and evaluated the MHeC-S. By translating and culturally adapting the MHeC to Spanish, we aimed to increase accessibility and availability of e-mental health care in the developing world, and assist vulnerable populations that have migrated to English-speaking countries. %M 31376271 %R 10.2196/14127 %U https://www.jmir.org/2019/8/e14127/ %U https://doi.org/10.2196/14127 %U http://www.ncbi.nlm.nih.gov/pubmed/31376271 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e13809 %T Identification of Patients in Need of Advanced Care for Depression Using Data Extracted From a Statewide Health Information Exchange: A Machine Learning Approach %A Kasthurirathne,Suranga N %A Biondich,Paul G %A Grannis,Shaun J %A Purkayastha,Saptarshi %A Vest,Joshua R %A Jones,Josette F %+ Center for Biomedical Informatics, Regenstrief Institute, 1101 W 10th St, Indianapolis, IN, 46202, United States, 1 3173323480, snkasthu@iupui.edu %K depression %K supervised machine learning %K delivery of health care %D 2019 %7 22.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: As the most commonly occurring form of mental illness worldwide, depression poses significant health and economic burdens to both the individual and community. Different types of depression pose different levels of risk. Individuals who suffer from mild forms of depression may recover without any assistance or be effectively managed by primary care or family practitioners. However, other forms of depression are far more severe and require advanced care by certified mental health providers. However, identifying cases of depression that require advanced care may be challenging to primary care providers and health care team members whose skill sets run broad rather than deep. Objective: This study aimed to leverage a comprehensive range of patient-level diagnostic, behavioral, and demographic data, as well as past visit history data from a statewide health information exchange to build decision models capable of predicting the need of advanced care for depression across patients presenting at Eskenazi Health, the public safety net health system for Marion County, Indianapolis, Indiana. Methods: Patient-level diagnostic, behavioral, demographic, and past visit history data extracted from structured datasets were merged with outcome variables extracted from unstructured free-text datasets and were used to train random forest decision models that predicted the need of advanced care for depression across (1) the overall patient population and (2) various subsets of patients at higher risk for depression-related adverse events; patients with a past diagnosis of depression; patients with a Charlson comorbidity index of ≥1; patients with a Charlson comorbidity index of ≥2; and all unique patients identified across the 3 above-mentioned high-risk groups. Results: The overall patient population consisted of 84,317 adult (aged ≥18 years) patients. A total of 6992 (8.29%) of these patients were in need of advanced care for depression. Decision models for high-risk patient groups yielded area under the curve (AUC) scores between 86.31% and 94.43%. The decision model for the overall patient population yielded a comparatively lower AUC score of 78.87%. The variance of optimal sensitivity and specificity for all decision models, as identified using Youden J Index, is as follows: sensitivity=68.79% to 83.91% and specificity=76.03% to 92.18%. Conclusions: This study demonstrates the ability to automate screening for patients in need of advanced care for depression across (1) an overall patient population or (2) various high-risk patient groups using structured datasets covering acute and chronic conditions, patient demographics, behaviors, and past visit history. Furthermore, these results show considerable potential to enable preventative care and can be easily integrated into existing clinical workflows to improve access to wraparound health care services. %M 31333196 %R 10.2196/13809 %U http://www.jmir.org/2019/7/e13809/ %U https://doi.org/10.2196/13809 %U http://www.ncbi.nlm.nih.gov/pubmed/31333196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e13065 %T The Cost-Effectiveness of an Internet Intervention to Facilitate Mental Health Help-Seeking by Young Adults: Randomized Controlled Trial %A Le,Long Khanh-Dao %A Sanci,Lena %A Chatterton,Mary Lou %A Kauer,Sylvia %A Buhagiar,Kerrie %A Mihalopoulos,Cathrine %+ Deakin Health Economics, Institute for Health Transformation, School of Health and Social Development, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 392468383, long.le@deakin.edu.au %K economic evaluation %K cost effectiveness %K mental health %K help-seeking %K internet intervention %D 2019 %7 22.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Little empirical evidence is available to support the effectiveness and cost-effectiveness of internet interventions to increase help-seeking behavior for mental health in young adults. Objective: The aim of this study was to evaluate the cost-effectiveness of a Web-based mental health help-seeking navigation tool (Link) in comparison with usual help-seeking strategies. Methods: A cost-utility analysis alongside the main randomized trial of Link was conducted from the Australian health care sector perspective. Young adults aged 18 to 25 years were randomized to the Link intervention (n=205) or usual care (n=208) with 1- and 3-month follow-ups. The primary outcome of this study was quality-adjusted life years (QALYs) measured by the assessment of quality of life–4D. Costs were calculated based on the self-reported resource use questionnaire and were reported in 2015 Australian dollars. Primary analyses were conducted as intention-to-treat and reported as incremental cost-effectiveness ratios. Completer analyses were conducted in a sensitivity analysis. Results: Significantly more QALYs were gained in the intervention group than the control group (0.15 vs 0.14; P<.001). The intervention was associated with significantly lower health professional consultation costs at 1-month follow-up (mean costs Aus $98 vs Aus $162; P<.05). Costs of hospital services were lower at 3 months in the intervention arm (mean costs Aus $47 vs Aus $101); however, there was insufficient sample size to detect a significant difference between the groups. There were no statistically significant differences in the total costs between the 2 arms. Relative to the control group, those who received the intervention experienced 0.01 more QALYs (0.00-0.02) and had lower total health sector costs of Aus −$81 (Aus −$348 to Aus $186) over 3 months. The intervention was found to be more effective and less costly compared with usual help-seeking strategies. The intervention was 100% likely to be cost-effective below a willingness-to-pay value-for-money threshold of Aus $28,033 per QALY. Results were robust in the sensitivity analysis. Conclusions: Our study found that the online youth mental health help-seeking Web service is a cost-effective intervention for young people aged 18 to 25 years compared with usual search strategies. Further research is required to confirm these results. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12614001223628; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?id=366731 %M 31333199 %R 10.2196/13065 %U http://www.jmir.org/2019/7/e13065/ %U https://doi.org/10.2196/13065 %U http://www.ncbi.nlm.nih.gov/pubmed/31333199 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e12869 %T Digital Mental Health Interventions for Depression, Anxiety, and Enhancement of Psychological Well-Being Among College Students: Systematic Review %A Lattie,Emily G %A Adkins,Elizabeth C %A Winquist,Nathan %A Stiles-Shields,Colleen %A Wafford,Q Eileen %A Graham,Andrea K %+ Center for Behavioral Intervention Technologies, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 3125033741, emily.lattie@northwestern.edu %K eHealth %K mHealth %K mental health %K students %K universities %D 2019 %7 22.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: College students are increasingly reporting common mental health problems, such as depression and anxiety, and they frequently encounter barriers to seeking traditional mental health treatments. Digital mental health interventions, such as those delivered via the Web and apps, offer the potential to improve access to mental health treatment. Objective: This study aimed to review the literature on digital mental health interventions focused on depression, anxiety, and enhancement of psychological well-being among samples of college students to identify the effectiveness, usability, acceptability, uptake, and adoption of such programs. Methods: We conducted a systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092800), and the search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) from the date of inception to April 2019. Data were synthesized using a systematic narrative synthesis framework, and formal quality assessments were conducted to address the risk of bias. Results: A total of 89 studies met the inclusion criteria. The majority of interventions (71/89, 80%) were delivered via a website, and the most common intervention was internet-based cognitive behavioral therapy (28, 31%). Many programs (33, 37%) featured human support in the form of coaching. The majority of programs were either effective (42, 47%) or partially effective (30, 34%) in producing beneficial changes in the main psychological outcome variables. Approximately half of the studies (45, 51%) did not present any usability or acceptability outcomes, and few studies (4, 4%) examined a broad implementation of digital mental health interventions on college campuses. Quality assessments revealed a moderate-to-severe risk of bias in many of the studies. Conclusions: Results suggest that digital mental health interventions can be effective for improving depression, anxiety, and psychological well-being among college students, but more rigorous studies are needed to ascertain the effective elements of these interventions. Continued research on improving the user experience of, and thus user engagement with, these programs appears vital for the sustainable implementation of digital mental health interventions on college campuses. %M 31333198 %R 10.2196/12869 %U http://www.jmir.org/2019/7/e12869/ %U https://doi.org/10.2196/12869 %U http://www.ncbi.nlm.nih.gov/pubmed/31333198 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e12556 %T Guided Self-Help Works: Randomized Waitlist Controlled Trial of Pacifica, a Mobile App Integrating Cognitive Behavioral Therapy and Mindfulness for Stress, Anxiety, and Depression %A Moberg,Christine %A Niles,Andrea %A Beermann,Dale %+ Pacifica Labs, Inc, 150 S 5th Street, Suite 825, Minneapolis, MN, 55402, United States, 1 6083470325, christine.moberg@gmail.com %K mHealth %K anxiety %K depression %K stress %K cognitive behavioral therapy %K smartphone app %D 2019 %7 8.6.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite substantial improvements in technology and the increased demand for technology-enabled behavioral health tools among consumers, little progress has been made in easing the burden of mental illness. This may be because of the inherent challenges of conducting traditional clinical trials in a rapidly evolving technology landscape. Objective: This study sought to validate the effectiveness of Pacifica, a popular commercially available app for the self-management of mild-to-moderate stress, anxiety, and depression. Methods: A total of 500 adults with mild-to-moderate anxiety or depression were recruited from in-app onboarding to participate in a randomized waitlist controlled trial of Pacifica. We conducted an all-virtual study, recruiting, screening, and randomizing participants through a Web-based participant portal. Study participants used the app for 1 month, with no level of use required, closely mimicking real-world app usage. Participants in the waitlist group were given access to the app after 1 month. Measurements included self-reported symptoms of stress, anxiety, depression, and self-efficacy. We performed an intent-to-treat analysis to examine the interactive effects of time and condition. Results: We found significant interactions between time and group. Participants in the active condition demonstrated significantly greater decreases in depression, anxiety, and stress and increases in self-efficacy. Although we did not find a relationship between overall engagement with the app and symptom improvement, participants who completed relatively more thought record exercises sustained improvements in their symptoms through the 2-month follow-up to a greater degree than those who completed fewer. In addition, we found that participants who reported concomitantly taking psychiatric medications during the trial benefitted less from the app, as measured by the symptoms of anxiety and stress. Conclusions: This study provides evidence that Pacifica, a popular commercially available self-help app, is effective in reducing self-reported symptoms of depression, anxiety, and stress, particularly among individuals who utilize thought records and are not taking psychiatric medication. Trial Registration: ClinicalTrials.gov NCT03333707; https://clinicaltrials.gov/ct2/show/NCT03333707 (Archived by WebCite at http://www.webcitation.org/78YE07ADB) %M 31199319 %R 10.2196/12556 %U https://www.jmir.org/2019/6/e12556/ %U https://doi.org/10.2196/12556 %U http://www.ncbi.nlm.nih.gov/pubmed/31199319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12248 %T Predisposing and Motivational Factors Related to Social Network Sites Use: Systematic Review %A Mancinelli,Elisa %A Bassi,Giulia %A Salcuni,Silvia %+ Department of General Psychology, University of Padua, Via Venezia 8, Padua, 35219, Italy, 39 3342799698, elisa.mancinelli@studenti.unipd.it %K social networks %K individual differences %K motivation %K adolescents %K adults %D 2019 %7 9.6.2019 %9 Review %J JMIR Form Res %G English %X Background: Social network sites (SNSs) have been defined as Web services that involve creating a private or semiprivate profile. Through these services, adolescents and adults can maintain and create new relationships. Adolescents, in particular, can be considered the main users of these sites as they spend a lot of time on SNSs. In using SNSs, individuals can exert greater control over the conversation and on the information shared, which is associated with a desire for self-presentation. Moreover, the need for self-presentation is related to personality traits such as those of the Big Five, namely extraversion, neuroticism, openness to experience, agreeableness, and conscientiousness, as well as emotional stability, introversion, narcissism, and motivational aspects. The latter are usually linked to an underlying social purpose that might predispose an individual to using SNSs, with the intent of satisfying particular needs, such as belongingness and interpersonal competency. Objective: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, this study aimed to present a systematic review of the scientific literature regarding the predisposing factors related to the Big Five personality traits and motivational aspects associated with the use of SNSs, for both adolescents (12-19 years) and adults (>20 years). Methods: A search ranging from 2007 to 2017 was conducted through the academic database of Google Scholar and PsycINFO, in which the following terms and their derivatives were considered: predisposing factors, personality traits, Big Five model, self-esteem, self-presentation, interpersonal competency, social network site, Facebook, motivation, five-factor model, use, abuse, and addiction. Based on a defined list of inclusion and exclusion criteria, a total of 9 papers were finally included in the review. Results: Our findings identified 3 main personality traits to be of greater value: extraversion, neuroticism, and openness to experience. Extraversion was a good predictor of motivation and SNS use, whereas the latter trait showed relevance for age differences. All 3 features further played a role in gender differences. Apart from extraversion, the self-presentational motive was also related to narcissism, whereas the need to belong presented an association with agreeableness and neuroticism. Further underlining the social value behind SNS use, people perceived interpersonal competency as being related to Facebook use intensity. Conclusions: Extraversion was recognized as the main forerunner for SNS use and motivation for use. Neuroticism seems to be related to an attempt at compensating for difficulties in real-life social contexts. Openness to experiences has a strong valence for both adults and older adults since SNSs are still perceived as a novelty. Moreover, gender differences in SNS usage were observed to be the product of differences in motivation. Implications and limitations of the study were discussed. %M 31199318 %R 10.2196/12248 %U http://formative.jmir.org/2019/2/e12248/ %U https://doi.org/10.2196/12248 %U http://www.ncbi.nlm.nih.gov/pubmed/31199318 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e11705 %T Proactive Suicide Prevention Online (PSPO): Machine Identification and Crisis Management for Chinese Social Media Users With Suicidal Thoughts and Behaviors %A Liu,Xingyun %A Liu,Xiaoqian %A Sun,Jiumo %A Yu,Nancy Xiaonan %A Sun,Bingli %A Li,Qing %A Zhu,Tingshao %+ Institute of Psychology, Chinese Academy of Sciences, No.16, Lincui Road, Beijing,, China, 86 150 1096 5509, tszhu@psych.ac.cn %K suicide identification %K crisis management %K machine learning %K microblog direct message %K social network %K Chinese young people %D 2019 %7 08.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a great public health challenge. Two hundred million people attempt suicide in China annually. Existing suicide prevention programs require the help-seeking initiative of suicidal individuals, but many of them have a low motivation to seek the required help. We propose that a proactive and targeted suicide prevention strategy can prompt more people with suicidal thoughts and behaviors to seek help. Objective: The goal of the research was to test the feasibility and acceptability of Proactive Suicide Prevention Online (PSPO), a new approach based on social media that combines proactive identification of suicide-prone individuals with specialized crisis management. Methods: We first located a microblog group online. Their comments on a suicide note were analyzed by experts to provide a training set for the machine learning models for suicide identification. The best-performing model was used to automatically identify posts that suggested suicidal thoughts and behaviors. Next, a microblog direct message containing crisis management information, including measures that covered suicide-related issues, depression, help-seeking behavior and an acceptability test, was sent to users who had been identified by the model to be at risk of suicide. For those who replied to the message, trained counselors provided tailored crisis management. The Simplified Chinese Linguistic Inquiry and Word Count was also used to analyze the users’ psycholinguistic texts in 1-month time slots prior to and postconsultation. Results: A total of 27,007 comments made in April 2017 were analyzed. Among these, 2786 (10.32%) were classified as indicative of suicidal thoughts and behaviors. The performance of the detection model was good, with high precision (.86), recall (.78), F-measure (.86), and accuracy (.88). Between July 3, 2017, and July 3, 2018, we sent out a total of 24,727 direct messages to 12,486 social media users, and 5542 (44.39%) responded. Over one-third of the users who were contacted completed the questionnaires included in the direct message. Of the valid responses, 89.73% (1259/1403) reported suicidal ideation, but more than half (725/1403, 51.67%) reported that they had not sought help. The 9-Item Patient Health Questionnaire (PHQ-9) mean score was 17.40 (SD 5.98). More than two-thirds of the participants (968/1403, 69.00%) thought the PSPO approach was acceptable. Moreover, 2321 users replied to the direct message. In a comparison of the frequency of word usage in their microblog posts 1-month before and after the consultation, we found that the frequency of death-oriented words significantly declined while the frequency of future-oriented words significantly increased. Conclusions: The PSPO model is suitable for identifying populations that are at risk of suicide. When followed up with proactive crisis management, it may be a useful supplement to existing prevention programs because it has the potential to increase the accessibility of antisuicide information to people with suicidal thoughts and behaviors but a low motivation to seek help. %M 31344675 %R 10.2196/11705 %U https://www.jmir.org/2019/5/e11705/ %U https://doi.org/10.2196/11705 %U http://www.ncbi.nlm.nih.gov/pubmed/31344675 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e12910 %T Using Machine Learning to Derive Just-In-Time and Personalized Predictors of Stress: Observational Study Bridging the Gap Between Nomothetic and Ideographic Approaches %A Rozet,Alan %A Kronish,Ian M %A Schwartz,Joseph E %A Davidson,Karina W %+ Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center, Presbyterian Hospital Building, 9th Floor, 622 W 168th Street, New York, NY, 10032, United States, 1 212 342 4493, ar3793@cumc.columbia.edu %K ecological momentary assessment %K machine learning %K stress-behavior pathway %K personal informatics %K self-quantification %K exercise %K weather %K just-in-time interventions %D 2019 %7 26.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Investigations into person-specific predictors of stress have typically taken either a population-level nomothetic approach or an individualized ideographic approach. Nomothetic approaches can quickly identify predictors but can be hindered by the heterogeneity of these predictors across individuals and time. Ideographic approaches may result in more predictive models at the individual level but require a longer period of data collection to identify robust predictors. Objective: Our objectives were to compare predictors of stress identified through nomothetic and ideographic models and to assess whether sequentially combining nomothetic and ideographic models could yield more accurate and actionable predictions of stress than relying on either model. At the same time, we sought to maintain the interpretability necessary to retrieve individual predictors of stress despite using nomothetic models. Methods: Data collected in a 1-year observational study of 79 participants performing low levels of exercise were used. Physical activity was continuously and objectively monitored by actigraphy. Perceived stress was recorded by participants via daily ecological momentary assessments on a mobile app. Environmental variables including daylight time, temperature, and precipitation were retrieved from the public archives. Using these environmental, actigraphy, and mobile assessment data, we built machine learning models to predict individual stress ratings using linear, decision tree, and neural network techniques employing nomothetic and ideographic approaches. The accuracy of the approaches for predicting individual stress ratings was compared based on classification errors. Results: Across the group of patients, an individual’s recent history of stress ratings was most heavily weighted in predicting a future stress rating in the nomothetic recurrent neural network model, whereas environmental factors such as temperature and daylight, as well as duration and frequency of bouts of exercise, were more heavily weighted in the ideographic models. The nomothetic recurrent neural network model was the highest performing nomothetic model and yielded 72% accuracy for an 80%/20% train/test split. Using the same 80/20 split, the ideographic models yielded 75% accuracy. However, restricting ideographic models to participants with more than 50 valid days in the training set, with the same 80/20 split, yielded 85% accuracy. Conclusions: We conclude that for some applications, nomothetic models may be useful for yielding higher initial performance while still surfacing personalized predictors of stress, before switching to ideographic models upon sufficient data collection. %M 31025942 %R 10.2196/12910 %U http://www.jmir.org/2019/4/e12910/ %U https://doi.org/10.2196/12910 %U http://www.ncbi.nlm.nih.gov/pubmed/31025942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11837 %T The Relationship Between Personality Traits, Psychopathological Symptoms, and Problematic Internet Use: A Complex Mediation Model %A Koronczai,Beatrix %A Kökönyei,Gyöngyi %A Griffiths,Mark D %A Demetrovics,Zsolt %+ Department of Developmental and Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, 46 Izabella St, Budapest, H-1064, Hungary, 36 1 461 2600, koronczai.beatrix@ppk.elte.hu %K problematic internet use %K personality %K psychopathology %K psychopathological symptoms %D 2019 %7 26.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: There are many empirical studies that demonstrate the associations between problematic internet use, psychopathological symptoms, and personality traits. However, complex models are scarce. Objective: The aim of this study was to build and test a mediation model based on problematic internet use, psychopathological symptoms, and personality traits. Methods: Data were collected from a medical addiction center (43 internet addicts) and internet cafés (222 customers) in Beijing (mean age 22.45, SD 4.96 years; 239/265, 90.2% males). Path analysis was applied to test the mediation models using structural equation modeling. Results: Based on the preliminary analyses (correlations and linear regression), two different models were built. In the first model, low conscientiousness and depression had a direct significant influence on problematic internet use. The indirect effect of conscientiousness—via depression—was nonsignificant. Emotional stability only affected problematic internet use indirectly, via depressive symptoms. In the second model, low conscientiousness also had a direct influence on problematic internet use, whereas the indirect path via the Global Severity Index was again nonsignificant. Emotional stability impacted problematic internet use indirectly via the Global Severity Index, whereas it had no direct effect on it, as in the first model. Conclusions: Personality traits (ie, conscientiousness as a protective factor and neuroticism as a risk factor) play a significant role in problematic internet use, both directly and indirectly (via distress level). %M 31025955 %R 10.2196/11837 %U http://www.jmir.org/2019/4/e11837/ %U https://doi.org/10.2196/11837 %U http://www.ncbi.nlm.nih.gov/pubmed/31025955 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11410 %T Improving Moderator Responsiveness in Online Peer Support Through Automated Triage %A Milne,David N %A McCabe,Kathryn L %A Calvo,Rafael A %+ School of Information, Systems and Modelling, Faculty of Engineering and Information Technology, University of Technology, Sydney, PO Box 123, Sydney, NSW 2007, Australia, 61 (02) 9514 3171, david.milne@uts.edu.au %K social support %K triage %K classification %K natural language processing %D 2019 %7 26.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Online peer support forums require oversight to ensure they remain safe and therapeutic. As online communities grow, they place a greater burden on their human moderators, which increases the likelihood that people at risk may be overlooked. This study evaluated the potential for machine learning to assist online peer support by directing moderators’ attention where it is most needed. Objective: This study aimed to evaluate the accuracy of an automated triage system and the extent to which it influences moderator behavior. Methods: A machine learning classifier was trained to prioritize forum messages as green, amber, red, or crisis depending on how urgently they require attention from a moderator. This was then launched as a set of widgets injected into a popular online peer support forum hosted by ReachOut.com, an Australian Web-based youth mental health service that aims to intervene early in the onset of mental health problems in young people. The accuracy of the system was evaluated using a holdout test set of manually prioritized messages. The impact on moderator behavior was measured as response ratio and response latency, that is, the proportion of messages that receive at least one reply from a moderator and how long it took for these replies to be made. These measures were compared across 3 periods: before launch, after an informal launch, and after a formal launch accompanied by training. Results: The algorithm achieved 84% f-measure in identifying content that required a moderator response. Between prelaunch and post-training periods, response ratios increased by 0.9, 4.4, and 10.5 percentage points for messages labelled as crisis, red, and green, respectively, but decreased by 5.0 percentage points for amber messages. Logistic regression indicated that the triage system was a significant contributor to response ratios for green, amber, and red messages, but not for crisis messages. Response latency was significantly reduced (P<.001), between the same periods, by factors of 80%, 80%, 77%, and 12% for crisis, red, amber, and green messages, respectively. Regression analysis indicated that the triage system made a significant and unique contribution to reducing the time taken to respond to green, amber, and red messages, but not to crisis messages, after accounting for moderator and community activity. Conclusions: The triage system was generally accurate, and moderators were largely in agreement with how messages were prioritized. It had a modest effect on response ratios, primarily because moderators were already more likely to respond to high priority content before the introduction of triage. However, it significantly and substantially reduced the time taken for moderators to respond to prioritized content. Further evaluations are needed to assess the impact of mistakes made by the triage algorithm and how changes to moderator responsiveness impact the well-being of forum members. %M 31025945 %R 10.2196/11410 %U https://www.jmir.org/2019/4/e11410/ %U https://doi.org/10.2196/11410 %U http://www.ncbi.nlm.nih.gov/pubmed/31025945 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11081 %T How Confidence in Prior Attitudes, Social Tag Popularity, and Source Credibility Shape Confirmation Bias Toward Antidepressants and Psychotherapy in a Representative German Sample: Randomized Controlled Web-Based Study %A Schweiger,Stefan %A Cress,Ulrike %+ Knowledge Construction Lab, Knowledge Media Research Center, Leibniz-Institut für Wissensmedien, Schleichstrasse 6, Tuebingen, 72076, Germany, 49 6702023838, schw.stefan@gmail.com %K attitude %K psychotherapy %K antidepressive agents %K culture %K Germany %K health literacy %K professional competence %K information systems %K consumer health information %K information dissemination %D 2019 %7 23.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In health-related, Web-based information search, people should select information in line with expert (vs nonexpert) information, independent of their prior attitudes and consequent confirmation bias. Objective: This study aimed to investigate confirmation bias in mental health–related information search, particularly (1) if high confidence worsens confirmation bias, (2) if social tags eliminate the influence of prior attitudes, and (3) if people successfully distinguish high and low source credibility. Methods: In total, 520 participants of a representative sample of the German Web-based population were recruited via a panel company. Among them, 48.1% (250/520) participants completed the fully automated study. Participants provided prior attitudes about antidepressants and psychotherapy. We manipulated (1) confidence in prior attitudes when participants searched for blog posts about the treatment of depression, (2) tag popularity —either psychotherapy or antidepressant tags were more popular, and (3) source credibility with banners indicating high or low expertise of the tagging community. We measured tag and blog post selection, and treatmentefficacy ratings after navigation. Results: Tag popularity predicted the proportion of selected antidepressant tags (beta=.44, SE 0.11; P<.001) and blog posts (beta=.46, SE 0.11; P<.001). When confidence was low (−1 SD), participants selected more blog posts consistent with prior attitudes (beta=−.26, SE 0.05; P<.001). Moreover, when confidence was low (−1 SD) and source credibility was high (+1 SD), the efficacy ratings of attitude-consistent treatments increased (beta=.34, SE 0.13; P=.01). Conclusions: We found correlational support for defense motivation account underlying confirmation bias in the mental health–related search context. That is, participants tended to select information that supported their prior attitudes, which is not in line with the current scientific evidence. Implications for presenting persuasive Web-based information are also discussed. Trial Registration: ClinicalTrials.gov NCT03899168; https://clinicaltrials.gov/ct2/show/NCT03899168 (Archived by WebCite at http://www.webcitation.org/77Nyot3Do) %M 31012865 %R 10.2196/11081 %U http://www.jmir.org/2019/4/e11081/ %U https://doi.org/10.2196/11081 %U http://www.ncbi.nlm.nih.gov/pubmed/31012865 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11706 %T Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders in Open Community Versus Clinical Service Recruitment: Meta-Analysis %A Romijn,Geke %A Batelaan,Neeltje %A Kok,Robin %A Koning,Jeroen %A van Balkom,Anton %A Titov,Nickolai %A Riper,Heleen %+ Department of Clinical, Neuro and Developmental Psychology, VU University, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, Amsterdam,, Netherlands, 31 20 59 89009, g.a.romijn@vu.nl %K anxiety disorders %K cognitive behavioral therapy %K internet %K recruitment method %K efficacy %K effectiveness %D 2019 %7 17.04.2019 %9 Review %J J Med Internet Res %G English %X Background: Ample studies have shown the effectiveness of internet-delivered cognitive behavioral therapy (iCBT) for anxiety disorders. These studies recruited their participants mainly from the community and, to a lesser extent, from within routine care services. Little is known about whether different recruitment strategies lead to different treatment effects. Objective: This meta-analysis compared clinical results obtained in trials with recruitment from the community versus results obtained in trials with clinical service recruitment and explored factors that may mediate differences in treatment outcome. Methods: We included randomized controlled trials in which the clinical effects of iCBT for anxiety disorders were compared with a control condition (waitlist controls or face-to-face cognitive behavioral therapy). We classified trials as open recruitment trials (recruitment from the community) or clinical service recruitment trials (recruitment through outpatient clinics). Pooled effect sizes based on measures examining anxiety symptoms, depressive symptoms, and quality of life were computed for each type of trial. Subgroup analyses examined whether clinical results from open recruitment trials differed from those obtained in clinical service recruitment trials. Additional analyses explored which demographic, clinical, and treatment-related factors contributed to differences in effect sizes of open recruitment versus clinical service recruitment trials. Results: We included 42 studies with 53 comparisons (43 open recruitment comparisons and 10 clinical recruitment comparisons). Analyses of anxiety measures revealed, first, that iCBT open recruitment studies with waitlist control comparators showed a significantly higher effect size for decrease in anxiety symptoms than did those with clinical recruitment (Q=10.09; P=.001). This association between recruitment method and effect size was no longer significant in a multivariate metaregression with treatment adherence and exclusion of patients with depressive symptoms entered as additional predictors of effect size. Second, effect size for decrease in anxiety symptoms did not differ significantly between clinical recruitment and open recruitment studies with face-to-face cognitive behavioral therapy comparators. The effects of open recruitment trials and clinical recruitment trials did not differ significantly for the secondary outcomes, compared with face-to-face cognitive behavioral therapy and waitlist controls. Conclusions: iCBT was effective in samples recruited in clinical practice, but effect sizes were smaller than those found in trials with an open recruitment method for studies with waitlist control comparators. Hence, for patients with anxiety disorders in routine care, the impact of iCBT may not be as positive as for study participants recruited from the community. The difference between open recruitment trials and clinical service recruitment trials might be partly explained by patients’ greater therapy adherence in open recruitment trials and the stricter exclusion of patients with severe depressive symptoms in these studies. Since most trials in this meta-analysis applied an open recruitment method, more studies with routine care populations are needed to further validate these findings. %M 30994462 %R 10.2196/11706 %U http://www.jmir.org/2019/4/e11706/ %U https://doi.org/10.2196/11706 %U http://www.ncbi.nlm.nih.gov/pubmed/30994462 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e12003 %T A Digital Game and School-Based Intervention for Students in Hong Kong: Quasi-Experimental Design %A Shum,Angie KY %A Lai,Eliza SY %A Leung,Wing Gi %A Cheng,Mabel NS %A Wong,Ho Kit %A So,Sam WK %A Law,Yik Wa %A Yip,Paul SF %+ The Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong,, China (Hong Kong), 852 28315232, sfpyip@hku.hk %K digital game-based learning %K school-based learning %K mental health %K schools %K students %K child welfare %K health promotion %K follow-up studies %K internet access %K public health %K non-randomized controlled trials %D 2019 %7 05.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In Hong Kong, with an increasing number of children experiencing mental health issues, there is a need to not only develop innovative interventions but also develop comprehensive prevention interventions so as to reduce their anxiety symptoms and enhance their emotional management and interpersonal relationships. Objective: The aim of this study was to determine the effectiveness of The Adventures of DoReMiFa, an integration model of the cognitive-behavioral approach and positive psychology by using digital game–based and school-based mental health enhancement intervention to magnify the social and emotional health and well-being of the school children in Hong Kong aged 9 to 11 years. Methods: A quasi-experimental design method was used to evaluate this digital game and school-based intervention. The Adventures of DoReMiFa was piloted in 4 primary schools where students were allocated to either an intervention or a control group. The participants were assessed at pre- and postintervention with a 6-month follow-up measuring their mental health knowledge, levels of anxiety symptoms, positive and negative thinking, perspective-taking, and self-esteem. Results: A total of 459 primary school students from 4 primary schools participated in the study. The response rate on the questionnaires answered on the Web was up to 85.1% (391/459). Compared with the control group, the intervention group was found to have significant association with improved mental health knowledge at the time immediately after the intervention (beta=.46; P=.01) and in the 6-month postintervention period (beta=.66; P<.001); for perspective-taking, the intervention group had exhibited a significant improvement 6 months after the completion of the universal program (beta=1.50; P=.03). The intervention, however, was found not to be effective in reducing the rates of anxiety symptoms and negative thinking among the participating students. Conclusions: The Adventures of DoReMiFa, an integration of a digital game–based and school-based mental health enhancement intervention, was shown to be effective in elevating the knowledge of mental health and promoting perspective-taking in the primary school students of Hong Kong. Although there was insufficient evidence to support a reduction in symptoms of anxiety and negative automatic thoughts, the overall results were still encouraging in that a preventive effect was found, indicating that the program has the potential to enhance the mental well-being of schoolchildren. It also suggests that knowledge enhancement may not necessarily lead to behavior change, and more focused effort may be needed to achieve the translation. The implications and limitations of this study and suggestions for future research were also discussed. %M 30950795 %R 10.2196/12003 %U https://www.jmir.org/2019/4/e12003/ %U https://doi.org/10.2196/12003 %U http://www.ncbi.nlm.nih.gov/pubmed/30950795 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11824 %T Digital Technology for Internet Access by Patients With Early-Stage Schizophrenia in Spain: Multicenter Research Study %A Fernández-Sotos,Patricia %A Fernández-Caballero,Antonio %A González,Pascual %A Aparicio,Ana Isabel %A Martínez-Gras,Isabel %A Torio,Iosune %A Dompablo,Mónica %A García-Fernández,Lorena %A Santos,José Luis %A Rodriguez-Jimenez,Roberto %+ Department of Psychiatry, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Avda. de Córdoba, s/n, Madrid, 28041, Spain, 34 913908426, roberto.rodriguez.jimenez@gmail.com %K information technology %K computers %K internet %K schizophrenia %D 2019 %7 05.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital technology and social networks are part of everyday life in the current internet age, especially among young people. To date, few studies have been published worldwide on the pattern of use of digital technology devices and applications in patients with early-stage schizophrenia and even fewer comparing them with healthy participants (not using data from general population surveys) from the same demographic areas. In Spain, no such study has been carried out. Objective: The aim of this study was to analyze how patients with early-stage schizophrenia use internet and social networks compared with healthy participants matched by age and gender and also to examine which devices are utilized to access internet resources. Methods: A cross-sectional, multicentric study was carried out through a semistructured interview asking about the use of digital technology devices and internet. The sample comprised 90 patients and 90 healthy participants. The semistructured interview was conducted on 30 outpatients and 30 healthy subjects in each of the 3 different cities (Madrid, Alicante, and Cuenca). Student t test was used for continuous variables and chi-square test for categorical variables. In the case of ordinal variables, nonparametric Mann-Whitney U and Kruskal-Wallis H tests for independent samples were performed to compare groups. Results: The results indicated that a large proportion of patients with early-stage schizophrenia have access to different digital devices and use them frequently. In addition, both groups coincide in the order of preference and the purpose for which they use the devices. However, a lower frequency of use of most digital technology devices was detected in patients compared with healthy participants. In the case of some devices, this was due to the impossibility of access and not a lack of interest. Conclusions: To our knowledge, this is the first study to analyze patterns of internet access and use of digital technology devices and applications in Spanish patients with early-stage schizophrenia compared with healthy participants from the same demographic areas. The results on significant access and use of digital technology and internet shown in this cross-sectional study will allow enhanced and more efficient treatment strategies to be planned, utilizing digital technology devices, for patients with early-stage schizophrenia. %M 30950798 %R 10.2196/11824 %U https://www.jmir.org/2019/4/e11824/ %U https://doi.org/10.2196/11824 %U http://www.ncbi.nlm.nih.gov/pubmed/30950798 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11485 %T To Each Stress Its Own Screen: A Cross-Sectional Survey of the Patterns of Stress and Various Screen Uses in Relation to Self-Admitted Screen Addiction %A Khalili-Mahani,Najmeh %A Smyrnova,Anna %A Kakinami,Lisa %+ PERFORM Centre, Design and Computation Arts, Concordia University, 7200 Rue Sherbrooke O, Montreal, QC, H4B1R6, Canada, 1 5148482424 ext 5370, najmeh.khalili-mahani@concordia.ca %K psychological stress %K addictive behavior %K coping behavior %K social network %K gaming, internet %K communications %K telemedicine %K eHealth %D 2019 %7 02.04.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The relationship between stress and screen addiction is often studied by exploring a single aspect of screen-related behavior in terms of maladaptive dependency or the risks associated with the content. Generally, little attention is given to the pattern of using different screens for different types of stressors, and variations arising from the subjective perception of stress and screen addiction are often neglected. Given that both addiction and stress are complex and multidimensional factors, we performed a multivariate analysis of the link between individual’s subjective perceptions of screen addiction, various types of stress, and the pattern of screen usage. Objective: Using the media-repertoires framework to study usage patterns, we explored (1) the relation between subjective and quantitative assessments of stress and screen addiction; and (2) differences in stress types in relation to subjective screen addiction and different types of needs for screens. We hypothesized that interindividual heterogeneity in screen-related behavior would reflect coping differences in dealing with different stressors. Methods: A multifactorial Web-based survey was conducted to gather data about screen-related behaviors (such as screen time, internet addiction, and salience of different types of screens and related activities), and different sources of stress (emotional states, perceptual risks, health problems, and general life domain satisfaction). We performed group comparisons based on whether participants reported themselves as addicted to internet and games (A1) or not (A0), and whether they had experienced a major life stress (S1) or not (S0). Results: Complete responses were obtained in 459 out of 654 survey responders, with the majority in the S1A0 (44.6%, 205/459) group, followed by S0A0 (25.9%, 119/459), S1A1 (19.8%, 91/459), and S0A1 (9.5%, 44/459). The S1A1 group was significantly different from S0A0 in all types of stress, internet overuse, and screen time (P<.001). Groups did not differ in rating screens important for short message service (SMS) or mail, searching information, shopping, and following the news, but a greater majority of A1 depended on screens for entertainment (χ23=20.5; P<.001), gaming (χ23=35.6; P<.001), and social networking (χ23=26.5; P<.001). Those who depended on screens for entertainment and social networking had up to 19% more emotional stress and up to 14% more perceptual stress. In contrast, those who relied on screens for work and professional networking had up to 10% higher levels of life satisfaction. Regression models including age, gender, and 4 stress types explained less than 30% of variation in internet use and less than 24% of the likelihood of being screen addicted. Conclusions: We showed a robust but heterogeneous link between screen dependency and emotional and perceptual stressors that shift the pattern of screen usage toward entertainment and social networking. Our findings underline the potential of using ludic and interactive apps for intervention against stress. %M 30938685 %R 10.2196/11485 %U https://www.jmir.org/2019/4/e11485/ %U https://doi.org/10.2196/11485 %U http://www.ncbi.nlm.nih.gov/pubmed/30938685 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11600 %T Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers %A Garabiles,Melissa R %A Harper Shehadeh,Melissa %A Hall,Brian J %+ Global and Community Mental Health Research Group, The University of Macau, E21-3040, Avenida da Universidade, Macau, 99908, China, 86 62899837, brianhall@um.edu.mo %K cultural adaptation %K migrant workers %K e-mental health %K overseas Filipino workers %D 2019 %7 29.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes. Objective: This study aimed to describe the cultural adaptation of the World Health Organization’s e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions. Methods: Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement. Results: Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. Conclusions: This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions. %M 30924784 %R 10.2196/11600 %U https://formative.jmir.org/2019/1/e11600/ %U https://doi.org/10.2196/11600 %U http://www.ncbi.nlm.nih.gov/pubmed/30924784 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 3 %P e12958 %T Feasibility and Acceptability of a Mental Health Website for Adults With an Intellectual Disability: Qualitative Evaluation %A Watfern,Chloe %A Heck,Chloe %A Rule,Chris %A Baldwin,Peter %A Boydell,Katherine M %+ Black Dog Institute, Hospital Road, Sydney, 2031, Australia, 61 93824530, chloe.watfern@unsw.edu.au %K mental health %K internet %K intellectual disability %K qualitative evaluation %K qualitative research %K health services accessibility %D 2019 %7 28.03.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Electronic mental health (e-mental health) programs for people with an intellectual disability are currently underexplored but may provide a way of mitigating some of the barriers that this population faces in accessing appropriate mental health services. Objective: The aim of this study was to examine the feasibility and acceptability of Healthy Mind, an e-mental health program for adults with an intellectual disability developed by the Black Dog Institute, focusing on the design and implementation of the website. Methods: A qualitative research design was used, which involved semistructured interviews and focus groups with people with an intellectual disability, support workers, and allied health professionals. People with an intellectual disability were also observed while using the website. A thematic analysis was used to interrogate the interview transcripts and observational field notes. Results: Participants found the content of the website informative and appreciated the many ways that the website had been made accessible to users. Participants voiced some differing requirements regarding the way information should be presented and accessed on the website. Acknowledging different types of support needs was identified as an important issue for website dissemination. Conclusions: The Healthy Mind website promises to provide an excellent tool for people with ID and their supporters. This research has pragmatic implications for the future development and implementation of the program, while contributing to knowledge in the broader fields of e-mental health and inclusive design for people with an intellectual disability. %M 30920378 %R 10.2196/12958 %U http://mental.jmir.org/2019/3/e12958/ %U https://doi.org/10.2196/12958 %U http://www.ncbi.nlm.nih.gov/pubmed/30920378 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12235 %T Do Search Engine Helpline Notices Aid in Preventing Suicide? Analysis of Archival Data %A Cheng,Qijin %A Yom-Tov,Elad %+ Microsoft Research, 13 Shenkar Street, Herzeliya, 46733, Israel, 972 747111359, eladyt@yahoo.com %K search engines %K suicide %D 2019 %7 26.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Search engines display helpline notices when people query for suicide-related information. Objective: In this study, we aimed to examine if these notices and other information displayed in response to suicide-related queries are correlated with subsequent searches for suicide prevention rather than harmful information. Methods: Anonymous suicide-related searches made on Bing and Google in the United States, the United Kingdom, Hong Kong, and Taiwan in a span of 10 months were extracted. Descriptive analyses and regression models were fit to the data to assess the correlation with observed behaviors. Results: Display of helpline notices was not associated with an observed change in the likelihood of or future suicide searches (P=.42). No statistically significant differences were observed in the likelihood of people making future suicide queries (both generally and specific types of suicide queries) when comparing search engines in locations that display helpline notices versus ones that do not. Pages with higher rank, being neutral to suicide, and those shown among more antisuicide pages were more likely to be clicked on. Having more antisuicide Web pages displayed was the only factor associated with further searches for suicide prevention information (hazard=1.18, P=.002). Conclusions: Helpline notices are not associated with harm. If they cause positive change in search behavior, it is small. This is possibly because of the variability in intent of users seeking suicide-related information. Nonetheless, helpline notice should be displayed, but more efforts should be made to improve the visibility and ranking of suicide prevention Web pages. %M 30912753 %R 10.2196/12235 %U http://www.jmir.org/2019/3/e12235/ %U https://doi.org/10.2196/12235 %U http://www.ncbi.nlm.nih.gov/pubmed/30912753 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11224 %T Health-Related Internet Usage and Design Feature Preference for E-Mental Health Programs Among Men and Women %A Smail-Crevier,Rachel %A Powers,Gabrielle %A Noel,Chelsea %A Wang,JianLi %+ Work & Mental Health Research Unit, The Royal's Institute of Mental Health Research, University of Ottawa, 1145 Carling Ave, Ottawa, ON, K1Z 7K4, Canada, 1 613 722 6521 ext 6057, jianli.wang@theroyal.ca %K occupational health %K workplace %K mental health %K preventive health program %K depression %K internet %D 2019 %7 18.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Major depressive episodes (MDEs) are prevalent in the workplace and affect workers’ health and productivity. Therefore, there is a pressing need for innovation in the prevention of MDEs in the workplace. Electronic mental (e-mental) health programs are a cost-effective approach toward the self-management of stress and emotional issues. E-mental health dropout rate, MDE prevalence, and symptoms greatly vary by sex and age. Thus, the development and implementation of e-mental health programs for the prevention of MDEs need to be examined through a sex and age lens to enhance program use and effectiveness. Objective: This study aimed to examine design feature preferences based on sex and age for an e-mental health program targeted toward depression prevention. Methods: Household residents across Canada were contacted using the random digit dialing method. 500 women and 511 men who were 18 years and older and who were at high risk of having MDEs were interviewed. Internet use was assessed using questions from the 2012 Canadian Internet Use Survey conducted by Statistics Canada, and preferred design features of e-mental health program questions were developed by the BroMatters team members. The proportions of likely use of specific features of e-mental health programs in women were estimated and compared with those in men using chi-square tests. The comparisons were made overall and by age groups. Results: Men (181/511, 35.4%) and women (211/500, 42.2%) differed significantly in their likelihood of using an e-mental health program. Compared with men (307/489, 62.8%), women (408/479, 85.2%) were more likely to use the internet for medical or health-related information. Women were more likely to use the following design features: practices and exercises to help reduce symptoms of stress and depression (350/500, 70.7%), a self-help interactive program that provides information about stress and work problems (302/500, 61.8%), the ability to ask questions and receive answers from mental health professionals via email or text message (294/500, 59.9%), and to receive printed materials by mail (215/500, 43.4%). Men preferred to receive information in a video game format (156/511, 30.7%). Younger men (46/73, 63%) and younger women (49/60, 81%) were more likely to access a program through a mobile phone or an app, and younger men preferred having access to information in a video game format. Conclusions: Factors such as sex and age influenced design feature preferences for an e-mental health program. Working women who are at high risk for MDEs preferred interactive programs incorporating practice and exercise for reducing stress, quality information about work stress, and some guidance from professionals. This suggests that sex and age should be taken into account when designing e-mental health programs to meet the needs of individuals seeking help via Web-based mental health programs and to enhance their use. %M 30882361 %R 10.2196/11224 %U http://www.jmir.org/2019/3/e11224/ %U https://doi.org/10.2196/11224 %U http://www.ncbi.nlm.nih.gov/pubmed/30882361 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11711 %T How Do Adolescents Use Electronic Diaries? A Mixed-Methods Study Among Adolescents With Depressive Symptoms %A Metsäranta,Kiki %A Kurki,Marjo %A Valimaki,Maritta %A Anttila,Minna %+ Department of Nursing Science, University of Turku, Hoitotieteen laitos, Joukahaisenkatu 3-5, Turun yliopisto, 20014, Finland, 358 456716156, kianme@utu.fi %K adolescent %K depression %K electronic diary %K mental health %K mobile phone %K outpatient care %D 2019 %7 20.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression in adolescence is common. Less than half of the adolescents with depression receive mental health care; furthermore, treatment tends to be suspended, and its success rates are low. There is a need for these adolescents to have a safe place to share their thoughts. Studies have shown that writing may be a useful treatment method for people with mental health problems. Objective: This study aims to describe the use of an electronic diary (e-diary) among adolescents with depressive symptoms. Methods: This paper describes a substudy of a randomized controlled trial. We used a mixed-methods approach to understand the way in which e-diaries were used by participants in the intervention under the randomized controlled trial. Data were collected during 2008-2010 at 2 university hospitals in Finland. Study participants (N=89) were 15-17-year-old adolescents who had been referred to an adolescent outpatient psychiatric clinic due to depressive symptoms. Participants were instructed to use the e-diary at least once a week to describe their thoughts, feelings, and moods. The content of the e-diary data was analyzed using descriptive statistics and inductive content analysis. Results: Overall, 53% (47/89) of the adolescents used the e-diary. Most of them (39/47, 83%) logged into the program during the first week, and about one-third (19/47, 40%) logged into the e-diary weekly as suggested. The number of words used in the e-diary per each log ranged between 8 and 1442 words. The 3 topics most often written about in the e-diary were related to mental health problems (mental disorder), social interaction (relationship), and one’s own development (identity). Conclusions: An e-diary may be a usable tool to reflect experiences and thoughts, especially among adolescents who have signs of depression. The results of this study can be used to develop user-centered electronic health applications that allow users to express their own thoughts and experiences in ways other than systematic mood monitoring. %M 30785408 %R 10.2196/11711 %U http://www.jmir.org/2019/2/e11711/ %U https://doi.org/10.2196/11711 %U http://www.ncbi.nlm.nih.gov/pubmed/30785408 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11694 %T Older Adults’ Perspectives on Using Digital Technology to Maintain Good Mental Health: Interactive Group Study %A Andrews,Jacob A %A Brown,Laura JE %A Hawley,Mark S %A Astell,Arlene J %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, United Kingdom, 44 1142220682, mark.hawley@sheffield.ac.uk %K mental health %K older adults %K technology %K digital technology %K Internet %K apps %D 2019 %7 13.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A growing number of apps to support good mental health and well-being are available on digital platforms. However, very few studies have examined older adults’ attitudes toward the use of these apps, despite increasing uptake of digital technologies by this demographic. Objective: This study sought to explore older adults’ perspectives on technology to support good mental health. Methods: A total of 15 older adults aged 50 years or older, in two groups, participated in sessions to explore the use of digital technologies to support mental health. Interactive activities were designed to capture participants’ immediate reactions to apps and websites designed to support mental health and to explore their experiences of using technology for these purposes in their own lives. Template analysis was used to analyze transcripts of the group discussions. Results: Older adults were motivated to turn to technology to improve mood through mechanisms of distraction, normalization, and facilitated expression of mental states, while aiming to reduce burden on others. Perceived barriers to use included fear of consequences and the impact of low mood on readiness to engage with technology, as well as a lack of prior knowledge applicable to digital technologies. Participants were aware of websites available to support mental health, but awareness alone did not motivate use. Conclusions: Older adults are motivated to use digital technologies to improve their mental health, but barriers remain that developers need to address for this population to access them. %M 30758292 %R 10.2196/11694 %U http://www.jmir.org/2019/2/e11694/ %U https://doi.org/10.2196/11694 %U http://www.ncbi.nlm.nih.gov/pubmed/30758292 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11128 %T Design and Delivery Features That May Improve the Use of Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Anxiety: A Realist Literature Synthesis With a Persuasive Systems Design Perspective %A Radomski,Ashley D %A Wozney,Lori %A McGrath,Patrick %A Huguet,Anna %A Hartling,Lisa %A Dyson,Michele P %A Bennett,Kathryn %A Newton,Amanda S %+ Department of Pediatrics, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 780 248 5581, mandi.newton@ualberta.ca %K internet %K cognitive behavioral therapy %K computer-assisted therapy %K persuasive communication %K anxiety %K children %K adolescents %K review %K adherence %D 2019 %7 05.02.2019 %9 Review %J J Med Internet Res %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) is a persuasive system as its design combines therapeutic content, technological features, and interactions between the user and the program to reduce anxiety for children and adolescents. How iCBT is designed and delivered differs across programs. Although iCBT is considered an effective approach for treating child and adolescent anxiety, rates of program use (eg, module completion) are highly variable for reasons that are not clear. As the extent to which users complete a program can impact anxiety outcomes, understanding what iCBT design and delivery features improve program use is critical for optimizing treatment effects. Objective: The objectives of this study were to use a realist synthesis approach to explore the design and delivery features of iCBT for children and adolescents with anxiety as described in the literature and to examine their relationship to program use outcomes. Methods: A search of published and gray literature was conducted up to November 2017. Prespecified inclusion criteria identified research studies, study protocols, and program websites on iCBT for child and adolescent anxiety. Literature was critically appraised for relevance and methodological rigor. The persuasive systems design (PSD) model, a comprehensive framework for designing and evaluating persuasive systems, was used to guide data extraction. iCBT program features were grouped under 4 PSD categories—Primary task support, Dialogue support, System credibility support, and Social support. iCBT design (PSD Mechanisms) and delivery features (Context of use) were linked to program use (Outcomes) using meta-ethnographic methods; these relationships were described as Context-Mechanism-Outcome configurations. For our configurations, we identified key PSD features and delivery contexts that generated moderate-to-high program use based on moderate-to-high quality evidence found across multiple iCBT programs. Results: A total of 44 documents detailing 10 iCBT programs were included. Seven iCBT programs had at least one document that scored high for relevance; most studies were of moderate-to-high methodological rigor. We developed 5 configurations that highlighted 8 PSD features (Tailoring, Personalization [Primary task supports]; Rewards, Reminders, Social role [Dialogue supports]; and Trustworthiness, Expertise, Authority [System credibility supports]) associated with moderate-to-high program use. Important features of delivery Context were adjunct support (a face-to-face, Web- or email-based communications component) and whether programs targeted the prevention or treatment of anxiety. Incorporating multiple PSD features may have additive or synergistic effects on program use. Conclusions: The Context-Mechanism-Outcome configurations we developed suggest that, when delivered with adjunct support, certain PSD features contribute to moderate-to-high use of iCBT prevention and treatment programs for children and adolescents with anxiety. Standardization of the definition and measurement of program use, formal testing of individual and combined PSD features, and use of real-world design and testing methods are important next steps to improving how we develop and deliver increasingly useful treatments to target users. %M 30720436 %R 10.2196/11128 %U https://www.jmir.org/2019/2/e11128/ %U https://doi.org/10.2196/11128 %U http://www.ncbi.nlm.nih.gov/pubmed/30720436 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 1 %P e9978 %T Sexual Desire, Mood, Attachment Style, Impulsivity, and Self-Esteem as Predictive Factors for Addictive Cybersex %A Varfi,Nektaria %A Rothen,Stephane %A Jasiowka,Katarzyna %A Lepers,Thibault %A Bianchi-Demicheli,Francesco %A Khazaal,Yasser %+ Geneva University Hospitals, Grand Pré 70 C, Geneve, 1206, Switzerland, 41 0766792018, yasser.khazaal@hcuge.ch %K sex %K internet %K addictive behavior %K impulsivity %D 2019 %7 21.01.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: An increasing number of studies are concerned with various aspects of cybersex addiction, the difficulty some persons have in limiting cybersex use despite a negative impact on everyday life. Objective: The aim of this study was to assess potential links between the outcome variable cybersex addiction, assessed with the Compulsive Internet Use Scale (CIUS) adapted for cybersex use, and several psychological and psychopathological factors, including sexual desire, mood, attachment style, impulsivity, and self-esteem, by taking into account the age, sex, and sexual orientation of cybersex users. Methods: A Web-based survey was conducted in which participants were assessed for sociodemographic variables and with the following instruments: CIUS adapted for cybersex use, Sexual Desire Inventory, and Short Depression-Happiness Scale. Moreover, attachment style was assessed with the Experiences in Close Relationships-Revised questionnaire (Anxiety and Avoidance subscales). Impulsivity was measured by using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency Impulsive Behavior Scale. Global self-esteem was assessed with the 1-item Self-Esteem Scale. Results: A sample of 145 subjects completed the study. Addictive cybersex use was associated with higher levels of sexual desire, depressive mood, avoidant attachment style, and male gender but not with impulsivity. Conclusions: Addictive cybersex use is a function of sexual desire, depressive mood, and avoidant attachment. %M 30664470 %R 10.2196/mental.9978 %U https://mental.jmir.org/2019/1/e9978/ %U https://doi.org/10.2196/mental.9978 %U http://www.ncbi.nlm.nih.gov/pubmed/30664470 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e12244 %T The Use of Social Networking Sites in Mental Health Interventions for Young People: Systematic Review %A Ridout,Brad %A Campbell,Andrew %+ Cyberpsychology Research Group, Faculty of Health Sciences, The University of Sydney, City Road, Sydney, 2006, Australia, 61 2 9351 7089, brad.ridout@sydney.edu.au %K social media %K social networking %K mental health %K social support %K support groups %D 2018 %7 18.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The onset of mental health problems peaks between adolescence and young adulthood; however, young people face barriers to treatment and are often reluctant to seek professional help. Many are instead seeking support and information regarding their mental health via the Web, especially via social networking sites (SNSs), and hence, there is a promising opportunity to use SNSs to deliver or integrate with youth-focused online mental health interventions. Previous reviews have evaluated the effectiveness of SNSs for specific disorders in young people; however, none of the reviews have covered the breadth of SNS–based youth mental health interventions available across all mental health issues. Objective: This review aimed to systematically identify available evidence regarding the use of SNS–based interventions to support the mental health of young people aged up to 25 years, to evaluate their effectiveness, suitability, and safety, and identify gaps and opportunities for future research. Methods: The PubMed and PsycINFO databases were searched using Medical Subject Headings terms and exploded keywords and phrases. Retrieved abstracts (n=974) were double screened, yielding 235 articles for screening at the full-text level. Of these, 9 articles met the review inclusion criteria. Given the small number of studies, and the variety of outcome measures used, a quantitative meta-analysis was not possible. Results: The 9 articles (quantitative studies, qualitative studies, and descriptions of the iterative design process) covered 5 separate interventions. Of the 5 interventions, 2 interventions used purpose-built platforms based on the moderated online social therapy (MOST) model, 2 used Facebook, and 1 evaluated a purpose-built mobile app. The 2 MOST interventions targeted specific mental health issues (depression and psychosis), whereas the others focused on improving mental health literacy, social support, and general well-being. Only 3 quantitative studies were identified, and all used a pre-post design (without a control group) to establish proof of concept. Of the outcome variables assessed, there were significant improvements in mental health knowledge and number of depressive symptoms but no improvement in anxiety or psychosis symptoms. Acceptability of and engagement with the SNS platforms were generally high, as were perceptions of usefulness and safety. Moderation by clinical experts was identified as a key component of the more successful interventions. When offered a choice, users showed a preference for mobile apps over Web-based interfaces. Conclusions: The evidence reviewed suggests young people find SNS–based interventions highly usable, engaging, and supportive. However, future studies need to address the current lack of high-quality evidence for their efficacy in reducing mental health symptoms. Given young people are already turning to SNSs to engage in knowledge seeking and peer-to-peer support, SNS–based youth mental health interventions provide an opportunity to address some of the barriers young people face in accessing qualified mental health support and information. %M 30563811 %R 10.2196/12244 %U https://www.jmir.org/2018/12/e12244/ %U https://doi.org/10.2196/12244 %U http://www.ncbi.nlm.nih.gov/pubmed/30563811 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 12 %P e11007 %T The Advantages and Disadvantages of Online and Blended Therapy: Survey Study Amongst Licensed Psychotherapists in Austria %A Schuster,Raphael %A Pokorny,Raffaela %A Berger,Thomas %A Topooco,Naira %A Laireiter,Anton-Rupert %+ Outpatient Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Hellbrunnerstraße 34, Salzburg, 5020, Austria, 43 6644156146, raphael.schuster@stud.sbg.ac.at %K computer-assisted therapy %K eHealth %K psychotherapy %K attitude of health personnel %K attitude to health %K mobile phone %D 2018 %7 18.12.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based and blended (face-to-face plus Web-based) interventions for mental health disorders are gaining significance. However, many licensed psychotherapists still have guarded attitudes toward computer-assisted therapy, hindering dissemination efforts. Objective: The objective of this study was to provide a therapist-oriented evaluation of Web-based and blended therapies and identify commonalities and differences in attitudes toward both formats. Furthermore, it aimed to test the impact of an information clip on expressed attitudes. Methods: In total, 95 Austrian psychotherapists were contacted and surveyed via their listed occupational email address. An 8-minute information video was shown to half of the therapists before 19 advantages and 13 disadvantages had to be rated on a 6-point Likert scale. Results: The sample resembled all assessed properties of Austrian psychotherapists (age, theoretical orientation, and region). Therapists did not hold a uniform overall preference. Instead, perceived advantages of both interventions were rated as neutral (t94=1.89, P=.06; d=0.11), whereas Web-based interventions were associated with more disadvantages and risks (t94=9.86, P<.001; d=0.81). The information clip did not excerpt any detectable effect on therapists’ attitudes (r95=−.109, P=.30). The application of modern technologies in the own therapeutic practice and cognitive behavioral orientation were positively related to the given ratings. Conclusions: This study is the first to directly compare therapists’ attitudes toward Web-based and blended therapies. Positive attitudes play a pivotal role in the dissemination of new technologies, but unexperienced therapists seem to lack knowledge on how to benefit from technology-aided treatments. To speed up implementation, these aspects need to be addressed in the development of new interventions. Furthermore, the preference of blended treatments over Web-based interventions seems to relate to avoidance of risks. Although this study is likely to represent therapists’ attitudes in countries with less advanced electronic health services, therapists’ attitudes in more advanced countries might present differently. %M 30563817 %R 10.2196/11007 %U https://www.jmir.org/2018/12/e11007/ %U https://doi.org/10.2196/11007 %U http://www.ncbi.nlm.nih.gov/pubmed/30563817 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e11467 %T Supported Internet-Delivered Cognitive Behavioral Therapy Programs for Depression, Anxiety, and Stress in University Students: Open, Non-Randomised Trial of Acceptability, Effectiveness, and Satisfaction %A Palacios,Jorge E %A Richards,Derek %A Palmer,Riley %A Coudray,Carissa %A Hofmann,Stefan G %A Palmieri,Patrick A %A Frazier,Patricia %+ E-mental Health Research Group, School of Psychology, University of Dublin, Trinity College Dublin, College Green, Dublin,, Ireland, 353 18961000, jorge.palacios@tcd.ie %K depression %K anxiety %K cognitive therapy %K students %D 2018 %7 14.12.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Many university campuses have limited mental health services that cannot cope with the high demand. One alternative is to use internet-delivered cognitive behavioral therapy (iCBT) as a way of tackling barriers such as lack of availability and scheduling issues. Objective: This study aimed to assess feasibility, acceptability, effectiveness, and satisfaction of a supported iCBT intervention offering 3 programs on depression, anxiety, and stress to university students. The design was an open or nonrandomized feasibility trial. Methods: Participants were recruited from 3 counseling centers at a large midwestern University in the United States. Those agreeing to take part chose 1 of 3 iCBT programs—Space from Depression, Space from Anxiety, or Space from Stress —all comprised 8 modules of media-rich interactive content. Participants were supported throughout the trial by a trained professional. The Patient Health Questionnaire 9 (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7) questionnaire, and stress subscale of the Depression Anxiety and Stress Scale (DASS-21) were completed at baseline, 8 weeks, and 3-month follow-up. A Satisfaction With Treatment (SAT) questionnaire was completed at 8 weeks, and qualitative interviews were completed by a subsample of participants at 3 months. Results: A total of 102 participants were recruited, with 52 choosing Space from Anxiety, 31 choosing Space from Depression, and 19 choosing Space from Stress. Mixed-effects models showed a significant decrease in symptoms of depression (F4=6.36, P<.001), anxiety (F4=7.97, P<.001), and stress (F4=8.50, P<.001) over time across all 3 programs. The largest decreases in PHQ-9 scores at 8 weeks were among participants who chose the Space from Depression program (d=0.84); at 3 months, the largest decreases in PHQ-9 scores were among those who chose the Space from Stress program (d=0.74). The largest decreases in GAD-7 scores were among those who chose the Space from Anxiety program (d=0.74 at 8 weeks and d=0.94 at 3 months). The largest decrease in DASS-21 stress subscale scores was among those who chose the Space from Stress program (d=0.49 at 8 weeks and d=1.16 at 3 months). The mean time spent using the platform per session was 27.4 min (SD 33.8), and participants completed 53% (SD 37.6) of the total program content on average. Most (37/53, 69%) participants found the programs helpful or very helpful and liked the convenience and flexibility of the intervention. Qualitative interviews (n=14) indicated the intervention met students’ expectations, and they saw it as a valuable complement to face-to-face treatment. Conclusions: The iCBT programs tested in our study appear to be feasible, acceptable, and effective in a university environment. Participants described the benefits of having a flexible, supported Web-based intervention available on campus. Larger trials should be conducted to further test the effectiveness of supported Web-based interventions that give students a choice of program depending on their symptom profile. %M 30552076 %R 10.2196/11467 %U http://mental.jmir.org/2018/4/e11467/ %U https://doi.org/10.2196/11467 %U http://www.ncbi.nlm.nih.gov/pubmed/30552076 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e10437 %T Economic Evaluation of an Internet-Based Preventive Cognitive Therapy With Minimal Therapist Support for Recurrent Depression: Randomized Controlled Trial %A Klein,Nicola S %A Bockting,Claudi LH %A Wijnen,Ben %A Kok,Gemma D %A van Valen,Evelien %A Riper,Heleen %A Cuijpers,Pim %A Dekker,Jack %A van der Heiden,Colin %A Burger,Huibert %A Smit,Filip %+ Department of Psychiatry, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, Amsterdam,, Netherlands, 31 20 891 3610, c.l.bockting@amc.uva.nl %K major depressive disorders %K recurrence %K cognitive therapy %K internet %K prevention %K cost effectiveness %D 2018 %7 26.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Major depressive disorder (MDD) is highly recurrent and has a significant disease burden. Although the effectiveness of internet-based interventions has been established for the treatment of acute MDD, little is known about their cost effectiveness, especially in recurrent MDD. Objectives: Our aim was to evaluate the cost effectiveness and cost utility of an internet-based relapse prevention program (mobile cognitive therapy, M-CT). Methods: The economic evaluation was performed alongside a single-blind parallel group randomized controlled trial. Participants were recruited via media, general practitioners, and mental health care institutions. In total, 288 remitted individuals with a history of recurrent depression were eligible, of whom 264 were randomly allocated to M-CT with minimal therapist support added to treatment as usual (TAU) or TAU alone. M-CT comprised 8 online lessons, and participants were advised to complete 1 lesson per week. The economic evaluation was performed from a societal perspective with a 24-month time horizon. The health outcomes were number of depression-free days according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, (DSM-IV) criteria assessed with the Structured Clinical Interview for DSM-IV axis I disorders by blinded interviewers after 3, 12, and 24 months. Quality-adjusted life years (QALYs) were self-assessed with the three level version of the EuroQol Five Dimensional Questionnaire (EQ-5D-3L). Costs were assessed with the Trimbos and Institute for Medical Technology Assessment Questionnaire on Costs Associated with Psychiatric Illness (TiC-P). Incremental cost-effectiveness ratios were calculated and cost-effectiveness planes and cost-effectiveness acceptability curves were displayed to assess the probability that M-CT is cost effective compared to TAU. Results: Mean total costs over 24 months were €8298 (US $9415) for M-CT and €7296 (US $8278) for TAU. No statistically significant differences were found between M-CT and TAU regarding depression-free days and QALYs (P=.37 and P=.92, respectively). The incremental costs were €179 (US $203) per depression-free day and €230,816 (US $261,875) per QALY. The cost-effectiveness acceptability curves suggested that for depression-free days, high investments have to be made to reach an acceptable probability that M-CT is cost effective compared to TAU. Regarding QALYs, considerable investments have to be made but the probability that M-CT is cost effective compared to TAU does not rise above 40%. Conclusions: The results suggest that adding M-CT to TAU is not effective and cost effective compared to TAU alone. Adherence rates were similar to other studies and therefore do not explain this finding. The participants scarcely booked additional therapist support, resulting in 17.3 minutes of mean total therapist support. More studies are needed to examine the cost effectiveness of internet-based interventions with respect to long-term outcomes and the role and optimal dosage of therapist support. Overall, more research is needed on scalable and cost-effective interventions that can reduce the burden of recurrent MDD. Trial registration: Netherlands Trial Register NTR2503; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2503 (Archived by WebCite at http://www.webcitation.org/73aBn41r3) %M 30478021 %R 10.2196/10437 %U http://www.jmir.org/2018/11/e10437/ %U https://doi.org/10.2196/10437 %U http://www.ncbi.nlm.nih.gov/pubmed/30478021 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10158 %T Web-Based Health Intervention for Young People Who Have a Parent with a Mental Illness: Delphi Study Among Potential Future Users %A Matar,Jodie L %A Maybery,Darryl J %A McLean,Louise A %A Reupert,Andrea %+ Education, Psychology Programs, Monash University, 19 Ancora Imparo Way, Clayton, 3800, Australia, 61 399024587, andrea.reupert@monash.edu %K Delphi studies %K early medical intervention %K internet %K preventative health %K Web-based intervention %K youth %D 2018 %7 31.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Young people who have a parent with a mental illness face elevated risks to their mental health and well-being. However, they may not have access to appropriate interventions. Web-based interventions may reach and meet the needs of this at-risk group, yet their preferences regarding the features of this medium are unknown. Objective: This study sought to determine the utility of a Web-based intervention to meet the needs of young people who have a parent with a mental illness and their perspectives regarding the types of features of such a website. Methods: A systematic, 2-round Delphi study was employed to solicit the views of 282 young people aged 16 to 21 years (Round 1, n=14; Round 2, n=268) from urban and regional settings in Australia who self-reported that their parent has a mental illness. “Regional” was used to refer to nonurban participants in the study. After ascertaining whether a Web-based intervention was warranted, Web-based intervention features were identified, including how the site might be facilitated, topics, duration and frequency, and the nature of the professional contact. The extent to which young people agreed on the importance of these factors was assessed. Differences and similarities across gender and location were investigated. A mixed method analytic framework was employed using thematic analysis as well as 2-way between-groups analysis of covariance (ANCOVA) controlling for age and chi-square test of independence analysis. Results: Both rounds highlighted a strong preference for a Web-based intervention. Consensus was reached for a professionally monitored site, young people and professionals having equal input into the weekly facilitated sessions (eg, sharing the lead role in discussions or deciding on relevant session content), unlimited time access, 1-hour, open discussion, weekly sessions over 6 weeks, psychoeducation about mental illness, and considerations for the management of safety violations. There were significant main effects of location type and several of the preferred features for a Web-based intervention for young people who have a parent with a mental illness. However, effect sizes were small to moderate, limiting practical application. Conclusions: Young people aged 16 to 21 years indicated a need for a professionally monitored, psychoeducational, Web-based intervention, with input from professional facilitators and other young people who have a parent with a mental illness, in addition to recommendations to external resources. These findings may inform the development of future Web-based interventions for this highly vulnerable group. %M 30381281 %R 10.2196/10158 %U http://www.jmir.org/2018/10/e10158/ %U https://doi.org/10.2196/10158 %U http://www.ncbi.nlm.nih.gov/pubmed/30381281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 9 %P e10743 %T Web-Based Cognitive Behavioral Therapy Blended With Face-to-Face Sessions for Major Depression: Randomized Controlled Trial %A Nakao,Shigetsugu %A Nakagawa,Atsuo %A Oguchi,Yoshiyo %A Mitsuda,Dai %A Kato,Noriko %A Nakagawa,Yuko %A Tamura,Noriko %A Kudo,Yuka %A Abe,Takayuki %A Hiyama,Mitsunori %A Iwashita,Satoru %A Ono,Yutaka %A Mimura,Masaru %+ Clinical and Translational Research Center, Keio University Hospital, 35, Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan, 81 3 3353 1211, anakagawa@keio.jp %K blended cognitive behavioral therapy %K cognitive behavioral therapy %K major depressive disorder %K major depression %K randomized controlled trial %D 2018 %7 21.9.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Meta-analyses of several randomized controlled trials have shown that cognitive behavioral therapy (CBT) has comparable efficacy to antidepressant medication, but therapist availability and cost-effectiveness is a problem. Objective: This study aimed to evaluate the effectiveness of Web-based CBT blended with face-to-face sessions that reduce therapist time in patients with major depression who were unresponsive to antidepressant medications. Methods: A 12-week, assessor-masked, parallel-group, waiting- list controlled, randomized trial was conducted at 3 medical institutions in Tokyo. Outpatients aged 20-65 years with a primary diagnosis of major depression who were taking ≥1 antidepressant medications at an adequate dose for ≥6 weeks and had a 17-item GRID-Hamilton Depression Rating Scale (HAMD) score of ≥14 were randomly assigned (1:1) to blended CBT or waiting-list groups using a computer allocation system, stratified by the study site with the minimization method, to balance age and baseline GRID-HAMD score. The CBT intervention was given in a combined format, comprising a Web-based program and 12 45-minute face-to-face sessions. Thus, across 12 weeks, a participant could receive up to 540 minutes of contact with a therapist, which is approximately two-thirds of the therapist contact time provided in the conventional CBT protocol, which typically provides 16 50-minute sessions. The primary outcome was the alleviation of depressive symptoms, as measured by a change in the total GRID-HAMD score from baseline (at randomization) to posttreatment (at 12 weeks). Moreover, in an exploratory analysis, we investigated whether the expected positive effects of the intervention were sustained during follow-up, 3 months after the posttreatment assessment. Analyses were performed on an intention-to-treat basis, and the primary outcome was analyzed using a mixed-effects model for repeated measures. Results: We randomized 40 participants to either blended CBT (n=20) or waiting-list (n=20) groups. All patients completed the 12-week treatment protocol and were included in the intention-to-treat analyses. Participants in the blended CBT group had significantly alleviated depressive symptoms at week 12, as shown by greater least squares mean changes in the GRID-HAMD score, than those in the waiting list group (−8.9 points vs −3.0 points; mean between-group difference=−5.95; 95% CI −9.53 to −2.37; P<.001). The follow-up effects within the blended CBT group, as measured by the GRID-HAMD score, were sustained at the 3-month follow-up (week 24) and posttreatment (week 12): posttreatment, 9.4 (SD 5.2), versus follow-up, 7.2 (SD 5.7); P=.009. Conclusions: Although our findings warrant confirmation in larger and longer term studies with active controls, these suggest that a combined form of CBT is effective in reducing depressive symptoms in patients with major depression who are unresponsive to antidepressant medications. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000009242; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000010852 (Archived by WebCite at http://www.webcitation. org/729VkpyYL) %M 30249583 %R 10.2196/10743 %U http://www.jmir.org/2018/9/e10743/ %U https://doi.org/10.2196/10743 %U http://www.ncbi.nlm.nih.gov/pubmed/30249583 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 9 %P e259 %T Using New and Innovative Technologies to Assess Clinical Stage in Early Intervention Youth Mental Health Services: Evaluation Study %A Ospina-Pinillos,Laura %A Davenport,Tracey %A Iorfino,Frank %A Tickell,Ashleigh %A Cross,Shane %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, Shops 1-3, 66-70 Parramatta Road, Camperdown, Sydney,, Australia, 61 028 627 6946, laura.ospinapinillos@sydney.edu.au %K staging model %K mental health %K primary health care %K telemedicine %K symptom assessment health service reform %D 2018 %7 10.09.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Globally there is increasing recognition that new strategies are required to reduce disability due to common mental health problems. As 75% of mental health and substance use disorders emerge during the teenage or early adulthood years, these strategies need to be readily accessible to young people. When considering how to provide such services at scale, new and innovative technologies show promise in augmenting traditional clinic-based services. Objective: The aim of this study was to test new and innovative technologies to assess clinical stage in early intervention youth mental health services using a prototypic online system known as the Mental Health eClinic (MHeC). Methods: The online assessment within the MHeC was compared directly against traditional clinician assessment within 2 Sydney-based youth-specific mental health services (headspace Camperdown and headspace Campbelltown). A total of 204 young people were recruited to the study. Eligible participants completed both face-to-face and online assessments, which were randomly allocated and counterbalanced at a 1-to-3 ratio. These assessments were (1) a traditional 45- to 60-minute headspace face-to-face assessment performed by a Youth Access Clinician and (2) an approximate 60-minute online assessment (including a self-report Web-based survey, immediate dashboard of results, and a video visit with a clinician). All assessments were completed within a 2-week timeframe from initial presentation. Results: Of the 72 participants who completed the study, 71% (51/72) were female and the mean age was 20.4 years (aged 16 to 25 years); 68% (49/72) of participants were recruited from headspace Camperdown and the remaining 32% (23/72) from headspace Campbelltown. Interrater agreement of participants’ stage, as determined after face-to-face assessment or online assessment, demonstrated fair agreement (kappa=.39, P<.001) with concordance in 68% of cases (49/72). Among the discordant cases, those who were allocated to a higher stage by online raters were more likely to report a past history of mental health disorders (P=.001), previous suicide planning (P=.002), and current cannabis misuse (P=.03) compared to those allocated to a lower stage. Conclusions: The MHeC presents a new and innovative method for determining key clinical service parameters. It has the potential to be adapted to varied settings in which young people are connected with traditional clinical services and assist in providing the right care at the right time. %M 30201602 %R 10.2196/jmir.9966 %U http://www.jmir.org/2018/9/e259/ %U https://doi.org/10.2196/jmir.9966 %U http://www.ncbi.nlm.nih.gov/pubmed/30201602 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e10058 %T Game Addiction Scale Assessment Through a Nationally Representative Sample of Young Adult Men: Item Response Theory Graded–Response Modeling %A Khazaal,Yasser %A Breivik,Kyrre %A Billieux,Joel %A Zullino,Daniele %A Thorens,Gabriel %A Achab,Sophia %A Gmel,Gerhard %A Chatton,Anne %+ Geneva University, Grand Pré 70c, Geneve, 1202, Switzerland, 41 223725550, yasser.khazaal@hcuge.ch %K internet addiction %K internet gaming disorder %K internet gaming %K item response theory %K game addiction scale %D 2018 %7 27.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The 7-item Game Addiction Scale (GAS) has been validated under standard confirmatory factor analysis and exhibits good psychometric properties. Whether this scale satisfies the necessary conditions for consideration by item response theory (IRT) modeling remains unknown. However, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) recently proposed criteria, in its section 3, to define internet gaming disorder (IGD) to promote research on this possible condition. Objective: The objective of our study was to (1) analyze GAS in the context of IRT (graded-response) modeling; (2) investigate differential item functioning (DIF), a feature of IRT modeling, in 2 subsamples; and (3) contribute to the ongoing (IGD) debate related to the validity of the DSM-5 criteria using GAS items as a proxy. Methods: We assessed 2 large representative samples of Swiss men (3320 French-speaking and 2670 German-speaking) with GAS. Results: All items comprised high discrimination parameters. GAS items such as relapse, conflict, withdrawal, and problems (loss of interests) were endorsed more frequently in more severe IGD stages, whereas items related to tolerance, salience (preoccupation), and mood modification (escape) were endorsed more widely among participants (including in less severe IGD stages). Several DIF effects were found but were classified as negligible. Conclusions: The results of the analyses partly support the relevance of using IRT to further establish the psychometric properties of the GAS items. This study contributes to testing the validity of the IGD criteria, although cautious generalization of our findings is required with GAS being only a proxy of the IGD criteria. %M 30150204 %R 10.2196/10058 %U http://www.jmir.org/2018/8/e10058/ %U https://doi.org/10.2196/10058 %U http://www.ncbi.nlm.nih.gov/pubmed/30150204 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e242 %T Therapist-Assisted Internet-Based Cognitive Behavioral Therapy Versus Progressive Relaxation in Obsessive-Compulsive Disorder: Randomized Controlled Trial %A Kyrios,Michael %A Ahern,Claire %A Fassnacht,Daniel B %A Nedeljkovic,Maja %A Moulding,Richard %A Meyer,Denny %+ College of Education, Psychology & Social Work, Flinders University, Sturt Roadd, Bedford Park, Adelaide,, Australia, 61 8 8201 3157, michael.kyrios@flinders.edu.au %K obsessive-compulsive disorder %K mental health %K cognitive behavioral therapy %K CBT %K online intervention %D 2018 %7 08.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Obsessive-compulsive disorder (OCD) is a highly disabling psychological disorder with a chronic course if left untreated. Cognitive behavioral therapy (CBT) has been shown to be an effective treatment, but access to face-to-face CBT is not always possible. Internet-based CBT (iCBT) has become an increasingly viable option. However, no study has compared iCBT to an analogous control condition using a randomized controlled trial (RCT). Objective: A 2-armed RCT was used to compare a therapist-assisted 12-module iCBT to an analogous active attention control condition (therapist-assisted internet-based standard progressive relaxation training, iPRT) in adult OCD. This paper reports pre-post findings for OCD symptom severity. Method: In total, 179 participants (117 females, 65.7%) were randomized (stratified by gender) into iCBT or iPRT. The iCBT intervention included psychoeducation, mood and behavioral management, exposure and response prevention (ERP), cognitive therapy, and relapse prevention; the iPRT intervention included psychoeducation and relaxation techniques as a way of managing OCD-related anxiety but did not incorporate ERP or other CBT elements. Both treatments included audiovisual content, case stories, demonstrations of techniques, downloadable audio content and worksheets, and expert commentary. All participants received 1 weekly email, with a maximum 15-minute preparation time per client from a remote therapist trained in e-therapy. Emails aimed to monitor progress, provide support and encouragement, and assist in individualizing the treatment. Participants were assessed for baseline and posttreatment OCD severity with the telephone-administered clinician-rated Yale-Brown Obsessive-Compulsive Scale and other measures by assessors who were blinded to treatment allocation. Results: No pretreatment differences were found between the 2 conditions. Intention-to-treat analysis revealed significant pre-post improvements in OCD symptom severity for both conditions (P<.001). However, relative to iPRT, iCBT showed significantly greater symptom severity improvement (P=.001); Cohen d for iCBT was 1.05 (95% CI 0.72-1.37), whereas for iPRT it was 0.48 (95% CI 0.22-0.73). The iCBT condition was superior in regard to reliable improvement (25/51, 49% vs 16/55, 29%; P=.04) and clinically significant pre-post-treatment changes (17/51, 33% vs 6/55, 11%; P=.005). Those undertaking iCBT post completion of iPRT showed further significant symptom amelioration (P<.001), although the sequential treatment was no more efficacious than iCBT alone (P=.63). Conclusion: This study is the first to compare a therapist-assisted iCBT program for OCD to an analogous active attention control condition using iPRT. Our findings demonstrate the large magnitude effect of iCBT for OCD; interestingly, iPRT was also moderately efficacious, albeit significantly less so than the iCBT intervention. The findings are compared to previous internet-based and face-to-face CBT treatment programs for OCD. Future directions for technology-enhanced programs for the treatment of OCD are outlined. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12611000321943; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=336704 (Archived by WebCite at http://www.webcitation.org/70ovUiOmd) %M 30089607 %R 10.2196/jmir.9566 %U http://www.jmir.org/2018/8/e242/ %U https://doi.org/10.2196/jmir.9566 %U http://www.ncbi.nlm.nih.gov/pubmed/30089607 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 7 %P e10668 %T Impact of Internet-Based Interventions on Caregiver Mental Health: Systematic Review and Meta-Analysis %A Sherifali,Diana %A Ali,Muhammad Usman %A Ploeg,Jenny %A Markle-Reid,Maureen %A Valaitis,Ruta %A Bartholomew,Amy %A Fitzpatrick-Lewis,Donna %A McAiney,Carrie %+ School of Nursing, Faculty of Health Sciences, McMaster University, HSC 3N28F, 1280 Main Street West, Hamilton, ON,, Canada, 1 905 525 9140 ext 21435, dsherif@mcmaster.ca %K internet %K support %K education %K mental health %K caregivers %K chronic conditions %D 2018 %7 03.07.2018 %9 Review %J J Med Internet Res %G English %X Background: The health of informal caregivers of adults with chronic conditions is increasingly vital since caregivers comprise a large proportion of supportive care to family members living in the community. Due to efficiency and reach, internet-based interventions for informal caregivers have the potential to mitigate the negative mental health outcomes associated with caregiving. Objective: The objective of this systematic review and meta-analysis was to examine the impact of internet-based interventions on caregiver mental health outcomes and the impact of different types of internet-based intervention programs. Methods: MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane, and AgeLine databases were searched for randomized controlled trials or controlled clinical trials published from January 1995 to April 2017 that compared internet-based intervention programs with no or minimal internet-based interventions for caregivers of adults with at least 1 chronic condition. The inclusion criteria were studies that included (1) adult informal caregivers (aged 18 years or older) of adults living in the community with a chronic condition; (2) an internet-based intervention program to deliver education, support, or monitoring to informal caregivers; and (3) outcomes of mental health. Title and abstract and full-text screening were completed in duplicate. Data were extracted by a single reviewer and verified by a second reviewer, and risk of bias assessments were completed accordingly. Where possible, data for mental health outcomes were meta-analyzed. Results: The search yielded 7923 unique citations of which 290 studies were screened at full-text. Of those, 13 studies met the inclusion criteria; 11 were randomized controlled trials, 1 study was a controlled clinical trial, and 1 study comprised both study designs. Beneficial effects of any internet-based intervention program resulted in a mean decrease of 0.48 points (95% CI –0.75 to –0.22) for stress and distress and a mean decrease of 0.40 points (95% CI –0.58 to –0.22) for anxiety among caregivers. For studies that examined internet-based information and education plus professional psychosocial support, the meta-analysis results showed small to medium beneficial effect sizes of the intervention for the mental health outcomes of depression (–0.34; 95% CI –0.63 to –0.05) and anxiety (–0.36; 95% CI –0.66 to –0.07). Some suggestion of a beneficial effect on overall health for the use of information and education plus combined peer and professional support was also shown (1.25; 95% CI 0.24 to 2.25). Overall, many studies were of poor quality and were rated at high risk of bias. Conclusions: The review found evidence for the benefit of internet-based intervention programs on mental health for caregivers of adults living with a chronic condition, particularly for the outcomes of caregiver depression, stress and distress, and anxiety. The types of interventions that predominated as efficacious included information and education with or without professional psychological support, and, to a lesser extent, with combined peer and psychological support. Further high-quality research is needed to inform the effectiveness of interactive, dynamic, and multicomponent internet-based interventions. Trial Registration: PROSPERO CRD42017075436; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=75436 (Archived by WebCite at http://www.webcitation.org/709M3tDvn) %M 29970358 %R 10.2196/10668 %U http://www.jmir.org/2018/7/e10668/ %U https://doi.org/10.2196/10668 %U http://www.ncbi.nlm.nih.gov/pubmed/29970358 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10386 %T Increasing the Availability of Psychological Treatments: A Multinational Study of a Scalable Method for Training Therapists %A O'Connor,Marianne %A Morgan,Katy E %A Bailey-Straebler,Suzanne %A Fairburn,Christopher G %A Cooper,Zafra %+ Centre for Research on Dissemination at Oxford, Department of Psychiatry, University of Oxford, Warneford Lane, Headington, Oxford, OX3 7JX, United Kingdom, 44 2038094213, zafra.cooper@psych.ox.ac.uk %K internet %K web-centered %K eating disorders %K cognitive therapy %K effective treatment %D 2018 %7 08.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the major barriers to the dissemination and implementation of psychological treatments is the scarcity of suitably trained therapists. A highly scalable form of Web-centered therapist training, undertaken without external support, has recently been shown to have promise in promoting therapist competence. Objective: The aim of this study was to conduct an evaluation of the acceptability and effectiveness of a scalable independent form of Web-centered training in a multinational sample of therapists and investigate the characteristics of those most likely to benefit. Methods: A cohort of eligible therapists was recruited internationally and offered access to Web-centered training in enhanced cognitive behavioral therapy, a multicomponent, evidence-based, psychological treatment for any form of eating disorder. No external support was provided during training. Therapist competence was assessed using a validated competence measure before training and after 20 weeks. Results: A total of 806 therapists from 33 different countries expressed interest in the study, and 765 (94.9%) completed a pretraining assessment. The median number of training modules completed was 15 out of a possible 18 (interquartile range, IQR: 4-18), and 87.9% (531/604) reported that they treated at least one patient during training as recommended. Median pretraining competence score was 7 (IQR: 5-10, range: 0-19; N=765), and following training, it was 12 (IQR: 9-15, range: 0-20; N=577). The expected change in competence scores from pretraining to posttraining was 3.5 (95% CI 3.1-3.8; P<.001). After training, 52% (300/574) of therapists with complete competence data met or exceeded the competence threshold, and 45% (95% CI 41-50) of those who had not met this threshold before training did so after training. Compliance with training predicted both an increase in competence scores and meeting or exceeding the competence threshold. Expected change in competence score increased for each extra training module completed (0.19, 95% CI 0.13-0.25), and those who treated a suitable patient during training had an expected change in competence score 1.2 (95% CI 0.4-2.1) points higher than those who did not. Similarly, there was an association between meeting the competence threshold after training and the number of modules completed (odds ratio, OR=1.11, 95% CI 1.07-1.15), and treating at least one patient during training was associated with competence after training (OR=2.2, 95% CI 1.2-4.1). Conclusions: Independent Web-centered training can successfully train large numbers of therapists dispersed across a wide geographical area. This finding is of importance because the availability of a highly scalable method of training potentially increases the number of people who might receive effective psychological treatments. %M 29884606 %R 10.2196/10386 %U http://www.jmir.org/2018/6/e10386/ %U https://doi.org/10.2196/10386 %U http://www.ncbi.nlm.nih.gov/pubmed/29884606 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e188 %T Developing a Mental Health eClinic to Improve Access to and Quality of Mental Health Care for Young People: Using Participatory Design as Research Methodologies %A Ospina-Pinillos,Laura %A Davenport,Tracey A %A Ricci,Cristina S %A Milton,Alyssa C %A Scott,Elizabeth M %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, Sydney, 2050, Australia, 61 0286276946, laura.ospinapinillos@sydney.edu.au %K mental health %K community-based participatory research %K eHealth %D 2018 %7 28.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Each year, many young Australians aged between 16 and 25 years experience a mental health disorder, yet only a small proportion access services and even fewer receive timely and evidence-based treatments. Today, with ever-increasing access to the Internet and use of technology, the potential to provide all young people with access (24 hours a day, 7 days a week) to the support they require to improve their mental health and well-being is promising. Objective: The aim of this study was to use participatory design (PD) as research methodologies with end users (young people aged between 16 and 25 years and youth health professionals) and our research team to develop the Mental Health eClinic (a Web-based mental health clinic) to improve timely access to, and better quality, mental health care for young people across Australia. Methods: A research and development (R&D) cycle for the codesign and build of the Mental Health eClinic included several iterative PD phases: PD workshops; translation of knowledge and ideas generated during workshops to produce mockups of webpages either as hand-drawn sketches or as wireframes (simple layout of a webpage before visual design and content is added); rapid prototyping; and one-on-one consultations with end users to assess the usability of the alpha build of the Mental Health eClinic. Results: Four PD workshops were held with 28 end users (young people n=18, youth health professionals n=10) and our research team (n=8). Each PD workshop was followed by a knowledge translation session. At the conclusion of this cycle, the alpha prototype was built, and one round of one-on-one end user consultation sessions was conducted (n=6; all new participants, young people n=4, youth health professionals n=2). The R&D cycle revealed the importance of five key components for the Mental Health eClinic: a home page with a visible triage system for those requiring urgent help; a comprehensive online physical and mental health assessment; a detailed dashboard of results; a booking and videoconferencing system to enable video visits; and the generation of a personalized well-being plan that includes links to evidence-based, and health professional–recommended, apps and etools. Conclusions: The Mental Health eClinic provides health promotion, triage protocols, screening, assessment, a video visit system, the development of personalized well-being plans, and self-directed mental health support for young people. It presents a technologically advanced and clinically efficient system that can be adapted to suit a variety of settings in which there is an opportunity to connect with young people. This will enable all young people, and especially those currently not able or willing to connect with face-to-face services, to receive best practice clinical services by breaking down traditional barriers to care and making health care more personalized, accessible, affordable, and available. %R 10.2196/jmir.9716 %U http://www.jmir.org/2018/5/e188/ %U https://doi.org/10.2196/jmir.9716 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e10028 %T A Mental Health Storytelling Intervention Using Transmedia to Engage Latinas: Grounded Theory Analysis of Participants’ Perceptions of the Story’s Main Character %A Heilemann,MarySue V %A Martinez,Adrienne %A Soderlund,Patricia D %+ School of Nursing, University of California, Los Angeles, Factor Building, Room 5252, Box 956919, Los Angeles, CA, 90095 6919, United States, 1 310 206 4735, mheilema@sonnet.ucla.edu %K depression %K anxiety %K transmedia storytelling %K Internet %K cell phone %K mental health %K eHealth %K mood disorders %K smartphone %D 2018 %7 02.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Transmedia storytelling was used to attract English-speaking Latina women with elevated symptoms of depression and anxiety to engage in an intervention that included videos and a webpage with links to symptom management resources. However, a main character for the storyline who was considered dynamic, compelling, and relatable by the target group was needed. Objective: We conducted interviews with 28 English-speaking Latinas (target group) with elevated symptoms of depression or anxiety who participated in an Internet-accessible transmedia storytelling intervention. The objective of this study was to examine participants’ perceptions of the lead character of the story. Development of this character was informed by deidentified data from previous studies with members of the target group. Critique of the character from a panel of therapists informed editing, as did input from women of the target group. Methods: All interviews were conducted via telephone, audio-recorded, and transcribed. Data analysis was guided by grounded theory methodology. Results: Participants embraced the main character, Catalina, related to her as a person with an emotional life and a temporal reality, reported that they learned from her and wanted more episodes that featured her and her life. Grounded theory analysis led to the development of one category (She “just felt so real”: relating to Catalina as a real person with a past, present, and future) with 4 properties. Properties included (1) relating emotionally to Catalina’s vulnerability, (2) recognizing shared experiences, (3) needing to support others while simultaneously lacking self-support, and (4) using Catalina as a springboard for imagining alternative futures. Participants found Catalina’s efforts to pursue mental health treatment to be meaningful and led them to compare themselves to her and consider how they might pursue treatment themselves. Conclusions: When creating a story-based mental health intervention to be delivered through an app, regardless of type, careful development of the main character is valuable. Theoretical guidance, previous deidentified data from the target group, critique from key stakeholders and members of the target group, and preliminary testing are likely to enhance the main character’s relatability and appropriateness, which can increase sustained engagement. %M 29720357 %R 10.2196/10028 %U http://www.jmir.org/2018/5/e10028/ %U https://doi.org/10.2196/10028 %U http://www.ncbi.nlm.nih.gov/pubmed/29720357 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e154 %T Guided Web-Based Cognitive Behavior Therapy for Perfectionism: Results From Two Different Randomized Controlled Trials %A Rozental,Alexander %A Shafran,Roz %A Wade,Tracey D %A Kothari,Radha %A Egan,Sarah J %A Ekberg,Linda %A Wiss,Maria %A Carlbring,Per %A Andersson,Gerhard %+ Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 1EH, United Kingdom, 44 0207 905 2232, r.shafran@ucl.ac.uk %K cognitive behavior therapy %K internet %K perfectionism %K follow-up studies %K cognitive therapy %D 2018 %7 26.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Perfectionism can become a debilitating condition that may negatively affect functioning in multiple areas, including mental health. Prior research has indicated that internet-based cognitive behavioral therapy can be beneficial, but few studies have included follow-up data. Objective: The objective of this study was to explore the outcomes at follow-up of internet-based cognitive behavioral therapy with guided self-help, delivered as 2 separate randomized controlled trials conducted in Sweden and the United Kingdom. Methods: In total, 120 participants randomly assigned to internet-based cognitive behavioral therapy were included in both intention-to-treat and completer analyses: 78 in the Swedish trial and 62 in the UK trial. The primary outcome measure was the Frost Multidimensional Perfectionism Scale, Concern over Mistakes subscale (FMPS CM). Secondary outcome measures varied between the trials and consisted of the Clinical Perfectionism Questionnaire (CPQ; both trials), the 9-item Patient Health Questionnaire (PHQ-9; Swedish trial), the 7-item Generalized Anxiety Disorder scale (GAD-7; Swedish trial), and the 21-item Depression Anxiety Stress Scale (DASS-21; UK trial). Follow-up occurred after 6 months for the UK trial and after 12 months for the Swedish trial. Results: Analysis of covariance revealed a significant difference between pretreatment and follow-up in both studies. Intention-to-treat within-group Cohen d effect sizes were 1.21 (Swedish trial; 95% CI 0.86-1.54) and 1.24 (UK trial; 95% CI 0.85-1.62) for the FMPS CM. Furthermore, 29 (59%; Swedish trial) and 15 (43%; UK trial) of the participants met the criteria for recovery on the FMPS CM. Improvements were also significant for the CPQ, with effect sizes of 1.32 (Swedish trial; 95% CI 0.97-1.66) and 1.49 (UK trial; 95% CI 1.09-1.88); the PHQ-9, effect size 0.60 (95% CI 0.28-0.92); the GAD-7, effect size 0.67 (95% CI 0.34-0.99); and the DASS-21, effect size 0.50 (95% CI 0.13-0.85). Conclusions: The results are promising for the use of internet-based cognitive behavioral therapy as a way of targeting perfectionism, but the findings need to be replicated and include a comparison condition. %M 29699968 %R 10.2196/jmir.9823 %U http://www.jmir.org/2018/4/e154/ %U https://doi.org/10.2196/jmir.9823 %U http://www.ncbi.nlm.nih.gov/pubmed/29699968 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e30 %T Worker Preferences for a Mental Health App Within Male-Dominated Industries: Participatory Study %A Peters,Dorian %A Deady,Mark %A Glozier,Nick %A Harvey,Samuel %A Calvo,Rafael A %+ Wellbeing Technology Lab, Faculty of Engineering and IT, University of Sydney, Bldg J03, Electrical Engineering, Sydney, 2006, Australia, 61 0289015604, dorian.peters@sydney.edu.au %K mental health %K mhealth %K mobile apps %K workplace %K men %K participatory design %D 2018 %7 25.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Men are less likely to seek help for mental health problems, possibly because of stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces such as the emergency services or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of mental health technologies men would be willing to engage with, and no app can be effective if the intended users do not engage with it. Objective: The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Methods: Workers from male-dominated workplaces in rural, suburban, and urban locations took part in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. Results: A total of 60 workers aged between 26 and 65 years, 92% (55/60) male, from male-dominated workplaces in rural (16/60, 27%), suburban (14/60, 23%), and urban (30/60, 50%) locations participated in one of the 6 workshops, resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term “mental health” was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment, and mood-fix tool were highly valued, and app characteristics such as brevity of interactions, minimal on-screen text, and a solutions-oriented approach were considered essential by participants. Some implementation strategies based on these findings are included in the discussion. Conclusions: Future mental health mobile phone apps targeting workers in male-dominated workplaces need to consider language use and preferred features, as well as balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights for mental health technologies, for men in general, and for others in high-stigma environments. %M 29695371 %R 10.2196/mental.8999 %U http://mental.jmir.org/2018/2/e30/ %U https://doi.org/10.2196/mental.8999 %U http://www.ncbi.nlm.nih.gov/pubmed/29695371 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e153 %T Perceived Drivers and Barriers to the Adoption of eMental Health by Psychologists: The Construction of the Levels of Adoption of eMental Health Model %A Feijt,Milou A %A de Kort,Yvonne AW %A Bongers,Inge MB %A IJsselsteijn,Wijnand A %+ Human-Technology Interaction, Department of Industrial Engineering & Innovation Sciences, Eindhoven University of Technology, IPO Building, 2nd Floor, P.O. Box 513, Eindhoven, 5600 MB, Netherlands, 31 40 247 5391, m.a.feijt@tue.nl %K eHealth %K mental health %K psychology, clinical %K diffusion of innovation %K technology %D 2018 %7 24.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet offers major opportunities in supporting mental health care, and a variety of technology-mediated mental and behavioral health services have been developed. Yet, despite growing evidence for the effectiveness of these services, their acceptance and use in clinical practice remains low. So far, the current literature still lacks a structured insight into the experienced drivers and barriers to the adoption of electronic mental health (eMental health) from the perspective of clinical psychologists. Objective: The aim of this study was to gain an in-depth and comprehensive understanding of the drivers and barriers for psychologists in adopting eMental health tools, adding to previous work by also assessing drivers and analyzing relationships among these factors, and subsequently by developing a structured representation of the obtained findings. Methods: The study adopted a qualitative descriptive approach consisting of in-depth semistructured interviews with clinical psychologists working in the Netherlands (N=12). On the basis of the findings, a model was constructed that was then examined through a communicative validation. Results: In general, a key driver for psychologists to adopt eMental health is the belief and experience that it can be beneficial to them or their clients. Perceived advantages that are novel to literature include the acceleration of the treatment process, increased intimacy of the therapeutic relationship, and new treatment possibilities due to eMental health. More importantly, a relation was found between the extent to which psychologists have adopted eMental health and the particular drivers and barriers they experience. This differentiation is incorporated in the Levels of Adoption of eMental Health (LAMH) model that was developed during this study to provide a structured representation of the factors that influence the adoption of eMental health. Conclusions: The study identified both barriers and drivers, several of which are new to the literature and found a relationship between the nature and importance of the various drivers and barriers perceived by psychologists and the extent to which they have adopted eMental health. These findings were structured in a conceptual model to further enhance the current understanding. The LAMH model facilitates further research on the process of adopting eMental health, which will subsequently enable targeted recommendations with respect to technology, training, and clinical practice to ensure that mental health care professionals as well as their clients will benefit optimally from the current (and future) range of available eMental health options. %M 29691215 %R 10.2196/jmir.9485 %U http://www.jmir.org/2018/4/e153/ %U https://doi.org/10.2196/jmir.9485 %U http://www.ncbi.nlm.nih.gov/pubmed/29691215 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e90 %T Assessing Therapeutic Alliance in the Context of mHealth Interventions for Mental Health Problems: Development of the Mobile Agnew Relationship Measure (mARM) Questionnaire %A Berry,Katherine %A Salter,Amy %A Morris,Rohan %A James,Susannah %A Bucci,Sandra %+ Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Oxford Road, Manchester, M139PL, United Kingdom, 44 1613060422, katherine.berry@manchester.ac.uk %K mobile health %K health care provider %K digital interventions %K therapeutic alliance %K mental health %K measure development %D 2018 %7 19.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions in the form of smartphone apps aim to improve mental health and enable people access to support as and when needed without having to face the stigma they may experience in accessing services. If we are to evaluate mobile health (mHealth) apps and advance scientific understanding, we also need tools to help us understand in what ways mHealth interventions are effective or not. The concept of therapeutic alliance, a measure of the quality of the relationship between a health care provider and a service user, is a key factor in explaining the effects of mental health interventions. The Agnew Relationship Measure (ARM) is a well-validated measure of therapeutic alliance in face-to-face therapy. Objective: This study presented the first attempt to (1) explore service users’ views of the concept of relationship within mHealth mental health interventions and (2) adapt a well-validated face-to-face measure of therapeutic alliance, the Agnew Relationship Measure (ARM), for use with mHealth interventions. Methods: In stage 1, we interviewed 9 mental health service users about the concept of therapeutic alliance in the context of a digital health intervention and derived key themes from interview transcripts using thematic analysis. In stage 2, we used rating scales and open-ended questions to elicit views from 14 service users and 10 mental health staff about the content and face validity of the scale, which replaced the word “therapist” with the word “app.” In stage 3, we used the findings from stages 1 and 2 to adapt the measure with the support of a decision-making algorithm about which items to drop, retain, or adapt. Results: Findings suggested that service users do identify relationship concepts when thinking about mHealth interventions, including forming a bond with an app and the ability to be open with an app. However, there were key differences between relationships with health professionals and relationships with apps. For example, apps were not as tailored and responsive to each person’s unique needs. Furthermore, apps were not capable of portraying uniquely human-like qualities such as friendliness, collaboration, and agreement. We made a number of changes to the ARM that included revising 16 items; removing 4 items due to lack of suitable alternatives; and adding 1 item to capture a key theme derived from stage 1 of the study (“The app is like having a member of my care team in my pocket”). Conclusions: This study introduces the mHealth version of the ARM, the mARM, that has good face and content validity. We encourage researchers to include this easy-to-use tool in digital health intervention studies to gather further data about its psychometric properties and advance our understanding of how therapeutic alliance influences the efficacy of mHealth interventions. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 34966555; http://www.isrctn.com/ISRCTN34966555 (Archived by WebCite at http://www.webcitation.org/6ymBVwKif) %M 29674307 %R 10.2196/jmir.8252 %U http://www.jmir.org/2018/4/e90/ %U https://doi.org/10.2196/jmir.8252 %U http://www.ncbi.nlm.nih.gov/pubmed/29674307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e129 %T Self-Harm, Suicidal Behaviours, and Cyberbullying in Children and Young People: Systematic Review %A John,Ann %A Glendenning,Alexander Charles %A Marchant,Amanda %A Montgomery,Paul %A Stewart,Anne %A Wood,Sophie %A Lloyd,Keith %A Hawton,Keith %+ Population Psychiatry, Suicide and Informatics, Medical School, Swansea University, Institute of Life Science 2, Swansea, SA2 8PP, United Kingdom, 44 01792602568 ext 2568, A.John@swansea.ac.uk %K cyberbullying %K bullying %K self-injurious behavior %K suicide %K suicide, attempted %K suicidal ideation %D 2018 %7 19.04.2018 %9 Review %J J Med Internet Res %G English %X Background: Given the concerns about bullying via electronic communication in children and young people and its possible contribution to self-harm, we have reviewed the evidence for associations between cyberbullying involvement and self-harm or suicidal behaviors (such as suicidal ideation, suicide plans, and suicide attempts) in children and young people. Objective: The aim of this study was to systematically review the current evidence examining the association between cyberbullying involvement as victim or perpetrator and self-harm and suicidal behaviors in children and young people (younger than 25 years), and where possible, to meta-analyze data on the associations. Methods: An electronic literature search was conducted for all studies published between January 1, 1996, and February 3, 2017, across sources, including MEDLINE, Cochrane, and PsycINFO. Articles were included if the study examined any association between cyberbullying involvement and self-harm or suicidal behaviors and reported empirical data in a sample aged under 25 years. Quality of included papers was assessed and data were extracted. Meta-analyses of data were conducted. Results: A total of 33 eligible articles from 26 independent studies were included, covering a population of 156,384 children and young people. A total of 25 articles (20 independent studies, n=115,056) identified associations (negative influences) between cybervictimization and self-harm or suicidal behaviors or between perpetrating cyberbullying and suicidal behaviors. Three additional studies, in which the cyberbullying, self-harm, or suicidal behaviors measures had been combined with other measures (such as traditional bullying and mental health problems), also showed negative influences (n=44,526). A total of 5 studies showed no significant associations (n=5646). Meta-analyses, producing odds ratios (ORs) as a summary measure of effect size (eg, ratio of the odds of cyber victims who have experienced SH vs nonvictims who have experienced SH), showed that, compared with nonvictims, those who have experienced cybervictimization were OR 2.35 (95% CI 1.65-3.34) times as likely to self-harm, OR 2.10 (95% CI 1.73-2.55) times as likely to exhibit suicidal behaviors, OR 2.57 (95% CI 1.69-3.90) times more likely to attempt suicide, and OR 2.15 (95% CI 1.70-2.71) times more likely to have suicidal thoughts. Cyberbullying perpetrators were OR 1.21 (95% CI 1.02-1.44) times more likely to exhibit suicidal behaviors and OR 1.23 (95% CI 1.10-1.37) times more likely to experience suicidal ideation than nonperpetrators. Conclusions: Victims of cyberbullying are at a greater risk than nonvictims of both self-harm and suicidal behaviors. To a lesser extent, perpetrators of cyberbullying are at risk of suicidal behaviors and suicidal ideation when compared with nonperpetrators. Policy makers and schools should prioritize the inclusion of cyberbullying involvement in programs to prevent traditional bullying. Type of cyberbullying involvement, frequency, and gender should be assessed in future studies. %M 29674305 %R 10.2196/jmir.9044 %U http://www.jmir.org/2018/4/e129/ %U https://doi.org/10.2196/jmir.9044 %U http://www.ncbi.nlm.nih.gov/pubmed/29674305 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e22 %T “Wish You Were Here”: Examining Characteristics, Outcomes, and Statistical Solutions for Missing Cases in Web-Based Psychotherapeutic Trials %A Karin,Eyal %A Dear,Blake F %A Heller,Gillian Z %A Crane,Monique F %A Titov,Nickolai %+ eCentreClinic, Department of Psychology, Macquarie University, 4 First Walk, Sydney, 2109, Australia, 61 298508657, eyal.karin@mq.edu.au %K psychotherapy %K treatment adherence and compliance %K missing data %K treatment efficacy %K statistical bias %D 2018 %7 19.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Missing cases following treatment are common in Web-based psychotherapy trials. Without the ability to directly measure and evaluate the outcomes for missing cases, the ability to measure and evaluate the effects of treatment is challenging. Although common, little is known about the characteristics of Web-based psychotherapy participants who present as missing cases, their likely clinical outcomes, or the suitability of different statistical assumptions that can characterize missing cases. Objective: Using a large sample of individuals who underwent Web-based psychotherapy for depressive symptoms (n=820), the aim of this study was to explore the characteristics of cases who present as missing cases at posttreatment (n=138), their likely treatment outcomes, and compare between statistical methods for replacing their missing data. Methods: First, common participant and treatment features were tested through binary logistic regression models, evaluating the ability to predict missing cases. Second, the same variables were screened for their ability to increase or impede the rate symptom change that was observed following treatment. Third, using recontacted cases at 3-month follow-up to proximally represent missing cases outcomes following treatment, various simulated replacement scores were compared and evaluated against observed clinical follow-up scores. Results: Missing cases were dominantly predicted by lower treatment adherence and increased symptoms at pretreatment. Statistical methods that ignored these characteristics can overlook an important clinical phenomenon and consequently produce inaccurate replacement outcomes, with symptoms estimates that can swing from −32% to 70% from the observed outcomes of recontacted cases. In contrast, longitudinal statistical methods that adjusted their estimates for missing cases outcomes by treatment adherence rates and baseline symptoms scores resulted in minimal measurement bias (<8%). Conclusions: Certain variables can characterize and predict missing cases likelihood and jointly predict lesser clinical improvement. Under such circumstances, individuals with potentially worst off treatment outcomes can become concealed, and failure to adjust for this can lead to substantial clinical measurement bias. Together, this preliminary research suggests that missing cases in Web-based psychotherapeutic interventions may not occur as random events and can be systematically predicted. Critically, at the same time, missing cases may experience outcomes that are distinct and important for a complete understanding of the treatment effect. %M 29674311 %R 10.2196/mental.8363 %U http://mental.jmir.org/2018/2/e22/ %U https://doi.org/10.2196/mental.8363 %U http://www.ncbi.nlm.nih.gov/pubmed/29674311 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 4 %P e121 %T Harnessing Reddit to Understand the Written-Communication Challenges Experienced by Individuals With Mental Health Disorders: Analysis of Texts From Mental Health Communities %A Park,Albert %A Conway,Mike %+ Department of Biomedical Informatics, School of Medicine, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108-3514, United States, 1 206 743 7843, alpark1216@gmail.com %K mental health %K depression %K depressive disorder, major %K depressive disorder %K bipolar disorder %K bipolar %K bipolar and related disorders %K schizophrenia %K schizotypal personality disorder %K schizophrenia spectrum and other psychotic disorders %K consumer health information %K informatics %K information science %K social support %K psychosocial support system %K community networks %K self-help groups %K communications media %D 2018 %7 10.04.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental disorders such as depression, bipolar disorder, and schizophrenia are common, incapacitating, and have the potential to be fatal. Despite the prevalence and gravity of mental disorders, our knowledge concerning everyday challenges associated with them is relatively limited. One of the most studied deficits related to everyday challenges is language impairment, yet we do not know how mental disorders can impact common forms of written communication, for example, social media. Objective: The aims of this study were to investigate written communication challenges manifest in online mental health communities focusing on depression, bipolar disorder, and schizophrenia, as well as the impact of participating in these online mental health communities on written communication. As the control, we selected three online health communities focusing on positive emotion, exercising, and weight management. Methods: We examined lexical diversity and readability, both important features for measuring the quality of writing. We used four well-established readability metrics that consider word frequencies and syntactic complexity to measure writers’ written communication ability. We then measured the lexical diversity by calculating the percentage of unique words in posts. To compare lexical diversity and readability among communities, we first applied pairwise independent sample t tests, followed by P value adjustments using the prespecified Hommel procedure to adjust for multiple comparison. To measure the changes, we applied linear least squares regression to the readability and lexical diversity scores against the interaction sequence for each member, followed by pairwise independent sample t tests and P value adjustments. Given the large sample of members, we also report effect sizes and 95% CIs for the pairwise comparisons. Results: On average, members of depression, bipolar disorder, and schizophrenia communities showed indications of difficulty expressing their ideas compared with three other online health communities. Our results also suggest that participating in these platforms has the potential to improve members’ written communication. For example, members of all three mental health communities showed statistically significant improvement in both lexical diversity and readability compared with members of the OHC focusing on positive emotion. Conclusions: We provide new insights into the written communication challenges faced by individuals suffering from depression, bipolar disorder, and schizophrenia. A comparison with three other online health communities suggests that written communication in mental health communities is significantly more difficult to read, while also consisting of a significantly less diverse lexicon. We contribute practical suggestions for utilizing our findings in Web-based communication settings to enhance members’ communicative experience. We consider these findings to be an important step toward understanding and addressing everyday written communication challenges among individuals suffering from mental disorders. %M 29636316 %R 10.2196/jmir.8219 %U http://www.jmir.org/2018/4/e121/ %U https://doi.org/10.2196/jmir.8219 %U http://www.ncbi.nlm.nih.gov/pubmed/29636316 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e29 %T Engagement With a Trauma Recovery Internet Intervention Explained With the Health Action Process Approach (HAPA): Longitudinal Study %A Yeager,Carolyn M %A Shoji,Kotaro %A Luszczynska,Aleksandra %A Benight,Charles C %+ Department of Psychology, University of Colorado Colorado Springs, 1420 Austin Bluffs Pkwy, Colorado Springs, CO, 80918, United States, 1 719 255 4661, cyeager@uccs.edu %K electronic health (eHealth) %K engagement %K trauma %K stress disorders, post-traumatic %K PTSD %K Health Action Process Approach (HAPA) %K outcome expectations %K internet %K digital health intervention %D 2018 %7 10.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: There has been a growing trend in the delivery of mental health treatment via technology (ie, electronic health, eHealth). However, engagement with eHealth interventions is a concern, and theoretically based research in this area is sparse. Factors that influence engagement are poorly understood, especially in trauma survivors with symptoms of posttraumatic stress. Objective: The aim of this study was to examine engagement with a trauma recovery eHealth intervention using the Health Action Process Approach theoretical model. Outcome expectancy, perceived need, pretreatment self-efficacy, and trauma symptoms influence the formation of intentions (motivational phase), followed by planning, which mediates the translation of intentions into engagement (volitional phase). We hypothesized the mediational effect of planning would be moderated by level of treatment self-efficacy. Methods: Trauma survivors from around the United States used the eHealth intervention for 2 weeks. We collected baseline demographic, social cognitive predictors, and distress symptoms and measured engagement subjectively and objectively throughout the intervention. Results: The motivational phase model explained 48% of the variance, and outcome expectations (beta=.36), perceived need (beta=.32), pretreatment self-efficacy (beta=.13), and trauma symptoms (beta=.21) were significant predictors of intention (N=440). In the volitional phase, results of the moderated mediation model indicated for low levels of treatment self-efficacy, planning mediated the effects of intention on levels of engagement (B=0.89, 95% CI 0.143-2.605; N=115). Conclusions: Though many factors can affect engagement, these results offer a theoretical framework for understanding engagement with an eHealth intervention. This study highlighted the importance of perceived need, outcome expectations, self-efficacy, and baseline distress symptoms in the formation of intentions to use the intervention. For those low in treatment self-efficacy, planning may play an important role in the translation of intentions into engagement. Results of this study may help bring some clarification to the question of what makes eHealth interventions work. %M 29636323 %R 10.2196/mental.9449 %U http://mental.jmir.org/2018/2/e29/ %U https://doi.org/10.2196/mental.9449 %U http://www.ncbi.nlm.nih.gov/pubmed/29636323 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e91 %T Evaluating a Web-Based Social Anxiety Intervention Among University Students: Randomized Controlled Trial %A McCall,Hugh Cameron %A Richardson,Chris G %A Helgadottir,Fjola Dogg %A Chen,Frances S %+ Department of Psychology, University of British Columbia, 3521-2136 West Mall, Vancouver, BC, V6T 1Z4, Canada, 1 604 822 2549, frances.chen@psych.ubc.ca %K social anxiety %K clinical trial %K internet %K cognitive behavior therapy %D 2018 %7 21.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Treatment rates for social anxiety, a prevalent and potentially debilitating condition, remain among the lowest of all major mental disorders today. Although computer-delivered interventions are well poised to surmount key barriers to the treatment of social anxiety, most are only marginally effective when delivered as stand-alone treatments. A new, Web-based cognitive behavioral therapy (CBT) intervention called Overcome Social Anxiety was recently created to address the limitations of prior computer-delivered interventions. Users of Overcome Social Anxiety are self-directed through various CBT modules incorporating cognitive restructuring and behavioral experiments. The intervention is personalized to each user’s symptoms, and automatic email reminders and time limits are used to encourage adherence. Objective: The purpose of this study was to conduct a randomized controlled trial to investigate the effectiveness of Overcome Social Anxiety in reducing social anxiety symptoms in a nonclinical sample of university students. As a secondary aim, we also investigated whether Overcome Social Anxiety would increase life satisfaction in this sample. Methods: Following eligibility screening, participants were randomly assigned to a treatment condition or a wait-list control condition. Only those assigned to the treatment condition were given access to Overcome Social Anxiety; they were asked to complete the program within 4 months. The social interaction anxiety scale (SIAS), the fear of negative evaluation scale (FNE), and the quality of life enjoyment and satisfaction questionnaire—short form (Q-LES-Q-SF) were administered to participants from both conditions during baseline and 4-month follow-up lab visits. Results: Over the course of the study, participants assigned to the treatment condition experienced a significant reduction in social anxiety (SIAS: P<.001, Cohen d=0.72; FNE: P<.001, Cohen d=0.82), whereas those assigned to the control condition did not (SIAS: P=.13, Cohen d=0.26; FNE: P=.40, Cohen d=0.14). Additionally, a direct comparison of the average change in social anxiety in the 2 conditions over the course of the study showed that those assigned to the treatment condition experienced significantly more improvement than those assigned to the control condition (SIAS: P=.03, Cohen d=0.56; FNE: P=.001, Cohen d=0.97). Although participants assigned to the treatment condition experienced a slight increase in life satisfaction, as measured by Q-LES-Q-SF scores, and those assigned to the control condition experienced a slight decrease, these changes were not statistically significant (treatment: P=.35, Cohen d=−0.18; control: P=.30, Cohen d=0.18). Conclusions: Our findings indicate that Overcome Social Anxiety is an effective intervention for treating symptoms of social anxiety and that it may have further utility in serving as a model for the development of new interventions. Additionally, our findings provide evidence that contemporary Web-based interventions can be sophisticated enough to benefit users even when delivered as stand-alone treatments, suggesting that further opportunities likely exist for the development of other Web-based mental health interventions. Trial Registration: ClinicalTrials.gov NCT02792127; https://clinicaltrials.gov/ct2/show/record/NCT02792127 (Archived by WebCite at http://www.webcitation.org/6xGSRh7MG) %M 29563078 %R 10.2196/jmir.8630 %U http://www.jmir.org/2018/3/e91/ %U https://doi.org/10.2196/jmir.8630 %U http://www.ncbi.nlm.nih.gov/pubmed/29563078 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e88 %T Internet-Based Cognitive Behavioral Therapy for Symptoms of Depression and Anxiety Among Patients With a Recent Myocardial Infarction: The U-CARE Heart Randomized Controlled Trial %A Norlund,Fredrika %A Wallin,Emma %A Olsson,Erik Martin Gustaf %A Wallert,John %A Burell,Gunilla %A von Essen,Louise %A Held,Claes %+ Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala, 75185, Sweden, 46 737441304, fredrika.norlund@kbh.uu.se %K eHealth %K treatment adherence and compliance %K patient acceptance of health care %K patient selection %K cardiac rehabilitation %D 2018 %7 08.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Symptoms of depression and anxiety are common after a myocardial infarction (MI). Internet-based cognitive behavioral therapy (iCBT) has shown good results in other patient groups. Objective: The aim of this study was to evaluate the effectiveness of an iCBT treatment to reduce self-reported symptoms of depression and anxiety among patients with a recent MI. Methods: In total, 3928 patients were screened for eligibility in 25 Swedish hospitals. Of these, 239 patients (33.5%, 80/239 women, mean age 60 years) with a recent MI and symptoms of depression or anxiety were randomly allocated to a therapist-guided, 14-week iCBT treatment (n=117), or treatment as usual (TAU; n=122). The iCBT treatment was designed for post-MI patients. The primary outcome was the total score of the Hospital Anxiety and Depression Scale (HADS) 14 weeks post baseline, assessed over the internet. Treatment effect was evaluated according to the intention-to-treat principle, with multiple imputations. For the main analysis, a pooled treatment effect was estimated, controlling for age, sex, and baseline HADS. Results: There was a reduction in HADS scores over time in the total study sample (mean delta=−5.1, P<.001) but no difference between the study groups at follow-up (beta=−0.47, 95% CI −1.95 to 1.00, P=.53). Treatment adherence was low. A total of 46.2% (54/117) of the iCBT group did not complete the introductory module. Conclusions: iCBT treatment for an MI population did not result in lower levels of symptoms of depression or anxiety compared with TAU. Low treatment adherence might have influenced the result. Trial Registration: ClinicalTrials.gov NCT01504191; https://clinicaltrials.gov/ct2/show/NCT01504191 (Archived at Webcite at http://www.webcitation.org/6xWWSEQ22) %M 29519777 %R 10.2196/jmir.9710 %U http://www.jmir.org/2018/3/e88/ %U https://doi.org/10.2196/jmir.9710 %U http://www.ncbi.nlm.nih.gov/pubmed/29519777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e79 %T The Optimization of an eHealth Solution (Thought Spot) with Transition-Aged Youth in Postsecondary Settings: Participatory Design Research %A VanHeerwaarden,Nicole %A Ferguson,Genevieve %A Abi-Jaoude,Alexxa %A Johnson,Andrew %A Hollenberg,Elisa %A Chaim,Gloria %A Cleverley,Kristin %A Eysenbach,Gunther %A Henderson,Joanna %A Levinson,Andrea %A Robb,Janine %A Sharpe,Sarah %A Voineskos,Aristotle %A Wiljer,David %+ Education, Technology & Innovation, University Health Network, 190 Elizabeth Street, R Fraser Elliott Building RFE 3S-411, Toronto, ON, M5G 2C4, Canada, 1 416 340 6322, david.wiljer@uhn.ca %K students %K transition-aged youth %K mental health %K substance use %K eHealth %K mobile apps %K participatory action research %K help-seeking %D 2018 %7 06.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Seventy percent of lifetime cases of mental illness emerge before the age of 24 years, but many youth are unable to access the support and services they require in a timely and appropriate way. With most youth using the internet, electronic health (eHealth) interventions are promising tools for reaching this population. Through participatory design research (PDR) engagement methods, Thought Spot, a Web- and mobile-based platform, was redeveloped to facilitate access to mental health services by transition-aged youth (aged 16-29 years) in postsecondary settings. Objective: The aim of this study was to describe the process of engaging with postsecondary students through the PDR approaches, with the ultimate goal of optimizing the Thought Spot platform. Methods: Consistent with the PDR approaches, five student-led workshops, attended by 41 individuals, were facilitated to obtain feedback regarding the platform’s usability and functionality and its potential value in a postsecondary setting. Various creative engagement activities were delivered to gather experiences and opinions, including semistructured focus groups, questionnaires, personas, journey mapping, and a world café. Innovative technological features and refinements were also brainstormed during the workshops. Results: By using PDR methods of engagement, participants knew that their ideas and recommendations would be applied. There was also an overall sense of respect and care integrated into each group, which facilitated an exchange of ideas and suggestions. Conclusions: The process of engaging with students to redesign the Thought Spot platform through PDR has been effective. Findings from these workshops will significantly inform new technological features within the app to enable positive help-seeking behaviors among students. These behaviors will be further explored in the second phase that involves a randomized controlled trial. %M 29510970 %R 10.2196/jmir.8102 %U http://www.jmir.org/2018/3/e79/ %U https://doi.org/10.2196/jmir.8102 %U http://www.ncbi.nlm.nih.gov/pubmed/29510970 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e62 %T Help-Seeking on Facebook Versus More Traditional Sources of Help: Cross-Sectional Survey of Military Veterans %A Teo,Alan R %A Marsh,Heather E %A Liebow,Samuel B L %A Chen,Jason I %A Forsberg,Christopher W %A Nicolaidis,Christina %A Saha,Somnath %A Dobscha,Steven K %+ Health Services Research and Development Center to Improve Veteran Involvement in Care, Department of Veterans Affairs Portland Health Care System, 3710 SW US Veterans Hospital Rd (R&D 66), Portland, OR,, United States, 1 503 220 8262 ext 52461, teoa@ohsu.edu %K social media %K social networking sites %K internet %K Facebook %K service use %K utilization %K treatment-seeking %D 2018 %7 26.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The media has devoted significant attention to anecdotes of individuals who post messages on Facebook prior to suicide. However, it is unclear to what extent social media is perceived as a source of help or how it compares to other sources of potential support for mental health problems. Objective: This study aimed to evaluate the degree to which military veterans with depression use social media for help-seeking in comparison to other more traditional sources of help. Methods: Cross-sectional self-report survey of 270 adult military veterans with probable major depression. Help-seeking intentions were measured with a modified General Help-Seeking Questionnaire. Facebook users and nonusers were compared via t tests, Chi-square, and mixed effects regression models. Associations between types of help-seeking were examined using mixed effects models. Results: The majority of participants were users of social media, primarily Facebook (n=162). Mean overall help-seeking intentions were similar between Facebook users and nonusers, even after adjustment for potential confounders. Facebook users were very unlikely to turn to Facebook as a venue for support when experiencing either emotional problems or suicidal thoughts. Compared to help-seeking intentions for Facebook, help-seeking intentions for formal (eg, psychologists), informal (eg, friends), or phone helpline sources of support were significantly higher. Results did not substantially change when examining users of other social media, women, or younger adults. Conclusions: In its current form, the social media platform Facebook is not seen as a venue to seek help for emotional problems or suicidality among veterans with major depression in the United States. %M 29483064 %R 10.2196/jmir.9007 %U http://www.jmir.org/2018/2/e62/ %U https://doi.org/10.2196/jmir.9007 %U http://www.ncbi.nlm.nih.gov/pubmed/29483064 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 2 %P e59 %T Attitudes Toward e-Mental Health Services in a Community Sample of Adults: Online Survey %A March,Sonja %A Day,Jamin %A Ritchie,Gabrielle %A Rowe,Arlen %A Gough,Jeffrey %A Hall,Tanya %A Yuen,Chin Yan Jackie %A Donovan,Caroline Leanne %A Ireland,Michael %+ Institute for Resilient Regions, School of Psychology and Counselling, University of Southern Queensland, Springfield Campus, Queensland, 4300, Australia, 61 734704434, Sonja.March@usq.edu.au %K eHealth %K mHealth %K consumer preference %K attitude %D 2018 %7 19.02.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite evidence that e-mental health services are effective, consumer preferences still appear to be in favor of face-to-face services. However, the theory of planned behavior (TPB) suggests that cognitive intentions are more proximal to behavior and thus may have a more direct influence on service use. Investigating individual characteristics that influence both preferences and intentions to use e-mental health services is important for better understanding factors that might impede or facilitate the use of these services. Objective: This study explores predictors of preferences and intentions to access e-mental health services relative to face-to-face services. Five domains were investigated (demographics, technology factors, personality, psychopathology, and beliefs), identified from previous studies and informed by the Internet interventions model. We expected that more participants would report intentions to use e-mental health services relative to reported preferences for this type of support and that these 5 domains would be significantly associated with both intentions and preferences toward online services. Methods: A mixed sample of 308 community members and university students was recruited through social media and the host institution in Australia. Ages ranged between 17 and 68 years, and 82.5% (254/308) were female. Respondents completed an online survey. Chi-square analysis and t tests were used to explore group differences, and logistic regression models were employed to explore factors predicting preferences and intentions. Results: Most respondents (85.7%, 264/308) preferred face-to-face services over e-mental health services. Relative to preferences, a larger proportion of respondents (39.6%, 122/308) endorsed intentions to use e-mental health services if experiencing mental health difficulties in the future. In terms of the 5 predictor domains, 95% CIs of odds ratios (OR) derived from bootstrapped standard errors suggested that prior experience with online services significantly predicted intentions to use self-help (95% CI 2.08-16.24) and therapist-assisted (95% CI 1.71-11.90) online services in future. Being older predicted increased intentions to use therapist-assisted online services in future (95% CI 1.01-1.06), as did more confidence using computers and the Internet (95% CI 1.06-2.69). Technology confidence was also found to predict greater preference for online services versus face-to-face options (95% CI 1.24-4.82), whereas higher doctor-related locus of control, or LOC (95% CI 0.76-0.95), and extraversion (95% CI 0.88-1.00) were predictive of lower likelihood of preferring online services relative to face-to-face services. Conclusions: Despite generally low reported preferences toward e-mental health services, intentions to access these services are higher, raising the question of how to best encourage translation of intentions into behavior (ie, actual use of programs). Strategies designed to ease people into new Internet-based mental health programs (to enhance confidence and familiarity) may be important for increasing the likelihood that they will return to such programs later. %M 29459357 %R 10.2196/jmir.9109 %U http://www.jmir.org/2018/2/e59/ %U https://doi.org/10.2196/jmir.9109 %U http://www.ncbi.nlm.nih.gov/pubmed/29459357 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e33 %T Gender Differences in and the Relationships Between Social Anxiety and Problematic Internet Use: Canonical Analysis %A Baloğlu,Mustafa %A Özteke Kozan,Hatice İrem %A Kesici,Şahin %+ Department of Special Education, Faculty of Education, Hacettepe University, Beytepe Campus, Ankara, 06610, Turkey, 90 3127806315, baloglu@hotmail.com %K anxiety %K Internet %K sex characteristics %K social anxiety disorder %K addictive behavior %D 2018 %7 24.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The cognitive-behavioral model of problematic Internet use (PIU) proposes that psychological well-being is associated with specific thoughts and behaviors on the Internet. Hence, there is growing concern that PIU is associated with psychological impairments. Objective: Given the proposal of gender schema theory and social role theory, men and women are predisposed to experience social anxiety and engage in Internet use differently. Thus, an investigation of gender differences in these areas is warranted. According to the cognitive-behavioral model of PIU, social anxiety is associated with specific cognitions and behaviors on the Internet. Thus, an investigation of the association between social anxiety and PIU is essential. In addition, research that takes into account the multidimensional nature of social anxiety and PIU is lacking. Therefore, this study aimed to explore multivariate gender differences in and the relationships between social anxiety and PIU. Methods: Participants included 505 college students, of whom 241 (47.7%) were women and 264 (52.3%) were men. Participants’ ages ranged from 18 to 22 years, with a mean age of 20.34 (SD=1.16). The Social Anxiety Scale and Problematic Internet Use Scale were used in data collection. Multivariate analysis of variance (MANOVA) and canonical correlation analysis were used. Results: Mean differences between men and women were not statistically significant in social anxiety (λ=.02, F3,501=2.47, P=.06). In all three PIU dimensions, men scored higher than women, and MANOVA shows that multivariate difference was statistically significant (λ=.94, F3,501=10.69, P<.001). Of the canonical correlation functions computed for men, only the first was significant (Rc=.43, λ=.78, χ29=64.7, P<.001) and accounted for 19% of the overlapping variance. Similarly, only the first canonical function was significant for women (Rc=.36, λ=.87, χ29=33.9, P<.001), which accounted for 13% of the overlapping variance. Conclusions: On the basis of the findings, we conclude that enhanced educational opportunities for women and their increasing role in the society have led women to become more active and thus closed the gap in social anxiety levels between men and women. We found that men showed more difficulties than women in terms of running away from personal problems (ie, social benefit), used the Internet more excessively, and experienced more interpersonal problems with significant others due to Internet use. We conclude that men are under a greater risk of social impairments due to PIU. Our overall conclusion is that there is a substantial amount of association between social anxiety and PIU and the association is stronger for men than it is for women. We advise that future research continue to investigate PIU and social anxiety as multidimensional constructs. %M 29367182 %R 10.2196/jmir.8947 %U http://www.jmir.org/2018/1/e33/ %U https://doi.org/10.2196/jmir.8947 %U http://www.ncbi.nlm.nih.gov/pubmed/29367182 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e12 %T Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety: Open Trial %A Shahnavaz,Shervin %A Hedman-Lagerlöf,Erik %A Hasselblad,Tove %A Reuterskiöld,Lena %A Kaldo,Viktor %A Dahllöf,Göran %+ Division of Pediatric Dentistry, Department of Dental Medicine, Karolinska Institutet, Box 4064, 14104, Huddinge,, Sweden, 46 8 52488091, shervin.shahnavaz@ki.se %K cognitive behavioral therapy %K dental fear %K dental phobia %K dentistry %K internet-based treatment %K pediatric dentistry %K psychology %K self efficacy %D 2018 %7 22.01.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects. Objective: The aim of this study was to test the hypothesis that psychologist-guided ICBT improves school-aged children’s and adolescents’ ability to manage dental anxiety by (1) decreasing avoidance and affecting the phobia diagnosis and (2) decreasing the dental fear and increasing the target groups’ self-efficacy. The study also aimed to examine the feasibility and acceptability of this novel treatment. Methods: This was an open, uncontrolled trial with assessments at baseline, posttreatment, and the 1-year follow-up. The study enrolled and treated 18 participants. The primary outcome was level of avoidance behaviors, as measured by the picture-guided behavioral avoidance test (PG-BAT). The secondary outcome was a diagnostic evaluation with the parents conducted by a psychologist. The specific phobia section of the structured interview Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) was used. Other outcome measures included level of dental anxiety and self-efficacy. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received Web-based guidance from a psychologist. Treatment also included training at dental clinics. Feasibility and acceptability were assessed by measures of engagement, adherence, compliance, completed measures, patient and parent satisfaction scale, and staff acceptability. Results: The level of avoidance (according to the primary outcome measure PG-BAT) and dental anxiety decreased and self-efficacy increased significantly (P<.001), within-group effect sizes for both the primary outcome (Cohen d=1.5), and other outcomes were large in the range of 0.9 and 1.5. According to K-SADS-PL, 53% (8/15) of the participants were free from diagnosable dental anxiety at the 1-year follow-up. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% (9/15) of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. The target group showed improvement in all the outcome measures. High levels of feasibility and acceptability were observed for the treatment. Conclusions: ICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies. %M 29358158 %R 10.2196/jmir.7803 %U http://www.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/jmir.7803 %U http://www.ncbi.nlm.nih.gov/pubmed/29358158 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 1 %P e2 %T From eHealth to iHealth: Transition to Participatory and Personalized Medicine in Mental Health %A Berrouiguet,Sofian %A Perez-Rodriguez,Mercedes M %A Larsen,Mark %A Baca-García,Enrique %A Courtet,Philippe %A Oquendo,Maria %+ Lab-STICC, IMT Atlantique, Université Bretagne Loire, Boulevard Tanguy Prigent, Technopole iroise, Brest,, France, 33 6 68 20 41 78, sofian.berrouiguet@gmail.com %K data mining %K decision making %K mobile phone %K Web app %K mental health %D 2018 %7 03.01.2018 %9 Viewpoint %J J Med Internet Res %G English %X Clinical assessment in psychiatry is commonly based on findings from brief, regularly scheduled in-person appointments. Although critically important, this approach reduces assessment to cross-sectional observations that miss essential information about disease course. The mental health provider makes all medical decisions based on this limited information. Thanks to recent technological advances such as mobile phones and other personal devices, electronic health (eHealth) data collection strategies now can provide access to real-time patient self-report data during the interval between visits. Since mobile phones are generally kept on at all times and carried everywhere, they are an ideal platform for the broad implementation of ecological momentary assessment technology. Integration of these tools into medical practice has heralded the eHealth era. Intelligent health (iHealth) further builds on and expands eHealth by adding novel built-in data analysis approaches based on (1) incorporation of new technologies into clinical practice to enhance real-time self-monitoring, (2) extension of assessment to the patient’s environment including caregivers, and (3) data processing using data mining to support medical decision making and personalized medicine. This will shift mental health care from a reactive to a proactive and personalized discipline. %M 29298748 %R 10.2196/jmir.7412 %U http://www.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/jmir.7412 %U http://www.ncbi.nlm.nih.gov/pubmed/29298748 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 12 %P e231 %T Direct to Public Peer Support and e-Therapy Program Versus Information to Aid Self-Management of Depression and Anxiety: Protocol for a Randomized Controlled Trial %A Kaylor-Hughes,Catherine J %A Rawsthorne,Mat %A Coulson,Neil S %A Simpson,Sandra %A Simons,Lucy %A Guo,Boliang %A James,Marilyn %A Moran,Paul %A Simpson,Jayne %A Hollis,Chris %A Avery,Anthony J %A Tata,Laila J %A Williams,Laura %A , %A Morriss,Richard K %+ National Institute for Health Research: Collaboration for Leadership in Applied Health Research and Care East Midlands, University of Nottingham, Institute of Mental Health Building, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 01158232478, richard.morriss@nottingham.ac.uk %K depression %K anxiety %K peer support %K online %K self-management %D 2017 %7 18.12.2017 %9 Protocol %J JMIR Res Protoc %G English %X Background: Regardless of geography or income, effective help for depression and anxiety only reaches a small proportion of those who might benefit from it. The scale of the problem suggests a role for effective, safe, anonymized public health–driven Web-based services such as Big White Wall (BWW), which offer immediate peer support at low cost. Objective: Using Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) methodology, the aim of this study was to determine the population reach, effectiveness, cost-effectiveness, and barriers and drivers to implementation of BWW compared with Web-based information compiled by UK’s National Health Service (NHS, NHS Choices Moodzone) in people with probable mild to moderate depression and anxiety disorder. Methods: A pragmatic, parallel-group, single-blind randomized controlled trial (RCT) is being conducted using a fully automated trial website in which eligible participants are randomized to receive either 6 months access to BWW or signposted to the NHS Moodzone site. The recruitment of 2200 people to the study will be facilitated by a public health engagement campaign involving general marketing and social media, primary care clinical champions, health care staff, large employers, and third sector groups. People will refer themselves to the study and will be eligible if they are older than 16 years, have probable mild to moderate depression or anxiety disorders, and have access to the Internet. Results: The primary outcome will be the Warwick-Edinburgh Mental Well-Being Scale at 6 weeks. We will also explore the reach, maintenance, cost-effectiveness, and barriers and drivers to implementation and possible mechanisms of actions using a range of qualitative and quantitative methods. Conclusions: This will be the first fully digital trial of a direct to public online peer support program for common mental disorders. The potential advantages of adding this to current NHS mental health services and the challenges of designing a public health campaign and RCT of two digital interventions using a fully automated digital enrollment and data collection process are considered for people with depression and anxiety. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 12673428; http://www.controlled-trials.com/ISRCTN12673428/12673428 (Archived by WebCite at http://www.webcitation.org/6uw6ZJk5a) %M 29254909 %R 10.2196/resprot.8061 %U http://www.researchprotocols.org/2017/12/e231/ %U https://doi.org/10.2196/resprot.8061 %U http://www.ncbi.nlm.nih.gov/pubmed/29254909 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e404 %T Individual Differences in the Relationship Between Attachment and Nomophobia Among College Students: The Mediating Role of Mindfulness %A Arpaci,Ibrahim %A Baloğlu,Mustafa %A Özteke Kozan,Hatice İrem %A Kesici,Şahin %+ Department of Special Education, Faculty of Education, Hacettepe University, Beytepe Campus, Ankara, 06110, Turkey, 90 3127806315, baloglu@hotmail.com %K reactive attachment disorder %K mindfulness %K anxiety %K phobic disorders %K phobia %K smartphone %D 2017 %7 14.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a growing interest in nomophobia, which is defined as the fear of being out of cellular phone contact, or "feelings of discomfort or anxiety experienced by individuals when they are unable to use their mobile phones or utilize the affordances these devices provide”. However, only limited research can be found in terms of its determinants at present. Contemporary literature suggests that the relationships among attachment styles, mindfulness, and nomophobia have not been investigated. Objective: This study aims to investigate the mediating effect of mindfulness on the relationship between attachment and nomophobia. In addition, the study also focuses on gender differences in attachment, mindfulness, and nomophobia. A theory-based structural model was tested to understand the essentials of the associations between the constructs. Methods: The Experiences in Close Relationships Scale, Nomophobia Questionnaire, and Mindful Attention Awareness Scale were used to collect data from undergraduate students (N=450; 70.9% women [319/450]; mean age=21.94 years [SD 3.61]). Two measurement models (ie, attachment and mindfulness) and a structural model were specified, estimated, and evaluated. Results: The structural equation model shows that the positive direct effects of avoidant (.13, P=.03) and anxious attachment (.48, P<.001) on nomophobia were significant. The negative direct effects of avoidant (−.18, P=.01) and anxious attachment (−.33, P<.001) on mindfulness were also significant. Moreover, mindfulness has a significant negative effect on nomophobia for women only (−.13, P=.03). Finally, the Sobel test showed that the indirect effects of avoidant and anxious attachment on nomophobia via mindfulness were significant (P<.001). The direct and indirect effects of anxious attachment, avoidant attachment, and mindfulness altogether accounted for 33% of the total variance in nomophobia. Gender comparison results show that there is a significant difference in attachment based on gender (F2,447=6.97, P=.01, Wilk λ=.97, partial η2=.03). Women (mean 68.46 [SD 16.96]) scored significantly higher than men (mean 63.59 [SD 15.97]) in anxious attachment (F1=7.93, P=.01, partial η2=.02). Gender differences in mindfulness were not significant (F4,448=3.45, P=.69). On the other hand, results do show significant gender differences in nomophobia (F4,445=2.71, P=.03, Wilk λ=.98, partial η2=.02) where women scored significantly higher than men. Conclusions: In general, individuals who are emotionally more dependent and crave more closeness and attention in the relationship tend to display higher levels of fear or discomfort when they have no access to their mobile phones. However, gender has a differential impact on the relationship between avoidant attachment and nomophobia. This study establishes the impact of mindfulness on nomophobia for women; therefore, future studies should test the effectiveness of mindfulness-based therapy approaches and confirm whether they are effective and efficient. On the basis of significant gender difference in nomophobia and attachment, we conclude that gender should be taken into account in mindfulness-based treatments dealing with nomophobia. %M 29242179 %R 10.2196/jmir.8847 %U http://www.jmir.org/2017/12/e404/ %U https://doi.org/10.2196/jmir.8847 %U http://www.ncbi.nlm.nih.gov/pubmed/29242179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e398 %T Two Novel Cognitive Behavioral Therapy–Based Mobile Apps for Agoraphobia: Randomized Controlled Trial %A Christoforou,Marina %A Sáez Fonseca,José Andrés %A Tsakanikos,Elias %+ Department of Psychology, University of Roehampton, Holybourne Avenue, London, SW15 4JD, United Kingdom, 44 020 8392 3080, elias.tsakanikos@roehampton.ac.uk %K agoraphobia %K anxiety %K eHealth %K computerized interventions %K mobile applications %K randomized controlled trial %K RCT %D 2017 %7 24.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the large body of literature demonstrating the effectiveness of cognitive behavioral treatments for agoraphobia, many patients remain untreated because of various barriers to treatment. Web-based and mobile-based interventions targeting agoraphobia may provide a solution to this problem, but there is a lack of research investigating the efficacy of such interventions. Objective: The objective of our study was to evaluate for the first time the effectiveness of a self-guided mobile-based intervention primarily targeting agoraphobic symptoms, with respect to a generic mobile app targeting anxiety. Methods: A Web-based randomized controlled trial (RCT) compared a novel mobile app designed to target agoraphobia (called Agoraphobia Free) with a mobile app designed to help with symptoms of anxiety in general (called Stress Free). Both interventions were based on established cognitive behavioral principles. We recruited participants (N=170) who self-identified as having agoraphobia and assessed them online at baseline, midpoint, and end point (posttreatment) over a period of 12 weeks. The primary outcome was symptom severity measured by the Panic and Agoraphobia Scale. Results: Both groups had statistically significant improvements in symptom severity over time (difference –5.97, 95% CI –8.49 to –3.44, P<.001 for Agoraphobia Free and –6.35, 95% CI –8.82 to –3.87, P<.001 for Stress Free), but there were no significant between-group differences on the primary outcome (difference 0.38, 95% CI –1.96 to 3.20, P=.64). Conclusions: This is, to our knowledge, the first RCT to provide evidence that people who identify as having agoraphobia may equally benefit from a diagnosis-specific and a transdiagnostic mobile-based intervention. We also discuss clinical and research implications for the development and dissemination of mobile mental health apps. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 98453199; http://www.isrctn.com /ISRCTN98453199 (Archived by WebCite at http://www.webcitation.org/6uR5vsdZw) %M 29175809 %R 10.2196/jmir.7747 %U http://www.jmir.org/2017/11/e398/ %U https://doi.org/10.2196/jmir.7747 %U http://www.ncbi.nlm.nih.gov/pubmed/29175809 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e373 %T Smartphone Cognitive Behavioral Therapy as an Adjunct to Pharmacotherapy for Refractory Depression: Randomized Controlled Trial %A Mantani,Akio %A Kato,Tadashi %A Furukawa,Toshi A %A Horikoshi,Masaru %A Imai,Hissei %A Hiroe,Takahiro %A Chino,Bun %A Funayama,Tadashi %A Yonemoto,Naohiro %A Zhou,Qi %A Kawanishi,Nao %+ Department of Health Promotion and Human Behavior, School of Public Health, Graduate School of Medicine, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 6068501, Japan, 81 757538941, furukawa@kuhp.kyoto-u.ac.jp %K major depressive disorder %K pharmacotherapy-resistant depression %K mobile phone app %K cognitive behavioral therapy %K eHealth %D 2017 %7 03.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: In the treatment of major depression, antidepressants are effective but not curative. Cognitive behavioral therapy (CBT) is also effective, alone or in combination with pharmacotherapy, but accessibility is a problem. Objective: The aim is to evaluate the effectiveness of a smartphone CBT app as adjunctive therapy among patients with antidepressant-resistant major depression. Methods: A multisite, assessor-masked, parallel-group randomized controlled trial was conducted in 20 psychiatric clinics and hospitals in Japan. Participants were eligible if they had a primary diagnosis of major depression and were antidepressant-refractory after taking one or more antidepressants at an adequate dosage for four or more weeks. After a 1-week run-in in which participants started the medication switch and had access to the welcome session of the app, patients were randomized to medication switch alone or to medication switch plus smartphone CBT app via the centralized Web system. The smartphone app, called Kokoro-app (“kokoro” means “mind” in Japanese), included sessions on self-monitoring, behavioral activation, and cognitive restructuring presented by cartoon characters. The primary outcome was depression severity as assessed by masked telephone assessors with the Patient Health Questionnaire-9 (PHQ-9) at week 9. The secondary outcomes included the Beck Depression Inventory-II (BDI-II) and Frequency, Intensity, and Burden of Side Effects Ratings (FIBSER). Results: In the total sample (N=164), 81 participants were allocated to the smartphone CBT in addition to medication change and 83 to medication change alone. In the former group, all but one participant (80/81, 99%) completed at least half, and 71 (88%) completed at least six of eight sessions. In the intention-to-treat analysis, patients allocated the CBT app scored 2.48 points (95% CI 1.23-3.72, P<.001; standardized mean difference 0.40) lower on PHQ-9 than the control at week 9. The former group also scored 4.1 points (95% CI 1.5-6.6, P=.002) lower on BDI-II and 0.76 points (95% CI –0.05 to 1.58, P=.07) lower on FIBSER. In the per-protocol sample (comfortable with the smartphone app, still symptomatic, and adherent to medication with mild or less side effects after run-in), the intervention group (n=60) scored 1.72 points (95% CI 0.25-3.18, P=.02) lower on PHQ-9, 3.2 points (95% CI –0.01 to 6.3, P=.05) lower on BDI-II, and 0.75 points (95% CI 0.03-1.47, P=.04) lower on FIBSER than the control (n=57). The treatment benefits were maintained up to week 17. Conclusions: This is the first study to demonstrate the effectiveness of a smartphone CBT in the treatment of clinically diagnosed depression. Given the merits of the mobile mental health intervention, including accessibility, affordability, quality control, and effectiveness, it is clinically worthwhile to consider adjunctive use of a smartphone CBT app when treating patients with antidepressant-resistant depression. Research into its effectiveness in wider clinical contexts is warranted. Trial Registration: Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik) %M 29101095 %R 10.2196/jmir.8602 %U http://www.jmir.org/2017/11/e373/ %U https://doi.org/10.2196/jmir.8602 %U http://www.ncbi.nlm.nih.gov/pubmed/29101095 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 4 %P e44 %T Exploring the Therapeutic Affordances of Self-Harm Online Support Communities: An Online Survey of Members %A Coulson,Neil S %A Bullock,Emma %A Rodham,Karen %+ University of Nottingham, Division of Rehabilitation & Ageing, School of Medicine, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom, 44 01158466642, neil.coulson@nottingham.ac.uk %K self-harm %K social network %K social support %K qualitative research %K online support group %D 2017 %7 13.10.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: A growing number of online communities have been established to support those who self-harm. However, little is known about the therapeutic affordances arising from engagement with these communities and resulting outcomes. Objective: The aim of this study was to explore the presence of therapeutic affordances as reported by members of self-harm online support communities. Methods: In total, 94 respondents (aged 13-63 years, mean=23.5 years; 94% female) completed an online survey exploring their experiences of engaging with a self-harm online support community. Respondents varied in terms of how long they had been accessing an online community, with 22% (21/94) accessing less than 1 year, 39% (37/94) 1 to 2 years, 14% (13/94) 2 to 3 years, and 24.5% (23/94) more than 3 years. Responses were analyzed using deductive thematic analysis. Results: The results of our analysis describe each of the five therapeutic affordances that were present in the data, namely (1) connection, the ability to make contact with others who self-harm for the purposes of mutual support and in so doing reduce feelings of loneliness and isolation; (2) adaptation, that is, how use of online support varies in relation to the personal circumstances of the individual user; (3) exploration, that is, the ability to learn about self-harm and learn about strategies to reduce or stop self-harming behavior; (4) narration, that is, the ability to share experiences, as well as read about the experiences of others; and (5) self-presentation, that is, how and what users present about themselves to others in the online community. Conclusions: Our findings suggest that engagement with self-harm online support communities may confer a range of therapeutic benefits for some users, which may serve to minimize the psychosocial burden of self-harm and promote positive coping strategies. In addition, the online nature of the support available may be helpful to those who are unable to access face-to-face support. %M 29030324 %R 10.2196/mental.8084 %U http://mental.jmir.org/2017/4/e44/ %U https://doi.org/10.2196/mental.8084 %U http://www.ncbi.nlm.nih.gov/pubmed/29030324 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e306 %T Blending Face-to-Face and Internet-Based Interventions for the Treatment of Mental Disorders in Adults: Systematic Review %A Erbe,Doris %A Eichert,Hans-Christoph %A Riper,Heleen %A Ebert,David Daniel %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Nägelsbachstr. 25a, Erlangen, 91052, Germany, 49 9131 85 67566, david.ebert@fau.de %K mental health %K Internet %K psychotherapy %K blended treatment %D 2017 %7 15.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Many studies have provided evidence for the effectiveness of Internet-based stand-alone interventions for mental disorders. A newer form of intervention combines the strengths of face-to-face (f2f) and Internet approaches (blended interventions). Objective: The aim of this review was to provide an overview of (1) the different formats of blended treatments for adults, (2) the stage of treatment in which these are applied, (3) their objective in combining face-to-face and Internet-based approaches, and (4) their effectiveness. Methods: Studies on blended concepts were identified through systematic searches in the MEDLINE, PsycINFO, Cochrane, and PubMed databases. Keywords included terms indicating face-to-face interventions (“inpatient,” “outpatient,” “face-to-face,” or “residential treatment”), which were combined with terms indicating Internet treatment (“internet,” “online,” or “web”) and terms indicating mental disorders (“mental health,” “depression,” “anxiety,” or “substance abuse”). We focused on three of the most common mental disorders (depression, anxiety, and substance abuse). Results: We identified 64 publications describing 44 studies, 27 of which were randomized controlled trials (RCTs). Results suggest that, compared with stand-alone face-to-face therapy, blended therapy may save clinician time, lead to lower dropout rates and greater abstinence rates of patients with substance abuse, or help maintain initially achieved changes within psychotherapy in the long-term effects of inpatient therapy. However, there is a lack of comparative outcome studies investigating the superiority of the outcomes of blended treatments in comparison with classic face-to-face or Internet-based treatments, as well as of studies identifying the optimal ratio of face-to-face and Internet sessions. Conclusions: Several studies have shown that, for common mental health disorders, blended interventions are feasible and can be more effective compared with no treatment controls. However, more RCTs on effectiveness and cost-effectiveness of blended treatments, especially compared with nonblended treatments are necessary. %M 28916506 %R 10.2196/jmir.6588 %U http://www.jmir.org/2017/9/e306/ %U https://doi.org/10.2196/jmir.6588 %U http://www.ncbi.nlm.nih.gov/pubmed/28916506 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e266 %T How do eHealth Programs for Adolescents With Depression Work? A Realist Review of Persuasive System Design Components in Internet-Based Psychological Therapies %A Wozney,Lori %A Huguet,Anna %A Bennett,Kathryn %A Radomski,Ashley D %A Hartling,Lisa %A Dyson,Michele %A McGrath,Patrick J %A Newton,Amanda S %+ Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 780 248 5581, mandi.newton@ualberta.ca %K persuasive systems %K mental health %K Internet-based intervention %K review %K psychological therapy %D 2017 %7 09.08.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Major depressive disorders are common among adolescents and can impact all aspects of their daily life. Traditional therapies, cognitive behavioral therapy (CBT), and interpersonal psychotherapy (IPT) have been delivered face-to-face. However, Internet-based (online) delivery of these therapies is emerging as an option for adolescents. Internet-based CBT and IPT involve therapeutic content, interaction between the user and the system, and different technological features embedded into the online program (eg, multimedia). Studies of Internet-based CBT and IPT for adolescent depression differ on all three aspects, and variable, positive therapy effects have been reported. A better understanding of the treatment conditions that influence therapy outcomes is important to designing and evaluating these novel therapies. Objective: Our aim was to examine the technological and program delivery features of Internet-based CBT and IPT for adolescent depression and to document their potential relation to treatment outcomes and program use. Methods: We performed a realist synthesis. We started with an extensive search of published and gray literature. We included intervention studies that evaluated Internet-based CBT or IPT for adolescent depression. We included mixed-methods and qualitative studies, theoretical papers, and policy/implementation documents if they included a focus on how Internet-based psychological therapy is proposed to work for adolescents with depression/depressive symptoms. We used the Mixed-Methods Appraisal Tool to assess the methodological quality of studies. We used the Persuasive System Design (PSD) model as a framework for data extraction and analysis to examine how Internet-based CBT and IPT, as technology-based systems, influence the attitudes and behaviors of system users. PSD components described for the therapies were linked to reported outcomes using a cross-case comparison method and thematic synthesis. Results: We identified 19 Internet-based CBT programs in 59 documents. Of those, 71% (42/59) were of moderate to high quality. The PSD features surface credibility (competent “look and feel”), dialogue support (online program + in-person support), liking and similarity (esthetics and content appeal to adolescent users), the reduction and tunneling of therapeutic content (reducing online content into simple tasks, guiding users), and use of self-monitoring were present in therapies that resulted in improved therapy engagement, satisfaction, and adherence, as well as symptom and functional impairments. Conclusions: When incorporated into Internet-based CBT for adolescent depression, PSD features may improve adolescent adherence, satisfaction, and depression-related outcomes. Testing of these features using hypothesis-driven dismantling approaches is recommended to advance our understanding of how these features contribute to therapy effectiveness. %M 28793983 %R 10.2196/jmir.7573 %U http://www.jmir.org/2017/8/e266/ %U https://doi.org/10.2196/jmir.7573 %U http://www.ncbi.nlm.nih.gov/pubmed/28793983 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 8 %P e267 %T Application of Synchronous Text-Based Dialogue Systems in Mental Health Interventions: Systematic Review %A Hoermann,Simon %A McCabe,Kathryn L %A Milne,David N %A Calvo,Rafael A %+ Positive Computing Laboratory, School of Electrical and Information Engineering, The University of Sydney, Building J03, Maze Crescent, Sydney, 2008, Australia, 61 2 9351 8171, rafael.calvo@sydney.edu.au %K chat %K dialog system %K remote psychotherapy %D 2017 %7 21.7.2017 %9 Review %J J Med Internet Res %G English %X Background: Synchronous written conversations (or “chats”) are becoming increasingly popular as Web-based mental health interventions. Therefore, it is of utmost importance to evaluate and summarize the quality of these interventions. Objective: The aim of this study was to review the current evidence for the feasibility and effectiveness of online one-on-one mental health interventions that use text-based synchronous chat. Methods: A systematic search was conducted of the databases relevant to this area of research (Medical Literature Analysis and Retrieval System Online [MEDLINE], PsycINFO, Central, Scopus, EMBASE, Web of Science, IEEE, and ACM). There were no specific selection criteria relating to the participant group. Studies were included if they reported interventions with individual text-based synchronous conversations (ie, chat or text messaging) and a psychological outcome measure. Results: A total of 24 articles were included in this review. Interventions included a wide range of mental health targets (eg, anxiety, distress, depression, eating disorders, and addiction) and intervention design. Overall, compared with the waitlist (WL) condition, studies showed significant and sustained improvements in mental health outcomes following synchronous text-based intervention, and post treatment improvement equivalent but not superior to treatment as usual (TAU) (eg, face-to-face and telephone counseling). Conclusions: Feasibility studies indicate substantial innovation in this area of mental health intervention with studies utilizing trained volunteers and chatbot technologies to deliver interventions. While studies of efficacy show positive post-intervention gains, further research is needed to determine whether time requirements for this mode of intervention are feasible in clinical practice. %M 28784594 %R 10.2196/jmir.7023 %U http://www.jmir.org/2017/8/e267/ %U https://doi.org/10.2196/jmir.7023 %U http://www.ncbi.nlm.nih.gov/pubmed/28784594 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e29 %T Peer Communication in Online Mental Health Forums for Young People: Directional and Nondirectional Support %A Prescott,Julie %A Hanley,Terry %A Ujhelyi,Katalin %+ School of Education and Psychology, University of Bolton, Deane Road, Bolton, BL3 5AB, United Kingdom, 44 0120490 ext 3676, j.prescott@bolton.ac.uk %K adolescence %K Internet %K social media, mental health %K qualitative research %D 2017 %7 02.08.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: The Internet has the potential to help young people by reducing the stigma associated with mental health and enabling young people to access services and professionals which they may not otherwise access. Online support can empower young people, help them develop new online friendships, share personal experiences, communicate with others who understand, provide information and emotional support, and most importantly help them feel less alone and normalize their experiences in the world. Objective: The aim of the research was to gain an understanding of how young people use an online forum for emotional and mental health issues. Specifically, the project examined what young people discuss and how they seek support on the forum (objective 1). Furthermore, it looked at how the young service users responded to posts to gain an understanding of how young people provided each other with peer-to-peer support (objective 2). Methods: Kooth is an online counseling service for young people aged 11-25 years and experiencing emotional and mental health problems. It is based in the United Kingdom and provides support that is anonymous, confidential, and free at the point of delivery. Kooth provided the researchers with all the online forum posts between a 2-year period, which resulted in a dataset of 622 initial posts and 3657 initial posts with responses. Thematic analysis was employed to elicit key themes from the dataset. Results: The findings support the literature that online forums provide young people with both informational and emotional support around a wide array of topics. The findings from this large dataset also reveal that this informational or emotional support can be viewed as directive or nondirective. The nondirective approach refers to when young people provide others with support by sharing their own experiences. These posts do not include explicit advice to act in a particular way, but the sharing process is hoped to be of use to the poster. The directive approach, in contrast, involves individuals making an explicit suggestion of what they believe the poster should do. Conclusions: This study adds to the research exploring what young people discuss within online forums and provides insights into how these communications take place. Furthermore, it highlights the challenge that organizations may encounter in mediating support that is multidimensional in nature (informational-emotional, directive-nondirective). %M 28768607 %R 10.2196/mental.6921 %U http://mental.jmir.org/2017/3/e29/ %U https://doi.org/10.2196/mental.6921 %U http://www.ncbi.nlm.nih.gov/pubmed/28768607 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e263 %T Web-Based Interventions to Improve Mental Health, General Caregiving Outcomes, and General Health for Informal Caregivers of Adults With Chronic Conditions Living in the Community: Rapid Evidence Review %A Ploeg,Jenny %A Markle-Reid,Maureen %A Valaitis,Ruta %A McAiney,Carrie %A Duggleby,Wendy %A Bartholomew,Amy %A Sherifali,Diana %+ School of Nursing, Faculty of Health Sciences, McMaster University, Room HSc 3N25C, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 22294, ploegj@mcmaster.ca %K Internet %K review %K chronic disease %K adult %K caregivers %D 2017 %7 28.07.2017 %9 Review %J J Med Internet Res %G English %X Background: Most adults with chronic conditions live at home and rely on informal caregivers to provide support. Caregiving can result in negative impacts such as poor mental and physical health. eHealth interventions may offer effective and accessible ways to provide education and support to informal caregivers. However, we know little about the impact of Web-based interventions for informal caregivers of community-dwelling adults with chronic conditions. Objective: The purpose of this rapid evidence review was to assess the impact of Web-based interventions on mental health, general caregiving outcomes, and general health for informal caregivers of persons with chronic conditions living in the community. Methods: A rapid evidence review of the current literature was employed to address the study purpose. EMBASE, MEDLINE, PsychInfo, CINAHL, Cochrane, and Ageline were searched covering all studies published from January 1995 to July 2016. Papers were included if they (1) included a Web-based modality to deliver an intervention; (2) included informal, unpaid adult caregivers of community-living adults with a chronic condition; (3) were either a randomized controlled trial (RCT) or controlled clinical trial (CCT); and (4) reported on any caregiver outcome as a result of use or exposure to the intervention. Results: A total of 20 papers (17 studies) were included in this review. Study findings were mixed with both statistically significant and nonsignificant findings on various caregiver outcomes. Of the 17 included studies, 10 had at least one significant outcome. The most commonly assessed outcome was mental health, which included depressive symptoms, stress or distress, and anxiety. Twelve papers examined the impact of interventions on the outcome of depressive symptoms; 4 found a significant decrease in depressive symptoms. Eight studies examined the outcome of stress or distress; 4 of these found a significant reduction in stress or distress as a result of the intervention. Three studies examined the outcome of anxiety; 2 of these found significant reductions in anxiety. Other significant results of the interventions were seen in the outcomes of caregiver gain (ie, positive aspects of caregiving), knowledge, bonding, reduction of anger-hostility, and negative mood. Based on this review, it is not possible to determine which interventions were most effective since studies differed in their design, sample, and intervention. Study results suggest that Web-based interventions may result in reduced depressive symptoms, anxiety, and stress or distress among informal caregivers of adults with chronic conditions in the community. Conclusions: This is the first review assessing the impact of Web-based technologies on mental health, general caregiving outcomes, and general health for caregivers of adults with chronic conditions living in the community. Further rigorous research is needed that includes adequately powered studies examining the critical components of the intervention and the dosage needed to have an effect. %M 28754652 %R 10.2196/jmir.7564 %U http://www.jmir.org/2017/7/e263/ %U https://doi.org/10.2196/jmir.7564 %U http://www.ncbi.nlm.nih.gov/pubmed/28754652 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e262 %T Smartphone-Based Monitoring of Objective and Subjective Data in Affective Disorders: Where Are We and Where Are We Going? Systematic Review %A Dogan,Ezgi %A Sander,Christian %A Wagner,Xenija %A Hegerl,Ulrich %A Kohls,Elisabeth %+ Medical Faculty, Department of Psychiatry and Psychotherapy, University Leipzig, Semmelweisstrasse 10, Haus 13, Leipzig, 04103, Germany, 49 341 9724558, Christian.Sander@medizin.uni-leipzig.de %K review %K mood disorders %K smartphone %K ecological momentary assessment %D 2017 %7 24.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic mental health interventions for mood disorders have increased rapidly over the past decade, most recently in the form of various systems and apps that are delivered via smartphones. Objective: We aim to provide an overview of studies on smartphone-based systems that combine subjective ratings with objectively measured data for longitudinal monitoring of patients with affective disorders. Specifically, we aim to examine current knowledge on: (1) the feasibility of, and adherence to, such systems; (2) the association of monitored data with mood status; and (3) the effects of monitoring on clinical outcomes. Methods: We systematically searched PubMed, Web of Science, PsycINFO, and the Cochrane Central Register of Controlled Trials for relevant articles published in the last ten years (2007-2017) by applying Boolean search operators with an iterative combination of search terms, which was conducted in February 2017. Additional articles were identified via pearling, author correspondence, selected reference lists, and trial protocols. Results: A total of 3463 unique records were identified. Twenty-nine studies met the inclusion criteria and were included in the review. The majority of articles represented feasibility studies (n=27); two articles reported results from one randomized controlled trial (RCT). In total, six different self-monitoring systems for affective disorders that used subjective mood ratings and objective measurements were included. These objective parameters included physiological data (heart rate variability), behavioral data (phone usage, physical activity, voice features), and context/environmental information (light exposure and location). The included articles contained results regarding feasibility of such systems in affective disorders, showed reasonable accuracy in predicting mood status and mood fluctuations based on the objectively monitored data, and reported observations about the impact of monitoring on clinical state and adherence of patients to the system usage. Conclusions: The included observational studies and RCT substantiate the value of smartphone-based approaches for gathering long-term objective data (aside from self-ratings to monitor clinical symptoms) to predict changes in clinical states, and to investigate causal inferences about state changes in patients with affective disorders. Although promising, a much larger evidence-base is necessary to fully assess the potential and the risks of these approaches. Methodological limitations of the available studies (eg, small sample sizes, variations in the number of observations or monitoring duration, lack of RCT, and heterogeneity of methods) restrict the interpretability of the results. However, a number of study protocols stated ambitions to expand and intensify research in this emerging and promising field. %M 28739561 %R 10.2196/jmir.7006 %U http://www.jmir.org/2017/7/e262/ %U https://doi.org/10.2196/jmir.7006 %U http://www.ncbi.nlm.nih.gov/pubmed/28739561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e245 %T Short Text Messages to Encourage Adherence to Medication and Follow-up for People With Psychosis (Mobile.Net): Randomized Controlled Trial in Finland %A Välimäki,Maritta %A Kannisto,Kati Anneli %A Vahlberg,Tero %A Hätönen,Heli %A Adams,Clive E %+ Department of Nursing Science, Joukahaisenkatu 3-5, University of Turku, 20014, Turku,, Finland, 358 40 5599235, mava@utu.fi %K text messaging %K psychotic disorders %K randomized controlled trial %K medication adherence %D 2017 %7 12.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: A text messaging service (short message service [SMS]) has the potential to target large groups of people with long-term illnesses such as serious mental disorders, who may have difficulty with treatment adherence. Robust research on the impact of mobile technology interventions for these patients remains scarce. Objective: The main objective of our study was to investigate the impact of individually tailored short text messages on the rate of psychiatric hospital readmissions, health care service use, and clinical outcomes. In addition, we analyzed treatment costs. Methods: Between September 2011 and November 2012, we randomly assigned 1139 people to a tailored text message intervention (n=569) or usual care (n=570). Participants received semiautomated text messages for up to 12 months or usual care. The primary outcome, based on routinely collected health register data, was patient readmission into a psychiatric hospital during a 12-month follow-up period. Secondary outcomes were related to other service use, coercion, medication, adverse events, satisfaction, social functioning, quality of life, and economic factors (cost analysis). Results: There was 98.24% (1119/1139) follow-up at 12 months. Tailored mobile telephone text messages did not reduce the rate of hospital admissions (242/563, 43.0% of the SMS group vs 216/556, 38.8% of the control group; relative risk 1.11; 95% CI 0.92-1.33; P=.28), time between hospitalizations (mean difference 7.0 days 95% CI –8.0 to 24.0; P=.37), time spent in a psychiatric hospital during the year (mean difference 2.0 days 95% CI –2.0 to 7.0; P=.35), or other service outcomes. People who received text messages were less disabled, based on Global Assessment Scale scores at the time of their readmission, than those who did not receive text messages (odds ratio 0.68; 95% CI 0.47-0.97; P=.04). The costs of treatment were higher for people in the SMS group than in the control group (mean €10,103 vs €9210, respectively, P<.001). Conclusions: High-grade routinely collected data can provide clear outcomes for pragmatic randomized trials. SMS messaging tailored with the input of each individual patient did not decrease the rate of psychiatric hospital visits after the 12 months of follow-up. Although there may have been other, more subtle effects, the results of these were not evident in outcomes of agreed importance to clinicians, policymakers, and patients and their families. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6rVzZrbuz). %M 28701292 %R 10.2196/jmir.7028 %U http://www.jmir.org/2017/7/e245/ %U https://doi.org/10.2196/jmir.7028 %U http://www.ncbi.nlm.nih.gov/pubmed/28701292 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e247 %T Using New and Emerging Technologies to Identify and Respond to Suicidality Among Help-Seeking Young People: A Cross-Sectional Study %A Iorfino,Frank %A Davenport,Tracey A %A Ospina-Pinillos,Laura %A Hermens,Daniel F %A Cross,Shane %A Burns,Jane %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett St, Camperdown, Sydney, 2050, Australia, 61 02 9351 0827, frank.iorfino@sydney.edu.au %K suicidal ideation %K mental health %K primary health care %K telemedicine %K health services %D 2017 %7 12.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicidal thoughts are common among young people presenting to face-to-face and online mental health services. The early detection and rapid response to these suicidal thoughts and other suicidal behaviors is a priority for suicide prevention and early intervention efforts internationally. Establishing how best to use new and emerging technologies to facilitate person-centered systematic assessment and early intervention for suicidality is crucial to these efforts. Objective: The aim of this study was to examine the use of a suicidality escalation protocol to respond to suicidality among help-seeking young people. Methods: A total of 232 young people in the age range of 16-25 years were recruited from either a primary mental health care service or online in the community. Each young person used the Synergy Online System and completed an initial clinical assessment online before their face-to-face or online clinical appointment. A suicidality escalation protocol was used to identify and respond to current and previous suicidal thoughts and behaviors. Results: A total of 153 young people (66%, 153/232) reported some degree of suicidality and were provided with a real-time alert online. Further levels of escalation (email or phone contact and clinical review) were initiated for the 35 young people (15%, 35/232) reporting high suicidality. Higher levels of psychological distress (P<.001) and a current alcohol or substance use problem (P=.02) predicted any level of suicidality compared with no suicidality. Furthermore, predictors of high suicidality compared with low suicidality were higher levels of psychological distress (P=.01), psychosis-like symptoms in the last 12 months (P=.01), a previous mental health problem (P=.01), and a history of suicide planning or attempts (P=.001). Conclusions: This study demonstrates the use of new and emerging technologies to facilitate the systematic assessment and detection of help-seeking young people presenting with suicidality. This protocol empowered the young person by suggesting pathways to care that were based on their current needs. The protocol also enabled an appropriate and timely response from service providers for young people reporting high suicidality that was associated with additional comorbid issues, including psychosis-like symptoms, and a history of suicide plans and attempts. %M 28701290 %R 10.2196/jmir.7897 %U http://www.jmir.org/2017/7/e247/ %U https://doi.org/10.2196/jmir.7897 %U http://www.ncbi.nlm.nih.gov/pubmed/28701290 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e243 %T Assessing Suicide Risk and Emotional Distress in Chinese Social Media: A Text Mining and Machine Learning Study %A Cheng,Qijin %A Li,Tim MH %A Kwok,Chi-Leung %A Zhu,Tingshao %A Yip,Paul SF %+ HKJC Center for Suicide Research and Prevention, The University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, Hong Kong,, China (Hong Kong), 852 2831 5232, chengqj@connect.hku.hk %K suicide %K psychological stress %K social media %K Chinese %K natural language %K machine learning %D 2017 %7 10.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Early identification and intervention are imperative for suicide prevention. However, at-risk people often neither seek help nor take professional assessment. A tool to automatically assess their risk levels in natural settings can increase the opportunity for early intervention. Objective: The aim of this study was to explore whether computerized language analysis methods can be utilized to assess one’s suicide risk and emotional distress in Chinese social media. Methods: A Web-based survey of Chinese social media (ie, Weibo) users was conducted to measure their suicide risk factors including suicide probability, Weibo suicide communication (WSC), depression, anxiety, and stress levels. Participants’ Weibo posts published in the public domain were also downloaded with their consent. The Weibo posts were parsed and fitted into Simplified Chinese-Linguistic Inquiry and Word Count (SC-LIWC) categories. The associations between SC-LIWC features and the 5 suicide risk factors were examined by logistic regression. Furthermore, the support vector machine (SVM) model was applied based on the language features to automatically classify whether a Weibo user exhibited any of the 5 risk factors. Results: A total of 974 Weibo users participated in the survey. Those with high suicide probability were marked by a higher usage of pronoun (odds ratio, OR=1.18, P=.001), prepend words (OR=1.49, P=.02), multifunction words (OR=1.12, P=.04), a lower usage of verb (OR=0.78, P<.001), and a greater total word count (OR=1.007, P=.008). Second-person plural was positively associated with severe depression (OR=8.36, P=.01) and stress (OR=11, P=.005), whereas work-related words were negatively associated with WSC (OR=0.71, P=.008), severe depression (OR=0.56, P=.005), and anxiety (OR=0.77, P=.02). Inconsistently, third-person plural was found to be negatively associated with WSC (OR=0.02, P=.047) but positively with severe stress (OR=41.3, P=.04). Achievement-related words were positively associated with depression (OR=1.68, P=.003), whereas health- (OR=2.36, P=.004) and death-related (OR=2.60, P=.01) words positively associated with stress. The machine classifiers did not achieve satisfying performance in the full sample set but could classify high suicide probability (area under the curve, AUC=0.61, P=.04) and severe anxiety (AUC=0.75, P<.001) among those who have exhibited WSC. Conclusions: SC-LIWC is useful to examine language markers of suicide risk and emotional distress in Chinese social media and can identify characteristics different from previous findings in the English literature. Some findings are leading to new hypotheses for future verification. Machine classifiers based on SC-LIWC features are promising but still require further optimization for application in real life. %M 28694239 %R 10.2196/jmir.7276 %U http://www.jmir.org/2017/7/e243/ %U https://doi.org/10.2196/jmir.7276 %U http://www.ncbi.nlm.nih.gov/pubmed/28694239 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e26 %T Preferences for Internet-Based Mental Health Interventions in an Adult Online Sample: Findings From an Online Community Survey %A Batterham,Philip J %A Calear,Alison L %+ Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton ACT, 2601, Australia, 61 61251031, philip.batterham@anu.edu.au %K Internet interventions %K mental health services %K preferences %K anxiety %K depression %D 2017 %7 30.06.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite extensive evidence that Internet interventions are effective in treating mental health problems, uptake of Internet programs is suboptimal. It may be possible to make Internet interventions more accessible and acceptable through better understanding of community preferences for delivery of online programs. Objective: This study aimed to assess community preferences for components, duration, frequency, modality, and setting of Internet interventions for mental health problems. Methods: A community-based online sample of 438 Australian adults was recruited using social media advertising and administered an online survey on preferences for delivery of Internet interventions, along with scales assessing potential correlates of these preferences. Results: Participants reported a preference for briefer sessions, although they recognized a trade-off between duration and frequency of delivery. No clear preference for the modality of delivery emerged, although a clear majority preferred tailored programs. Participants preferred to access programs through a computer rather than a mobile device. Although most participants reported that they would seek help for a mental health problem, more participants had a preference for face-to-face sources only than online programs only. Younger, female, and more educated participants were significantly more likely to prefer Internet delivery. Conclusions: Adults in the community have a preference for Internet interventions with short modules that are tailored to individual needs. Individuals who are reluctant to seek face-to-face help may also avoid Internet interventions, suggesting that better implementation of existing Internet programs requires increasing acceptance of Internet interventions and identifying specific subgroups who may be resistant to seeking help. %M 28666976 %R 10.2196/mental.7722 %U http://mental.jmir.org/2017/2/e26/ %U https://doi.org/10.2196/mental.7722 %U http://www.ncbi.nlm.nih.gov/pubmed/28666976 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e228 %T Researching Mental Health Disorders in the Era of Social Media: Systematic Review %A Wongkoblap,Akkapon %A Vadillo,Miguel A %A Curcin,Vasa %+ Department of Informatics, King's College London, Strand, London, WC2R 2LS, United Kingdom, 44 20 7848 2588, akkapon.wongkoblap@kcl.ac.uk %K mental health %K mental disorders %K social networking %K artificial intelligence %K machine learning %K public health informatics %K depression %K anxiety %K infodemiology %D 2017 %7 29.06.2017 %9 Review %J J Med Internet Res %G English %X Background: Mental illness is quickly becoming one of the most prevalent public health problems worldwide. Social network platforms, where users can express their emotions, feelings, and thoughts, are a valuable source of data for researching mental health, and techniques based on machine learning are increasingly used for this purpose. Objective: The objective of this review was to explore the scope and limits of cutting-edge techniques that researchers are using for predictive analytics in mental health and to review associated issues, such as ethical concerns, in this area of research. Methods: We performed a systematic literature review in March 2017, using keywords to search articles on data mining of social network data in the context of common mental health disorders, published between 2010 and March 8, 2017 in medical and computer science journals. Results: The initial search returned a total of 5386 articles. Following a careful analysis of the titles, abstracts, and main texts, we selected 48 articles for review. We coded the articles according to key characteristics, techniques used for data collection, data preprocessing, feature extraction, feature selection, model construction, and model verification. The most common analytical method was text analysis, with several studies using different flavors of image analysis and social interaction graph analysis. Conclusions: Despite an increasing number of studies investigating mental health issues using social network data, some common problems persist. Assembling large, high-quality datasets of social media users with mental disorder is problematic, not only due to biases associated with the collection methods, but also with regard to managing consent and selecting appropriate analytics techniques. %M 28663166 %R 10.2196/jmir.7215 %U http://www.jmir.org/2017/6/e228/ %U https://doi.org/10.2196/jmir.7215 %U http://www.ncbi.nlm.nih.gov/pubmed/28663166 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e21 %T Perspectives of Family Members on Using Technology in Youth Mental Health Care: A Qualitative Study %A Lal,Shalini %A Daniel,Winnie %A Rivard,Lysanne %+ University of Montreal Hospital Research Center, University of Montreal, S-03-452, 850 St-Denis St, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000 ext 31676, shalini.lal@umontreal.ca %K family %K adolescent %K young adult %K technology %K telemedicine %K mental health services %K psychotic disorders %D 2017 %7 23.06.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Information and communication technologies (ICTs) are increasingly recognized as having an important role in the delivery of mental health services for youth. Recent studies have evaluated young people’s access and use of technology, as well as their perspectives on using technology to receive mental health information, services, and support; however, limited attention has been given to the perspectives of family members in this regard. Objective: The aim of this study was to explore the perspectives of family members on the use of ICTs to deliver mental health services to youth within the context of specialized early intervention for a first-episode psychosis (FEP). Methods: Six focus groups were conducted with family members recruited from an early intervention program for psychosis. Twelve family members participated in the study (target sample was 12-18, and recruitment efforts took place over the duration of 1 year). A 12-item semistructured focus group guide was developed to explore past experiences of technology and recommendations for the use of technology in youth mental health service delivery. A qualitative thematic analysis guided the identification and organization of common themes and patterns identified across the dataset. Results: Findings were organized by the following themes: access and use of technology, potential negative impacts of technology on youth in recovery, potential benefits of using technology to deliver mental health services to youth, and recommendations to use technology for (1) providing quality information in a manner that is accessible to individuals of diverse socioeconomic backgrounds, (2) facilitating communication with health care professionals and services, and (3) increasing access to peer support. Conclusions: To our knowledge, this is among the first (or the first) to explore the perspectives of family members of youth being treated for FEP on the use of technology for mental health care. Our results highlight the importance of considering diverse experiences and attitudes toward the role of technology in youth mental health, digital literacy skills, phases of recovery, and sociodemographic factors when engaging family members in technology-enabled youth mental health care research and practice. Innovative methods to recruit and elicit the perspectives of family members on this topic are warranted. It is also important to consider educational strategies to inform and empower family members on the role, benefits, and use of ICTs in relation to mental health care for FEP. %M 28645887 %R 10.2196/mental.7296 %U http://mental.jmir.org/2017/2/e21/ %U https://doi.org/10.2196/mental.7296 %U http://www.ncbi.nlm.nih.gov/pubmed/28645887 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e214 %T Scaling Up Psychological Treatments: A Countrywide Test of the Online Training of Therapists %A Fairburn,Christopher G %A Allen,Elizabeth %A Bailey-Straebler,Suzanne %A O'Connor,Marianne E %A Cooper,Zafra %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford,, United Kingdom, 44 186 561 3199, credo@medsci.ox.ac.uk %K psychotherapy %K training %K dissemination %K Internet %K eating disorders %K cognitive behavior therapy %D 2017 %7 16.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: A major barrier to the widespread dissemination of psychological treatments is the way that therapists are trained. The current method is not scalable. Objective: Our objective was to conduct a proof-of-concept study of Web-centered training, a scalable online method for training therapists. Methods: The Irish Health Service Executive identified mental health professionals across the country whom it wanted to be trained in a specific psychological treatment for eating disorders. These therapists were given access to a Web-centered training program in transdiagnostic cognitive behavior therapy for eating disorders. The training was accompanied by a scalable form of support consisting of brief encouraging telephone calls from a nonspecialist. The trainee therapists completed a validated measure of therapist competence before and after the training. Results: Of 102 therapists who embarked upon the training program, 86 (84.3%) completed it. There was a substantial increase in their competence scores following the training (mean difference 5.84, 95% Cl –6.62 to –5.05; P<.001) with 42.5% (34/80) scoring above a predetermined cut-point indicative of a good level of competence. Conclusions: Web-centered training proved feasible and acceptable and resulted in a marked increase in therapist competence scores. If these findings are replicated, Web-centered training would provide a means of simultaneously training large numbers of geographically dispersed trainees at low cost, thereby overcoming a major obstacle to the widespread dissemination of psychological treatments. %M 28623184 %R 10.2196/jmir.7864 %U http://www.jmir.org/2017/6/e214/ %U https://doi.org/10.2196/jmir.7864 %U http://www.ncbi.nlm.nih.gov/pubmed/28623184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e213 %T Effectiveness of a Web-Based Intervention in Reducing Depression and Sickness Absence: Randomized Controlled Trial %A Beiwinkel,Till %A Eißing,Tabea %A Telle,Nils-Torge %A Siegmund-Schultze,Elisabeth %A Rössler,Wulf %+ Innovation Incubator, Competence Tandem Integrated Care, Leuphana University of Lüneburg, Scharnhorststr 1, Lüneburg, 21335, Germany, 49 4131677 ext 7826, till.beiwinkel@leuphana.de %K Internet %K depression %K absenteeism %K cognitive therapy %K randomized controlled trial %D 2017 %7 15.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is highly prevalent in the working population and is associated with significant loss of workdays; however, access to evidence-based treatment is limited. Objective: This study evaluated the effectiveness of a Web-based intervention in reducing mild to moderate depression and sickness absence. Methods: In an open-label randomized controlled trial, participants were recruited from a large-scale statutory health insurance and were assigned to two groups. The intervention group had access to a 12 week Web-based program consisting of structured interactive sessions and therapist support upon request. The wait-list control group had access to unguided Web-based psycho-education. Depressive symptoms were self-assessed at baseline, post-treatment, and follow-up (12 weeks after treatment) using the Patient Health Questionnaire (PHQ-9) and Beck Depression Inventory (BDI-II) as primary outcome measures. Data on sickness absence was retrieved from health insurance records. Intention-to-treat (ITT) analysis and per-protocol (PP) analysis were performed. Results: Of the 180 participants who were randomized, 88 completed the post-assessment (retention rate: 48.8%, 88/180). ITT analysis showed a significant between-group difference in depressive symptoms during post-treatment in favor of the intervention group, corresponding to a moderate effect size (PHQ-9: d=0.55, 95% CI 0.25-0.85, P<.001, and BDI-II: d=0.41, CI 0.11-0.70, P=.004). PP analysis partially supported this result, but showed a non-significant effect on one primary outcome (PHQ-9: d=0.61, 95% CI 0.15-1.07, P=.04, and BDI-II: d=0.25 95% CI −0.18 to 0.65, P=.37). Analysis of clinical significance using reliable change index revealed that significantly more participants who used the Web-based intervention (63%, 63/100) responded to the treatment versus the control group (33%, 27/80; P<.001). The number needed to treat (NNT) was 4.08. Within both groups, there was a reduction in work absence frequency (IG: −67.23%, P<.001, CG: −82.61%, P<.001), but no statistical difference in sickness absence between groups was found (P=.07). Conclusions: The Web-based intervention was effective in reducing depressive symptoms among adults with sickness absence. As this trial achieved a lower power than calculated, its results should be replicated in a larger sample. Further validation of health insurance records as an outcome measure for eHealth trials is needed. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 02446836; http://www.isrctn.com/ISRCTN02446836 (Archived by WebCite at http://www.webcitation.org/6jx4SObnw) %M 28619701 %R 10.2196/jmir.6546 %U http://www.jmir.org/2017/6/e213/ %U https://doi.org/10.2196/jmir.6546 %U http://www.ncbi.nlm.nih.gov/pubmed/28619701 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e191 %T Toward the Design of Evidence-Based Mental Health Information Systems for People With Depression: A Systematic Literature Review and Meta-Analysis %A Wahle,Fabian %A Bollhalder,Lea %A Kowatsch,Tobias %A Fleisch,Elgar %+ Center for Digital Health Interventions, Institute of Technology Management, University of St Gallen, Dufourstrasse 40a, Büro 1-236, St Gallen, 9000, Switzerland, 41 712247244, tobias.kowatsch@unisg.ch %K literature review %K mental health %K design feature %K depression %K information systems %D 2017 %7 31.05.2017 %9 Review %J J Med Internet Res %G English %X Background: Existing research postulates a variety of components that show an impact on utilization of technology-mediated mental health information systems (MHIS) and treatment outcome. Although researchers assessed the effect of isolated design elements on the results of Web-based interventions and the associations between symptom reduction and use of components across computer and mobile phone platforms, there remains uncertainty with regard to which components of technology-mediated interventions for mental health exert the greatest therapeutic gain. Until now, no studies have presented results on the therapeutic benefit associated with specific service components of technology-mediated MHIS for depression. Objective: This systematic review aims at identifying components of technology-mediated MHIS for patients with depression. Consequently, all randomized controlled trials comparing technology-mediated treatments for depression to either waiting-list control, treatment as usual, or any other form of treatment for depression were reviewed. Updating prior reviews, this study aims to (1) assess the effectiveness of technology-supported interventions for the treatment of depression and (2) add to the debate on what components in technology-mediated MHIS for the treatment of depression should be standard of care. Methods: Systematic searches in MEDLINE, PsycINFO, and the Cochrane Library were conducted. Effect sizes for each comparison between a technology-enabled intervention and a control condition were computed using the standard mean difference (SMD). Chi-square tests were used to test for heterogeneity. Using subgroup analysis, potential sources of heterogeneity were analyzed. Publication bias was examined using visual inspection of funnel plots and Begg’s test. Qualitative data analysis was also used. In an explorative approach, a list of relevant components was extracted from the body of literature by consensus between two researchers. Results: Of 6387 studies initially identified, 45 met all inclusion criteria. Programs analyzed showed a significant trend toward reduced depressive symptoms (SMD –0.58, 95% CI –0.71 to –0.45, P<.001). Heterogeneity was large (I2≥76). A total of 15 components were identified. Conclusions: Technology-mediated MHIS for the treatment of depression has a consistent positive overall effect compared to controls. A total of 15 components have been identified. Further studies are needed to quantify the impact of individual components on treatment effects and to identify further components that are relevant for the design of future technology-mediated interventions for the treatment of depression and other mental disorders. %M 28566267 %R 10.2196/jmir.7381 %U http://www.jmir.org/2017/5/e191/ %U https://doi.org/10.2196/jmir.7381 %U http://www.ncbi.nlm.nih.gov/pubmed/28566267 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e17 %T Diversity in eMental Health Practice: An Exploratory Qualitative Study of Aboriginal and Torres Strait Islander Service Providers %A Bird,Jennifer %A Rotumah,Darlene %A Bennett-Levy,James %A Singer,Judy %+ University Centre for Rural Health—North Coast, School of Rural Health, University of Sydney, PO Box 3074, Lismore, 2480, Australia, 61 266207570, james.bennett-levy@ucrh.edu.au %K eMental Health %K Aboriginal and Torres Strait Islanders %K social and emotional wellbeing %K health education %K health promotion %K mental health %K indigenous health services %K culturally appropriate technology %K internet %K implementation %K training %D 2017 %7 29.05.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: In Australia, mental health services are undergoing major systemic reform with eMental Health (eMH) embedded in proposed service models for all but those with severe mental illness. Aboriginal and Torres Strait Islander service providers have been targeted as a national priority for training and implementation of eMH into service delivery. Implementation studies on technology uptake in health workforces identify complex and interconnected variables that influence how individual practitioners integrate new technologies into their practice. To date there are only two implementation studies that focus on eMH and Aboriginal and Torres Strait Islander service providers. They suggest that the implementation of eMH in the context of Aboriginal and Torres Strait Islander populations may be different from the implementation of eMH with allied health professionals and mainstream health services. Objective: The objective of this study is to investigate how Aboriginal and Torres Strait Islander service providers in one regional area of Australia used eMH resources in their practice following an eMH training program and to determine what types of eMH resources they used. Methods: Individual semistructured qualitative interviews were conducted with a purposive sample of 16 Aboriginal and Torres Strait Islander service providers. Interviews were co-conducted by one indigenous and one non-indigenous interviewer. A sample of transcripts were coded and thematically analyzed by each interviewer and then peer reviewed. Consensus codes were then applied to all transcripts and themes identified. Results: It was found that 9 of the 16 service providers were implementing eMH resources into their routine practice. The findings demonstrate that participants used eMH resources for supporting social inclusion, informing and educating, assessment, case planning and management, referral, responding to crises, and self and family care. They chose a variety of types of eMH resources to use with their clients, both culturally specific and mainstream. While they referred clients to online treatment programs, they used only eMH resources designed for mobile devices in their face-to-face contact with clients. Conclusions: This paper provides Aboriginal and Torres Strait islander service providers and the eMH field with findings that may inform and guide the implementation of eMH resources. It may help policy developers locate this workforce within broader service provision planning for eMH. The findings could, with adaptation, have wider application to other workforces who work with Aboriginal and Torres Strait Islander clients. The findings highlight the importance of identifying and addressing the particular needs of minority groups for eMH services and resources. %M 28554880 %R 10.2196/mental.7878 %U http://mental.jmir.org/2017/2/e17/ %U https://doi.org/10.2196/mental.7878 %U http://www.ncbi.nlm.nih.gov/pubmed/28554880 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e176 %T Mental Health Mobile Apps for Preadolescents and Adolescents: A Systematic Review %A Grist,Rebecca %A Porter,Joanna %A Stallard,Paul %+ Child and Adolescent Mental Health Group, Department for Health, University of Bath, Wessex House, Claverton Down, Bath, BA2 7AY, United Kingdom, 44 2253850 ext 86, r.grist@bath.ac.uk %K mobile apps %K smartphone apps %K mHealth %K mental health %K self-help %K child %K adolescent %K preadolescent %K review %D 2017 %7 25.05.2017 %9 Review %J J Med Internet Res %G English %X Background: There are an increasing number of mobile apps available for adolescents with mental health problems and an increasing interest in assimilating mobile health (mHealth) into mental health services. Despite the growing number of apps available, the evidence base for their efficacy is unclear. Objective: This review aimed to systematically appraise the available research evidence on the efficacy and acceptability of mobile apps for mental health in children and adolescents younger than 18 years. Methods: The following were systematically searched for relevant publications between January 2008 and July 2016: APA PsychNet, ACM Digital Library, Cochrane Library, Community Care Inform-Children, EMBASE, Google Scholar, PubMed, Scopus, Social Policy and Practice, Web of Science, Journal of Medical Internet Research, Cyberpsychology, Behavior and Social Networking, and OpenGrey. Abstracts were included if they described mental health apps (targeting depression, bipolar disorder, anxiety disorders, self-harm, suicide prevention, conduct disorder, eating disorders and body image issues, schizophrenia, psychosis, and insomnia) for mobile devices and for use by adolescents younger than 18 years. Results: A total of 24 publications met the inclusion criteria. These described 15 apps, two of which were available to download. Two small randomized trials and one case study failed to demonstrate a significant effect of three apps on intended mental health outcomes. Articles that analyzed the content of six apps for children and adolescents that were available to download established that none had undergone any research evaluation. Feasibility outcomes suggest acceptability of apps was good and app usage was moderate. Conclusions: Overall, there is currently insufficient research evidence to support the effectiveness of apps for children, preadolescents, and adolescents with mental health problems. Given the number and pace at which mHealth apps are being released on app stores, methodologically robust research studies evaluating their safety, efficacy, and effectiveness is promptly needed. %M 28546138 %R 10.2196/jmir.7332 %U http://www.jmir.org/2017/5/e176/ %U https://doi.org/10.2196/jmir.7332 %U http://www.ncbi.nlm.nih.gov/pubmed/28546138 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e170 %T Attachment Style and Internet Addiction: An Online Survey %A Eichenberg,Christiane %A Schott,Markus %A Decker,Oliver %A Sindelar,Brigitte %+ Sigmund Freud PrivatUniversität Wien, Kelsenstr 2, Vienna,, Austria, 43 1 7984098, eichenberg@sfu.ac.at %K Internet %K addictive behavior %K surveys and questionnaires %K Rorschach test %D 2017 %7 17.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the clinically relevant problems of Internet use is the phenomenon of Internet addiction. Considering the fact that there is ample evidence for the relationship between attachment style and substance abuse, it stands to reason that attachment theory can also make an important contribution to the understanding of the pathogenesis of Internet addiction. Objective: The aim of this study was to examine people’s tendency toward pathological Internet usage in relation to their attachment style. Methods: An online survey was conducted. Sociodemographic data, attachment style (Bielefeld questionnaire partnership expectations), symptoms of Internet addiction (scale for online addiction for adults), used Web-based services, and online relationship motives (Cyber Relationship Motive Scale, CRMS-D) were assessed. In order to confirm the findings, a study using the Rorschach test was also conducted. Results: In total, 245 subjects were recruited. Participants with insecure attachment style showed a higher tendency to pathological Internet usage compared with securely attached participants. An ambivalent attachment style was particularly associated with pathological Internet usage. Escapist and social-compensatory motives played an important role for insecurely attached subjects. However, there were no significant effects with respect to Web-based services and apps used. Results of the analysis of the Rorschach protocol with 16 subjects corroborated these results. Users with pathological Internet use frequently showed signs of infantile relationship structures in the context of social groups. This refers to the results of the Web-based survey, in which interpersonal relationships were the result of an insecure attachment style. Conclusions: Pathological Internet use was a function of insecure attachment and limited interpersonal relationships. %M 28526662 %R 10.2196/jmir.6694 %U http://www.jmir.org/2017/5/e170/ %U https://doi.org/10.2196/jmir.6694 %U http://www.ncbi.nlm.nih.gov/pubmed/28526662 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e141 %T Efficacy of a Web-Based Guided Recommendation Service for a Curated List of Readily Available Mental Health and Well-Being Mobile Apps for Young People: Randomized Controlled Trial %A Bidargaddi,Niranjan %A Musiat,Peter %A Winsall,Megan %A Vogl,Gillian %A Blake,Victoria %A Quinn,Stephen %A Orlowski,Simone %A Antezana,Gaston %A Schrader,Geoffrey %+ Digital Psychiatry & Personal Health Informatics Group, School of Medicine, Flinders University, Flinders at Tonsley, 1284 South Road, Clovelly Park, 5042, Australia, 61 872218842, niranjan.bidargaddi@flinders.edu.au %K well-being %K mental health %K young people %K online intervention %K apps %K engagement %D 2017 %7 12.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental disorders are highly prevalent for the people who are aged between 16 and 25 years and can permanently disrupt the development of these individuals. Easily available mobile health (mHealth) apps for mobile phones have great potential for the prevention and early intervention of mental disorders in young adults, but interventions are required that can help individuals to both identify high-quality mobile apps and use them to change health and lifestyle behavior. Objectives: The study aimed to assess the efficacy of a Web-based self-guided app recommendation service (“The Toolbox”) in improving the well-being of young Australians aged between 16 and 25 years. The intervention was developed in collaboration with young adults and consists of a curated list of 46 readily available health and well-being apps, assessed and rated by professionals and young people. Participants are guided by an interactive quiz and subsequently receive recommendations for particular apps to download and use based on their personal goals. Methods: The study was a waitlist, parallel-arm, randomized controlled trial. Our primary outcome measure was change in well-being as measured by the Mental Health Continuum-Short Form (MHC-SF). We also employed ecological momentary assessments (EMAs) to track mood, energy, rest, and sleep. Participants were recruited from the general Australian population, via several Web-based and community strategies. The study was conducted through a Web-based platform consisting of a landing Web page and capabilities to administer study measures at different time points. Web-based measurements were self-assessed at baseline and 4 weeks, and EMAs were collected repeatedly at regular weekly intervals or ad hoc when participants interacted with the study platform. Primary outcomes were analyzed using linear mixed-models and intention-to-treat (ITT) analysis. Results: A total of 387 participants completed baseline scores and were randomized into the trial. Results demonstrated no significant effect of “The Toolbox” intervention on participant well-being at 4 weeks compared with the control group (P=.66). There were also no significant differences between the intervention and control groups at 4 weeks on any of the subscales of the MHC-SF (psychological: P=.95, social: P=.42, emotional: P=.95). Repeat engagement with the study platform resulted in a significant difference in mood, energy, rest, and sleep trajectories between intervention and control groups as measured by EMAs (P<.01). Conclusions: This was the first study to assess the effectiveness of a Web-based well-being intervention in a sample of young adults. The design of the intervention utilized expert rating of existing apps and end-user codesign approaches resulting in an app recommendation service. Our finding suggests that recommended readily available mental health and well-being apps may not lead to improvements in the well-being of a nonclinical sample of young people, but might halt a decline in mood, energy, rest, and sleep. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12614000710628; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=366145 (Archived by WebCite at http://www.webcitation.org/ 6pWDsnKme) %M 28500020 %R 10.2196/jmir.6775 %U http://www.jmir.org/2017/5/e141/ %U https://doi.org/10.2196/jmir.6775 %U http://www.ncbi.nlm.nih.gov/pubmed/28500020 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e151 %T Embodied Conversational Agents in Clinical Psychology: A Scoping Review %A Provoost,Simon %A Lau,Ho Ming %A Ruwaard,Jeroen %A Riper,Heleen %+ Department of Clinical, Neuro & Developmental Psychology, Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 205985059, s.j.provoost@vu.nl %K eHealth %K review %K embodied conversational agent %K human computer interaction %K clinical psychology %K mental disorders %K intelligent agent %K health behavior %D 2017 %7 09.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Embodied conversational agents (ECAs) are computer-generated characters that simulate key properties of human face-to-face conversation, such as verbal and nonverbal behavior. In Internet-based eHealth interventions, ECAs may be used for the delivery of automated human support factors. Objective: We aim to provide an overview of the technological and clinical possibilities, as well as the evidence base for ECA applications in clinical psychology, to inform health professionals about the activity in this field of research. Methods: Given the large variety of applied methodologies, types of applications, and scientific disciplines involved in ECA research, we conducted a systematic scoping review. Scoping reviews aim to map key concepts and types of evidence underlying an area of research, and answer less-specific questions than traditional systematic reviews. Systematic searches for ECA applications in the treatment of mood, anxiety, psychotic, autism spectrum, and substance use disorders were conducted in databases in the fields of psychology and computer science, as well as in interdisciplinary databases. Studies were included if they conveyed primary research findings on an ECA application that targeted one of the disorders. We mapped each study’s background information, how the different disorders were addressed, how ECAs and users could interact with one another, methodological aspects, and the study’s aims and outcomes. Results: This study included N=54 publications (N=49 studies). More than half of the studies (n=26) focused on autism treatment, and ECAs were used most often for social skills training (n=23). Applications ranged from simple reinforcement of social behaviors through emotional expressions to sophisticated multimodal conversational systems. Most applications (n=43) were still in the development and piloting phase, that is, not yet ready for routine practice evaluation or application. Few studies conducted controlled research into clinical effects of ECAs, such as a reduction in symptom severity. Conclusions: ECAs for mental disorders are emerging. State-of-the-art techniques, involving, for example, communication through natural language or nonverbal behavior, are increasingly being considered and adopted for psychotherapeutic interventions in ECA research with promising results. However, evidence on their clinical application remains scarce. At present, their value to clinical practice lies mostly in the experimental determination of critical human support factors. In the context of using ECAs as an adjunct to existing interventions with the aim of supporting users, important questions remain with regard to the personalization of ECAs’ interaction with users, and the optimal timing and manner of providing support. To increase the evidence base with regard to Internet interventions, we propose an additional focus on low-tech ECA solutions that can be rapidly developed, tested, and applied in routine practice. %M 28487267 %R 10.2196/jmir.6553 %U http://www.jmir.org/2017/5/e151/ %U https://doi.org/10.2196/jmir.6553 %U http://www.ncbi.nlm.nih.gov/pubmed/28487267 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e148 %T Automated Text Messaging as an Adjunct to Cognitive Behavioral Therapy for Depression: A Clinical Trial %A Aguilera,Adrian %A Bruehlman-Senecal,Emma %A Demasi,Orianna %A Avila,Patricia %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall, MC 7400, Berkeley, CA, 94720, United States, 1 5106428564, aguila@berkeley.edu %K depression %K text messaging %K cognitive behavioral therapy %K mhealth %K mental health %K Latinos %D 2017 %7 08.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy. Objectives: The aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, we aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients. Methods: Patients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week’s content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills. Results: Intent-to-treat analyses on therapy attendance during 16 sessions of weekly therapy found that patients assigned to the text messaging adjunct stayed in therapy significantly longer (median of 13.5 weeks before dropping out) than patients assigned to the control condition (median of 3 weeks before dropping out; Wilcoxon-Mann-Whitney z=−2.21, P=.03). Patients assigned to the text messaging adjunct also generally attended more sessions (median=6 sessions) during this period than patients assigned to the control condition (median =2.5 sessions), but the effect was not significant (Wilcoxon-Mann-Whitney z=−1.65, P=.10). Both patients assigned to the text messaging adjunct (B=−.29, 95% CI −0.38 to −0.19, z=−5.80, P<.001) and patients assigned to the control conditions (B=−.20, 95% CI −0.32 to −0.07, z=−3.12, P=.002) experienced significant decreases in depressive symptom severity over the course of treatment; however, the conditions did not significantly differ in their degree of symptom reduction. Conclusions: This study provides support for automated text messaging as a tool to sustain engagement in CBT for depression over time. There were no differences in depression outcomes between conditions, but this may be influenced by low follow-up rates of patients who dropped out of treatment. %M 28483742 %R 10.2196/jmir.6914 %U http://www.jmir.org/2017/5/e148/ %U https://doi.org/10.2196/jmir.6914 %U http://www.ncbi.nlm.nih.gov/pubmed/28483742 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e156 %T Characterizing Awareness of Schizophrenia Among Facebook Users by Leveraging Facebook Advertisement Estimates %A Saha,Koustuv %A Weber,Ingmar %A Birnbaum,Michael L %A De Choudhury,Munmun %+ School of Interactive Computing, Georgia Institute of Technology, Technology Square Research Building, 85 Fifth Street NW, Atlanta, GA, 30308, United States, 1 4046929496, koustuv.saha@gatech.edu %K schizophrenia %K psychotic disorders %K online social networks %K health awareness %K mental health %K public health %K Facebook %D 2017 %7 08.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Schizophrenia is a rare but devastating condition, affecting about 1% of the world’s population and resulting in about 2% of the US health care expenditure. Major impediments to appropriate and timely care include misconceptions, high levels of stigma, and lack of public awareness. Facebook offers novel opportunities to understand public awareness and information access related to schizophrenia, and thus can complement survey-based approaches to assessing awareness that are limited in scale, robustness, and temporal and demographic granularity. Objective: The aims of this study were to (1) construct an index that measured the awareness of different demographic groups around schizophrenia-related information on Facebook; (2) study how this index differed across demographic groups and how it correlated with complementary Web-based (Google Trends) and non–Web-based variables about population well-being (mental health indicators and infrastructure), and (3) examine the relationship of Facebook derived schizophrenia index with other types of online activity as well as offline health and mental health outcomes and indicators. Methods: Data from Facebook’s advertising platform was programmatically collected to compute the proportion of users in a target demographic group with an interest related to schizophrenia. On consultation with a clinical expert, several topics were combined to obtain a single index measuring schizophrenia awareness. This index was then analyzed for differences across US states, gender, age, ethnic affinity, and education level. A statistical approach was developed to model a group’s awareness index based on the group’s characteristics. Results: Overall, 1.03% of Facebook users in the United States have a schizophrenia-related interest. The schizophrenia awareness index (SAI) is higher for females than for males (1.06 vs 0.97, P<.001), and it is highest for the people who are aged 25-44 years (1.35 vs 1.03 for all ages, P<.001). The awareness index drops for higher education levels (0.68 for MA or PhD vs 1.92 for no high school degree, P<.001), and Hispanics have the highest level of interest (1.57 vs 1.03 for all ethnic affinities, P<.001). A regression model fit to predict a group’s interest level achieves an adjusted R2=0.55. We also observe a positive association between our SAI and mental health services (or institutions) per 100,000 residents in a US state (Pearson r=.238, P<.001), but a negative association with the state-level human development index (HDI) in United States (Pearson r=−.145, P<.001) and state-level volume of mental health issues in United States (Pearson r=−.145, P<.001). Conclusions: Facebook’s advertising platform can be used to construct a plausible index of population-scale schizophrenia awareness. However, only estimates of awareness can be obtained, and the index provides no information on the quality of the information users receive online. %M 28483739 %R 10.2196/jmir.6815 %U http://www.jmir.org/2017/5/e156/ %U https://doi.org/10.2196/jmir.6815 %U http://www.ncbi.nlm.nih.gov/pubmed/28483739 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e145 %T Shifting Practices Toward Recovery-Oriented Care Through an E-Recovery Portal in Community Mental Health Care: A Mixed-Methods Exploratory Study %A Gammon,Deede %A Strand,Monica %A Eng,Lillian Sofie %A Børøsund,Elin %A Varsi,Cecilie %A Ruland,Cornelia %+ Center for Shared Decision-Making and Collaborative Care Research, Oslo University Hospital, Klaus Thorgårdsvei 3, 3rd Floor, Oslo, N-0377, Norway, 47 90977963, deede.gammon@rr-research.no %K recovery %K eHealth %K mental health %K psychiatry %K user involvement %K empowerment %K working relationships %K participatory research %K secure email %K e-recovery %D 2017 %7 02.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health care is shifting from a primary focus on symptom reduction toward personal recovery-oriented care, especially for persons with long-term mental health care needs. Web-based portals may facilitate this shift, but little is known about how such tools are used or the role they may play in personal recovery. Objective: The aim was to illustrate uses and experiences with the secure e-recovery portal “ReConnect” as an adjunct to ongoing community mental health care and explore its potential role in shifting practices toward recovery. Methods: ReConnect was introduced into two Norwegian mental health care communities and used for 6 months. The aim was to support personal recovery and collaboration between service users and health care providers. Among inclusion criteria for participation were long-term care needs and at least one provider willing to interact with service users through ReConnect. The portal was designed to support ongoing collaboration as each service user-provider dyad/team found appropriate and consisted of (1) a toolbox of resources for articulating and working with recovery processes, such as status/goals/activities relative to life domains (eg, employment, social network, health), medications, network map, and exercises (eg, sleep hygiene, mindfulness); (2) messaging with providers who had partial access to toolbox content; and (3) a peer support forum. Quantitative data (ie, system log, questionnaires) were analyzed using descriptive statistics. Qualitative data (eg, focus groups, forum postings) are presented relative to four recovery-oriented practice domains: personally defined recovery, promoting citizenship, working relationships, and organizational commitment. Results: Fifty-six participants (29 service users and 27 providers) made up 29 service user-provider dyads. Service users reported having 11 different mental health diagnoses, with a median 2 (range 1-7) diagnoses each. The 27 providers represented nine different professional backgrounds. The forum was the most frequently used module with 1870 visits and 542 postings. Service users’ control over toolbox resources (eg, defining and working toward personal goals), coupled with peer support, activated service users in their personal recovery processes and in community engagement. Some providers (30%, 8/27) did not interact with service users through ReConnect. Dyads that used the portal resources did so in highly diverse ways, and participants reported needing more than 6 months to discover and adapt optimal uses relative to their individual and collaborative needs. Conclusions: Regardless of providers’ portal use, service users’ control over toolbox resources, coupled with peer support, offered an empowering common frame of reference that represented a shift toward recovery-oriented practices within communities. Although service users’ autonomous use of the portal can eventually influence providers in the direction of recovery practices, a fundamental shift is unlikely without broader organizational commitments aligned with recovery principles (eg, quantified goals for service user involvement in care plans). %M 28465277 %R 10.2196/jmir.7524 %U http://www.jmir.org/2017/5/e145/ %U https://doi.org/10.2196/jmir.7524 %U http://www.ncbi.nlm.nih.gov/pubmed/28465277 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 5 %P e59 %T Text Message Feedback to Support Mindfulness Practice in People With Depressive Symptoms: A Pilot Randomized Controlled Trial %A Kraft,Susanne %A Wolf,Markus %A Klein,Thomas %A Becker,Thomas %A Bauer,Stephanie %A Puschner,Bernd %+ Section Process-Outcome Research, Department of Psychiatry II, Ulm University, 3rd floor, Ludwig-Heilmeyer-Str 2, Günzburg, 89312, Germany, 49 8221 982866, bernd.puschner@bkh-guenzburg.de %K mindfulness %K text messaging %K pilot study %K randomized controlled trial %D 2017 %7 02.05.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: It has been shown that mindfulness practice can be helpful in preventing relapse from depression. However, practicing mindfulness regularly at home is often a challenge for people with depression. Mobile phone text messaging (short message service, SMS) may be a feasible approach to assist regular mindfulness home practice. Objective: The aim of this study was to evaluate the feasibility of text message–based feedback to support mindfulness practice in people with depressive symptoms after inpatient psychiatric treatment. Methods: Participants received a manualized group introduction to three mindfulness exercises during inpatient treatment and were randomized at hospital discharge. All participants were asked to practice the exercises daily during the 4-month follow-up period. Only participants allocated to the intervention group received reinforcing feedback via mobile phone text messages after reporting their mindfulness practice via text message. Participation rates and satisfaction with the interventions were evaluated, and effects on relevant outcomes were explored. Results: Of the 176 eligible inpatients invited to participate, 65.9% (116/176) attended the introductory mindfulness group at least once, 33.0% (58/176) were willing to participate in the study, and 41 were randomized. The majority 85% (35/41) of these participants completed the study. Among the participants allocated to the intervention group (n=21), 81% (17/21) used the text message support at least once. The average number of text messages sent during the intervention period was 14 (SD 21, range 0-91). Satisfaction rates were high. Preliminary analyses of the effects of the intervention yielded mixed results. Conclusions: Findings indicate that text messaging following inpatient treatment is feasible for some, but not for all people with depressive symptoms. Modest use of the text messaging intervention and its mixed effects imply that dose and ingredients of the intervention should be increased for this group of patients in a future full-size RCT. Such a larger study should also include a process evaluation to investigate moderators of the effect of mindfulness practice and text message feedback on clinical outcome. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 58808893; http://www.controlled-trials.com/ISRCTN58808893 (Archived by Webcite at http://www.webcitation.org/6pmrDRnGt) %M 28465278 %R 10.2196/mhealth.7095 %U http://mhealth.jmir.org/2017/5/e59/ %U https://doi.org/10.2196/mhealth.7095 %U http://www.ncbi.nlm.nih.gov/pubmed/28465278 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e119 %T Health Evaluation and Referral Assistant: A Randomized Controlled Trial of a Web-Based Screening, Brief Intervention, and Referral to Treatment System to Reduce Risky Alcohol Use Among Emergency Department Patients %A Haskins,Brianna L %A Davis-Martin,Rachel %A Abar,Beau %A Baumann,Brigitte M %A Harralson,Tina %A Boudreaux,Edwin D %+ University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 5084211400, brianna.haskins@umassmed.edu %K alcohol consumption %K intervention study %K emergency medicine %K referral and consultation %D 2017 %7 01.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Computer technologies hold promise for implementing alcohol screening, brief intervention, and referral to treatment (SBIRT). Questions concerning the most effective and appropriate SBIRT model remain. Objective: The aim of this study was to evaluate the impact of a computerized SBIRT system called the Health Evaluation and Referral Assistant (HERA) on risky alcohol use treatment initiation. Methods: Alcohol users (N=319) presenting to an emergency department (ED) were considered for enrollment. Those enrolled (n=212) were randomly assigned to the HERA, to complete a patient-administered assessment using a tablet computer, or a minimal-treatment control, and were followed for 3 months. Analyses compared alcohol treatment provider contact, treatment initiation, treatment completion, and alcohol use across condition using univariate comparisons, generalized estimating equations (GEEs), and post hoc chi-square analyses. Results: HERA participants (n=212; control=115; intervention=97) did not differ between conditions on initial contact with an alcohol treatment provider, treatment initiation, treatment completion, or change in risky alcohol use behavior. Subanalyses indicated that HERA participants, who accepted a faxed referral, were more likely to initiate contact with a treatment provider and initiate treatment for risky alcohol use, but were not more likely to continue engaging in treatment, or to complete treatment and change risky alcohol use behavior over the 3-month period following the ED visit. Conclusions: The HERA promoted initial contact with an alcohol treatment provider and initiation of treatment for those who accepted the faxed referral, but it did not lead to reduced risky alcohol use behavior. Factors which may have limited the HERA’s impact include lack of support for the intervention by clinical staff, the low intensity of the brief and stand-alone design of the intervention, and barriers related to patient follow-through, (eg, a lack of transportation or childcare, fees for services, or schedule conflicts). Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): NCT01153373; https://clinicaltrials.gov/ct2/show/NCT01153373 (Archived by WebCite at http://www.webcitation.org/6pHQEpuIF) %M 28461283 %R 10.2196/jmir.6812 %U http://www.jmir.org/2017/5/e119/ %U https://doi.org/10.2196/jmir.6812 %U http://www.ncbi.nlm.nih.gov/pubmed/28461283 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e128 %T Toward Game-Based Digital Mental Health Interventions: Player Habits and Preferences %A Mandryk,Regan Lee %A Birk,Max Valentin %+ Interaction Lab, Department of Computer Science, University of Saskatchewan, 176 Thorvaldson Bldg, 110 Science Place, Saskatoon, SK, S7N5C9, Canada, 1 3069664888, regan@cs.usask.ca %K computer games %K mental health %K depression %K anxiety %D 2017 %7 20.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Designers of digital interventions for mental health often leverage interactions from games because the intrinsic motivation that results from game-based interventions may increase participation and translate into improved treatment efficacy. However, there are outstanding questions about the suitability (eg, are desktop or mobile interventions more appropriate?) and intervention potential (eg, do people with depression activate enough to play?) of games for mental health. Objective: In this paper, we aimed to describe the presently unknown relationship between gaming activity and indicators of well-being so that designers make informed choices when designing game-based interventions for mental health. Methods: We gathered validated scales of well-being (Beck’s Depression Inventory [BDI-II], Patient Health Questionnaire [PHQ-9], trait anxiety [TA], and basic psychological needs satisfaction [BPNS]), play importance (control over game behavior: control; gamer identity: identity), and play behavior (play frequency, platform preferences, and genre preferences) in a Web-based survey (N=491). Results: The majority of our participants played games a few times a week (45.3%, 222/490) or daily (34.3%, 168/490). In terms of depression, play frequency was associated with PHQ-9 (P=.003); PHQ-9 scores were higher for those who played daily than for those who played a few times a week or less. Similarly, for BDI-II (P=.01), scores were higher for those who played daily than for those who played once a week or less. Genre preferences were not associated with PHQ-9 (P=.32) or BDI-II (P=.68); however, platform preference (ie, mobile, desktop, or console) was associated with PHQ-9 (P=.04); desktop-only players had higher PHQ-9 scores than those who used all platforms. Platform preference was not associated with BDI-II (P=.18). In terms of anxiety, TA was not associated with frequency (P=.23), platform preference (P=.07), or genre preference (P=.99). In terms of needs satisfaction, BPNS was not associated with frequency (P=.25) or genre preference (P=.53), but it was associated with platform preference (P=.01); desktop-only players had lower needs satisfaction than those who used all platforms. As expected, play frequency was associated with identity (P<.001) and control (P<.001); those who played more had identified more as a gamer and had less control over their gameplay. Genre preference was associated with identity (P<.001) and control (P<.001); those who played most common genres had higher control over their play and identified most as gamers. Platform preference was not associated with control (P=.80), but was with identity (P=.001); those who played on all devices identified more as a gamer than those who played on mobiles or consoles only. Conclusions: Our results suggest that games are a suitable approach for mental health interventions as they are played broadly by people across a range of indicators of mental health. We further unpack the platform preferences and genre preferences of players with varying levels of well-being. %M 28428161 %R 10.2196/jmir.6906 %U http://www.jmir.org/2017/4/e128/ %U https://doi.org/10.2196/jmir.6906 %U http://www.ncbi.nlm.nih.gov/pubmed/28428161 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e12 %T A Mixed-Methods Study Using a Nonclinical Sample to Measure Feasibility of Ostrich Community: A Web-Based Cognitive Behavioral Therapy Program for Individuals With Debt and Associated Stress %A Smail,Dawn %A Elison,Sarah %A Dubrow-Marshall,Linda %A Thompson,Catherine %+ School of Health Sciences, University of Salford, Salford, M5 4WT, United Kingdom, 44 161 296 3486, c.thompson@salford.ac.uk %K cognitive behavioral therapy %K computer-assisted therapy %K psychological stress %K economic recession %K mental health %D 2017 %7 10.04.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: There are increasing concerns about the health and well-being of individuals facing financial troubles. For instance, in the United Kingdom, the relationship between debt and mental health difficulties is becoming more evident due to the economic downturn and welfare reform. Access to debt counseling services is limited and individuals may be reluctant to access services due to stigma. In addition, most of these services may not be appropriately resourced to address the psychological impact of debt. This study describes outcomes from an Internet-based cognitive behavioral therapy (ICBT) program, Ostrich Community (OC), which was developed to provide support to those struggling with debt and associated psychological distress. Objective: The aim of this feasibility study was to assess the suitability and acceptability of the OC program in a nonclinical sample and examine mental health and well-being outcomes from using the program. Methods: A total of 15 participants (who were not suffering from severe financial difficulty) were assisted in working through the 8-week ICBT program. Participants rated usability and satisfaction with the program, and after completion 7 participants took part in a semistructured interview to provide further feedback. Before the first session and after the final session all participants completed questionnaires to measure well-being and levels of depression, stress, and anxiety and pre- and postscores were compared. Results: Satisfaction was high and themes emerging from the interviews indicate that the program has the potential to promote effective financial behaviors and improve financial and global psychosocial well-being. When postcompletion scores were compared with those taken before the program, significant improvements were identified on psychometric measures of well-being, stress, and anxiety. Conclusions: The OC program is the first ICBT program that targets poor mental health associated with financial difficulty. This feasibility study indicates that OC may be an effective intervention for increasing financial resilience, supporting individuals to become financially independent, and promoting positive financial and global well-being. Further work with individuals suffering from debt and associated emotional difficulties will help to examine clinical effectiveness more closely. %M 28396305 %R 10.2196/mental.6809 %U http://mental.jmir.org/2017/2/e12/ %U https://doi.org/10.2196/mental.6809 %U http://www.ncbi.nlm.nih.gov/pubmed/28396305 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e88 %T Pregnant Women’s Views on the Feasibility and Acceptability of Web-Based Mental Health E-Screening Versus Paper-Based Screening: A Randomized Controlled Trial %A Kingston,Dawn %A Austin,Marie-Paule %A Veldhuyzen van Zanten,Sander %A Harvalik,Paula %A Giallo,Rebecca %A McDonald,Sarah D %A MacQueen,Glenda %A Vermeyden,Lydia %A Lasiuk,Gerri %A Sword,Wendy %A Biringer,Anne %+ Faculty of Nursing, University of Calgary, 2500 University Ave NW, Calgary, AB, T2N 1N4, Canada, 1 4032202634, dawn.kingston@ucalgary.ca %K pregnancy %K mental health %K screening %K prenatal care %K computers %D 2017 %7 07.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Major international guidelines recommend mental health screening during the perinatal period. However, substantial barriers to screening have been reported by pregnant and postpartum women and perinatal care providers. E-screening offers benefits that may address implementation challenges. Objective: The primary objective of this randomized controlled trial was to evaluate the feasibility and acceptability of Web-based mental health e-screening compared with paper-based screening among pregnant women. A secondary objective was to identify factors associated with women’s preferences for e-screening and disclosure of mental health concerns. Methods: Pregnant women recruited from community and hospital-based antenatal clinics and hospital-based prenatal classes were computer-randomized to a fully automated Web-based e-screening intervention group or a paper-based control group. Women were eligible if they spoke or read English, were willing to be randomized to e-screening, and were willing to participate in a follow-up diagnostic interview. The intervention group completed the Antenatal Psychosocial Health Assessment and the Edinburgh Postnatal Depression Scale on a tablet computer, while controls completed them on paper. All women completed self-report baseline questions and were telephoned 1 week after randomization by a blinded research assistant for a MINI International Neuropsychiatric Interview. Renker and Tonkin’s tool of feasibility and acceptability of computerized screening was used to assess the feasibility and acceptability of e-screening compared with paper-based screening. Intention-to-treat analysis was used. To identify factors associated with preference for e-screening and disclosure, variables associated with each outcome at P<.20 were simultaneously entered into final multivariable models to estimate adjusted odds ratios (AORs) and 95% CIs. Results: Of the 675 eligible women approached, 636 agreed to participate (participation rate 94.2%) and were randomized to the intervention (n=305) or control (n=331) groups. There were no significant baseline differences between groups. More women in the e-screening group strongly or somewhat agreed that they would like to use a tablet for answering questions on emotional health (57.9%, 175/302 vs 37.2%, 121/325) and would prefer using a tablet to paper (46.0%, 139/302 vs 29.2%, 95/325), compared with women in the paper-based screening group. There were no differences between groups in women’s disclosure of emotional health concerns (94.1%, 284/302 vs 90.2%, 293/325). Women in the e-screening group consistently reported the features of e-screening more favorably than controls (more private or confidential, less impersonal, less time-consuming). In the multivariable models, being in the e-screening group was significantly associated with preferring e-screening (AOR 2.29, 95% CI 1.66-3.17), while no factors were significantly associated with disclosure. Conclusions: The findings suggest that mental health e-screening is feasible and acceptable to pregnant women. Trial Registration: Clinicaltrials.gov NCT01899534; https://clinicaltrials.gov/ct2/show/NCT01899534 (Archived by WebCite at http://www.webcitation.org/6ntWg1yWb) %M 28389421 %R 10.2196/jmir.6866 %U http://www.jmir.org/2017/4/e88/ %U https://doi.org/10.2196/jmir.6866 %U http://www.ncbi.nlm.nih.gov/pubmed/28389421 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e100 %T The Multimodal Assessment of Adult Attachment Security: Developing the Biometric Attachment Test %A Parra,Federico %A Miljkovitch,Raphaële %A Persiaux,Gwenaelle %A Morales,Michelle %A Scherer,Stefan %+ Institute for Creative Technologies, University of Southern California, 12015 E Waterfront Dr, Los Angeles, CA, 90094, United States, 33 782132695, federico.parra@hotmail.com %K psychometrics %K linguistics %K heart rate %K facial expression %K psychophysiology %K psychopathology %K COVAREP %K attachment %D 2017 %7 06.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Attachment theory has been proven essential for mental health, including psychopathology, development, and interpersonal relationships. Validated psychometric instruments to measure attachment abound but suffer from shortcomings common to traditional psychometrics. Recent developments in multimodal fusion and machine learning pave the way for new automated and objective psychometric instruments for adult attachment that combine psychophysiological, linguistic, and behavioral analyses in the assessment of the construct. Objective: The aim of this study was to present a new exposure-based, automatic, and objective adult-attachment assessment, the Biometric Attachment Test (BAT), which exposes participants to a short standardized set of visual and music stimuli, whereas their immediate reactions and verbal responses, captured by several computer sense modalities, are automatically analyzed for scoring and classification. We also aimed to empirically validate two of its assumptions: its capacity to measure attachment security and the viability of using themes as placeholders for rotating stimuli. Methods: A total of 59 French participants from the general population were assessed using the Adult Attachment Questionnaire (AAQ), the Adult Attachment Projective Picture System (AAP), and the Attachment Multiple Model Interview (AMMI) as ground truth for attachment security. They were then exposed to three different BAT stimuli sets, whereas their faces, voices, heart rate (HR), and electrodermal activity (EDA) were recorded. Psychophysiological features, such as skin-conductance response (SCR) and Bayevsky stress index; behavioral features, such as gaze and facial expressions; as well as linguistic and paralinguistic features, were automatically extracted. An exploratory analysis was conducted using correlation matrices to uncover the features that are most associated with attachment security. A confirmatory analysis was conducted by creating a single composite effects index and by testing it for correlations with attachment security. The stability of the theory-consistent features across three different stimuli sets was explored using repeated measures analysis of variances (ANOVAs). Results: In total, 46 theory-consistent correlations were found during the exploration (out of 65 total significant correlations). For example, attachment security as measured by the AAP was correlated with positive facial expressions (r=.36, P=.01). AMMI’s security with the father was inversely correlated with the low frequency (LF) of HRV (r=−.87, P=.03). Attachment security to partners as measured by the AAQ was inversely correlated with anger facial expression (r=−.43, P=.001). The confirmatory analysis showed that the composite effects index was significantly correlated to security in the AAP (r=.26, P=.05) and the AAQ (r=.30, P=.04) but not in the AMMI. Repeated measures ANOVAs conducted individually on each of the theory-consistent features revealed that only 7 of the 46 (15%) features had significantly different values among responses to three different stimuli sets. Conclusions: We were able to validate two of the instrument’s core assumptions: its capacity to measure attachment security and the viability of using themes as placeholders for rotating stimuli. Future validation of other of its dimensions, as well as the ongoing development of its scoring and classification algorithms is discussed. %M 28385683 %R 10.2196/jmir.6898 %U http://www.jmir.org/2017/4/e100/ %U https://doi.org/10.2196/jmir.6898 %U http://www.ncbi.nlm.nih.gov/pubmed/28385683 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e107 %T #WhyWeTweetMH: Understanding Why People Use Twitter to Discuss Mental Health Problems %A Berry,Natalie %A Lobban,Fiona %A Belousov,Maksim %A Emsley,Richard %A Nenadic,Goran %A Bucci,Sandra %+ Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Room S42, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom, 44 1613060428, natalie.berry@manchester.ac.uk %K mental health %K Twitter %K social media %D 2017 %7 05.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Use of the social media website Twitter is highly prevalent and has led to a plethora of Web-based social and health-related data available for use by researchers. As such, researchers are increasingly using data from social media to retrieve and analyze mental health-related content. However, there is limited evidence regarding why people use this emerging platform to discuss mental health problems in the first place. Objectives: The aim of this study was to explore the reasons why individuals discuss mental health on the social media website Twitter. The study was the first of its kind to implement a study-specific hashtag for research; therefore, we also examined how feasible it was to circulate and analyze a study-specific hashtag for mental health research. Methods: Text mining methods using the Twitter Streaming Application Programming Interface (API) and Twitter Search API were used to collect and organize tweets from the hashtag #WhyWeTweetMH, circulated between September 2015 and November 2015. Tweets were analyzed thematically to understand the key reasons for discussing mental health using the Twitter platform. Results: Four overarching themes were derived from the 132 tweets collected: (1) sense of community; (2) raising awareness and combatting stigma; (3) safe space for expression; and (4) coping and empowerment. In addition, 11 associated subthemes were also identified. Conclusions: The themes derived from the content of the tweets highlight the perceived therapeutic benefits of Twitter through the provision of support and information and the potential for self-management strategies. The ability to use Twitter to combat stigma and raise awareness of mental health problems indicates the societal benefits that can be facilitated via the platform. The number of tweets and themes identified demonstrates the feasibility of implementing study-specific hashtags to explore research questions in the field of mental health and can be used as a basis for other health-related research. %M 28381392 %R 10.2196/jmir.6173 %U http://www.jmir.org/2017/4/e107/ %U https://doi.org/10.2196/jmir.6173 %U http://www.ncbi.nlm.nih.gov/pubmed/28381392 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e10 %T Public Acceptability of E-Mental Health Treatment Services for Psychological Problems: A Scoping Review %A Apolinário-Hagen,Jennifer %A Kemper,Jessica %A Stürmer,Carolina %+ Institute for Psychology, Department of Health Psychology, University of Hagen, Bldg D, 1st Fl, Universitätsstr 33, Hagen, 58097, Germany, 49 2331 987 2272, jennifer.apolinario-hagen@fernuni-hagen.de %K mental health %K eHealth %K acceptability of healthcare %K public opinion %K attitude to computers %K patient preference %K diffusion of innovation %K cognitive therapy %K computer literacy %K review %D 2017 %7 03.04.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Over the past decades, the deficient provision of evidence-based interventions for the prevention and treatment of mental health problems has become a global challenge across health care systems. In view of the ongoing diffusion of new media and mobile technologies into everyday life, Web-delivered electronic mental health (e-mental health) treatment services have been suggested to expand the access to professional help. However, the large-scale dissemination and adoption of innovative e-mental health services is progressing slowly. This discrepancy between potential and actual impact in public health makes it essential to explore public acceptability of e-mental health treatment services across health care systems. Objective: This scoping review aimed to identify and evaluate recent empirical evidence for public acceptability, service preferences, and attitudes toward e-mental health treatments. On the basis of both frameworks for technology adoption and previous research, we defined (1) perceived helpfulness and (2) intentions to use e-mental health treatment services as indicators for public acceptability in the respective general population of reviewed studies. This mapping should reduce heterogeneity and help derive implications for systematic reviews and public health strategies. Methods: We systematically searched electronic databases (MEDLINE/PubMed, PsycINFO, Psyndex, PsycARTICLES, and Cochrane Library, using reference management software for parallel searches) to identify surveys published in English in peer-reviewed journals between January 2010 and December 2015, focusing on public perceptions about e-mental health treatments outside the context of clinical, psychosocial, or diagnostic interventions. Both indicators were obtained from previous review. Exclusion criteria further involved studies targeting specific groups or programs. Results: The simultaneous database search identified 76 nonduplicate records. Four articles from Europe and Australia were included in this scoping review. Sample sizes ranged from 217 to 2411 participants of ages 14-95 years. All included studies used cross-sectional designs and self-developed measures for outcomes related to both defined indicators of public acceptability. Three surveys used observational study designs, whereas one study was conducted as an experiment investigating the impact of brief educational information on attitudes. Taken together, the findings of included surveys suggested that e-mental health treatment services were perceived as less helpful than traditional face-to-face interventions. Additionally, intentions to future use e-mental health treatments were overall smaller in comparison to face-to-face services. Professional support was essential for help-seeking intentions in case of psychological distress. Therapist-assisted e-mental health services were preferred over unguided programs. Unexpectedly, assumed associations between familiarity with Web-based self-help for health purposes or “e-awareness” and intentions to use e-mental health services were weak or inconsistent. Conclusions: Considering the marginal amount and heterogeneity of pilot studies focusing on public acceptability of e-mental health treatments, further research using theory-led approaches and validated measures is required to understand psychological facilitator and barriers for the implementation of innovative services into health care. %M 28373153 %R 10.2196/mental.6186 %U http://mental.jmir.org/2017/2/e10/ %U https://doi.org/10.2196/mental.6186 %U http://www.ncbi.nlm.nih.gov/pubmed/28373153 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 2 %P e11 %T Internet Addiction Through the Phase of Adolescence: A Questionnaire Study %A Karacic,Silvana %A Oreskovic,Stjepan %+ Health Center Sveti Kriz, Cesta domovinske zahvalnosti 1, Trogir - Arbanija, 21224, Croatia, 385 21 888118, hotel-sveti-kriz@st.t-com.hr %K adolescents %K Internet addiction %K stages of adolescence %D 2017 %7 03.04.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescents increasingly use the Internet for communication, education, entertainment, and other purposes in varying degrees. Given their vulnerable age, they may be prone to Internet addiction. Objective: Our aim was to identify possible differences in the purpose of Internet use among adolescents with respect to age subgroup, country of residence, and gender and the distribution of Internet addiction across age subgroups. Another aim was to determine if there is a correlation between the purpose of Internet use and age and if this interaction influences the level of addiction to the Internet. Methods: The study included a simple random sample of 1078 adolescents—534 boys and 525 girls—aged 11-18 years attending elementary and grammar schools in Croatia, Finland, and Poland. Adolescents were asked to complete an anonymous questionnaire and provide data on age, gender, country of residence, and purpose of Internet use (ie, school/work or entertainment). Collected data were analyzed with the chi-square test for correlations. Results: Adolescents mostly used the Internet for entertainment (905/1078, 84.00%). More female than male adolescents used it for school/work (105/525, 20.0% vs 64/534, 12.0%, respectively). Internet for the purpose of school/work was mostly used by Polish adolescents (71/296, 24.0%), followed by Croatian (78/486, 16.0%) and Finnish (24/296, 8.0%) adolescents. The level of Internet addiction was the highest among the 15-16-year-old age subgroup and was lowest in the 11-12-year-old age subgroup. There was a weak but positive correlation between Internet addiction and age subgroup (P=.004). Male adolescents mostly contributed to the correlation between the age subgroup and level of addiction to the Internet (P=.001). Conclusions: Adolescents aged 15-16 years, especially male adolescents, are the most prone to the development of Internet addiction, whereas adolescents aged 11-12 years show the lowest level of Internet addiction. %M 28373154 %R 10.2196/mental.5537 %U http://mental.jmir.org/2017/2/e11/ %U https://doi.org/10.2196/mental.5537 %U http://www.ncbi.nlm.nih.gov/pubmed/28373154 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e85 %T Assessing Feasibility and Acceptability of Web-Based Enhanced Relapse Prevention for Bipolar Disorder (ERPonline): A Randomized Controlled Trial %A Lobban,Fiona %A Dodd,Alyson L %A Sawczuk,Adam P %A Asar,Ozgur %A Dagnan,Dave %A Diggle,Peter J %A Griffiths,Martin %A Honary,Mahsa %A Knowles,Dawn %A Long,Rita %A Morriss,Richard %A Parker,Rob %A Jones,Steven %+ Spectrum Centre, Faculty of Health and Medicine, Lancaster University, Bailrigg Campus, Lancaster, LA14YT, United Kingdom, 44 01524593752, f.lobban@lancaster.ac.uk %K Internet %K randomized controlled trial %K feasibility studies %K bipolar disorder %D 2017 %7 24.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Interventions that teach people with bipolar disorder (BD) to recognize and respond to early warning signs (EWS) of relapse are recommended but implementation in clinical practice is poor. Objectives: The objective of this study was to test the feasibility and acceptability of a randomized controlled trial (RCT) to evaluate a Web-based enhanced relapse prevention intervention (ERPonline) and to report preliminary evidence of effectiveness. Methods: A single-blind, parallel, primarily online RCT (n=96) over 48 weeks comparing ERPonline plus usual treatment with “waitlist (WL) control” plus usual treatment for people with BD recruited through National Health Services (NHSs), voluntary organizations, and media. Randomization was independent, minimized on number of previous episodes (<8, 8-20, 21+). Primary outcomes were recruitment and retention rates, levels of intervention use, adverse events, and participant feedback. Process and clinical outcomes were assessed by telephone and Web and compared using linear models with intention-to-treat analysis. Results: A total of 280 people registered interest online, from which 96 met inclusion criteria, consented, and were randomized (49 to WL, 47 to ERPonline) over 17 months, with 80% retention in telephone and online follow-up at all time points, except at week 48 (76%). Acceptability was high for both ERPonline and trial methods. ERPonline cost approximately £19,340 to create, and £2176 per year to host and maintain the site. Qualitative data highlighted the importance of the relationship that the users have with Web-based interventions. Differences between the group means suggested that access to ERPonline was associated with: a more positive model of BD at 24 weeks (10.70, 95% CI 0.90 to 20.5) and 48 weeks (13.1, 95% CI 2.44 to 23.93); increased monitoring of EWS of depression at 48 weeks (−1.39, 95% CI −2.61 to −0.163) and of hypomania at 24 weeks (−1.72, 95% CI −2.98 to −0.47) and 48 weeks (−1.61, 95% CI −2.92 to −0.30), compared with WL. There was no evidence of impact of ERPonline on clinical outcomes or medication adherence, but relapse rates across both arms were low (15%) and the sample remained high functioning throughout. One person died by suicide before randomization and 5 people in ERPonline and 6 in WL reported ideas of suicide or self-harm. None were deemed study related by an independent Trial Steering Committee (TSC). Conclusions: ERPonline offers a cheap accessible option for people seeking ongoing support following successful treatment. However, given high functioning and low relapse rates in this study, testing clinical effectiveness for this population would require very large sample sizes. Building in human support to use ERPonline should be considered. Trial registration: International Standard Randomized Controlled Trial Number (ISRCTN): 56908625; http://www.isrctn.com/ISRCTN56908625 (Archived by WebCite at http://www.webcitation.org/6of1ON2S0) %M 28341619 %R 10.2196/jmir.7008 %U http://www.jmir.org/2017/3/e85/ %U https://doi.org/10.2196/jmir.7008 %U http://www.ncbi.nlm.nih.gov/pubmed/28341619 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e84 %T The Efficacy of Internet-Based Mindfulness Training and Cognitive-Behavioral Training With Telephone Support in the Enhancement of Mental Health Among College Students and Young Working Adults: Randomized Controlled Trial %A Mak,Winnie WS %A Chio,Floria HN %A Chan,Amy TY %A Lui,Wacy WS %A Wu,Ellery KY %+ Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong,, China (Hong Kong), 852 39436577, wwsmak@psy.cuhk.edu.hk %K mental health promotion %K Internet-based interventions %K mindfulness-based training %K cognitive-behavioral training %K randomized controlled trial %D 2017 %7 22.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: College students and working adults are particularly vulnerable to stress and other mental health problems, and mental health promotion and prevention are needed to promote their mental health. In recent decades, mindfulness-based training has demonstrated to be efficacious in treating physical and psychological conditions. Objective: The aim of our study was to examine the efficacy of an Internet-based mindfulness training program (iMIND) in comparison with the well-established Internet-based cognitive-behavioral training program (iCBT) in promoting mental health among college students and young working adults. Methods: This study was a 2-arm, unblinded, randomized controlled trial comparing iMIND with iCBT. Participants were recruited online and offline via mass emails, advertisements in newspapers and magazines, announcement and leaflets in primary care clinics, and social networking sites. Eligible participants were randomized into either the iMIND (n=604) or the iCBT (n=651) condition. Participants received 8 Web-based sessions with information and exercises related to mindfulness or cognitive-behavioral principles. Telephone or email support was provided by trained first tier supporters who were supervised by the study’s research team. Primary outcomes included mental and physical health-related measures, which were self-assessed online at preprogram, postprogram, and 3-month follow-up. Results: Among the 1255 study participants, 213 and 127 completed the post- and 3-month follow-up assessment, respectively. Missing data were treated using restricted maximum likelihood estimation. Both iMIND (n=604) and iCBT (n=651) were efficacious in improving mental health, psychological distress, life satisfaction, sleep disturbance, and energy level. Conclusions: Both Internet-based mental health programs showed potential in improving the mental health from pre- to postassessment, and such improvement was sustained at the 3-month follow-up. The high attrition rate in this study suggests the need for refinement in future technology-based psychological programs. Mental health professionals need to team up with experts in information technology to increase personalization of Web-based interventions to enhance adherence. Trial Registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR-TRC-12002623; https://www2.ccrb.cuhk.edu.hk/ registry/public/191 (Archived by WebCite at http://www.webcitation.org/6kxt8DjM4). %M 28330831 %R 10.2196/jmir.6737 %U http://www.jmir.org/2017/3/e84/ %U https://doi.org/10.2196/jmir.6737 %U http://www.ncbi.nlm.nih.gov/pubmed/28330831 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 3 %P e71 %T Longitudinal Changes in Psychological States in Online Health Community Members: Understanding the Long-Term Effects of Participating in an Online Depression Community %A Park,Albert %A Conway,Mike %+ Department of Biomedical Informatics, School of Medicine, University of Utah, 421 Wakara Way #140, Salt Lake City, UT, 84108-3514, United States, 1 206 743 7843, alpark1216@gmail.com %K mental health %K depression %K consumer health information %K informatics %K information science %K social support %K psychosocial support system %K community networks %K self-help groups %K communications media %D 2017 %7 20.03.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Major depression is a serious challenge at both the individual and population levels. Although online health communities have shown the potential to reduce the symptoms of depression, emotional contagion theory suggests that negative emotion can spread within a community, and prolonged interactions with other depressed individuals has potential to worsen the symptoms of depression. Objective: The goals of our study were to investigate longitudinal changes in psychological states that are manifested through linguistic changes in depression community members who are interacting with other depressed individuals. Methods: We examined emotion-related language usages using the Linguistic Inquiry and Word Count (LIWC) program for each member of a depression community from Reddit. To measure the changes, we applied linear least-squares regression to the LIWC scores against the interaction sequence for each member. We measured the differences in linguistic changes against three online health communities focusing on positive emotion, diabetes, and irritable bowel syndrome. Results: On average, members of an online depression community showed improvement in 9 of 10 prespecified linguistic dimensions: “positive emotion,” “negative emotion,” “anxiety,” “anger,” “sadness,” “first person singular,” “negation,” “swear words,” and “death.” Moreover, these members improved either significantly or at least as much as members of other online health communities. Conclusions: We provide new insights into the impact of prolonged participation in an online depression community and highlight the positive emotion change in members. The findings of this study should be interpreted with caution, because participating in an online depression community is not the sole factor for improvement or worsening of depressive symptoms. Still, the consistent statistical results including comparative analyses with different communities could indicate that the emotion-related language usage of depression community members are improving either significantly or at least as much as members of other online communities. On the basis of these findings, we contribute practical suggestions for designing online depression communities to enhance psychosocial benefit gains for members. We consider these results to be an important step toward a better understanding of the impact of prolonged participation in an online depression community, in addition to providing insights into the long-term psychosocial well-being of members. %M 28320692 %R 10.2196/jmir.6826 %U http://www.jmir.org/2017/3/e71/ %U https://doi.org/10.2196/jmir.6826 %U http://www.ncbi.nlm.nih.gov/pubmed/28320692 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 2 %P e55 %T Issues for eHealth in Psychiatry: Results of an Expert Survey %A Nicholas,Jennifer %A Huckvale,Kit %A Larsen,Mark Erik %A Basu,Ashna %A Batterham,Philip J %A Shaw,Frances %A Sendi,Shahbaz %+ Black Dog Institute, University of New South Wales Australia, Hospital Rd, Prince of Wales Hospital, Randwick, Sydney,, Australia, 61 9382 9260, j.nicholas@blackdog.org.au %K eHealth %K mental health %K technology adoption %D 2017 %7 28.02.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Technology has changed the landscape in which psychiatry operates. Effective, evidence-based treatments for mental health care are now available at the fingertips of anyone with Internet access. However, technological solutions for mental health are not necessarily sought by consumers nor recommended by clinicians. Objective: The objectives of this study are to identify and discuss the barriers to introducing eHealth technology-supported interventions within mental health. Methods: An interactive polling tool was used to ask “In this brave new world, what are the key issues that need to be addressed to improve mental health (using technology)?” Respondents were the multidisciplinary attendees of the “Humans and Machines: A Quest for Better Mental Health” conference, held in Sydney, Australia, in 2016. Responses were categorized into 10 key issues using team-based qualitative analysis. Results: A total of 155 responses to the question were received from 66 audience members. Responses were categorized into 10 issues and ordered by importance: access to care, integration and collaboration, education and awareness, mental health stigma, data privacy, trust, understanding and assessment of mental health, government and policy, optimal design, and engagement. In this paper, each of the 10 issues are outlined, and potential solutions are discussed. Many of the issues were interrelated, having implications for other key areas identified. Conclusions: As many of the issues identified directly related to barriers to care, priority should be given to addressing these issues that are common across mental health delivery. Despite new challenges raised by technology, technology-supported mental health interventions represent a tremendous opportunity to address in a timely way these major concerns and improve the receipt of effective, evidence-based therapy by those in need. %M 28246068 %R 10.2196/jmir.6957 %U http://www.jmir.org/2017/2/e55/ %U https://doi.org/10.2196/jmir.6957 %U http://www.ncbi.nlm.nih.gov/pubmed/28246068 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 2 %P e46 %T Factors Associated With Dropout During Recruitment and Follow-Up Periods of a mHealth-Based Randomized Controlled Trial for Mobile.Net to Encourage Treatment Adherence for People With Serious Mental Health Problems %A Kannisto,Kati Anneli %A Korhonen,Joonas %A Adams,Clive E %A Koivunen,Marita Hannele %A Vahlberg,Tero %A Välimäki,Maritta Anneli %+ Department of Nursing Science, University of Turku, Joukahaisenkatu 3-5, Turku, FI-20014, Finland, 358 505312652, kaankan@utu.fi %K text messaging %K mobile health %K antipsychotics %K mental health %K psychiatric services %K methodological study %D 2017 %7 21.02.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinical trials are the gold standard of evidence-based practice. Still many papers inadequately report methodology in randomized controlled trials (RCTs), particularly for mHealth interventions for people with serious mental health problems. To ensure robust enough evidence, it is important to understand which study phases are the most vulnerable in the field of mental health care. Objective: We mapped the recruitment and the trial follow-up periods of participants to provide a picture of the dropout predictors from a mHealth-based trial. As an example, we used a mHealth-based multicenter RCT, titled “Mobile.Net,” targeted at people with serious mental health problems. Methods: Recruitment and follow-up processes of the Mobile.Net trial were monitored and analyzed. Recruitment outcomes were recorded as screened, eligible, consent not asked, refused, and enrolled. Patient engagement was recorded as follow-up outcomes: (1) attrition during short message service (SMS) text message intervention and (2) attrition during the 12-month follow-up period. Multiple regression analysis was used to identify which demographic factors were related to recruitment and retention. Results: We recruited 1139 patients during a 15-month period. Of 11,530 people screened, 36.31% (n=4186) were eligible. This eligible group tended to be significantly younger (mean 39.2, SD 13.2 years, P<.001) and more often women (2103/4181, 50.30%) than those who were not eligible (age: mean 43.7, SD 14.6 years; women: 3633/6514, 55.78%). At the point when potential participants were asked to give consent, a further 2278 refused. Those who refused were a little older (mean 40.2, SD 13.9 years) than those who agreed to participate (mean 38.3, SD 12.5 years; t1842=3.2, P<.001). We measured the outcomes after 12 months of the SMS text message intervention. Attrition from the SMS text message intervention was 4.8% (27/563). The patient dropout rate after 12 months was 0.36% (4/1123), as discovered from the register data. In all, 3.12% (35/1123) of the participants withdrew from the trial. However, dropout rates from the patient survey (either by paper or telephone interview) were 52.45% (589/1123) and 27.8% (155/558), respectively. Almost all participants (536/563, 95.2%) tolerated the intervention, but those who discontinued were more often women (21/27, 78%; P=.009). Finally, participants’ age (P<.001), gender (P<.001), vocational education (P=.04), and employment status (P<.001) seemed to predict their risk of dropping out from the postal survey. Conclusions: Patient recruitment and engagement in the 12-month follow-up conducted with a postal survey were the most vulnerable phases in the SMS text message-based trial. People with serious mental health problems may need extra support during the recruitment process and in engaging them in SMS text message-based trials to ensure robust enough evidence for mental health care. ClinicalTrial: International Standard Randomized Controlled Trial Number (ISRCTN): 27704027; http://www.isrctn.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/6oHcU2SFp) %M 28223262 %R 10.2196/jmir.6417 %U http://www.jmir.org/2017/2/e46/ %U https://doi.org/10.2196/jmir.6417 %U http://www.ncbi.nlm.nih.gov/pubmed/28223262 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 1 %P e6 %T Use of Online Forums for Perinatal Mental Illness, Stigma, and Disclosure: An Exploratory Model %A Moore,Donna %A Drey,Nicholas %A Ayers,Susan %+ Centre for Maternal and Child Health, School of Health Sciences, City, University of London, Northampton Square, London,, United Kingdom, 44 20 7040 5, Donna.Moore.1@city.ac.uk %K Internet %K social stigma %K depression %K postpartum %K mood disorder %K female %D 2017 %7 20.02.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Perinatal mental illness is a global health concern; however, many women with the illness do not get the treatment they need to recover. Interventions that reduce the stigma around perinatal mental illness have the potential to enable women to disclose their symptoms to health care providers and consequently access treatment. There are many online forums for perinatal mental illness and thousands of women use them. Preliminary research suggests that online forums may promote help-seeking behavior, potentially because they have a role in challenging stigma. This study draws from these findings and theoretical concepts to present a model of forum use, stigma, and disclosure. Objective: This study tested a model that measured the mediating role of stigma between online forum use and disclosure of affective symptoms to health care providers. Methods: A Web-based survey of 200 women who were pregnant or had a child younger than 5 years and considered themselves to be experiencing psychological distress was conducted. Women were recruited through social media and questions measured forum usage, perinatal mental illness stigma, disclosure to health care providers, depression and anxiety symptoms, barriers to disclosure, and demographic information. Results: There was a significant positive indirect effect of length of forum use on disclosure of symptoms through internal stigma, b=0.40, bias-corrected and accelerated (BCa) 95% CI 0.13-0.85. Long-term forum users reported higher levels of internal stigma, and higher internal stigma was associated with disclosure of symptoms to health care providers when controlling for symptoms of depression and anxiety. Conclusions: Internal stigma mediates the relationship between length of forum use and disclosure to health care providers. Findings suggest that forums have the potential to enable women to recognize and reveal their internal stigma, which may in turn lead to greater disclosure of symptoms to health care providers. Clinicians could refer clients to trustworthy and moderated online forums that facilitate expression of perinatal mental illness stigma and promote disclosure to health care providers. %M 28219879 %R 10.2196/mental.5926 %U http://mental.jmir.org/2017/1/e6/ %U https://doi.org/10.2196/mental.5926 %U http://www.ncbi.nlm.nih.gov/pubmed/28219879 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 1 %P e3 %T Tips and Traps: Lessons From Codesigning a Clinician E-Monitoring Tool for Computerized Cognitive Behavioral Therapy %A Sundram,Frederick %A Hawken,Susan J %A Stasiak,Karolina %A Lucassen,Mathijs FG %A Fleming,Theresa %A Shepherd,Matthew %A Greenwood,Andrea %A Osborne,Raechel %A Merry,Sally N %+ Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand, 64 9 923 7521, f.sundram@auckland.ac.nz %K e-therapy %K psychotherapy %K cognitive therapy %K depression %K psychology, adolescent %K primary health care %D 2017 %7 11.01.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Computerized cognitive behavioral therapy (cCBT) is an acceptable and promising treatment modality for adolescents with mild-to-moderate depression. Many cCBT programs are standalone packages with no way for clinicians to monitor progress or outcomes. We sought to develop an electronic monitoring (e-monitoring) tool in consultation with clinicians and adolescents to allow clinicians to monitor mood, risk, and treatment adherence of adolescents completing a cCBT program called SPARX (Smart, Positive, Active, Realistic, X-factor thoughts). Objective: The objectives of our study were as follows: (1) assess clinicians’ and adolescents’ views on using an e-monitoring tool and to use this information to help shape the development of the tool and (2) assess clinician experiences with a fully developed version of the tool that was implemented in their clinical service. Methods: A descriptive qualitative study using semistructured focus groups was conducted in New Zealand. In total, 7 focus groups included clinicians (n=50) who worked in primary care, and 3 separate groups included adolescents (n=29). Clinicians were general practitioners (GPs), school guidance counselors, clinical psychologists, youth workers, and nurses. Adolescents were recruited from health services and a high school. Focus groups were run to enable feedback at 3 phases that corresponded to the consultation, development, and postimplementation stages. Thematic analysis was applied to transcribed responses. Results: Focus groups during the consultation and development phases revealed the need for a simple e-monitoring registration process with guides for end users. Common concerns were raised in relation to clinical burden, monitoring risk (and effects on the therapeutic relationship), alongside confidentiality or privacy and technical considerations. Adolescents did not want to use their social media login credentials for e-monitoring, as they valued their privacy. However, adolescents did want information on seeking help and personalized monitoring and communication arrangements. Postimplementation, clinicians who had used the tool in practice revealed no adverse impact on the therapeutic relationship, and adolescents were not concerned about being e-monitored. Clinicians did need additional time to monitor adolescents, and the e-monitoring tool was used in a different way than was originally anticipated. Also, it was suggested that the registration process could be further streamlined and integrated with existing clinical data management systems, and the use of clinician alerts could be expanded beyond the scope of simply flagging adolescents of concern. Conclusions: An e-monitoring tool was developed in consultation with clinicians and adolescents. However, the study revealed the complexity of implementing the tool in clinical practice. Of salience were privacy, parallel monitoring systems, integration with existing electronic medical record systems, customization of the e-monitor, and preagreed monitoring arrangements between clinicians and adolescents. %M 28077345 %R 10.2196/mental.5878 %U http://mental.jmir.org/2017/1/e3/ %U https://doi.org/10.2196/mental.5878 %U http://www.ncbi.nlm.nih.gov/pubmed/28077345 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e1 %T Translating E-Mental Health Into Practice: What Are the Barriers and Enablers to E-Mental Health Implementation by Aboriginal and Torres Strait Islander Health Professionals? %A Bennett-Levy,James %A Singer,Judy %A DuBois,Simon %A Hyde,Kelly %+ University Centre for Rural Health, University of Sydney, PO Box 3074, Lismore, NSW 2480, Australia, 61 266207570, james.bennett-levy@ucrh.edu.au %K e-mental health %K indigenous populations %K Aboriginal and Torres Strait Islander peoples %K professional supervision %K professional consultation %K service implementation %K health education %K mobile apps %D 2017 %7 11.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: With increasing evidence for the effectiveness of e-mental health interventions for enhancing mental health and well-being, a growing challenge is how to translate promising research findings into service delivery contexts. A 2012 e-mental health initiative by the Australian Federal Government (eMHPrac) has sought to address the issue through several strategies, one of which has been to train different health professional workforces in e-mental health (e-MH). Objective: The aim of the study was to report on the barriers and enablers of e-MH uptake in a cohort of predominantly Aboriginal and Torres Strait Islander health professionals (21 Indigenous, 5 non-Indigenous) who occupied mainly support or case management roles within their organizations. Methods: A 3- or 2-day e-MH training program was followed by up to 5 consultation sessions (mean 2.4 sessions) provided by the 2 trainers. The trainer-consultants provided written reports on each of the 30 consultation sessions for 7 consultation groups. They were also interviewed as part of the study. The written reports and interview data were thematically analyzed by 2 members of the research team. Results: Uptake of e-MH among the consultation group was moderate (22%-30% of participants). There were significant organizational barriers to uptake resulting from procedural and administrative problems, demanding workloads, prohibitive policies, and a lack of fit between the organizational culture and the introduction of new technologies. Personal barriers included participant beliefs about the applicability of e-MH to certain populations, and workers’ lack of confidence and skills. However, enthusiastic managers and tech-savvy champions could provide a counter-balance as organizational enablers of e-MH; and the consultation sessions themselves appear to have enhanced skills and confidence, shifted attitudes to new technologies, and seeded a perception that e-MH could be a valuable health education resource. Conclusions: A conclusion from the program was that it was important to match e-MH training and resources to work roles. In the latter stages of the consultation sessions, the Aboriginal and Torres Strait Islander health professionals responded very positively to YouTube video clips and apps with a health education dimension. Therapy-oriented apps and programs may fit less well within the scope of practice of some workforces, including this one. We suggest that researchers broaden their focus and definitions of e-MH and give rather more weight to e-MH’s health education possibilities. Developing criteria for evaluating apps and YouTube videos may empower a rather greater section of health workforce to use e-MH with their clients. %M 28077347 %R 10.2196/jmir.6269 %U http://www.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/jmir.6269 %U http://www.ncbi.nlm.nih.gov/pubmed/28077347 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 5 %N 1 %P e1 %T The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study %A Riahi,Sanaz %A Fischler,Ilan %A Stuckey,Melanie I %A Klassen,Philip E %A Chen,John %+ Ontario Shores Centre for Mental Health Sciences, 700 Gordon Street, Whitby, ON,, Canada, 1 905 430 4055, riahis@ontarioshores.ca %K electronic health records %K health information management %K medical informatics %K mental health %K organizational innovation %K psychiatry %K quality improvement %D 2017 %7 05.01.2017 %9 Original Paper %J JMIR Med Inform %G English %X Background: Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective: The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods: The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results: Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions: EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. %M 28057607 %R 10.2196/medinform.6512 %U http://medinform.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/medinform.6512 %U http://www.ncbi.nlm.nih.gov/pubmed/28057607 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e10 %T IntelliCare: An Eclectic, Skills-Based App Suite for the Treatment of Depression and Anxiety %A Mohr,David C %A Tomasino,Kathryn Noth %A Lattie,Emily G %A Palac,Hannah L %A Kwasny,Mary J %A Weingardt,Kenneth %A Karr,Chris J %A Kaiser,Susan M %A Rossom,Rebecca C %A Bardsley,Leland R %A Caccamo,Lauren %A Stiles-Shields,Colleen %A Schueller,Stephen M %+ Center for Behavioral Intervention Technologies (CBITs), Department of Preventive Medicine, Northwestern University, 750 N Lakeshore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 1403, d-mohr@northwestern.edu %K mHealth %K eHealth %K mobile health %K depression %K anxiety %D 2017 %7 05.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital mental health tools have tended to use psychoeducational strategies based on treatment orientations developed and validated outside of digital health. These features do not map well to the brief but frequent ways that people use mobile phones and mobile phone apps today. To address these challenges, we developed a suite of apps for depression and anxiety called IntelliCare, each developed with a focused goal and interactional style. IntelliCare apps prioritize interactive skills training over education and are designed for frequent but short interactions. Objective: The overall objective of this study was to pilot a coach-assisted version of IntelliCare and evaluate its use and efficacy at reducing symptoms of depression and anxiety. Methods: Participants, recruited through a health care system, Web-based and community advertising, and clinical research registries, were included in this single-arm trial if they had elevated symptoms of depression or anxiety. Participants had access to the 14 IntelliCare apps from Google Play and received 8 weeks of coaching on the use of IntelliCare. Coaching included an initial phone call plus 2 or more texts per week over the 8 weeks, with some participants receiving an additional brief phone call. Primary outcomes included the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. Participants were compensated up to US $90 for completing all assessments; compensation was not for app use or treatment engagement. Results: Of the 99 participants who initiated treatment, 90.1% (90/99) completed 8 weeks. Participants showed substantial reductions in the PHQ-9 and GAD-7 (P<.001). Participants used the apps an average of 195.4 (SD 141) times over the 8 weeks. The average length of use was 1.1 (SD 2.1) minutes, and 95% of participants downloaded 5 or more of the IntelliCare apps. Conclusions: This study supports the IntelliCare framework of providing a suite of skills-focused apps that can be used frequently and briefly to reduce symptoms of depression and anxiety. The IntelliCare system is elemental, allowing individual apps to be used or not used based on their effectiveness and utility, and it is eclectic, viewing treatment strategies as elements that can be applied as needed rather than adhering to a singular, overarching, theoretical model. Trial Registration: Clinicaltrials.gov NCT02176226; http://clinicaltrials.gov/ct2/show/NCT02176226 (Archived by WebCite at http://www.webcitation/6mQZuBGk1) %M 28057609 %R 10.2196/jmir.6645 %U http://www.jmir.org/2017/1/e10/ %U https://doi.org/10.2196/jmir.6645 %U http://www.ncbi.nlm.nih.gov/pubmed/28057609 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e4 %T Complaint-Directed Mini-Interventions for Depressive Complaints: A Randomized Controlled Trial of Unguided Web-Based Self-Help Interventions %A Lokman,Suzanne %A Leone,Stephanie S %A Sommers-Spijkerman,Marion %A van der Poel,Agnes %A Smit,Filip %A Boon,Brigitte %+ Department of Public Mental Health, Trimbos Institute: Netherlands Institute of Mental Health and Addiction, Da Costakade 45, Utrecht, 3521 VS, Netherlands, 31 30 2959385, slokman@trimbos.nl %K prevention %K depression %K Internet-based intervention %K randomized controlled trial %D 2017 %7 04.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Prevention of depression is important due to the substantial burden of disease associated with it. To this end, we developed a novel, brief, and low-threshold Web-based self-help approach for depressive complaints called complaint-directed mini-interventions (CDMIs). These CDMIs focus on highly prevalent complaints that are demonstrably associated with depression and have a substantial economic impact: stress, sleep problems, and worry. Objective: The aim was to evaluate the effectiveness of the Web-based self-help CDMIs in a sample of adults with mild-to-moderate depressive symptoms compared to a wait-list control group. Methods: A two-armed randomized controlled trial was conducted. An open recruitment strategy was used. Participants were randomized to either the Web-based CDMIs or the no-intervention wait-list control group. The CDMIs are online, unguided, self-help interventions, largely based on cognitive behavioral techniques, which consist of 3 to 4 modules with up to 6 exercises per module. Participants are free to choose between the modules and exercises. Assessments, using self-report questionnaires, took place at baseline and at 3 and 6 months after baseline. The control group was given access to the intervention following the 3-month assessment. The primary goal of the CDMIs is to reduce depressive complaints. The primary outcome of the study was a reduction in depressive complaints as measured by the Inventory of Depressive Symptomatology Self-Report (IDS-SR). Secondary outcomes included reductions in stress, worry, sleep problems, and anxiety complaints, and improvements in well-being. Data were analyzed using linear mixed models. Results: In total, 329 participants enrolled in the trial, of which 165 were randomized to the intervention group and 164 to the control group. Approximately three-quarters of the intervention group actually created an account. Of these participants, 91.3% (116/127) logged into their chosen CDMI at least once during the 3-month intervention period (median 3, range 0-166). After 3 months, there was a significant reduction in depressive symptomatology for participants in the intervention group compared to participants in the wait-list control group (reduction in depression: mean –4.47, 95% CI –6.54 to –2.40; Cohen d=–0.70). Furthermore, significant effects were observed for sleep problems, worry, anxiety, and well-being, with effect sizes ranging from –0.29 to –0.40. The intervention did not significantly reduce stress. At 6-month follow-up, the improvements in the intervention group were generally sustained. Conclusions: This study shows that the online self-help CDMIs have a positive impact on various mental health outcomes. Future research should focus on which specific strategies may boost adherence, and increase the reach of the CDMIs among people with low socioeconomic status. ClinicalTrial: Netherlands Trial Register (NTR): NTR4612; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4612 (Archived by WebCite at http://www.webcitation.org/6n4PVYddM) %M 28052840 %R 10.2196/jmir.6581 %U http://www.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/jmir.6581 %U http://www.ncbi.nlm.nih.gov/pubmed/28052840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e5 %T Preventing Depression in Adults With Subthreshold Depression: Health-Economic Evaluation Alongside a Pragmatic Randomized Controlled Trial of a Web-Based Intervention %A Buntrock,Claudia %A Berking,Matthias %A Smit,Filip %A Lehr,Dirk %A Nobis,Stephanie %A Riper,Heleen %A Cuijpers,Pim %A Ebert,David %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Nägelsbachstr. 25a, Erlangen, 91052, Germany, 49 91318567568, buntrockclaudia@gmail.com %K prevention %K major depressive disorders %K Internet %K early intervention %K cost effectiveness %D 2017 %7 04.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders. Objective: To evaluate the cost-effectiveness of a Web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression (sD). Methods: A pragmatic randomized controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomized to a Web-based guided self-help intervention (ie, cognitive-behavioral therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with Web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs). Results: In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0.82 vs 0.70). Likewise, QALY health gains were in favor of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (£116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (£17,000), the intervention’s likelihood of being cost-effective was 99% for gaining a DFY and 64% or 99% for gaining an EQ-5D or a SF-6D QALY. Conclusions: Our study supports guidelines recommending Web-based treatment for sD and adds that this not only restores health in people with sD, but additionally reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale. Trial registration: German Clinical Trials Register: DRKS00004709; http://www.drks.de/DRKS00004709 (Archived by WebCite at http://www.webcitation.org/6kAZVUxy9) %M 28052841 %R 10.2196/jmir.6587 %U http://www.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/jmir.6587 %U http://www.ncbi.nlm.nih.gov/pubmed/28052841 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 1 %P e1 %T How Do People Experiencing Schizophrenia Spectrum Disorders or Other Psychotic Disorders Use the Internet to Get Information on Their Mental Health? Literature Review and Recommendations %A Villani,Murielle %A Kovess-Masfety,Viviane %+ Fondation Pierre Deniker, 36 Avenue Raymond Poincaré, Paris,, France, 33 6 03 69 60 02, muriellevillani@gmail.com %K Internet %K health information %K e-mental health %K e-support %K schizophrenia spectrum disorders %K psychotic disorders %D 2017 %7 03.01.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Studies show that the Internet has become an influential source of information for people experiencing serious psychiatric conditions such as schizophrenia spectrum disorders or other psychotic disorders, among which the rate of Internet users is growing, with rates ranging from 33.3% to 79.5% given the country. Between 20.5% and 56.4% of these Internet users seek mental health information. Objective: Focusing on this population’s Web searches about their mental health, this paper examines what type of content they look for and what could be the benefits and disadvantages of this navigation. Methods: We conducted a literature review through medical and psychological databases between 2000 and 2015 using the keywords “Internet,” “Web,” “virtual,” “health information,” “schizophrenia,” “psychosis,” “e-mental health,” “e-support,” and “telepsychiatry.” Results: People experiencing schizophrenia spectrum disorders or other psychotic disorders wish to find on the Internet trustful, nonstigmatizing information about their disease, flexibility, security standards, and positive peer-to-peer exchanges. E-mental health also appears to be desired by a substantial proportion of them. In this field, the current developments towards intervention and early prevention in the areas of depression and bipolar and anxiety disorders become more and more operational for schizophrenia spectrum disorders and other psychotic disorders as well. The many benefits of the Internet as a source of information and support, such as empowerment, enhancement of self-esteem, relief from peer information, better social interactions, and more available care, seem to outbalance the difficulties. Conclusions: In this paper, after discussing the challenges related to the various aspects of the emergence of the Internet into the life of people experiencing schizophrenia spectrum disorders or other psychotic disorders, we will suggest areas of future research and practical recommendations for this major transition. %M 28049620 %R 10.2196/mental.5946 %U http://mental.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/mental.5946 %U http://www.ncbi.nlm.nih.gov/pubmed/28049620 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 12 %P e330 %T The Use and Effectiveness of Mobile Apps for Depression: Results From a Fully Remote Clinical Trial %A Arean,Patricia A %A Hallgren,Kevin A %A Jordan,Joshua T %A Gazzaley,Adam %A Atkins,David C %A Heagerty,Patrick J %A Anguera,Joaquin A %+ Department of Neurology, University of California San Francisco, 675 Nelson Rising Lane, San Francisco, CA, 94158, United States, 1 415 502 7322, joaquin.anguera@ucsf.edu %K depression %K mobile apps %K RCT %K randomized controlled trial %K cognitive training %K iPST %K problem-solving therapy %D 2016 %7 20.12.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps for mental health have the potential to overcome access barriers to mental health care, but there is little information on whether patients use the interventions as intended and the impact they have on mental health outcomes. Objective: The objective of our study was to document and compare use patterns and clinical outcomes across the United States between 3 different self-guided mobile apps for depression. Methods: Participants were recruited through Web-based advertisements and social media and were randomly assigned to 1 of 3 mood apps. Treatment and assessment were conducted remotely on each participant’s smartphone or tablet with minimal contact with study staff. We enrolled 626 English-speaking adults (≥18 years old) with mild to moderate depression as determined by a 9-item Patient Health Questionnaire (PHQ-9) score ≥5, or if their score on item 10 was ≥2. The apps were (1) Project: EVO, a cognitive training app theorized to mitigate depressive symptoms by improving cognitive control, (2) iPST, an app based on an evidence-based psychotherapy for depression, and (3) Health Tips, a treatment control. Outcomes were scores on the PHQ-9 and the Sheehan Disability Scale. Adherence to treatment was measured as number of times participants opened and used the apps as instructed. Results: We randomly assigned 211 participants to iPST, 209 to Project: EVO, and 206 to Health Tips. Among the participants, 77.0% (482/626) had a PHQ-9 score >10 (moderately depressed). Among the participants using the 2 active apps, 57.9% (243/420) did not download their assigned intervention app but did not differ demographically from those who did. Differential treatment effects were present in participants with baseline PHQ-9 score >10, with the cognitive training and problem-solving apps resulting in greater effects on mood than the information control app (χ22=6.46, P=.04). Conclusions: Mobile apps for depression appear to have their greatest impact on people with more moderate levels of depression. In particular, an app that is designed to engage cognitive correlates of depression had the strongest effect on depressed mood in this sample. This study suggests that mobile apps reach many people and are useful for more moderate levels of depression. ClinicalTrial: Clinicaltrials.gov NCT00540865; https://www.clinicaltrials.gov/ct2/show/NCT00540865 (Archived by WebCite at http://www.webcitation.org/6mj8IPqQr) %M 27998876 %R 10.2196/jmir.6482 %U http://www.jmir.org/2016/12/e330/ %U https://doi.org/10.2196/jmir.6482 %U http://www.ncbi.nlm.nih.gov/pubmed/27998876 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 4 %P e53 %T Developing an Unguided Internet-Delivered Intervention for Emotional Distress in Primary Care Patients: Applying Common Factor and Person-Based Approaches %A Geraghty,Adam WA %A Muñoz,Ricardo F %A Yardley,Lucy %A Mc Sharry,Jennifer %A Little,Paul %A Moore,Michael %+ Primary Care and Population Sciences, University of Southampton, Aldermoor Health Centre, Southampton, United Kingdom, 44 2380241051, a.w.geraghty@soton.ac.uk %K Internet %K unguided %K distress %K person-based approach %D 2016 %7 20.12.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Developing effective, unguided Internet interventions for mental health represents a challenge. Without structured human guidance, engagement with these interventions is often limited and the effectiveness reduced. If their effectiveness can be increased, they have great potential for broad, low-cost dissemination. Improving unguided Internet interventions for mental health requires a renewed focus on the proposed underlying mechanisms of symptom improvement and the involvement of target users from the outset. Objective: The aim of our study was to develop an unguided e-mental health intervention for distress in primary care patients, drawing on meta-theory of psychotherapeutic change and utilizing the person-based approach (PBA) to guide iterative qualitative piloting with patients. Methods: Common factors meta-theory informed the selection and structure of therapeutic content, enabling flexibility whilst retaining the proposed necessary ingredients for effectiveness. A logic model was designed outlining intervention components and proposed mechanisms underlying improvement. The PBA provided a framework for systematically incorporating target-user perspective into the intervention development. Primary care patients (N=20) who had consulted with emotional distress in the last 12 months took part in exploratory qualitative interviews, and a subsample (n=13) undertook think-aloud interviews with a prototype of the intervention. Results: A flexible intervention was developed, to be used as and when patients need, diverting from a more traditional, linear approach. Based on the in-depth qualitative findings, disorder terms such as “depression” were avoided, and discussions of psychological symptoms were placed in the context of stressful life events. Think-aloud interviews showed that patients were positive about the design and structure of the intervention. On the basis of patient feedback, modifications were made to increase immediate access to all therapeutic techniques. Conclusions: Detailing theoretical assumptions underlying Internet interventions for mental health, and integrating this approach with systematic in-depth qualitative research with target patients is important. These strategies may provide novel ways for addressing the challenges of unguided delivery. The resulting intervention, Healthy Paths, will be evaluated in primary care-based randomized controlled trials, and deployed as a massive open online intervention (MOOI). %M 27998878 %R 10.2196/mental.5845 %U http://mental.jmir.org/2016/4/e53/ %U https://doi.org/10.2196/mental.5845 %U http://www.ncbi.nlm.nih.gov/pubmed/27998878 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 11 %P e309 %T Do We Still Have a Digital Divide in Mental Health? A Five-Year Survey Follow-up %A Robotham,Dan %A Satkunanathan,Safarina %A Doughty,Lisa %A Wykes,Til %+ Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, United Kingdom, 44 207848 ext 0219, dan.robotham@kcl.ac.uk %K digital divide %K socioeconomic factors %K technology %K mobile phone %K psychotic disorders %K distance counseling %D 2016 %7 22.11.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Nearly everyone in society uses the Internet in one form or another. The Internet is heralded as an efficient way of providing mental health treatments and services. However, some people are still excluded from using Internet-enabled technology through lack of resources, skills, and confidence. Objective: Five years ago, we showed that people with severe mental illness were at risk of digital exclusion, especially middle-aged patients with psychosis and/or people from black or minority ethnic groups with psychosis. An understanding of the breadth of potential digital exclusion is vital for the implementation of digital health services. The aim of this study is to understand the context of digital exclusion for people who experience mental illness. Methods: We conducted a survey involving people with a primary diagnosis of psychosis or depression in London, United Kingdom. A total of 241 participants were recruited: 121 with psychosis and 120 with depression. The majority of surveys were collected face-to-face (psychosis: n=109; depression: n=71). Participants answered questions regarding familiarity, access, use, motivation, and confidence with Internet-enabled technologies (ie, computers and mobile phones). Variables predicting digital exclusion were identified in regression analyses. The results were compared with the survey conducted in 2011. Results: Digital exclusion has declined since 2011. Online survey collection introduced biases into the sample, masking those who were likely to be excluded. Only 18.3% (20/109) of people with psychosis in our sample were digitally excluded, compared with 30% (28/93) in 2011 (χ21=3.8, P=.04). People with psychosis had less confidence in using the Internet than people with depression (χ21=7.4, P=.004). Only 9.9% (24/241) of participants in the total sample were digitally excluded, but the majority of these people had psychosis (n=20). Those with psychosis who were digitally excluded were significantly older than their included peers (t30=3.3, P=.002) and had used services for longer (t97=2.5, P=.02). Younger people were more likely to use mobile phones. Digitally excluded participants cited a lack of knowledge as a barrier to digital inclusion, and most wanted to use the Internet via computers (rather than mobile phones). Conclusions: Digital exclusion is lower, but some remain excluded. Facilitating inclusion among this population means helping them develop skills and confidence in using technology, and providing them with access. Providing mobile phones without basic information technology training may be counterproductive because excluded people may be excluded from mobile technology too. An evidence-based digital inclusion strategy is needed within the National Health Service to help digitally excluded populations access Internet-enabled services. %M 27876684 %R 10.2196/jmir.6511 %U http://www.jmir.org/2016/11/e309/ %U https://doi.org/10.2196/jmir.6511 %U http://www.ncbi.nlm.nih.gov/pubmed/27876684 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e218 %T The Effects of an E-Mental Health Program and Job Coaching on the Risk of Major Depression and Productivity in Canadian Male Workers: Protocol for a Randomized Controlled Trial %A Wang,JianLi %A Patten,Scott B %A Lam,Raymond W %A Attridge,Mark %A Ho,Kendall %A Schmitz,Norbert %A Marchand,Alain %A Lashewicz,Bonnie M %+ Department of Psychiatry, University of Calgary, Room 4D69, TRW Building, 3280 Hospital Dr. NW, Calgary, AB, T2N 4Z6, Canada, 1 4032108653, jlwang@ucalgary.ca %K Internet %K RCT %K men %K workplace %K major depression %K prevention %D 2016 %7 15.11.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Major depression (MDE) is prevalent in men and affects men’s health and productivity. Because of the stigma against depression and social/gender norms, men are less likely to seek help for emotion and stress-related issues. Therefore, innovative solutions tailored for men are needed. With rapid development of the Internet and information technologies, one promising solution that has drawn considerable attentions is electronic mental (e-mental) health programs and services. Objective: The objective of our study is to evaluate the effectiveness of the e-mental health program BroHealth on reducing the risk of having MDE and improving productivity and return to investment. Methods: The target population is Canadian working men who are at high risk of having MDE (N=1200). Participants will be recruited using the method of random digit dialing across the country and workplace advertisement. Eligible participants will be randomly allocated into the following groups: (1) a control group, (2) a group receiving BroHealth only, and (3) a group receiving BroHealth and telephone-based job coaching service. The groups will be assessed at 6 and 12 months after randomization. The primary outcome is the risk proportion of MDE over 12 months, which will be assessed by the World Health Organization's (WHO’s) Composite International Diagnostic Interview-Short Form for Major Depression. Intention-to-treat principle will be used in the analysis. The 12-month proportions of MDE in the groups will be estimated and compared. Logistic regression modeling will be used to examine the effect of the intervention on the outcome, controlling for the effects of baseline confounders. Results: It is anticipated that the randomized controlled trial (RCT) will be completed by 2018. This study has been approved by the Conjoint Health Research Ethics Review Board of the University of Calgary. The trial is funded by a team grant from the Movember Foundation, a global charity for men’s health. BroHealth was developed at the Digital Emergency Medicine, University of British Columbia, and the usability testing has been completed. Conclusions: BroHealth was developed based on men’s needs. We hypothesized that BroHealth will be an effective, acceptable, and sustainable product for early prevention of MDE in workplaces. ClinicalTrial: Clinicaltrials.gov NCT02777112; https://clinicaltrials.gov/ct2/show/NCT02777112 (Archived by WebCite at http://www.webcitation.org/6lbOQpiCG) %M 27847352 %R 10.2196/resprot.6350 %U http://www.researchprotocols.org/2016/4/e218/ %U https://doi.org/10.2196/resprot.6350 %U http://www.ncbi.nlm.nih.gov/pubmed/27847352 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 4 %P e48 %T Awareness, Access and Use of Internet Self-Help Websites for Depression by University Students %A Culjak,Gordana %A Kowalenko,Nick %A Tennant,Christopher %+ Discipline of Psychiatry, Sydney Medical School, University of Sydney, New South Wales, Sydney, 2006, Australia, 61 9351 2222, gordana.culjak@uni.sydney.edu.au %K depression %K awareness %K Internet %K self-help %K university %K students %K eHealth %K health promotion %K prevention %D 2016 %7 27.10.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: University students have a higher prevalence rate of depression than the average 18 to 24 year old. Internet self-help has been demonstrated to be effective in decreasing self-rated measures of depression in this population, so it is important to explore the awareness, access and use of such self-help resources in this population. Objective: The objective of this study is to explore university students’ awareness, access and use of Internet self-help websites for depression and related problems. Methods: A total of 2691 university students were surveyed at 3 time points. Results: When asked about browsing behavior, 69.6% (1494/2146) of students reported using the Internet for entertainment. Most students were not familiar with self-help websites for emotional health, although this awareness increased as they completed further assessments. Most students considered user-friendliness, content and interactivity as very important in the design of a self-help website. After being exposed to a self-help website, more students reported visiting websites for emotional health than those who had not been exposed. Conclusions: More students reported visiting self-help websites after becoming aware of such resources. Increased awareness of depression and related treatment resources may increase use of such resources. It is important to increase public awareness with the aim of increasing access to targeted strategies for young people. %M 27789425 %R 10.2196/mental.5311 %U http://mental.jmir.org/2016/4/e48/ %U https://doi.org/10.2196/mental.5311 %U http://www.ncbi.nlm.nih.gov/pubmed/27789425 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 10 %P e280 %T How Veterans With Post-Traumatic Stress Disorder and Comorbid Health Conditions Utilize eHealth to Manage Their Health Care Needs: A Mixed-Methods Analysis %A Whealin,Julia M %A Jenchura,Emily C %A Wong,Ava C %A Zulman,Donna M %+ Clinical Informatics Service, VA Pacific Island Health Care System, 3375 Koapaka Street, Suite I-150, Honolulu, HI, 96819, United States, 1 (808) 566 1935, Julia.Whealin@va.gov %K stress disorders, post-traumatic %K telemedicine %K electronic mail %K social media %K self-care %K computer literacy %D 2016 %7 26.10.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health conditions are prevalent among US veterans and pose a number of self-management and health care navigation challenges. Post-Traumatic Stress Disorder (PTSD) with comorbid chronic medical conditions (CMCs) is especially common, in both returning Iraq or Afghanistan and earlier war-era veterans. Patient-facing electronic health (eHealth) technology may offer innovative strategies to support these individuals’ needs. Objective: This study was designed to identify the types of eHealth tools that veterans with PTSD and comorbid CMCs use, understand how they currently use eHealth technology to self-manage their unique health care needs, and identify new eHealth resources that veterans feel would empower them to better manage their health care. Methods: A total of 119 veterans with PTSD and at least one CMC who have used the electronic personal health record system of the US Department of Veterans Affairs (VA) responded to a mailed survey about their chronic conditions and preferences related to the use of technology. After the survey, 2 focus groups, stratified by sex, were conducted with a subgroup of patients to explore how veterans with PTSD and comorbid CMCs use eHealth technology to support their complex health care needs. Focus groups were transcribed verbatim and analyzed using standard content analysis methods for coding textual data, guided by the “Fit between Individual, Task, and Technology” framework. Results: Survey respondents had a mean age of 64.0 (SD 12.0) years, 85.1% (97/114) were male, 72.4% (84/116) were white, and 63.1% (70/111) had an annual household income of < US $50,000. Mean score on a measure of eHealth literacy was 27.7 (SD 9.8). Of the respondents, 44.6% (50/112) used health-related technology 1 to 3 times per month and 21.4% (24/112) used technology less than once per month. Veterans reported using technology most often to search for health information (78.9%, 90/114), communicate with providers (71.1%, 81/114), and track medications (64.9%, 74/114). Five major themes emerged that describe how eHealth technology influences veterans with PTSD and comorbid CMCs: (1) interactions with social support, (2) condition management, (3) access to and communication with providers, (4) information access, and (5) coordination of care. Conclusions: The “Fit between Individual, Task, and Technology” model provided a useful framework to examine the clinical tasks that arose for veterans and their resourceful adoption of eHealth tools. This study suggests that veterans who use the Web are eager to incorporate eHealth technology into their care and self-management activities. Findings illustrate a number of ways in which the VA and eHealth technology developers can refine existing applications, develop new resources, and better promote tools that address challenges experienced by veterans with PTSD and comorbid CMCs. %M 27784650 %R 10.2196/jmir.5594 %U http://www.jmir.org/2016/10/e280/ %U https://doi.org/10.2196/jmir.5594 %U http://www.ncbi.nlm.nih.gov/pubmed/27784650 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 4 %P e46 %T Evaluation of a Digital Game-Based Learning Program for Enhancing Youth Mental Health: A Structural Equation Modeling of the Program Effectiveness %A Huen,Jenny MY %A Lai,Eliza SY %A Shum,Angie KY %A So,Sam WK %A Chan,Melissa KY %A Wong,Paul WC %A Law,YW %A Yip,Paul SF %+ Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China (Hong Kong), 852 39174375, sfpyip@hku.hk %K digital game-based learning %K mental health %K program evaluation %K Internet %D 2016 %7 07.10.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital game-based learning (DGBL) makes use of the entertaining power of digital games for educational purposes. Effectiveness assessment of DGBL programs has been underexplored and no attempt has been made to simultaneously model both important components of DGBL: learning attainment (ie, educational purposes of DGBL) and engagement of users (ie, entertaining power of DGBL) in evaluating program effectiveness. Objective: This study aimed to describe and evaluate an Internet-based DGBL program, Professor Gooley and the Flame of Mind, which promotes mental health to adolescents in a positive youth development approach. In particular, we investigated whether user engagement in the DGBL program could enhance their attainment on each of the learning constructs per DGBL module and subsequently enhance their mental health as measured by psychological well-being. Methods: Users were assessed on their attainment on each learning construct, psychological well-being, and engagement in each of the modules. One structural equation model was constructed for each DGBL module to model the effect of users' engagement and attainment on the learning construct on their psychological well-being. Results: Of the 498 secondary school students that registered and participated from the first module of the DGBL program, 192 completed all 8 modules of the program. Results from structural equation modeling suggested that a higher extent of engagement in the program activities facilitated users’ attainment on the learning constructs on most of the modules and in turn enhanced their psychological well-being after controlling for users’ initial psychological well-being and initial attainment on the constructs. Conclusions: This study provided evidence that Internet intervention for mental health, implemented with the technologies and digital innovations of DGBL, could enhance youth mental health. Structural equation modeling is a promising approach in evaluating the effectiveness of DGBL programs. %M 27717921 %R 10.2196/mental.5656 %U http://mental.jmir.org/2016/4/e46/ %U https://doi.org/10.2196/mental.5656 %U http://www.ncbi.nlm.nih.gov/pubmed/27717921 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e112 %T Measuring Users’ Receptivity Toward an Integral Intervention Model Based on mHealth Solutions for Patients With Treatment-Resistant Schizophrenia (m-RESIST): A Qualitative Study %A Huerta-Ramos,Elena %A Escobar-Villegas,Maria Soledad %A Rubinstein,Katya %A Unoka,Zsolt Szabolcs %A Grasa,Eva %A Hospedales,Margarita %A Jääskeläinen,Erika %A Rubio-Abadal,Elena %A Caspi,Asaf %A Bitter,István %A Berdun,Jesus %A Seppälä,Jussi %A Ochoa,Susana %A Fazekas,Kata %A , %A Corripio,Iluminada %A Usall,Judith %+ Parc Sanitari Sant Joan de Déu, CIBERSAM G11, Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain, 34 936406350 ext 12347, mehuerta@pssjd.org %K mHealth solution %K treatment-resistant schizophrenia %K intervention model %K qualitative research %K needs assessment %D 2016 %7 28.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the theoretical potential of mHealth solutions in the treatment of patients with schizophrenia, there remains a lack of technological tools in clinical practice. Objective: The aim of this study was to measure the receptivity of patients, informal carers, and clinicians to a European integral intervention model focused on patients with persistent positive symptoms: Mobile Therapeutic Attention for Patients with Treatment-Resistant Schizophrenia (m-RESIST). Methods: Before defining the system requirements, a qualitative study of the needs of outpatients with treatment-resistant schizophrenia was carried out in Spain, Israel, and Hungary. We analyzed the opinions of patients, informal carers, and clinicians concerning the services originally intended to be part of the solution. A total of 9 focus groups (72 people) and 35 individual interviews were carried out in the 3 countries, using discourse analysis as the framework. Results: A webpage and an online forum were perceived as suitable to get both reliable information on the disease and support. Data transmission by a smart watch (monitoring), Web-based visits, and instant messages (clinical treatment) were valued as ways to improve contact with clinicians. Alerts were appreciated as reminders of daily tasks and appointments. Avoiding stressful situations for outpatients, promoting an active role in the management of the disease, and maintaining human contact with clinicians were the main suggestions provided for improving the effectiveness of the solution. Conclusions: Positive receptivity toward m-RESIST services is related to its usefulness in meeting user needs, its capacity to empower them, and the possibility of maintaining human contact. %M 27682896 %R 10.2196/mhealth.5716 %U http://mhealth.jmir.org/2016/3/e112/ %U https://doi.org/10.2196/mhealth.5716 %U http://www.ncbi.nlm.nih.gov/pubmed/27682896 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e255 %T Post-9/11 Veterans and Their Partners Improve Mental Health Outcomes with a Self-directed Mobile and Web-based Wellness Training Program: A Randomized Controlled Trial %A Kahn,Janet R %A Collinge,William %A Soltysik,Robert %+ College of Medicine, Department of Psychiatry, University of Vermont, 240 Maple Street, Burlington, VT, 05401, United States, 1 802 578 2990, Janet.Kahn@uvm.edu %K veterans %K PTSD %K moral injury %K mind-body therapies %K mindfulness %K patient-centered care %K compassion %K Web-based program %K reintegration %D 2016 %7 27.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Veterans with history of deployment in the Global War on Terror face significant and ongoing challenges with high prevalences of adverse psychological, physical, spiritual, and family impacts. Together, these challenges contribute to an emerging public health crisis likely to extend well into the future. Innovative approaches are needed that reach veterans and their family members with strategies they can employ over time in their daily lives to promote improved adjustment and well-being. Objective: The objective of this study was to evaluate effects of use of a Web-based, self-directed program of instruction in mind- and body-based wellness skills to be employed by Global War on Terror veterans and their significant relationship partners on mental health and wellness outcomes associated with postdeployment readjustment. Methods: We recruited 160 veteran-partner dyads in 4 regions of the United States (San Diego, CA; Dallas, TX; Fayetteville, NC; and New York, NY) through publicity by the Iraq and Afghanistan Veterans of America to its membership. Dyads were randomly allocated to 1 of 4 study arms: Mission Reconnect (MR) program alone, MR plus the Prevention and Relationship Enhancement Program (PREP) for Strong Bonds weekend program for military couples, PREP alone, and waitlist control. We administered a battery of standardized and investigator-generated instruments assessing mental health outcomes at baseline, 8 weeks, and 16 weeks. Dyads in the MR arms were provided Web-based and mobile app video and audio instruction in a set of mindfulness-related stress reduction and contemplative practices, as well as partner massage for reciprocal use. All participants provided weekly reports on frequency and duration of self-care practices for the first 8 weeks, and at 16 weeks. Results: During the first 8-week reporting period, veterans and partners assigned to MR arms used some aspect of the program a mean of 20 times per week, totaling nearly 2.5 hours per week, with only modest declines in use at 16 weeks. Significant improvements were seen at 8 and 16 weeks in measures of posttraumatic stress disorder, depression, sleep quality, perceived stress, resilience, self-compassion, and pain for participants assigned to MR arms. In addition, significant reductions in self-reported levels of pain, tension, irritability, anxiety, and depression were associated with use of partner massage. Conclusions: Both veterans and partners were able to learn and make sustained use of a range of wellness practices taught in the MR program. Home-based, self-directed interventions may be of particular service to veterans who are distant from, averse to, or prohibited by schedule from using professional services. Leveraging the partner relationship may enhance sustained use of self-directed interventions for this population. Use of the MR program appears to be an accessible, low-cost approach that supports well-being and reduces multiple symptoms among post-9/11 veterans and their partners. Trial Registration: Clinicaltrials.gov NCT01680419; https://clinicaltrials.gov/ct2/show/NCT01680419 (Archived by WebCite at http://www.webcitation.org/6jJuadfzj) %M 27678169 %R 10.2196/jmir.5800 %U http://www.jmir.org/2016/9/e255/ %U https://doi.org/10.2196/jmir.5800 %U http://www.ncbi.nlm.nih.gov/pubmed/27678169 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e44 %T Cultural Adaptation of Minimally Guided Interventions for Common Mental Disorders: A Systematic Review and Meta-Analysis %A Harper Shehadeh,Melissa %A Heim,Eva %A Chowdhary,Neerja %A Maercker,Andreas %A Albanese,Emiliano %+ Institute of Global Health, Faculty of Medicine, University of Geneva, Campus Biotech Building G6, 9 Chemin des Mines, Geneva, 1202, Switzerland, 41 797589701, Melissa.Harper@etu.unige.ch %K cultural adaptation %K depression %K anxiety %K self-help %K minimally guided intervention %K e-mental health %K bibliotherapy %D 2016 %7 26.09.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Cultural adaptation of mental health care interventions is key, particularly when there is little or no therapist interaction. There is little published information on the methods of adaptation of bibliotherapy and e-mental health interventions. Objective: To systematically search for evidence of the effectiveness of minimally guided interventions for the treatment of common mental disorders among culturally diverse people with common mental disorders; to analyze the extent and effects of cultural adaptation of minimally guided interventions for the treatment of common mental disorders. Methods: We searched Embase, PubMed, the Cochrane Library, and PsycINFO for randomized controlled trials that tested the efficacy of minimally guided or self-help interventions for depression or anxiety among culturally diverse populations. We calculated pooled standardized mean differences using a random-effects model. In addition, we administered a questionnaire to the authors of primary studies to assess the cultural adaptation methods used in the included primary studies. We entered this information into a meta-regression to investigate effects of the extent of adaptation on intervention efficacy. Results: We included eight randomized controlled trials (RCTs) out of the 4911 potentially eligible records identified by the search: four on e-mental health and four on bibliotherapy. The extent of cultural adaptation varied across the studies, with language translation and use of metaphors being the most frequently applied elements of adaptation. The pooled standardized mean difference for primary outcome measures of depression and anxiety was -0.81 (95% CI -0.10 to -0.62). Higher cultural adaptation scores were significantly associated with greater effect sizes (P=.04). Conclusions: Our results support the results of previous systematic reviews on the cultural adaptation of face-to-face interventions: the extent of cultural adaptation has an effect on intervention efficacy. More research is warranted to explore how cultural adaptation may contribute to improve the acceptability and effectiveness of minimally guided psychological interventions for common mental disorders. %M 27670598 %R 10.2196/mental.5776 %U http://mental.jmir.org/2016/3/e44/ %U https://doi.org/10.2196/mental.5776 %U http://www.ncbi.nlm.nih.gov/pubmed/27670598 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e45 %T Can We Foster a Culture of Peer Support and Promote Mental Health in Adolescence Using a Web-Based App? A Control Group Study %A Bohleber,Laura %A Crameri,Aureliano %A Eich-Stierli,Brigitte %A Telesko,Rainer %A von Wyl,Agnes %+ School of Applied Psychology, Zurich University of Applied Sciences, Pfingstweidstrasse 96, POB 707, Zurich,, Switzerland, 41 58 934 84 36, bohb@zhaw.ch %K mental health %K health promotion %K mobile applications %K adolescence %K peer group %K mentors %D 2016 %7 23.09.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescence with its many transitions is a vulnerable period for the development of mental illnesses. Establishing effective mental health promotion programs for this age group is a challenge crucial to societal health. Programs must account for the specific developmental tasks that adolescents face. Considering peer influence and fostering adolescent autonomy strivings is essential. Participation in a program should be compelling to young people, and their affinity to new technologies offers unprecedented opportunities in this respect. Objective: The Companion App was developed as a Web-based app giving adolescents access to a peer mentoring system and interactive, health-relevant content to foster a positive peer culture among adolescents and thereby strengthen social support and reduce stress. Methods: In a control group study design, a group of employed (n=546) and unemployed (n=73) adolescents had access to the Companion App during a 10-month period. The intervention was evaluated using a combination of quantitative and qualitative approaches. Linear mixed effects models were used to analyze changes in chronic stress levels and perception of social support. Monthly feedback on the app and qualitative interviews at the end of the study allowed for an in-depth exploration of the adolescents’ perception of the intervention. Results: Adolescents in the intervention group did not use the Companion App consistently. The intervention had no significant effect on chronic stress levels or the perception of social support. Adolescents reported endorsing the concept of the app and the implementation of a peer mentoring system in particular. However, technical difficulties and insufficiently obvious benefits of using the app impeded more frequent usage. Conclusions: The Companion Project implemented a theory-driven and innovative approach to mental health promotion in adolescence, taking into account the specifics of this developmental phase. Particularities of the implementation context, technical aspects of the app, and insufficient incentives may have played considerable roles concerning the difficulties of the Companion Project to establish commitment. However, adopting peer mentoring as a strategy and using an app still seems to us a promising approach in mental health promotion in adolescents. Future projects should be careful to invest enough resources into the technical development of an app and consider a large use of incentives to establish commitment. When targeting risk groups, such as unemployed adolescents, it may be expedient to use more structured approaches including face-to-face support. %M 27663691 %R 10.2196/mental.5597 %U http://mental.jmir.org/2016/3/e45/ %U https://doi.org/10.2196/mental.5597 %U http://www.ncbi.nlm.nih.gov/pubmed/27663691 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e111 %T Mobile Sensing and Support for People With Depression: A Pilot Trial in the Wild %A Wahle,Fabian %A Kowatsch,Tobias %A Fleisch,Elgar %A Rufer,Michael %A Weidt,Steffi %+ University of St Gallen, Institute of Technology Management, Dufourstrasse 40a, Büro 1-236, St Gallen, 9000, Switzerland, 41 712247244, tobias.kowatsch@unisg.ch %K depression %K mHealth %K  activities of daily living %K classification %K context awareness %K cognitive behavioral therapy %D 2016 %7 21.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Depression is a burdensome, recurring mental health disorder with high prevalence. Even in developed countries, patients have to wait for several months to receive treatment. In many parts of the world there is only one mental health professional for over 200 people. Smartphones are ubiquitous and have a large complement of sensors that can potentially be useful in monitoring behavioral patterns that might be indicative of depressive symptoms and providing context-sensitive intervention support. Objective: The objective of this study is 2-fold, first to explore the detection of daily-life behavior based on sensor information to identify subjects with a clinically meaningful depression level, second to explore the potential of context sensitive intervention delivery to provide in-situ support for people with depressive symptoms. Methods: A total of 126 adults (age 20-57) were recruited to use the smartphone app Mobile Sensing and Support (MOSS), collecting context-sensitive sensor information and providing just-in-time interventions derived from cognitive behavior therapy. Real-time learning-systems were deployed to adapt to each subject’s preferences to optimize recommendations with respect to time, location, and personal preference. Biweekly, participants were asked to complete a self-reported depression survey (PHQ-9) to track symptom progression. Wilcoxon tests were conducted to compare scores before and after intervention. Correlation analysis was used to test the relationship between adherence and change in PHQ-9. One hundred twenty features were constructed based on smartphone usage and sensors including accelerometer, Wifi, and global positioning systems (GPS). Machine-learning models used these features to infer behavior and context for PHQ-9 level prediction and tailored intervention delivery. Results: A total of 36 subjects used MOSS for ≥2 weeks. For subjects with clinical depression (PHQ-9≥11) at baseline and adherence ≥8 weeks (n=12), a significant drop in PHQ-9 was observed (P=.01). This group showed a negative trend between adherence and change in PHQ-9 scores (rho=−.498, P=.099). Binary classification performance for biweekly PHQ-9 samples (n=143), with a cutoff of PHQ-9≥11, based on Random Forest and Support Vector Machine leave-one-out cross validation resulted in 60.1% and 59.1% accuracy, respectively. Conclusions: Proxies for social and physical behavior derived from smartphone sensor data was successfully deployed to deliver context-sensitive and personalized interventions to people with depressive symptoms. Subjects who used the app for an extended period of time showed significant reduction in self-reported symptom severity. Nonlinear classification models trained on features extracted from smartphone sensor data including Wifi, accelerometer, GPS, and phone use, demonstrated a proof of concept for the detection of depression superior to random classification. While findings of effectiveness must be reproduced in a RCT to proof causation, they pave the way for a new generation of digital health interventions leveraging smartphone sensors to provide context sensitive information for in-situ support and unobtrusive monitoring of critical mental health states. %M 27655245 %R 10.2196/mhealth.5960 %U http://mhealth.jmir.org/2016/3/e111/ %U https://doi.org/10.2196/mhealth.5960 %U http://www.ncbi.nlm.nih.gov/pubmed/27655245 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e43 %T E-Mental Health Innovations for Aboriginal and Torres Strait Islander Australians: A Qualitative Study of Implementation Needs in Health Services %A Puszka,Stefanie %A Dingwall,Kylie M %A Sweet,Michelle %A Nagel,Tricia %+ Menzies School of Health Research, Charles Darwin University, PO Box 41096, Casuarina , NT, 0811, Australia, 61 08 8946 8422, Stefanie.Puszka@menzies.edu.au %K eHealth %K Indigenous health services %K mental health services %K diffusion of innovation %K culturally appropriate technology %D 2016 %7 19.09.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Electronic mental health (e-mental health) interventions offer effective, easily accessible, and cost effective treatment and support for mental illness and well-being concerns. However, e-mental health approaches have not been well utilized by health services to date and little is known about their implementation in practice, particularly in diverse contexts and communities. Objective: This study aims to understand stakeholder perspectives on the requirements for implementing e-mental health approaches in regional and remote health services for Indigenous Australians. Methods: Qualitative interviews were conducted with 32 managers, directors, chief executive officers (CEOs), and senior practitioners of mental health, well-being, alcohol and other drug and chronic disease services. Results: The implementation of e-mental health approaches in this context is likely to be influenced by characteristics related to the adopter (practitioner skill and knowledge, client characteristics, communication barriers), the innovation (engaging and supportive approach, culturally appropriate design, evidence base, data capture, professional development opportunities), and organizational systems (innovation-systems fit, implementation planning, investment). Conclusions: There is potential for e-mental health approaches to address mental illness and poor social and emotional well-being amongst Indigenous people and to advance their quality of care. Health service stakeholders reported that e-mental health interventions are likely to be most effective when used to support or extend existing health services, including elements of client-driven and practitioner-supported use. Potential solutions to obstacles for integration of e-mental health approaches into practice were proposed including practitioner training, appropriate tool design using a consultative approach, internal organizational directives and support structures, adaptations to existing systems and policies, implementation planning and organizational and government investment. %M 27644259 %R 10.2196/mental.5837 %U http://mental.jmir.org/2016/3/e43/ %U https://doi.org/10.2196/mental.5837 %U http://www.ncbi.nlm.nih.gov/pubmed/27644259 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e103 %T Acceptance and Commitment Therapy in Daily Life Training: A Feasibility Study of an mHealth Intervention %A Batink,Tim %A Bakker,Jindra %A Vaessen,Thomas %A Kasanova,Zuzana %A Collip,Dina %A van Os,Jim %A Wichers,Marieke %A Germeys,Inez %A Peeters,Frenk %+ Department of Psychiatry and Psychology, Maastricht University Medical Centre, Maastricht University, SN2, Vijverdalseweg 1, Maastricht,, Netherlands, 31 620 454 912, tim.batink@maastrichtuniversity.nl %K mHealth %K behavior change %K daily life intervention %K acceptance and commitment therapy %K experience sampling %D 2016 %7 15.09.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the development of mHealth, it is possible to treat patients in their natural environment. Mobile technology helps to bridge the gap between the therapist’s office and the “real world.” The ACT in Daily Life training (ACT-DL) was designed as an add-on intervention to help patients practice with acceptance and commitment therapy in their daily lives. The ACT-DL consists of two main components: daily monitoring using experience sampling and ACT training in daily life. Objectives: To assess the acceptability and feasibility of the ACT-DL in a general outpatient population. A secondary objective was to conduct a preliminary examination of the effectiveness of the ACT-DL. Methods: An observational comparative study was conducted. The experimental group consisted of 49 patients who volunteered for ACT-DL, and the control group consisted of 112 patients who did not volunteer. As part of an inpatient treatment program, both groups received a 6-week ACT training. Participants went home to continue their treatment on an outpatient basis, during which time the experimental group received the 4-week add-on ACT-DL. Acceptability and feasibility of the ACT-DL was assessed weekly by telephone survey. Effectiveness of the ACT-DL was evaluated with several self-report questionnaires ( Flexibility Index Test (FIT-60): psychological flexibility, Brief Symptom Inventory: symptoms, Utrechtse Coping List: coping, and Quality of life visual analog scale (QoL-VAS): quality of life). Results: More than three-quarters of the participants (76%) completed the full 4-week training. User evaluations showed that ACT-DL stimulated the use of ACT in daily life: participants practiced over an hour a week (mean 78.8 minutes, standard deviation 54.4), doing 10.4 exercises (standard deviation 6.0) on average. Both ACT exercises and metaphors were experienced as useful components of the training (rated 5 out of 7). Repeated measures ANCOVA did not show significant effects of the ACT-DL on psychological flexibility (P=.88), symptoms (P=.39), avoidant coping (P=.28), or quality of life (P=.15). Conclusions: This is the first study that uses experience sampling to foster awareness in daily life in combination with acceptance and commitment therapy to foster skill building. Adherence to the ACT-DL was high for an intensive mHealth intervention. ACT-DL appears to be an acceptable and feasible mHealth intervention, suitable for a broad range of mental health problems. However, short-term effectiveness could not be demonstrated. Additional clinical trials are needed to examine both short-term and long-term effects. %M 27634747 %R 10.2196/mhealth.5437 %U http://mhealth.jmir.org/2016/3/e103/ %U https://doi.org/10.2196/mhealth.5437 %U http://www.ncbi.nlm.nih.gov/pubmed/27634747 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 9 %P e236 %T The Implementation of Internet Interventions for Depression: A Scoping Review %A Drozd,Filip %A Vaskinn,Linda %A Bergsund,Hans Bugge %A Haga,Silje Marie %A Slinning,Kari %A Bjørkli,Cato Alexander %+ National Network for Infant Mental Health, Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, PO Box 4623 Nydalen, Oslo, 0405, Norway, 47 975 16 188, filip.drozd@r-bup.no %K depression %K scoping review %K implementation %K Internet interventions %D 2016 %7 08.09.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is one of the most common mental health problems among adults, but effective treatments are not widely accessible. The Internet holds promise as a cost-effective and convenient delivery platform of interventions for depression. However, studies suggest that Internet interventions are not widely available in routine settings. Objective: The aim of this study was to review the literature and examine whether there are systematic differences in reporting of the various implementation components on Internet interventions for depression, and then to examine what is known about and is characteristic of the implementation of these Internet interventions in regular care settings. Methods: We performed a scoping review, drawing upon a broad range of the literature on Internet interventions for depression in regular care, and used the active implementation framework to extract data. Results: Overall, the results suggested that knowledge about the implementation of Internet interventions for depression in regular care is limited. However, guided support from health professionals emphasizing program adherence and recruitment of end users to the interventions emerged as 2 main themes. We identified 3 additional themes among practitioners, including their qualifications, training, and supervision, but these were scarcely described in the literature. The competency drivers (ie, staff and user selection, training, and supervision) have received the most attention, while little attention has been given to organizational (ie, decision support, administration, and system intervention) and leadership drivers. Conclusions: Research has placed little emphasis on reporting on the implementation of interventions in practice. Leadership and organizational drivers, in particular, have been largely neglected. The results of this scoping review have implications for future research and efforts to successfully implement Internet interventions for depression in regular care. %M 27608548 %R 10.2196/jmir.5670 %U http://www.jmir.org/2016/9/e236/ %U https://doi.org/10.2196/jmir.5670 %U http://www.ncbi.nlm.nih.gov/pubmed/27608548 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e231 %T An Internet-Based Intervention for Depression in Primary Care in Spain: A Randomized Controlled Trial %A Montero-Marín,Jesús %A Araya,Ricardo %A Pérez-Yus,María C %A Mayoral,Fermín %A Gili,Margalida %A Botella,Cristina %A Baños,Rosa %A Castro,Adoración %A Romero-Sanchiz,Pablo %A López-Del-Hoyo,Yolanda %A Nogueira-Arjona,Raquel %A Vives,Margarita %A Riera,Antoni %A García-Campayo,Javier %+ Aragon Health Sciences Institute, Avda. San Juan Bosco, 13. 50009. Zaragoza., Zaragoza,, Spain, 34 (+34) 976715895, mcperezy@gmail.com %D 2016 %7 26.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is the most prevalent cause of illness-induced disability worldwide. Face-to-face psychotherapeutic interventions for depression can be challenging, so there is a need for other alternatives that allow these interventions to be offered. One feasible alternative is Internet-based psychological interventions. This is the first randomized controlled trial (RCT) on the effectiveness of an Internet-based intervention on depression in primary health care in Spain. Objective: Our aim was to compare the effectiveness of a low-intensity therapist-guided (LITG) Internet-based program and a completely self-guided (CSG) Internet-based program with improved treatment as usual (iTAU) care for depression. Methods: Multicenter, three-arm, parallel, RCT design, carried out between November 2012 and January 2014, with a follow-up of 15 months. In total, 296 adults from primary care settings in four Spanish regions, with mild or moderate major depression, were randomized to LITG (n=96), CSG (n=98), or iTAU (n=102). Research completers at follow-up were 63.5%. The intervention was Smiling is Fun, an Internet program based on cognitive behavioral therapy. All patients received iTAU by their general practitioners. Moreover, LITG received Smiling is Fun and the possibility of psychotherapeutic support on request by email, whereas CSG received only Smiling is Fun. The main outcome was the Beck Depression Inventory-II at 3 months from baseline. Mixed-effects multilevel analysis for repeated measures were undertaken. Results: There was no benefit for either CSG [(B coefficient=-1.15; P=.444)] or LITG [(B=-0.71; P=.634)] compared to iTAU, at 3 months. There were differences at 6 months [iTAU vs CSG (B=-4.22; P=.007); iTAU vs LITG (B=-4.34; P=.005)] and 15 months [iTAU vs CSG (B=-5.10; P=.001); iTAU vs LITG (B=-4.62; P=.002)]. There were no differences between CSG and LITG at any time. Adjusted and intention-to-treat models confirmed these findings. Conclusions: An Internet-based intervention for depression combined with iTAU conferred a benefit over iTAU alone in the Spanish primary health care system. Trial Registration: Clinicaltrials.gov NCT01611818; https://register.clinicaltrials.gov/prs/app/action/SelectProtocol? selectaction=Edit&uid=U0001NPQ&ts=2&cx=gctdh2&sid=S0003KJ6 (Archived by WebCite at http://www.webcitation.org/6jbsUvUDz) %M 27565118 %R 10.2196/jmir.5695 %U http://www.jmir.org/2016/8/e231/ %U https://doi.org/10.2196/jmir.5695 %U http://www.ncbi.nlm.nih.gov/pubmed/27565118 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e40 %T Who Are the Young People Choosing Web-based Mental Health Support? Findings From the Implementation of Australia's National Web-based Youth Mental Health Service, eheadspace %A Rickwood,Debra %A Webb,Marianne %A Kennedy,Vanessa %A Telford,Nic %+ headspace National Youth Mental Health Foundation, Level 2, South Tower, 485 La Trobe Street, Melbourne, 3000, Australia, 61 3 9027 0141, vkennedy@headspace.org.au %K mental health %K adolescent %K help-seeking behavior %K telemedicine %K counseling %K Internet %D 2016 %7 25.08.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: The adolescent and early adult years are periods of peak prevalence and incidence for most mental disorders. Despite the rapid expansion of Web-based mental health care, and increasing evidence of its effectiveness, there is little research investigating the characteristics of young people who access Web-based mental health care. headspace, Australia’s national youth mental health foundation, is ideally placed to explore differences between young people who seek Web-based mental health care and in-person mental health care as it offers both service modes for young people, and collects corresponding data from each service type. Objective: The objective of this study was to provide a comprehensive profile of young people seeking Web-based mental health care through eheadspace (the headspace Web-based counseling platform), and to compare this with the profile of those accessing help in-person through a headspace center. Methods: Demographic and clinical presentation data were collected from all eheadspace clients aged 12 to 25 years (the headspace target age range) who received their first counseling session between November 1, 2014 and April 30, 2015 via online chat or email (n=3414). These Web-based clients were compared with all headspace clients aged 12 to 25 who received their first center-based counseling service between October 1, 2014 and March 31, 2015 (n=20,015). Results: More eheadspace than headspace center clients were female (78.1% compared with 59.1%), and they tended to be older. A higher percentage of eheadspace clients presented with high or very high levels of psychological distress (86.6% compared with 73.2%), but they were at an earlier stage of illness on other indicators of clinical presentation compared with center clients. Conclusions: The findings of this study suggest that eheadspace is reaching a unique client group who may not otherwise seek help or who might wait longer before seeking help if in-person mental health support was their only option. Web-based support can lead young people to seek help at an earlier stage of illness and appears to be an important component in a stepped continuum of mental health care. %M 27562729 %R 10.2196/mental.5988 %U http://mental.jmir.org/2016/3/e40/ %U https://doi.org/10.2196/mental.5988 %U http://www.ncbi.nlm.nih.gov/pubmed/27562729 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e221 %T Effectiveness of Web-Delivered Acceptance and Commitment Therapy in Relation to Mental Health and Well-Being: A Systematic Review and Meta-Analysis %A Brown,Menna %A Glendenning,Alexander %A Hoon,Alice E %A John,Ann %+ Swansea University, Medical School, ILS2, Swansea, SA2 8PP, United Kingdom, 44 179260 ext 6213, menna.brown@swansea.ac.uk %K acceptance and commitment therapy %K systematic review %K meta-analysis %K depression %K anxiety %K quality of life %K Internet-based %K mobile-based %D 2016 %7 24.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The need for effective interventions to improve mental health and emotional well-being at a population level are gaining prominence both in the United Kingdom and globally. Advances in technology and widespread adoption of Internet capable devices have facilitated rapid development of Web-delivered psychological therapies. Interventions designed to manage a range of affective disorders by applying diverse therapeutic approaches are widely available. Objective: The main aim of this review was to evaluate the evidence base of acceptance and commitment therapy (ACT) in a Web-based delivery format. Method: A systematic review of the literature and meta-analysis was conducted. Two electronic databases were searched for Web-delivered interventions utilizing ACT for the management of affective disorders or well-being. Only Randomized Controlled Trials (RCTs) were included. Results: The search strategy identified 59 articles. Of these, 10 articles met the inclusion criteria specified. The range of conditions and outcome measures that were identified limited the ability to draw firm conclusions about the efficacy of Web-delivered ACT-based intervention for anxiety or well-being. Conclusions: ACT in a Web-based delivery format was found to be effective in the management of depression. Rates of adherence to study protocols and completion were high overall suggesting that this therapeutic approach is highly acceptable for patients and the general public. %M 27558740 %R 10.2196/jmir.6200 %U http://www.jmir.org/2016/8/e221/ %U https://doi.org/10.2196/jmir.6200 %U http://www.ncbi.nlm.nih.gov/pubmed/27558740 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e38 %T Effectiveness of Internet-Based Interventions for the Prevention of Mental Disorders: A Systematic Review and Meta-Analysis %A Sander,Lasse %A Rausch,Leonie %A Baumeister,Harald %+ Institute of Psychology, Depatment of Rehabilitationpsychology and Psychotherapy, University of Freiburg, Engelberger Str. 41, Freiburg, 79085, Germany, +49 7612033049, lasse.sander@psychologie.uni-freiburg.de %K prevention %K systematic review %K meta-analysis %K mental disorders %K Internet and mobile-based %D 2016 %7 17.08.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental disorders are highly prevalent and associated with considerable disease burden and personal and societal costs. However, they can be effectively reduced through prevention measures. The Internet as a medium appears to be an opportunity for scaling up preventive interventions to a population level. Objective: The aim of this study was to systematically summarize the current state of research on Internet-based interventions for the prevention of mental disorders to give a comprehensive overview of this fast-growing field. Methods: A systematic database search was conducted (CENTRAL, Medline, PsycINFO). Studies were selected according to defined eligibility criteria (adult population, Internet-based mental health intervention, including a control group, reporting onset or severity data, randomized controlled trial). Primary outcome was onset of mental disorder. Secondary outcome was symptom severity. Study quality was assessed using the Cochrane Risk of Bias Tool. Meta-analytical pooling of results took place if feasible. Results: After removing duplicates, 1169 studies were screened of which 17 were eligible for inclusion. Most studies examined prevention of eating disorders or depression or anxiety. Two studies on posttraumatic stress disorder and 1 on panic disorder were also included. Overall study quality was moderate. Only 5 studies reported incidence data assessed by means of standardized clinical interviews (eg, SCID). Three of them found significant differences in onset with a number needed to treat of 9.3-41.3. Eleven studies found significant improvements in symptom severity with small-to-medium effect sizes (d=0.11- d=0.76) in favor of the intervention groups. The meta-analysis conducted for depression severity revealed a posttreatment pooled effect size of standardized mean difference (SMD) =−0.35 (95% CI, −0.57 to −0.12) for short-term follow-up, SMD = −0.22 (95% CI, −0.37 to −0.07) for medium-term follow-up, and SMD = −0.14 (95% CI, -0.36 to 0.07) for long-term follow-up in favor of the Internet-based psychological interventions when compared with waitlist or care as usual. Conclusions: Internet-based interventions are a promising approach to prevention of mental disorders, enhancing existing methods. Study results are still limited due to inadequate diagnostic procedures. To be able to appropriately comment on effectiveness, future studies need to report incidence data assessed by means of standardized interviews. Public health policy should promote research to reduce health care costs over the long term, and health care providers should implement existing, demonstrably effective interventions into routine care. %M 27535468 %R 10.2196/mental.6061 %U http://mental.jmir.org/2016/3/e38/ %U https://doi.org/10.2196/mental.6061 %U http://www.ncbi.nlm.nih.gov/pubmed/27535468 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 3 %P e160 %T Predicting Negative Emotions Based on Mobile Phone Usage Patterns: An Exploratory Study %A Hung,Galen Chin-Lun %A Yang,Pei-Ching %A Chang,Chia-Chi %A Chiang,Jung-Hsien %A Chen,Ying-Yeh %+ Department of General Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, No. 309,, Songde Rd., Xinyi Dst.,, Taipei, 106, Taiwan, 886 2 27263141 ext 1270, galenhung@tpech.gov.tw %K mobile phone usage %K depression %K emotion %K machine learning %K affective computing %D 2016 %7 10.08.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Prompt recognition and intervention of negative emotions is crucial for patients with depression. Mobile phones and mobile apps are suitable technologies that can be used to recognize negative emotions and intervene if necessary. Objective: Mobile phone usage patterns can be associated with concurrent emotional states. The objective of this study is to adapt machine-learning methods to analyze such patterns for the prediction of negative emotion. Methods: We developed an Android-based app to capture emotional states and mobile phone usage patterns, which included call logs (and use of apps). Visual analog scales (VASs) were used to report negative emotions in dimensions of depression, anxiety, and stress. In the system-training phase, participants were requested to tag their emotions for 14 consecutive days. Five feature-selection methods were used to determine individual usage patterns and four machine-learning methods were tested. Finally, rank product scoring was used to select the best combination to construct the prediction model. In the system evaluation phase, participants were then requested to verify the predicted negative emotions for at least 5 days. Results: Out of 40 enrolled healthy participants, we analyzed data from 28 participants, including 30% (9/28) women with a mean (SD) age of 29.2 (5.1) years with sufficient emotion tags. The combination of time slots of 2 hours, greedy forward selection, and Naïve Bayes method was chosen for the prediction model. We further validated the personalized models in 18 participants who performed at least 5 days of model evaluation. Overall, the predictive accuracy for negative emotions was 86.17%. Conclusion: We developed a system capable of predicting negative emotions based on mobile phone usage patterns. This system has potential for ecological momentary intervention (EMI) for depressive disorders by automatically recognizing negative emotions and providing people with preventive treatments before it escalates to clinical depression. %M 27511748 %R 10.2196/resprot.5551 %U http://www.researchprotocols.org/2016/3/e160/ %U https://doi.org/10.2196/resprot.5551 %U http://www.ncbi.nlm.nih.gov/pubmed/27511748 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e96 %T Quantifying App Store Dynamics: Longitudinal Tracking of Mental Health Apps %A Larsen,Mark Erik %A Nicholas,Jennifer %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 293828508, mark.larsen@blackdog.org.au %K mobile applications %K mobile apps %K mental health %K telemedicine %K depression %K bipolar disorder %K suicide %D 2016 %7 09.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: For many mental health conditions, mobile health apps offer the ability to deliver information, support, and intervention outside the clinical setting. However, there are difficulties with the use of a commercial app store to distribute health care resources, including turnover of apps, irrelevance of apps, and discordance with evidence-based practice. Objective: The primary aim of this study was to quantify the longevity and rate of turnover of mental health apps within the official Android and iOS app stores. The secondary aim was to quantify the proportion of apps that were clinically relevant and assess whether the longevity of these apps differed from clinically nonrelevant apps. The tertiary aim was to establish the proportion of clinically relevant apps that included claims of clinical effectiveness. We performed additional subgroup analyses using additional data from the app stores, including search result ranking, user ratings, and number of downloads. Methods: We searched iTunes (iOS) and the Google Play (Android) app stores each day over a 9-month period for apps related to depression, bipolar disorder, and suicide. We performed additional app-specific searches if an app no longer appeared within the main search Results: On the Android platform, 50% of the search results changed after 130 days (depression), 195 days (bipolar disorder), and 115 days (suicide). Search results were more stable on the iOS platform, with 50% of the search results remaining at the end of the study period. Approximately 75% of Android and 90% of iOS apps were still available to download at the end of the study. We identified only 35.3% (347/982) of apps as being clinically relevant for depression, of which 9 (2.6%) claimed clinical effectiveness. Only 3 included a full citation to a published study. Conclusions: The mental health app environment is volatile, with a clinically relevant app for depression becoming unavailable to download every 2.9 days. This poses challenges for consumers and clinicians seeking relevant and long-term apps, as well as for researchers seeking to evaluate the evidence base for publicly available apps. %M 27507641 %R 10.2196/mhealth.6020 %U http://mhealth.jmir.org/2016/3/e96/ %U https://doi.org/10.2196/mhealth.6020 %U http://www.ncbi.nlm.nih.gov/pubmed/27507641 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e37 %T Internet Mindfulness Meditation Intervention for the General Public: Pilot Randomized Controlled Trial %A Wahbeh,Helané %A Oken,Barry S %+ Oregon Health & Science University, 3181 SW Sam Jackson Park Road CR120, Portland, OR,, United States, 1 503 494 3528, wahbehh@ohsu.edu %K Internet %K mindfulness %K meditation %K behavior modification %K controlled trial %D 2016 %7 08.08.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mindfulness meditation interventions improve a variety of health conditions and quality of life, are inexpensive, easy to implement, have minimal if any side effects, and engage patients to take an active role in their treatment. However, the group format can be an obstacle for many to take structured meditation programs. Internet Mindfulness Meditation Intervention (IMMI) is a program that could make mindfulness meditation accessible to all people who want and need to receive it. However, the feasibility, acceptability, and ability of IMMI to increase meditation practice have yet to be evaluated. Objectives: The primary objectives of this pilot randomized controlled study were to (1) evaluate the feasibility and acceptability of IMMIs in the general population and (2) to evaluate IMMI’s ability to change meditation practice behavior. The secondary objective was to collect preliminary data on health outcomes. Methods: Potential participants were recruited from online and offline sources. In a randomized controlled trial, participants were allocated to IMMI or Access to Guided Meditation arm. IMMI included a 1-hour Web-based training session weekly for 6 weeks along with daily home practice guided meditations between sessions. The Access to Guided Meditation arm included a handout on mindfulness meditation and access to the same guided meditation practices that the IMMI participants received, but not the 1-hour Web-based training sessions. The study activities occurred through the participants’ own computer and Internet connection and with research-assistant telephone and email contact. Feasibility and acceptability were measured with enrollment and completion rates and participant satisfaction. The ability of IMMI to modify behavior and increase meditation practice was measured by objective adherence of daily meditation practice via Web-based forms. Self-report questionnaires of quality of life, self-efficacy, depression symptoms, sleep disturbance, perceived stress, and mindfulness were completed before and after the intervention period via Web-based surveys. Results: We enrolled 44 adults were enrolled and 31 adults completed all study activities. There were no group differences on demographics or important variables at baseline. Participants rated the IMMI arm higher than the Access to Guided Meditation arm on Client Satisfaction Questionnaire. IMMI was able to increase home practice behavior significantly compared to the Access to Guided Meditation arm: days practiced (P=.05), total minutes (P=.01), and average minutes (P=.05). As expected, there were no significant differences on health outcomes. Conclusions: In conclusion, IMMI was found to be feasible and acceptable. The IMMI arm had increased daily meditation practice compared with the Access to Guided Meditation control group. More interaction through staff and/or through built-in email or text reminders may increase daily practice even more. Future studies will examine IMMI’s efficacy at improving health outcomes in the general population and also compare it directly to the well-studied mindfulness-based group interventions to evaluate relative efficacy. Trial Registration: Clinicaltrials.gov NCT02655835; http://clinicaltrials.gov/ct2/show/NCT02655835 (Archived by WebCite at http://www.webcitation/ 6jUDuQsG2) %M 27502759 %R 10.2196/mental.5900 %U http://mental.jmir.org/2016/3/e37/ %U https://doi.org/10.2196/mental.5900 %U http://www.ncbi.nlm.nih.gov/pubmed/27502759 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e90 %T Usage and Dose Response of a Mobile Acceptance and Commitment Therapy App: Secondary Analysis of the Intervention Arm of a Randomized Controlled Trial %A Mattila,Elina %A Lappalainen,Raimo %A Välkkynen,Pasi %A Sairanen,Essi %A Lappalainen,Päivi %A Karhunen,Leila %A Peuhkuri,Katri %A Korpela,Riitta %A Kolehmainen,Marjukka %A Ermes,Miikka %+ VTT Technical Research Centre of Finland Ltd, Tekniikankatu 1, Tampere, 33720, Finland, 358 207223384, elina.m.mattila@vtt.fi %K mobile apps %K Acceptance and Commitment Therapy %K retrospective study %K adherence %D 2016 %7 28.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps offer a promising medium to deliver psychological interventions. A mobile app based on Acceptance and Commitment Therapy (ACT) was developed and studied in a randomized controlled trial (RCT). Objective: To study usage metrics of a mobile ACT intervention and dose-response relationship between usage and improvement in psychological flexibility. Methods: An RCT was conducted to investigate the effectiveness of different lifestyle interventions for overweight people with psychological stress. This paper presents a secondary analysis of the group that received an 8-week mobile ACT intervention. Most of the analyzed 74 participants were female (n=64, 86%). Their median age was 49.6 (interquartile range, IQR 45.4-55.3) years and their mean level of psychological flexibility, measured with the Acceptance and Action Questionnaire II, was 20.4 (95% confidence interval 18.3-22.5). Several usage metrics describing the intensity of use, usage of content, and ways of use were calculated. Linear regression analyses were performed to study the dose-response relationship between usage and the change in psychological flexibility and to identify the usage metrics with strongest association with improvement. Binary logistic regression analyses were further used to assess the role of usage metrics between those who showed improvement in psychological flexibility and those who did not. In addition, associations between usage and baseline participant characteristics were studied. Results: The median number of usage sessions was 21 (IQR 11.8-35), the number of usage days was 15 (IQR 9.0-24), and the number of usage weeks was 7.0 (IQR 4.0-8.0). The participants used the mobile app for a median duration of 4.7 (IQR 3.2-7.2) hours and performed a median of 63 (IQR 46-98) exercises. There was a dose-response relationship between usage and the change in psychological flexibility. The strongest associations with psychological flexibility (results adjusted with gender, age, and baseline psychological variables) were found for lower usage of Self as context related exercises (B=0.22, P=.001) and higher intensity of use, described by the number of usage sessions (B=−0.10, P=.01), usage days (B=−0.17, P=.008), and usage weeks (B=−0.73, P=.02), the number of exercises performed (B=−0.02, P=.03), and the total duration of use (B=−0.30, P=.04). Also, higher usage of Acceptance related exercises (B=−0.18, P=.04) was associated with improvement. Active usage was associated with female gender, older age, and not owning a smart mobile phone before the study. Conclusions: The results indicated that active usage of a mobile ACT intervention was associated with improved psychological flexibility. Usage metrics describing intensity of use as well as two metrics related to the usage of content were found to be most strongly associated with improvement. Trial Registration: ClinicalTrials.gov NCT01738256; https://clinicaltrials.gov/ct2/show/NCT01738256 (Archived by WebCite at http://www.webcitation.org/6iTePjPLL) %M 27468653 %R 10.2196/mhealth.5241 %U http://mhealth.jmir.org/2016/3/e90/ %U https://doi.org/10.2196/mhealth.5241 %U http://www.ncbi.nlm.nih.gov/pubmed/27468653 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e33 %T Feasibility and Outcomes of an Internet-Based Mindfulness Training Program: A Pilot Randomized Controlled Trial %A Kvillemo,Pia %A Brandberg,Yvonne %A Bränström,Richard %+ Department of Clinical Neuroscience, Karolinska Institutet, Berzeliusväg 3, plan 6, Stockholm,, Sweden, 46 7 067 348 64, pia.kvillemo@ki.se %K mindfulness %K Internet-based intervention %K Internet %K usability %K acceptability %K feasibility %K randomized controlled trial %D 2016 %7 22.07.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Interventions based on meditation and mindfulness techniques have been shown to reduce stress and increase psychological well-being in a wide variety of populations. Self-administrated Internet-based mindfulness training programs have the potential to be a convenient, cost-effective, easily disseminated, and accessible alternative to group-based programs. Objective: This randomized controlled pilot trial with 90 university students in Stockholm, Sweden, explored the feasibility, usability, acceptability, and outcomes of an 8-week Internet-based mindfulness training program. Methods: Participants were randomly assigned to either an intervention (n=46) or an active control condition (n=44). Intervention participants were invited to an Internet-based 8-week mindfulness program, and control participants were invited to an Internet-based 4-week expressive writing program. The programs were automated apart from weekly reminders via email. Main outcomes in pre- and postassessments were psychological well-being and depression symptoms. To assess the participant’s experiences, those completing the full programs were asked to fill out an assessment questionnaire and 8 of the participants were interviewed using a semistructured interview guide. Descriptive and inferential statistics, as well as content analysis, were performed. Results: In the mindfulness program, 28 out of 46 students (60%) completed the first week and 18 out of 46 (39%) completed the full program. In the expressive writing program, 35 out of 44 students (80%) completed the first week and 31 out of 44 (70%) completed the full program. There was no statistically significantly stronger intervention effect for the mindfulness intervention compared to the active control intervention. Those completing the mindfulness group reported high satisfaction with the program. Most of those interviewed were satisfied with the layout and technique and with the support provided by the study coordinators. More frequent contact with study coordinators was suggested as a way to improve program adherence and completion. Most participants considered the program to be meaningful and helpful but also challenging. The flexibility in performing the exercises at a suitable time and place was appreciated. A major difficulty was, however, finding enough time to practice. Conclusions: The program was usable, acceptable, and showed potential for increasing psychological well-being for those completing it. However, additional modification of the program might be needed to increase retention and compliance. ClinicalTrial: ClinicalTrials.gov NCT02062762; https://clinicaltrials.gov/ct2/show/NCT0206276 (Archived by WebCite at http://www.webcitation.org/6j9I5SGJ4) %M 27450466 %R 10.2196/mental.5457 %U http://mental.jmir.org/2016/3/e33/ %U https://doi.org/10.2196/mental.5457 %U http://www.ncbi.nlm.nih.gov/pubmed/27450466 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e31 %T Are Mental Health Effects of Internet Use Attributable to the Web-Based Content or Perceived Consequences of Usage? A Longitudinal Study of European Adolescents %A Hökby,Sebastian %A Hadlaczky,Gergö %A Westerlund,Joakim %A Wasserman,Danuta %A Balazs,Judit %A Germanavicius,Arunas %A Machín,Núria %A Meszaros,Gergely %A Sarchiapone,Marco %A Värnik,Airi %A Varnik,Peeter %A Westerlund,Michael %A Carli,Vladimir %+ National Centre for Suicide Research and Prevention of Mental Ill-Health, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Granits väg 4, Stockholm, 17177, Sweden, 46 735106890, sebastian.hokby@ki.se %K problematic Internet use %K addictive behavior %K Internet %K mental health %K adolescent health %K longitudinal study %D 2016 %7 13.07.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Adolescents and young adults are among the most frequent Internet users, and accumulating evidence suggests that their Internet behaviors might affect their mental health. Internet use may impact mental health because certain Web-based content could be distressing. It is also possible that excessive use, regardless of content, produces negative consequences, such as neglect of protective offline activities. Objective: The objective of this study was to assess how mental health is associated with (1) the time spent on the Internet, (2) the time spent on different Web-based activities (social media use, gaming, gambling, pornography use, school work, newsreading, and targeted information searches), and (3) the perceived consequences of engaging in those activities. Methods: A random sample of 2286 adolescents was recruited from state schools in Estonia, Hungary, Italy, Lithuania, Spain, Sweden, and the United Kingdom. Questionnaire data comprising Internet behaviors and mental health variables were collected and analyzed cross-sectionally and were followed up after 4 months. Results: Cross-sectionally, both the time spent on the Internet and the relative time spent on various activities predicted mental health (P<.001), explaining 1.4% and 2.8% variance, respectively. However, the consequences of engaging in those activities were more important predictors, explaining 11.1% variance. Only Web-based gaming, gambling, and targeted searches had mental health effects that were not fully accounted for by perceived consequences. The longitudinal analyses showed that sleep loss due to Internet use (ß=.12, 95% CI=0.05-0.19, P=.001) and withdrawal (negative mood) when Internet could not be accessed (ß=.09, 95% CI=0.03-0.16, P<.01) were the only consequences that had a direct effect on mental health in the long term. Perceived positive consequences of Internet use did not seem to be associated with mental health at all. Conclusions: The magnitude of Internet use is negatively associated with mental health in general, but specific Web-based activities differ in how consistently, how much, and in what direction they affect mental health. Consequences of Internet use (especially sleep loss and withdrawal when Internet cannot be accessed) seem to predict mental health outcomes to a greater extent than the specific activities themselves. Interventions aimed at reducing the negative mental health effects of Internet use could target its negative consequences instead of the Internet use itself. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 65120704; http://www.isrctn.com/ISRCTN65120704?q=&filters=recruitmentCountry:Lithuania&sort=&offset= 5&totalResults=32&page=1&pageSize=10&searchType=basic-search (Archived by WebCite at http://www.webcitation/abcdefg) %M 27417665 %R 10.2196/mental.5925 %U http://mental.jmir.org/2016/3/e31/ %U https://doi.org/10.2196/mental.5925 %U http://www.ncbi.nlm.nih.gov/pubmed/27417665 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e79 %T Deriving Requirements for Pervasive Well-Being Technology From Work Stress and Intervention Theory: Framework and Case Study %A Koldijk,Saskia %A Kraaij,Wessel %A Neerincx,Mark A %+ Delft University of Technology, Interactive Intelligence, Mekelweg 4, Delft,, Netherlands, 31 888665875, M.A.Neerincx@tudelft.nl %K psychological stress %K professional burn-out %K behavioral symptoms %K self-management %K health technology %K early medical intervention %D 2016 %7 05.07.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Stress in office environments is a big concern, often leading to burn-out. New technologies are emerging, such as easily available sensors, contextual reasoning, and electronic coaching (e-coaching) apps. In the Smart Reasoning for Well-being at Home and at Work (SWELL) project, we explore the potential of using such new pervasive technologies to provide support for the self-management of well-being, with a focus on individuals' stress-coping. Ideally, these new pervasive systems should be grounded in existing work stress and intervention theory. However, there is a large diversity of theories and they hardly provide explicit directions for technology design. Objective: The aim of this paper is to present a comprehensive and concise framework that can be used to design pervasive technologies that support knowledge workers to decrease stress. Methods: Based on a literature study we identify concepts relevant to well-being at work and select different work stress models to find causes of work stress that can be addressed. From a technical perspective, we then describe how sensors can be used to infer stress and the context in which it appears, and use intervention theory to further specify interventions that can be provided by means of pervasive technology. Results: The resulting general framework relates several relevant theories: we relate “engagement and burn-out” to “stress”, and describe how relevant aspects can be quantified by means of sensors. We also outline underlying causes of work stress and how these can be addressed with interventions, in particular utilizing new technologies integrating behavioral change theory. Based upon this framework we were able to derive requirements for our case study, the pervasive SWELL system, and we implemented two prototypes. Small-scale user studies proved the value of the derived technology-supported interventions. Conclusions: The presented framework can be used to systematically develop theory-based technology-supported interventions to address work stress. In the area of pervasive systems for well-being, we identified the following six key research challenges and opportunities: (1) performing multi-disciplinary research, (2) interpreting personal sensor data, (3) relating measurable aspects to burn-out, (4) combining strengths of human and technology, (5) privacy, and (6) ethics. %M 27380749 %R 10.2196/mhealth.5341 %U http://mhealth.jmir.org/2016/3/e79/ %U https://doi.org/10.2196/mhealth.5341 %U http://www.ncbi.nlm.nih.gov/pubmed/27380749 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e29 %T Online Obsessive-Compulsive Disorder Treatment: Preliminary Results of the “OCD? Not Me!” Self-Guided Internet-Based Cognitive Behavioral Therapy Program for Young People %A Rees,Clare Samantha %A Anderson,Rebecca Anne %A Kane,Robert Thomas %A Finlay-Jones,Amy Louise %+ School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, 6845, Australia, 61 8 9266 3442, c.rees@curtin.edu.au %K adolescent %K anxiety disorders/therapy %K Australia %K Internet %K obsessive-compulsive disorder %K self-care %K therapy %K computer-assisted/statistics and numerical data %K treatment outcome %K young adult %K iCBT %K adolescents %D 2016 %7 05.07.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: The development and evaluation of Internet-delivered cognitive behavioral therapy (iCBT) interventions provides a potential solution for current limitations in the acceptability, availability, and accessibility of mental health care for young people with obsessive-compulsive disorder (OCD). Preliminary results support the effectiveness of therapist-assisted iCBT for young people with OCD; however, no previous studies have examined the effectiveness of completely self-guided iCBT for OCD in young people. Objective: We aimed to conduct a preliminary evaluation of the effectiveness of the OCD? Not Me! program for reducing OCD-related psychopathology in young people (12-18 years). This program is an eight-stage, completely self-guided iCBT treatment for OCD, which is based on exposure and response prevention. Methods: These data were early and preliminary results of a longer study in which an open trial design is being used to evaluate the effectiveness of the OCD? Not Me! program. Participants were required to have at least subclinical levels of OCD to be offered the online program. Participants with moderate-high suicide/self-harm risk or symptoms of eating disorder or psychosis were not offered the program. OCD symptoms and severity were measured at pre- and posttest, and at the beginning of each stage of the program. Data was analyzed using generalized linear mixed models. Results: A total of 334 people were screened for inclusion in the study, with 132 participants aged 12 to 18 years providing data for the final analysis. Participants showed significant reductions in OCD symptoms (P<.001) and severity (P<.001) between pre- and posttest. Conclusions: These preliminary results suggest that fully automated iCBT holds promise as a way of increasing access to treatment for young people with OCD; however, further research needs to be conducted to replicate the results and to determine the feasibility of the program. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000152729; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363654 (Archived by WebCite at http://www.webcitation.org/ 6iD7EDFqH) %M 27381977 %R 10.2196/mental.5363 %U http://mental.jmir.org/2016/3/e29/ %U https://doi.org/10.2196/mental.5363 %U http://www.ncbi.nlm.nih.gov/pubmed/27381977 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 3 %P e30 %T Exploring the Use of Information and Communication Technology by People With Mood Disorder: A Systematic Review and Metasynthesis %A Fulford,Hamish %A McSwiggan,Linda %A Kroll,Thilo %A MacGillivray,Stephen %+ School of Nursing and Health Sciences, Centre for Health and Related Research, University of Dundee, Airlie Place, Dundee,, United Kingdom, 44 01382388534, s.a.macgillivray@dundee.ac.uk %K information and communication technology %K ICTs %K mood disorder %K metasynthesis %K self-management %D 2016 %7 01.07.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: There is a growing body of evidence relating to how information and communication technology (ICT) can be used to support people with physical health conditions. Less is known regarding mental health, and in particular, mood disorder. Objective: To conduct a metasynthesis of all qualitative studies exploring the use of ICTs by people with mood disorder. Methods: Searches were run in eight electronic databases using a systematic search strategy. Qualitative and mixed-method studies published in English between 2007 and 2014 were included. Thematic synthesis was used to interpret and synthesis the results of the included studies. Results: Thirty-four studies were included in the synthesis. The methodological design of the studies was qualitative or mixed-methods. A global assessment of study quality identified 22 studies as strong and 12 weak with most having a typology of findings either at topical or thematic survey levels of data transformation. A typology of ICT use by people with mood disorder was created as a result of synthesis. Conclusions: The systematic review and metasynthesis clearly identified a gap in the research literature as no studies were identified, which specifically researched how people with mood disorder use mobile ICT. Further qualitative research is recommended to understand the meaning this type of technology holds for people. Such research might provide valuable information on how people use mobile technology in their lives in general and also, more specifically, how they are being used to help with their mood disorders. %M 27370327 %R 10.2196/mental.5966 %U http://mental.jmir.org/2016/3/e30/ %U https://doi.org/10.2196/mental.5966 %U http://www.ncbi.nlm.nih.gov/pubmed/27370327 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e178 %T Trajectories of Suicidal Ideation in People Seeking Web-Based Help for Suicidality: Secondary Analysis of a Dutch Randomized Controlled Trial %A Madsen,Trine %A van Spijker,Bregje %A Karstoft,Karen-Inge %A Nordentoft,Merete %A Kerkhof,Ad JFM %+ Copenhagen Mental Health Center, Copenhagen University Hospital, Kildegårdsvej 28, opgang 15, 4.sal, Hellerup, 2900, Denmark, 45 35316236, trine.madsen@regionh.dk %K suicidal ideation %K online self-help %K trajectories %K latent growth mixture modeling %D 2016 %7 30.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicidal ideation (SI) is a common mental health problem. Variability in intensity of SI over time has been linked to suicidal behavior, yet little is known about the temporal course of SI. Objective: The primary aim was to identify prototypical trajectories of SI in the general population and, secondarily, to examine whether receiving Web-based self-help for SI, psychiatric symptoms, or sociodemographics predicted membership in the identified SI trajectories. Methods: We enrolled 236 people, from the general Dutch population seeking Web-based help for SI, in a randomized controlled trial comparing a Web-based self-help for SI group with a control group. We assessed participants at inclusion and at 2, 4, and 6 weeks. The Beck Scale for Suicide Ideation was applied at all assessments and was included in latent growth mixture modeling analysis to empirically identify trajectories. Results: We identified 4 SI trajectories. The high stable trajectory represented 51.7% (122/236) of participants and was characterized by constant high level of SI. The high decreasing trajectory (50/236, 21.2%) consisted of people with a high baseline SI score followed by a gradual decrease to a very low score. The third trajectory, high increasing (12/236, 5.1%), also had high initial SI score, followed by an increase to the highest level of SI at 6 weeks. The fourth trajectory, low stable (52/236, 22.0%) had a constant low level of SI. Previous attempted suicide and having received Web-based self-help for SI predicted membership in the high decreasing trajectory. Conclusions: Many adults experience high persisting levels of SI, though results encouragingly indicate that receiving Web-based self-help for SI increased membership in a decreasing trajectory of SI. %M 27363482 %R 10.2196/jmir.5904 %U http://www.jmir.org/2016/6/e178/ %U https://doi.org/10.2196/jmir.5904 %U http://www.ncbi.nlm.nih.gov/pubmed/27363482 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e181 %T Evaluation Methods for Assessing Users’ Psychological Experiences of Web-Based Psychosocial Interventions: A Systematic Review %A Feather,Jacqueline Susan %A Howson,Moira %A Ritchie,Linda %A Carter,Philip D %A Parry,David Tudor %A Koziol-McLain,Jane %+ Centre for Interdisciplinary Trauma Research, Department of Psychology, Auckland University of Technology, A-12, Private Bag 92006, Auckland, 1142, New Zealand, 64 99219999 ext 7693, jackie.feather@aut.ac.nz %K eHealth %K medical informatics applications %K web browser %K Web-based %K usability %K computer systems %K psychology, clinical %K usability testing %K eHealth evaluation %D 2016 %7 30.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of Web-based interventions to deliver mental health and behavior change programs is increasingly popular. They are cost-effective, accessible, and generally effective. Often these interventions concern psychologically sensitive and challenging issues, such as depression or anxiety. The process by which a person receives and experiences therapy is important to understanding therapeutic process and outcomes. While the experience of the patient or client in traditional face-to-face therapy has been evaluated in a number of ways, there appeared to be a gap in the evaluation of patient experiences of therapeutic interventions delivered online. Evaluation of Web-based artifacts has focused either on evaluation of experience from a computer Web-design perspective through usability testing or on evaluation of treatment effectiveness. Neither of these methods focuses on the psychological experience of the person while engaged in the therapeutic process. Objective: This study aimed to investigate what methods, if any, have been used to evaluate the in situ psychological experience of users of Web-based self-help psychosocial interventions. Methods: A systematic literature review was undertaken of interdisciplinary databases with a focus on health and computer sciences. Studies that met a predetermined search protocol were included. Results: Among 21 studies identified that examined psychological experience of the user, only 1 study collected user experience in situ. The most common method of understanding users’ experience was through semistructured interviews conducted posttreatment or questionnaires administrated at the end of an intervention session. The questionnaires were usually based on standardized tools used to assess user experience with traditional face-to-face treatment. Conclusions: There is a lack of methods specified in the literature to evaluate the interface between Web-based mental health or behavior change artifacts and users. Main limitations in the research were the nascency of the topic and cross-disciplinary nature of the field. There is a need to develop and deliver methods of understanding users’ psychological experiences while using an intervention. %M 27363519 %R 10.2196/jmir.5455 %U http://www.jmir.org/2016/6/e181/ %U https://doi.org/10.2196/jmir.5455 %U http://www.ncbi.nlm.nih.gov/pubmed/27363519 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e146 %T Adherence to Internet-Based Mobile-Supported Stress Management: A Pooled Analysis of Individual Participant Data From Three Randomized Controlled Trials %A Zarski,Anna-Carlotta %A Lehr,Dirk %A Berking,Matthias %A Riper,Heleen %A Cuijpers,Pim %A Ebert,David Daniel %+ Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nuremberg, Nägelsbachstr. 25a, Erlangen, 91052, Germany, 49 9131 85 67570, Anna-Carlotta.Zarski@fau.de %K guidance %K treatment adherence %K predictors %K Internet intervention %K work-related stress %K stress management %D 2016 %7 29.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Nonadherence to treatment is a prevalent issue in Internet interventions. Guidance from health care professionals has been found to increase treatment adherence rates in Internet interventions for a range of physical and mental disorders. Evaluating different guidance formats of varying intensity is important, particularly with respect to improvement of effectiveness and cost-effectiveness. Identifying predictors of nonadherence allows for the opportunity to better adapt Internet interventions to the needs of participants especially at risk for discontinuing treatment. Objective: The goal of this study was to investigate the influence of different guidance formats (content-focused guidance, adherence-focused guidance, and administrative guidance) on adherence and to identify predictors of nonadherence in an Internet-based mobile-supported stress management intervention (ie, GET.ON Stress) for employees. Methods: The data from the groups who received the intervention were pooled from three randomized controlled trials (RCTs) that evaluated the efficacy of the same Internet-based mobile-supported stress management intervention (N=395). The RCTs only differed in terms of the guidance format (content-focused guidance vs waitlist control, adherence-focused guidance vs waitlist control, administrative guidance vs waitlist control). Adherence was defined by the number of completed treatment modules (0-7). An ANOVA was performed to compare the adherence rates from the different guidance formats. Multiple hierarchical linear regression analysis was conducted to evaluate predictors of nonadherence, which included gender, age, education, symptom-related factors, and hope for improvement. Results: In all, 70.5% (93/132) of the content-focused guidance sample, 68.9% (91/132) of the adherence-focused guidance sample, and 42.0% (55/131) of the participants in the administrative guidance sample completed all treatment modules. Guidance had a significant effect on treatment adherence (F2,392=11.64, P<.001; ω2=.05). Participants in the content-focused guidance (mean 5.70, SD 2.32) and adherence-focused guidance samples (mean 5.58, SD 2.33) completed significantly more modules than participants in the administrative guidance sample (mean 4.36, SD 2.78; t223=4.53, P<.001; r=.29). Content-focused guidance was not significantly associated with higher adherence compared to adherence-focused guidance (t262=0.42, P=.67; r=.03). The effect size of r=.03 (95% CI –0.09 to 0.15) did not pass the equivalence margin of r=.20 and the upper bound of the 95% CI lay below the predefined margin, indicating equivalence between adherence-focused guidance and content-focused guidance. Beyond the influence of guidance, none of the predictors significantly predicted nonadherence. Conclusions: Guidance has been shown to be an influential factor in promoting adherence to an Internet-based mobile-supported stress management intervention. Adherence-focused guidance, which included email reminders and feedback on demand, was equivalent to content-focused guidance with regular feedback while requiring only approximately a quarter of the coaching resources. This could be a promising discovery in terms of cost-effectiveness. However, even after considering guidance, sociodemographic, and symptom-related characteristics, most interindividual differences in nonadherence remain unexplained. Clinical Trial: DRKS00004749; http://drks-neu.uniklinik-freiburg.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL _ID=DRKS00004749 (Archived by WebCite at http://www.webcitation.org/6QiDk9Zn8); DRKS00005112; http://drks-neu.uniklinik-freiburg. de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005112 (Archived by WebCite at http://www.webcitation.org/6QiDysvev); DRKS00005384; http://drks-neu.uniklinik-freiburg.de/ drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00005384 (Archived by WebCite at http://www.webcitation.org/6QiE0xcpE) %M 27357528 %R 10.2196/jmir.4493 %U http://www.jmir.org/2016/6/e146/ %U https://doi.org/10.2196/jmir.4493 %U http://www.ncbi.nlm.nih.gov/pubmed/27357528 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e176 %T How a Fully Automated eHealth Program Simulates Three Therapeutic Processes: A Case Study %A Holter,Marianne T. S %A Johansen,Ayna %A Brendryen,Håvar %+ The Norwegian Centre for Addiction Research, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Postboks 1039 Blindern, Oslo, 0315, Norway, 47 93 62 30 61, m.t.s.holter@medisin.uio.no %K Internet %K eHealth %K telemedicine %K behavior therapy %K motivational interviewing %K working alliance %K intervention mapping %K smoking cessation %K cell phones %K text messaging %D 2016 %7 28.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth programs may be better understood by breaking down the components of one particular program and discussing its potential for interactivity and tailoring in regard to concepts from face-to-face counseling. In the search for the efficacious elements within eHealth programs, it is important to understand how a program using lapse management may simultaneously support working alliance, internalization of motivation, and behavior maintenance. These processes have been applied to fully automated eHealth programs individually. However, given their significance in face-to-face counseling, it may be important to simulate the processes simultaneously in interactive, tailored programs. Objective: We propose a theoretical model for how fully automated behavior change eHealth programs may be more effective by simulating a therapist’s support of a working alliance, internalization of motivation, and managing lapses. Methods: We show how the model is derived from theory and its application to Endre, a fully automated smoking cessation program that engages the user in several “counseling sessions” about quitting. A descriptive case study based on tools from the intervention mapping protocol shows how each therapeutic process is simulated. Results: The program supports the user’s working alliance through alliance factors, the nonembodied relational agent Endre and computerized motivational interviewing. Computerized motivational interviewing also supports internalized motivation to quit, whereas a lapse management component responds to lapses. The description operationalizes working alliance, internalization of motivation, and managing lapses, in terms of eHealth support of smoking cessation. Conclusions: A program may simulate working alliance, internalization of motivation, and lapse management through interactivity and individual tailoring, potentially making fully automated eHealth behavior change programs more effective. %M 27354373 %R 10.2196/jmir.5415 %U http://www.jmir.org/2016/6/e176/ %U https://doi.org/10.2196/jmir.5415 %U http://www.ncbi.nlm.nih.gov/pubmed/27354373 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e156 %T Does a Mobile Phone Depression-Screening App Motivate Mobile Phone Users With High Depressive Symptoms to Seek a Health Care Professional’s Help? %A BinDhim,Nasser F %A Alanazi,Eman M %A Aljadhey,Hisham %A Basyouni,Mada H %A Kowalski,Stefan R %A Pont,Lisa G %A Shaman,Ahmed M %A Trevena,Lyndal %A Alhawassi,Tariq M %+ College of Health Sciences, Health Informatics, Saudi Electronic University, Abu Baker St, Riyadh, 11673, Saudi Arabia, 966 112613500 ext 1065, nbin6641@uni.sydney.edu.au %K mental health %K depression %K mobile phone %K public health informatics %K patients’ screening %D 2016 %7 27.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The objective of disease screening is to encourage high-risk subjects to seek health care diagnosis and treatment. Mobile phone apps can effectively screen mental health conditions, including depression. However, it is not known how effective such screening methods are in motivating users to discuss the obtained results of such apps with health care professionals. Does a mobile phone depression-screening app motivate users with high depressive symptoms to seek health care professional advice? This study aimed to address this question. Method: This was a single-cohort, prospective, observational study of a free mobile phone depression app developed in English and released on Apple’s App Store. Apple App Store users (aged 18 or above) in 5 countries, that is, Australia, Canada, New Zealand (NZ), the United Kingdom (UK), and the United States (US), were recruited directly via the app’s download page. The participants then completed the Patient Health Questionnaire (PHQ-9), and their depression screening score was displayed to them. If their score was 11 or above and they had never been diagnosed with depression before, they were advised to take their results to their health care professional. They were to follow up after 1 month. Results: A group of 2538 participants from the 5 countries completed PHQ-9 depression screening with the app. Of them, 322 participants were found to have high depressive symptoms and had never been diagnosed with depression, and received advice to discuss their results with health care professionals. About 74% of those completed the follow-up; approximately 38% of these self-reported consulting their health care professionals about their depression score. Only positive attitude toward depression as a real disease was associated with increased follow-up response rate (odds ratio (OR) 3.2, CI 1.38-8.29). Conclusions: A mobile phone depression-screening app motivated some users to seek a depression diagnosis. However, further study should investigate how other app users use the screening results provided by such apps. %M 27349441 %R 10.2196/jmir.5726 %U http://www.jmir.org/2016/6/e156/ %U https://doi.org/10.2196/jmir.5726 %U http://www.ncbi.nlm.nih.gov/pubmed/27349441 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 2 %P e28 %T Feasibility of an Immersive Virtual Reality Intervention for Hospitalized Patients: An Observational Cohort Study %A Mosadeghi,Sasan %A Reid,Mark William %A Martinez,Bibiana %A Rosen,Bradley Todd %A Spiegel,Brennan Mason Ross %+ Cedars-Sinai Health System, Health Services Research, 116 N Robertson Boulevard, Suite 400, Los Angeles, CA, 90048, United States, 1 310 423 6467, Brennan.Spiegel@cshs.org %K virtual reality therapy %K hospitalization %K feasibility studies %D 2016 %7 27.06.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Virtual reality (VR) offers immersive, realistic, three-dimensional experiences that “transport” users to novel environments. Because VR is effective for acute pain and anxiety, it may have benefits for hospitalized patients; however, there are few reports using VR in this setting. Objective: The aim was to evaluate the acceptability and feasibility of VR in a diverse cohort of hospitalized patients. Methods: We assessed the acceptability and feasibility of VR in a cohort of patients admitted to an inpatient hospitalist service over a 4-month period. We excluded patients with motion sickness, stroke, seizure, dementia, nausea, and in isolation. Eligible patients viewed VR experiences (eg, ocean exploration; Cirque du Soleil; tour of Iceland) with Samsung Gear VR goggles. We then conducted semistructured patient interview and performed statistical testing to compare patients willing versus unwilling to use VR. Results: We evaluated 510 patients; 423 were excluded and 57 refused to participate, leaving 30 participants. Patients willing versus unwilling to use VR were younger (mean 49.1, SD 17.4 years vs mean 60.2, SD 17.7 years; P=.01); there were no differences by sex, race, or ethnicity. Among users, most reported a positive experience and indicated that VR could improve pain and anxiety, although many felt the goggles were uncomfortable. Conclusions: Most inpatient users of VR described the experience as pleasant and capable of reducing pain and anxiety. However, few hospitalized patients in this “real-world” series were both eligible and willing to use VR. Consistent with the “digital divide” for emerging technologies, younger patients were more willing to participate. Future research should evaluate the impact of VR on clinical and resource outcomes. ClinicalTrial: Clinicaltrials.gov NCT02456987; https://clinicaltrials.gov/ct2/show/NCT02456987 (Archived by WebCite at http://www.webcitation.org/6iFIMRNh3) %M 27349654 %R 10.2196/mental.5801 %U http://mental.jmir.org/2016/2/e28/ %U https://doi.org/10.2196/mental.5801 %U http://www.ncbi.nlm.nih.gov/pubmed/27349654 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e152 %T Changing Mental Health and Positive Psychological Well-Being Using Ecological Momentary Interventions: A Systematic Review and Meta-analysis %A Versluis,Anke %A Verkuil,Bart %A Spinhoven,Philip %A van der Ploeg,Melanie M %A Brosschot,Jos F %+ Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Wassenaarseweg 52, Leiden, 2333 AK, Netherlands, 31 715276343, a.versluis@fsw.leidenuniv.nl %K mHealth %K ecological momentary intervention %K mental health %K anxiety %K depression %K stress %K meta-analysis %K systematic review %D 2016 %7 27.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health problems are highly prevalent, and there is need for the self-management of (mental) health. Ecological momentary interventions (EMIs) can be used to deliver interventions in the daily life of individuals using mobile devices. Objectives: The aim of this study was to systematically assess and meta-analyze the effect of EMI on 3 highly prevalent mental health outcomes (anxiety, depression, and perceived stress) and positive psychological outcomes (eg, acceptance). Methods: PsycINFO and Web of Science were searched for relevant publications, and the last search was done in September 2015. Three concepts were used to find publications: (1) mental health, (2) mobile phones, and (3) interventions. A total of 33 studies (using either a within- or between-subject design) including 43 samples that received an EMI were identified (n=1301), and relevant study characteristics were coded using a standardized form. Quality assessment was done with the Cochrane Collaboration tool. Results: Most of the EMIs focused on a clinical sample, used an active intervention (that offered exercises), and in over half of the studies, additional support by a mental health professional (MHP) was given. The EMI lasted on average 7.48 weeks (SD=6.46), with 2.80 training episodes per day (SD=2.12) and 108.25 total training episodes (SD=123.00). Overall, 27 studies were included in the meta-analysis, and after removing 6 outliers, a medium effect was found on mental health in the within-subject analyses (n=1008), with g=0.57 and 95% CI (0.45-0.70). This effect did not differ as function of outcome type (ie, anxiety, depression, perceived stress, acceptance, relaxation, and quality of life). The only moderator for which the effect varied significantly was additional support by an MHP (MHP-supported EMI, g=0.73, 95% CI: 0.57-0.88; stand-alone EMI, g=0.45, 95% CI: 0.22-0.69; stand-alone EMI with access to care as usual, g=0.38, 95% CI: 0.11-0.64). In the between-subject studies, 13 studies were included, and a small to medium effect was found (g=0.40, 95% CI: 0.22-0.57). Yet, these between-subject analyses were at risk for publication bias and were not suited for moderator analyses. Furthermore, the overall quality of the studies was relatively low. Conclusions: Results showed that there was a small to medium effect of EMIs on mental health and positive psychological well-being and that the effect was not different between outcome types. Moreover, the effect was larger with additional support by an MHP. Future randomized controlled trials are needed to further strengthen the results and to determine potential moderator variables. Overall, EMIs offer great potential for providing easy and cost-effective interventions to improve mental health and increase positive psychological well-being. %M 27349305 %R 10.2196/jmir.5642 %U http://www.jmir.org/2016/6/e152/ %U https://doi.org/10.2196/jmir.5642 %U http://www.ncbi.nlm.nih.gov/pubmed/27349305 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e165 %T Do Web-based Mental Health Literacy Interventions Improve the Mental Health Literacy of Adult Consumers? Results From a Systematic Review %A Brijnath,Bianca %A Protheroe,Joanne %A Mahtani,Kamal Ram %A Antoniades,Josefine %+ Curtin University, School of Occupational Therapy and Social Work, Building 401, Bentley Campus, Perth, 6152, Australia, 61 8 9266 5206, bianca.brijnath@curtin.edu.au %K health literacy %K health care seeking behavior %K Internet %K intervention study %K mental health %K social stigma %D 2016 %7 20.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Low levels of mental health literacy (MHL) have been identified as an important contributor to the mental health treatment gap. Interventions to improve MHL have used traditional media (eg, community talks, print media) and new platforms (eg, the Internet). Evaluations of interventions using conventional media show improvements in MHL improve community recognition of mental illness as well as knowledge, attitude, and intended behaviors toward people having mental illness. However, the potential of new media, such as the Internet, to enhance MHL has yet to be systematically evaluated. Objective: Study aims were twofold: (1) To systematically appraise the efficacy of Web-based interventions in improving MHL. (2) To establish if increases in MHL translated into improvement in individual health seeking and health outcomes as well as reductions in stigma toward people with mental illness. Methods: We conducted a systematic search and appraisal of all original research published between 2000 and 2015 that evaluated Web-based interventions to improve MHL. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to report findings. Results: Fourteen studies were included: 10 randomized controlled trials and 4 quasi-experimental studies. Seven studies were conducted in Australia. A variety of Web-based interventions were identified ranging from linear, static websites to highly interactive interventions such as social media games. Some Web-based interventions were specifically designed for people living with mental illness whereas others were applicable to the general population. Interventions were more likely to be successful if they included “active ingredients” such as a structured program, were tailored to specific populations, delivered evidenced-based content, and promoted interactivity and experiential learning. Conclusions: Web-based interventions targeting MHL are more likely to be successful if they include active ingredients. Improvements in MHL see concomitant improvements in health outcomes, especially for individuals with mild to moderate depression. The most promising interventions suited to this cohort appear to be MoodGYM and BluePages, 2 interventions from Australia. However, the relationship between MHL and formal and informal help seeking is less clear; self-stigma appears to be an important mediator with results showing that despite improvements in MHL and community attitudes to mental illness, individuals with mental illness still seek help at relatively low rates. Overall, the Internet is a viable method to improve MHL. Future studies could explore how new technology interfaces (eg, mobile phones vs computers) can help improve MHL, mental health outcomes, and reduce stigma. %M 27323907 %R 10.2196/jmir.5463 %U http://www.jmir.org/2016/6/e165/ %U https://doi.org/10.2196/jmir.5463 %U http://www.ncbi.nlm.nih.gov/pubmed/27323907 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e138 %T Web-Based Assessment of Mental Well-Being in Early Adolescence: A Reliability Study %A Hamann,Christoph %A Schultze-Lutter,Frauke %A Tarokh,Leila %+ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bolligenstr. 111, Haus A, Bern, 3000, Switzerland, 41 31 932 8554, leila_tarokh@brown.edu %K early adolescence %K online assessment %K reliability %D 2016 %7 15.06.2016 %9 Short Paper %J J Med Internet Res %G English %X Background: The ever-increasing use of the Internet among adolescents represents an emerging opportunity for researchers to gain access to larger samples, which can be queried over several years longitudinally. Among adolescents, young adolescents (ages 11 to 13 years) are of particular interest to clinicians as this is a transitional stage, during which depressive and anxiety symptoms often emerge. However, it remains unclear whether these youngest adolescents can accurately answer questions about their mental well-being using a Web-based platform. Objective: The aim of the study was to examine the accuracy of responses obtained from Web-based questionnaires by comparing Web-based with paper-and-pencil versions of depression and anxiety questionnaires. Methods: The primary outcome was the score on the depression and anxiety questionnaires under two conditions: (1) paper-and-pencil and (2) Web-based versions. Twenty-eight adolescents (aged 11-13 years, mean age 12.78 years and SD 0.78; 18 females, 64%) were randomly assigned to complete either the paper-and-pencil or the Web-based questionnaire first. Intraclass correlation coefficients (ICCs) were calculated to measure intrarater reliability. Intraclass correlation coefficients were calculated separately for depression (Children’s Depression Inventory, CDI) and anxiety (Spence Children’s Anxiety Scale, SCAS) questionnaires. Results: On average, it took participants 17 minutes (SD 6) to answer 116 questions online. Intraclass correlation coefficient analysis revealed high intrarater reliability when comparing Web-based with paper-and-pencil responses for both CDI (ICC=.88; P<.001) and the SCAS (ICC=.95; P<.001). According to published criteria, both of these values are in the “almost perfect” category indicating the highest degree of reliability. Conclusions: The results of the study show an excellent reliability of Web-based assessment in 11- to 13-year-old children as compared with the standard paper-pencil assessment. Furthermore, we found that Web-based assessments with young adolescents are highly feasible, with all enrolled participants completing the Web-based form. As early adolescence is a time of remarkable social and behavioral changes, these findings open up new avenues for researchers from diverse fields who are interested in studying large samples of young adolescents over time. %M 27306932 %R 10.2196/jmir.5482 %U http://www.jmir.org/2016/6/e138/ %U https://doi.org/10.2196/jmir.5482 %U http://www.ncbi.nlm.nih.gov/pubmed/27306932 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 2 %P e25 %T The Preference for Internet-Based Psychological Interventions by Individuals Without Past or Current Use of Mental Health Treatment Delivered Online: A Survey Study With Mixed-Methods Analysis %A Wallin,Emma Emmett Karolina %A Mattsson,Susanne %A Olsson,Erik Martin Gustaf %+ Department of Psychology, University of Uppsala, Blåsenhus, von Kraemers allé 1E, Uppsala, 75142, Sweden, 46 18 4710000, emma.wallin@psyk.uu.se %K patient acceptance of health care %K patient preference %K patient satisfaction %K Internet-based cognitive behavioral therapy %K chronic disease %K mental health care %K eHealth %K implementation %K qualitative research %D 2016 %7 14.06.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: The use of the Internet has the potential to increase access to evidence-based mental health services for a far-reaching population at a low cost. However, low take-up rates in routine care indicate that barriers for implementing Internet-based interventions have not yet been fully identified. Objective: The aim of this study was to evaluate the preference for Internet-based psychological interventions as compared to treatment delivered face to face among individuals without past or current use of mental health treatment delivered online. A further aim was to investigate predictors of treatment preference and to complement the quantitative analyses with qualitative data about the perceived advantages and disadvantages of Internet-based interventions. Methods: Two convenience samples were used. Sample 1 was recruited in an occupational setting (n=231) and Sample 2 consisted of individuals previously treated for cancer (n=208). Data were collected using a paper-and-pencil survey and analyzed using mixed methods. Results: The preference for Internet-based psychological interventions was low in both Sample 1 (6.5%) and Sample 2 (2.6%). Most participants preferred psychological interventions delivered face to face. Use of the Internet to search for and read health-related information was a significant predictor of treatment preference in both Sample 1 (odds ratio [OR] 2.82, 95% CI 1.18-6.75) and Sample 2 (OR 3.52, 95% CI 1.33-9.29). Being born outside of Sweden was a significant predictor of preference for Internet-based interventions, but only in Sample 2 (OR 6.24, 95% CI 1.29-30.16). Similar advantages and disadvantages were mentioned in both samples. Perceived advantages of Internet-based interventions included flexibility regarding time and location, low effort, accessibility, anonymity, credibility, user empowerment, and improved communication between therapist and client. Perceived disadvantages included anonymity, low credibility, impoverished communication between therapist and client, fear of negative side effects, requirements of computer literacy, and concerns about confidentiality. Conclusions: Internet-based interventions were reported as the preferred choice by a minority of participants. The results suggest that Internet-based interventions have specific advantages that may facilitate help-seeking among some individuals and some disadvantages that may restrict its use. Initiatives to increase treatment acceptability may benefit from addressing the advantages and disadvantages reported in this study. %M 27302200 %R 10.2196/mental.5324 %U http://mental.jmir.org/2016/2/e25/ %U https://doi.org/10.2196/mental.5324 %U http://www.ncbi.nlm.nih.gov/pubmed/27302200 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e135 %T Fundamentals for Future Mobile-Health (mHealth): A Systematic Review of Mobile Phone and Web-Based Text Messaging in Mental Health %A Berrouiguet,Sofian %A Baca-García,Enrique %A Brandt,Sara %A Walter,Michel %A Courtet,Philippe %+ Brest Medical University Hospital at Bohars, Adult Psychiatry, Hôpital de la Cavale Blanche-Bd Tanguy Prigent, Brest, 29200, France, 33 668204178, sofian.berrouiguet@gmail.com %K text messaging %K cell phones %K mental health %K Internet %K medical informatics %D 2016 %7 10.06.2016 %9 Review %J J Med Internet Res %G English %X Background: Mobile phone text messages (short message service, SMS) are used pervasively as a form of communication. Almost 100% of the population uses text messaging worldwide and this technology is being suggested as a promising tool in psychiatry. Text messages can be sent either from a classic mobile phone or a web-based application. Reviews are needed to better understand how text messaging can be used in mental health care and other fields of medicine. Objective: The objective of the study was to review the literature regarding the use of mobile phone text messaging in mental health care. Methods: We conducted a thorough literature review of studies involving text messaging in health care management. Searches included PubMed, PsycINFO, Cochrane, Scopus, Embase and Web of Science databases on May 25, 2015. Studies reporting the use of text messaging as a tool in managing patients with mental health disorders were included. Given the heterogeneity of studies, this review was summarized using a descriptive approach. Results: From 677 initial citations, 36 studies were included in the review. Text messaging was used in a wide range of mental health situations, notably substance abuse (31%), schizophrenia (22%), and affective disorders (17%). We identified four ways in which text messages were used: reminders (14%), information (17%), supportive messages (42%), and self-monitoring procedures (42%). Applications were sometimes combined. Conclusions: We report growing interest in text messaging since 2006. Text messages have been proposed as a health care tool in a wide spectrum of psychiatric disorders including substance abuse, schizophrenia, affective disorders, and suicide prevention. Most papers described pilot studies, while some randomized clinical trials (RCTs) were also reported. Overall, a positive attitude toward text messages was reported. RCTs reported improved treatment adherence and symptom surveillance. Other positive points included an increase in appointment attendance and in satisfaction with management and health care services. Insight into message content, preventative strategies, and innovative approaches derived from the mental health field may be applicable in other medical specialties. %M 27287668 %R 10.2196/jmir.5066 %U http://www.jmir.org/2016/6/e135/ %U https://doi.org/10.2196/jmir.5066 %U http://www.ncbi.nlm.nih.gov/pubmed/27287668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e157 %T Barriers and Facilitation Measures Related to People With Mental Disorders When Using the Web: A Systematic Review %A Bernard,Renaldo %A Sabariego,Carla %A Cieza,Alarcos %+ Department of Medical Informatics, Biometry and Epidemiology – IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-Universität München, Marchioninistraße 17, Munich, 81377, Germany, 49 89 2180 78229, renaldo.bernard@med.lmu.de %K World Wide Web %K mental disorders %K systematic review %K accessibility %K interaction design %K Web-based interaction %D 2016 %7 09.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental disorders (MDs) affect almost 1 in 4 adults at some point during their lifetime, and coupled with substance use disorders are the fifth leading cause of disability adjusted life years worldwide. People with these disorders often use the Web as an informational resource, platform for convenient self-directed treatment, and a means for many other kinds of support. However, some features of the Web can potentially erect barriers for this group that limit their access to these benefits, and there is a lack of research looking into this eventuality. Therefore, it is important to identify gaps in knowledge about “what” barriers exist and “how” they could be addressed so that this knowledge can inform Web professionals who aim to ensure the Web is inclusive to this population. Objective: The objective of this study was to provide an overview of existing evidence regarding the barriers people with mental disorders experience when using the Web and the facilitation measures used to address such barriers. Methods: This study involved a systematic review of studies that have considered the difficulties people with mental disorders experience when using digital technologies. Digital technologies were included because knowledge about any barriers here would likely be also applicable to the Web. A synthesis was performed by categorizing data according to the 4 foundational principles of Web accessibility as proposed by the World Wide Web Consortium, which forms the necessary basis for anyone to gain adequate access to the Web. Facilitation measures recommended by studies were later summarized into a set of minimal recommendations. Results: A total of 16 publications were included in this review, comprising 13 studies and 3 international guidelines. Findings suggest that people with mental disorders experience barriers that limit how they perceive, understand, and operate websites. Identified facilitation measures target these barriers in addition to ensuring that Web content can be reliably interpreted by a wide range of user applications. Conclusions: People with mental disorders encounter barriers on the Web, and attempts have been made to remove or reduce these barriers. As forewarned by experts in the area, only a few studies investigating this issue were found. More rigorous research is needed to be exhaustive and to have a larger impact on improving the Web for people with mental disorders. %M 27282115 %R 10.2196/jmir.5442 %U http://www.jmir.org/2016/6/e157/ %U https://doi.org/10.2196/jmir.5442 %U http://www.ncbi.nlm.nih.gov/pubmed/27282115 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 2 %P e27 %T Computer-Assisted In Sensu Exposure for Posttraumatic Stress Disorder: Development and Evaluation %A Görg,Nora %A Priebe,Kathlen %A Deuschel,Tilman %A Schüller,Martin %A Schriner,Friederike %A Kleindienst,Nikolaus %A Ludäscher,Petra %A Schmahl,Christian %A Bohus,Martin %+ Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, D-68167, Germany, 49 621 1703 ext 4412, nora.goerg@zi-mannheim.de %K dissociative disorders %K behavior therapy %K posttraumatic stress disorder %K technology %D 2016 %7 08.06.2016 %9 Original Paper %J JMIR Ment Health %G English %X Background: Dissociative states during psychotherapy sessions reduce the benefit of exposure-based therapy for posttraumatic stress disorder (PTSD). Thus, in evidence-based therapeutic programs such as dialectical behavior therapy for PTSD (DBT-PTSD), therapists apply specific antidissociative skills to reduce dissociative features during in sensu exposure. In addition to therapist-guided sessions, exposure protocols often require that the patients listen to audio recordings of exposure sessions in self-management. The problem of how to prevent dissociative features during such self-administered exposure exercises has not been resolved yet. Hence, we developed the computer program MORPHEUS that supports the application of self-administered exposure exercises. MORPHEUS continuously monitors the level of dissociative states and offers state-related antidissociative skills. Objective: This study sought to examine the acceptance and feasibility of the MORPHEUS program. Methods: Patients who underwent 12 weeks of residential DBT-PTSD treatment used MORPHEUS during exposure exercises in self-management. After the treatment, they filled out evaluation questionnaires. Results: In sum, 26 patients receiving a 12-week standard DBT-PTSD program participated in this study; 2 participants could not be analyzed because of missing data. All the patients used MORPHEUS as often as it was required according to the DBT-PTSD treatment (2 to 5 times a week). The overall acceptance and feasibility as rated by the patients was high: for example, patients found the skills useful to block dissociation (mean 4.24 on a scale from 0 to 5, SD 0.24) and stated that they would use the program again (mean 4.72 on a scale from 0 to 5, SD 0.11). Furthermore, patients indicated that they would recommend MORPHEUS to a friend (mean 4.44 on a scale from 0 to 5, SD 0.12). In 82% (32/39) of the cases, the use of antidissociative skills was related to a decrease in dissociation. In 18% (5/39), dissociation remained unchanged or increased. Conclusions: The evaluative data suggest high acceptability and feasibility of MORPHEUS. Further studies should evaluate the effectiveness of the skills applied during the program. Trial Registration: World Health Organization International Clinical Trials Registry Platform: DRKS00006226; http://apps.who.int/trialsearch/Trial2.aspx?TrialID= DRKS00006226 (Archived by WebCite at http://www.webcitation.org/ 6hxuFbIUr) %M 27277899 %R 10.2196/mental.5697 %U http://mental.jmir.org/2016/2/e27/ %U https://doi.org/10.2196/mental.5697 %U http://www.ncbi.nlm.nih.gov/pubmed/27277899 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e153 %T Primary Care Provider Views About Usefulness and Dissemination of a Web-Based Depression Treatment Information Decision Aid %A Beaulac,Julie %A Westmacott,Robin %A Walker,John R %A Vardanyan,Gohar %A , %+ The Ottawa Hospital, Psychology Department, 501 Smyth Road, Room 7300 General Campus, Ottawa, ON, K1H 8L6, Canada, 1 613 737 8899 ext 75078, jbeaulac@toh.on.ca %K decision aid %K depression %K treatment %K dissemination %D 2016 %7 08.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Decisions related to mental health are often complex, problems often remain undetected and untreated, information unavailable or not used, and treatment decisions frequently not informed by best practice or patient preferences. Objective: The objective of this paper was to obtain the opinions of health professionals working in primary health care settings about a Web-based information decision aid (IDA) for patients concerning treatment options for depression and the dissemination of the resources in primary care settings. Methods: Participants were recruited from primary care clinics in Winnipeg and Ottawa, Canada, and included 48 family physicians, nurses, and primary care staff. The study design was a qualitative framework analytic approach of 5 focus groups. Focus groups were conducted during regular staff meetings, were digitally recorded, and transcripts created. Analysis involved a content and theme analysis. Results: Seven key themes emerged including the key role of the primary care provider, common questions about treatments, treatment barriers, sources of patient information, concern about quality and quantity of available information, positive opinions about the IDA, and disseminating the IDA. The most common questions mentioned were about medication and side effects and alternatives to medication. Patients have limited access to alternative treatment options owing to cost and availability. Conclusions: Practitioners evaluated the IDA positively. The resources were described as useful, supportive of providers’ messages, and accessible for patients. There was unanimous consensus that information needs to be available electronically through the Internet. %M 27277709 %R 10.2196/jmir.5458 %U http://www.jmir.org/2016/6/e153/ %U https://doi.org/10.2196/jmir.5458 %U http://www.ncbi.nlm.nih.gov/pubmed/27277709 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e132 %T Preferred Features of E-Mental Health Programs for Prevention of Major Depression in Male Workers: Results From a Canadian National Survey %A Wang,JianLi %A Lam,Raymond W %A Ho,Kendall %A Attridge,Mark %A Lashewicz,Bonnie M %A Patten,Scott B %A Marchand,Alain %A Aiken,Alice %A Schmitz,Norbert %A Gundu,Sarika %A Rewari,Nitika %A Hodgins,David %A Bulloch,Andrew %A Merali,Zul %+ Department of Psychiatry, University of Calgary, 3280 Hospital Dr. NW, Calgary, AB, T2N4Z6, Canada, 1 403 2108653, jlwang@ucalgary.ca %K depression %K Internet %K prevention %K e-mental health programs %K design features %K men %D 2016 %7 06.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Major depression is a prevalent mental disorder and imposes considerable burden on health and productivity. Men are not immune to major depression, yet they often delay seeking help because of perceived stigma and gender norms. E-mental health programs hold potential for early prevention of major depression. However, we have little knowledge about men’s preferences for design features of e-mental health programs. Objectives: The objective of this study was to (1) estimate and compare the proportions of Internet use for medical information, preferred design features, and likely use of e-mental health programs; (2) examine factors associated with the likely use of e-mental health programs; and (3) understand potential barriers to the use of e-mental health programs among Canadian working men, who were at high risk of a major depressive episode (MDE). Methods: A cross-sectional survey in 10 Canadian provinces was conducted between March and December 2015. Random digit dialing method was used through household landlines and cell phones to collect data from 511 working men who were at high risk of having an MDE and 330 working men who were at low risk of having an MDE. Results: High-risk men were more likely to endorse the importance of accessing health resources on the Internet than low-risk men (83.4% vs 75.0%, respectively; P=.01). Of the 17 different features assessed, the top three features most likely to be used by high-risk men were: “information about improving sleep hygiene” (61.3%), “practice and exercise to help reduce symptoms of stress and depression” (59.5%), and “having access to quality information and resources about work stress issues” (57.8%). Compared with men at low risk for MDE, men at high risk for MDE were much more likely to consider using almost every one of the different design features. Differences in preferences for the design features by age among men at high risk of MDE were found only for 3 of 17 features. Differences in preferences for design features between English- and French-speaking participants were found only for 4 out of the 17 features. Analysis of qualitative data revealed that privacy issues, perceived stigma, ease of navigation, personal relevance, and lack of personal interaction, time, and knowledge were identified as barriers to the use of e-mental health programs in working men who were at high risk of MDE. Conclusion: E-mental health programs may be a promising strategy for prevention of depression in working men. Development of e-mental health programs should consider men’s preferences and perceived barriers to enhance the acceptability of this approach. %M 27267782 %R 10.2196/jmir.5685 %U http://www.jmir.org/2016/6/e132/ %U https://doi.org/10.2196/jmir.5685 %U http://www.ncbi.nlm.nih.gov/pubmed/27267782 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 3 %N 2 %P e14 %T Finding Web-Based Anxiety Interventions on the World Wide Web: A Scoping Review %A Ashford,Miriam Thiel %A Olander,Ellinor K %A Ayers,Susan %+ Centre for Maternal and Child Health Research, School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, United Kingdom, 44 20 7040 ext 5775, miriam.ashford@city.ac.uk %K Anxiety %K mental health %K web-based interventions %K internet %K technology %K consumer %K access to health care %D 2016 %7 01.06.2016 %9 Review %J JMIR Ment Health %G English %X Background: One relatively new and increasingly popular approach of increasing access to treatment is Web-based intervention programs. The advantage of Web-based approaches is the accessibility, affordability, and anonymity of potentially evidence-based treatment. Despite much research evidence on the effectiveness of Web-based interventions for anxiety found in the literature, little is known about what is publically available for potential consumers on the Web. Objective: Our aim was to explore what a consumer searching the Web for Web-based intervention options for anxiety-related issues might find. The objectives were to identify currently publically available Web-based intervention programs for anxiety and to synthesize and review these in terms of (1) website characteristics such as credibility and accessibility; (2) intervention program characteristics such as intervention focus, design, and presentation modes; (3) therapeutic elements employed; and (4) published evidence of efficacy. Methods: Web keyword searches were carried out on three major search engines (Google, Bing, and Yahoo—UK platforms). For each search, the first 25 hyperlinks were screened for eligible programs. Included were programs that were designed for anxiety symptoms, currently publically accessible on the Web, had an online component, a structured treatment plan, and were available in English. Data were extracted for website characteristics, program characteristics, therapeutic characteristics, as well as empirical evidence. Programs were also evaluated using a 16-point rating tool. Results: The search resulted in 34 programs that were eligible for review. A wide variety of programs for anxiety, including specific anxiety disorders, and anxiety in combination with stress, depression, or anger were identified and based predominantly on cognitive behavioral therapy techniques. The majority of websites were rated as credible, secure, and free of advertisement. The majority required users to register and/or to pay a program access fee. Half of the programs offered some form of paid therapist or professional support. Programs varied in treatment length and number of modules and employed a variety of presentation modes. Relatively few programs had published research evidence of the intervention’s efficacy. Conclusions: This review represents a snapshot of available Web-based intervention programs for anxiety that could be found by consumers in March 2015. The consumer is confronted with a diversity of programs, which makes it difficult to identify an appropriate program. Limited reports and existence of empirical evidence for efficacy make it even more challenging to identify credible and reliable programs. This highlights the need for consistent guidelines and standards on developing, providing, and evaluating Web-based interventions and platforms with reliable up-to-date information for professionals and consumers about the characteristics, quality, and accessibility of Web-based interventions. %M 27251763 %R 10.2196/mental.5349 %U http://mental.jmir.org/2016/2/e14/ %U https://doi.org/10.2196/mental.5349 %U http://www.ncbi.nlm.nih.gov/pubmed/27251763 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 5 %P e121 %T Acceptability of Interventions Delivered Online and Through Mobile Phones for People Who Experience Severe Mental Health Problems: A Systematic Review %A Berry,Natalie %A Lobban,Fiona %A Emsley,Richard %A Bucci,Sandra %+ School of Psychological Sciences, Faculty of Medical and Human Sciences, University of Manchester, Room S42, Zochonis Building, Brunswick Street, Manchester, M13 9PL, United Kingdom, 44 16130 ext 60428, natalie.berry@manchester.ac.uk %K mHealth %K eHealth %K severe mental health %K psychosis %K bipolar disorder %K personality disorder %K severe mental health problems (SMI) %K acceptability %D 2016 %7 31.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychological interventions are recommended for people with severe mental health problems (SMI). However, barriers exist in the provision of these services and access is limited. Therefore, researchers are beginning to develop and deliver interventions online and via mobile phones. Previous research has indicated that interventions delivered in this format are acceptable for people with SMI. However, a comprehensive systematic review is needed to investigate the acceptability of online and mobile phone-delivered interventions for SMI in depth. Objective: This systematic review aimed to 1) identify the hypothetical acceptability (acceptability prior to or without the delivery of an intervention) and actual acceptability (acceptability where an intervention was delivered) of online and mobile phone-delivered interventions for SMI, 2) investigate the impact of factors such as demographic and clinical characteristics on acceptability, and 3) identify common participant views in qualitative studies that pinpoint factors influencing acceptability. Methods: We conducted a systematic search of the databases PubMed, Embase, PsycINFO, CINAHL, and Web of Science in April 2015, which yielded a total of 8017 search results, with 49 studies meeting the full inclusion criteria. Studies were included if they measured acceptability through participant views, module completion rates, or intervention use. Studies delivering interventions were included if the delivery method was online or via mobile phones. Results: The hypothetical acceptability of online and mobile phone-delivered interventions for SMI was relatively low, while actual acceptability tended to be high. Hypothetical acceptability was higher for interventions delivered via text messages than by emails. The majority of studies that assessed the impact of demographic characteristics on acceptability reported no significant relationships between the two. Additionally, actual acceptability was higher when participants were provided remote online support. Common qualitative factors relating to acceptability were safety and privacy concerns, the importance of an engaging and appealing delivery format, the inclusion of peer support, computer and mobile phone literacy, technical issues, and concerns about the impact of psychological state on intervention use. Conclusions: This systematic review provides an in-depth focus on the acceptability of online and mobile phone-delivered interventions for SMI and identified the need for further research in this area. Based on the results from this review, we recommend that researchers measure both hypothetical and actual acceptability to identify whether initial perceptions of online and mobile phone-delivered interventions change after access. In addition, more focus is needed on the potential impact of demographic and clinical characteristics on acceptability. The review also identified issues with module completion rates and intervention use as measures of acceptability. We therefore advise researchers to obtain qualitative reports of acceptability throughout each phase of intervention development and testing. Further implications and opportunities for future research are discussed. %M 27245693 %R 10.2196/jmir.5250 %U http://www.jmir.org/2016/5/e121/ %U https://doi.org/10.2196/jmir.5250 %U http://www.ncbi.nlm.nih.gov/pubmed/27245693 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 2 %P e20 %T Community Structure of a Mental Health Internet Support Group: Modularity in User Thread Participation %A Carron-Arthur,Bradley %A Reynolds,Julia %A Bennett,Kylie %A Bennett,Anthony %A Cunningham,John Alastair %A Griffiths,Kathleen Margaret %+ National Institute for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston road, Acton, 2601, Australia, 61 2 6125 6825, Bradley.Carron-Arthur@anu.edu.au %K internet %K support group %K social network %K modularity %K mental health %K super user %D 2016 %7 30.05.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Little is known about the community structure of mental health Internet support groups, quantitatively. A greater understanding of the factors, which lead to user interaction, is needed to explain the design information of these services and future research concerning their utility. Objective: A study was conducted to determine the characteristics of users associated with the subgroup community structure of an Internet support group for mental health issues. Methods: A social network analysis of the Internet support group BlueBoard (blueboard.anu.edu.au) was performed to determine the modularity of the community using the Louvain method. Demographic characteristics age, gender, residential location, type of user (consumer, carer, or other), registration date, and posting frequency in subforums (depression, generalized anxiety, social anxiety, panic disorder, bipolar disorder, obsessive compulsive disorder, borderline personality disorder, eating disorders, carers, general (eg, “chit chat”), and suggestions box) of the BlueBoard users were assessed as potential predictors of the resulting subgroup structure. Results: The analysis of modularity identified five main subgroups in the BlueBoard community. Registration date was found to be the largest contributor to the modularity outcome as observed by multinomial logistic regression. The addition of this variable to the final model containing all other factors improved its classification accuracy by 46.3%, that is, from 37.9% to 84.2%. Further investigation of this variable revealed that the most active and central users registered significantly earlier than the median registration time in each group. Conclusions: The five subgroups resembled five generations of BlueBoard in distinct eras that transcended discussion about different mental health issues. This finding may be due to the activity of highly engaged and central users who communicate with many other users. Future research should seek to determine the generalizability of this finding and investigate the role that highly active and central users may play in the formation of this phenomenon. %M 27242012 %R 10.2196/mental.4961 %U http://mental.jmir.org/2016/2/e20/ %U https://doi.org/10.2196/mental.4961 %U http://www.ncbi.nlm.nih.gov/pubmed/27242012 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e103 %T Effectiveness of a Web-Based Screening and Fully Automated Brief Motivational Intervention for Adolescent Substance Use: A Randomized Controlled Trial %A Arnaud,Nicolas %A Baldus,Christiane %A Elgán,Tobias H %A De Paepe,Nina %A Tønnesen,Hanne %A Csémy,Ladislav %A Thomasius,Rainer %+ German Centre for Addiction Research in Childhood and Adolescence (DZSKJ), Centre for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 040 7410 59861, n.arnaud@uke.de %K substance use %K adolescents %K brief intervention %K web-based intervention %K motivational interviewing %K randomized controlled trial %D 2016 %7 24.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Mid-to-late adolescence is a critical period for initiation of alcohol and drug problems, which can be reduced by targeted brief motivational interventions. Web-based brief interventions have advantages in terms of acceptability and accessibility and have shown significant reductions of substance use among college students. However, the evidence is sparse among adolescents with at-risk use of alcohol and other drugs. Objective: This study evaluated the effectiveness of a targeted and fully automated Web-based brief motivational intervention with no face-to-face components on substance use among adolescents screened for at-risk substance use in four European countries. Methods: In an open-access, purely Web-based randomized controlled trial, a convenience sample of adolescents aged 16-18 years from Sweden, Germany, Belgium, and the Czech Republic was recruited using online and offline methods and screened online for at-risk substance use using the CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble) screening instrument. Participants were randomized to a single session brief motivational intervention group or an assessment-only control group but not blinded. Primary outcome was differences in past month drinking measured by a self-reported AUDIT-C-based index score for drinking frequency, quantity, and frequency of binge drinking with measures collected online at baseline and after 3 months. Secondary outcomes were the AUDIT-C-based separate drinking indicators, illegal drug use, and polydrug use. All outcome analyses were conducted with and without Expectation Maximization (EM) imputation of missing follow-up data. Results: In total, 2673 adolescents were screened and 1449 (54.2%) participants were randomized to the intervention or control group. After 3 months, 211 adolescents (14.5%) provided follow-up data. Compared to the control group, results from linear mixed models revealed significant reductions in self-reported past-month drinking in favor of the intervention group in both the non-imputed (P=.010) and the EM-imputed sample (P=.022). Secondary analyses revealed a significant effect on drinking frequency (P=.037) and frequency of binge drinking (P=.044) in the non-imputation-based analyses and drinking quantity (P=.021) when missing data were imputed. Analyses for illegal drug use and polydrug use revealed no significant differences between the study groups (Ps>.05). Conclusions: Although the study is limited by a large drop-out, significant between-group effects for alcohol use indicate that targeted brief motivational intervention in a fully automated Web-based format can be effective to reduce drinking and lessen existing substance use service barriers for at-risk drinking European adolescents. Trial Registration: International Standard Randomized Controlled Trial Registry: ISRCTN95538913; http://www.isrctn.com/ISRCTN95538913 (Archived by WebCite at http://www.webcitation.org/6XkuUEwBx) %M 27220276 %R 10.2196/jmir.4643 %U http://www.jmir.org/2016/5/e103/ %U https://doi.org/10.2196/jmir.4643 %U http://www.ncbi.nlm.nih.gov/pubmed/27220276 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 2 %P e18 %T A Thematic Analysis of Stigma and Disclosure for Perinatal Depression on an Online Forum %A Moore,Donna %A Ayers,Susan %A Drey,Nicholas %+ Centre for Maternal and Child Health, School of Health Sciences, City University London, Northampton Square, London, EC1V OHB, United Kingdom, 44 207 040 5060, Donna.Moore.1@city.ac.uk %K perinatal %K online %K Internet %K depression %K eHealth %D 2016 %7 19.05.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Perinatal mental illness is a global health concern; however, many women do not get the treatment they need to recover. Some women choose not to seek professional help and get no treatment because they feel stigmatized. Online forums for various health conditions, including perinatal mental health, can be beneficial for members. Little is known about the role that online forums for perinatal mental illness play in reducing stigma and subsequent disclosure of symptoms to health care providers and treatment uptake. Objective: This study aimed to examine stigma and disclosure in forums and describe any potential disadvantages of forum use. Methods: An online forum for mothers was examined and 1546 messages extracted from 102 threads from the antenatal and postnatal depression section. These messages were subjected to deductive systematic thematic analysis to identify common themes regarding stigma and disclosure of symptoms and potential disadvantages of forum use. Results: Two major themes were identified: stigma and negative experiences of disclosure. Stigma had 3 subthemes: internal stigma, external stigma, and treatment stigma. Many women were concerned about feeling like a “bad” or “failed” mother and worried that if they disclosed their symptoms to a health care provider they would be stigmatized. Posts in response to this frequently encouraged women to disclose their symptoms to health care providers and accept professional treatment. Forum discourse reconstructed the ideology of motherhood as compatible with perinatal mental illness, especially if the woman sought help and adhered to treatment. Many women overcame stigma and replied that they had taken advice and disclosed to a health care provider and/or taken treatment. Conclusions: Forum use may increase women's disclosure to health care providers by challenging their internal and external stigma and this may strengthen professional treatment uptake and adherence. However, a few posts described negative experiences when disclosing to health care providers. %M 27197516 %R 10.2196/mental.5611 %U http://mental.jmir.org/2016/2/e18/ %U https://doi.org/10.2196/mental.5611 %U http://www.ncbi.nlm.nih.gov/pubmed/27197516 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 2 %P e17 %T Consensus Among International Ethical Guidelines for the Provision of Videoconferencing-Based Mental Health Treatments %A Sansom-Daly,Ursula M %A Wakefield,Claire E %A McGill,Brittany C %A Wilson,Helen L %A Patterson,Pandora %+ Discipline of Paediatrics, School of Women's and Children's Health, UNSW Medicine, University of New South Wales, Behavioural Sciences Unit, Kids Cancer Centre, Level 1 South Wing, Sydney Children's Hospital, High St, Randwick, 2031, Australia, 61 9382 3114, ursula@unsw.edu.au %K Internet %K videoconferencing %K Skype %K mental health %K cognitive therapy %K ethics, professional %K guidelines as topic %K professional practice %K societies %K standards %D 2016 %7 18.05.2016 %9 Review %J JMIR Mental Health %G English %X Background: Online technologies may reduce barriers to evidence-based mental health care, yet they also create numerous ethical challenges. Recently, numerous professional organizations and expert groups have produced best-practice guidelines to assist mental health professionals in delivering online interventions in an ethically and clinically sound manner. However, there has been little critical examination of these international best-practice guidelines regarding appropriate electronic mental health (e-mental health) service delivery via technologies such as videoconferencing (including Skype), particularly for specific, vulnerable populations. Further, the extent to which concordance exists between these guidelines remains unclear. Synthesizing this literature to provide clear guidance to both mental health professionals and researchers is critical to ensure continued progress in the field of e-mental health. Objective: This study aims to review all currently available ethical and best-practice guidelines relating to videoconferencing-delivered mental health treatments in order to ascertain the recommendations for which international consensus could be found. Additionally, this review examines the extent to which each set of guidance addresses several key special populations, including children and young people, and populations living with illness. Methods: This systematic review examined guidelines using a two-armed search strategy, examining (1) professional organizations’ published guidance; and (2) MEDLINE, PsycINFO, and EMBASE for the past ten years. In order to determine consensus for best-practice, a recommendation was considered "firm" if 50% or more of the reviewed guidelines endorsed it and "tentative" if recommended by fewer guidelines than these. The professional guidelines were also scored by two raters using the Appraisal of Guidelines for Research and Evaluation II (AGREE-II) criteria. Results: In the study, 19 guidelines were included, yielding 11 specific "firm" and a further 123 "tentative-level" recommendations regarding the appropriateness of e-mental health, competence, legal and regulatory issues, confidentiality, consent, professional boundaries, and crisis management. International consensus yielded firm guidance across almost all areas except professional boundaries and some aspects of determining the appropriateness of e-mental health. Few guidelines specifically addressed special populations. Overall guideline quality varied; however, 42% (8/19) of the guidelines scored at least 5 out of 7. Conclusions: This synthesis of guidelines provides a foundation for clinicians and researchers utilizing e-mental health worldwide. The lack of specific guidance relating to special populations is an area warranting further attention in order to strengthen mental health professionals’ and researchers’ capacity to ethically and effectively tailor e-mental health interventions to these groups. %M 27192931 %R 10.2196/mental.5481 %U http://mental.jmir.org/2016/2/e17/ %U https://doi.org/10.2196/mental.5481 %U http://www.ncbi.nlm.nih.gov/pubmed/27192931 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 5 %P e109 %T Therapeutic Affordances of Online Support Group Use in Women With Endometriosis %A Shoebotham,Amie %A Coulson,Neil S %+ Division of Rehabilitation & Ageing, School of Medicine, University of Nottingham, Medical School, Queen's Medical Centre, Nottingham, NG7 2UH, United Kingdom, 44 1158466642, neil.coulson@nottingham.ac.uk %K endometriosis, social network, social support, qualitative research %D 2016 %7 09.05.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet has provided women living with endometriosis new opportunities to seek support online. Online support groups may provide a range of therapeutic affordances that may benefit these women. Objective: To examine the presence of therapeutic affordances as perceived by women who use endometriosis online support groups. Methods: Sixty-nine women (aged 19-50 years, mean 34.2 years; 65.2% (45/69) United Kingdom, 21.7% (15/69) United States) participated in a Web-based interview exploring online support group use. Participants had been using online support groups for an average of 2 years and 4 months (range = 1 month to 14 years, 9 months). Responses were analyzed using inductive thematic analysis. Results: The analysis revealed 4 therapeutic affordances related to online support group use: (1) “connection,” that is, the ability to connect in order to support each other, exchange advice, and to try to overcome feelings of loneliness; (2) “exploration,” that is, the ability to look for information, learn, and bolster their knowledge; (3) “narration,” that is, the ability to share their experiences, as well as read about the experiences of others; and (4) “self-presentation,” that is, the ability to manage how they present themselves online. The associated outcomes of use were predominantly positive, such as reassurance and improved coping. However, a number of negative aspects were revealed including the following: concerns about the accuracy of information, arguments between members, overreliance on the group, becoming upset by negative experiences or good news items, and confidentiality of personal information. Conclusions: Our findings support the previously proposed SCENA (Self-presentation, Connection, Exploration, Narration, and Adaptation) model and reveal a range of positive aspects that may benefit members, particularly in relation to reassurance and coping. However, negative aspects need to be addressed to maximize the potential benefit of support groups. Some of these can be addressed relatively easily through making privacy policies clearer, including health professionals to moderate content, and structuring forums to encourage the sharing of positive stories. %M 27160641 %R 10.2196/jmir.5548 %U http://www.jmir.org/2016/5/e109/ %U https://doi.org/10.2196/jmir.5548 %U http://www.ncbi.nlm.nih.gov/pubmed/27160641 %0 Journal Article %@ 2369-2529 %I JMIR Publications Inc. %V 3 %N 1 %P e5 %T Systemic Lisbon Battery: Normative Data for Memory and Attention Assessments %A Gamito,Pedro %A Morais,Diogo %A Oliveira,Jorge %A Ferreira Lopes,Paulo %A Picareli,Luís Felipe %A Matias,Marcelo %A Correia,Sara %A Brito,Rodrigo %+ Cognition and People-centric Computing Laboratories– COPELABS. Lusophone University of Humanities and Technologies, Campo Grande, 376, Lisbon, 1749 - 02, Portugal, 351 217505020 ext 7003, pedro.gamito@ulusofona.pt %K Systemic Lisbon Battery %K attention %K memory %K cognitive assessment %K virtual reality %D 2016 %7 04.05.2016 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Memory and attention are two cognitive domains pivotal for the performance of instrumental activities of daily living (IADLs). The assessment of these functions is still widely carried out with pencil-and-paper tests, which lack ecological validity. The evaluation of cognitive and memory functions while the patients are performing IADLs should contribute to the ecological validity of the evaluation process. Objective: The objective of this study is to establish normative data from virtual reality (VR) IADLs designed to activate memory and attention functions. Methods: A total of 243 non-clinical participants carried out a paper-and-pencil Mini-Mental State Examination (MMSE) and performed 3 VR activities: art gallery visual matching task, supermarket shopping task, and memory fruit matching game. The data (execution time and errors, and money spent in the case of the supermarket activity) was automatically generated from the app. Results: Outcomes were computed using non-parametric statistics, due to non-normality of distributions. Age, academic qualifications, and computer experience all had significant effects on most measures. Normative values for different levels of these measures were defined. Conclusions: Age, academic qualifications, and computer experience should be taken into account while using our VR-based platform for cognitive assessment purposes. %M 28582246 %R 10.2196/rehab.4155 %U http://rehab.jmir.org/2016/1/e5/ %U https://doi.org/10.2196/rehab.4155 %U http://www.ncbi.nlm.nih.gov/pubmed/28582246 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e80 %T Effectiveness of a Web-Based Guided Self-help Intervention for Outpatients With a Depressive Disorder: Short-term Results From a Randomized Controlled Trial %A Kenter,Robin Maria Francisca %A Cuijpers,Pim %A Beekman,Aartjan %A van Straten,Annemieke %+ Faculty of Behavioural and Movement Sciences, Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 20 59 88970, robin.kenter@vu.nl %K depression %K outpatient clinics %K Internet-based treatment %K problem solving therapy %K specialized mental health care %D 2016 %7 31.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Research has convincingly demonstrated that symptoms of depression can be reduced through guided Internet-based interventions. However, most of those studies recruited people form the general population. There is insufficient evidence for the effectiveness when delivered in routine clinical practice in outpatient clinics. Objective: The objective of this randomized controlled trial was to study patients with a depressive disorder (as defined by the Diagnostic and Statistical Manual of Disorders, fourth edition), as assessed by trained interviewers with the Composite International Diagnostic Interview, who registered for treatment at an outpatient mental health clinic. We aimed to examine the effectiveness of guided Internet-based self-help before starting face-to-face treatment. Methods: We recruited 269 outpatients, aged between 18 and 79 years, from outpatient clinics and randomly allocated them to Internet-based problem solving therapy (n=136), with weekly student support, or to a control condition, who remained on the waitlist with a self-help booklet (control group; n=133). Participants in both conditions were allowed to take up face-to-face treatment at the outpatient clinics afterward. We measured the primary outcome, depressive symptoms, by Center for Epidemiological Studies Depression scale (CES-D). Secondary outcome measures were the Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), Insomnia Severity Index questionnaire (ISI), and EuroQol visual analog scale (EQ-5D VAS). All outcomes were assessed by telephone at posttest (8 weeks after baseline). Results: Posttest measures were completed by 184 (68.4%) participants. We found a moderate to large within-group effect size for both the intervention (d=0.75) and the control (d=0.69) group. However, the between-group effect size was very small (d=0.07), and regression analysis on posttreatment CES-D scores revealed no significant differences between the groups (b=1.134, 95% CI –2.495 to 4.763). The per-protocol analysis (≥4 sessions completed) results were also not significant (b=1.154, 95% CI –1.978 to 7.637). Between-group differences were small and not significant for all secondary outcomes. Adherence to the intervention was low. Only 36% (49/136) received an adequate dosage of the intervention (≥4 of 5 sessions). The overall treatment satisfaction was moderate. Conclusions: Internet-based problem solving therapy is not more effective in reducing symptoms of depression than receiving an unguided self-help book during the waitlist period at outpatient mental health clinics. The effect sizes are much smaller than those found in earlier research in the general population, and the low rates of adherence indicate that the acceptability of the intervention at this stage of treatment for depressed outpatients is low. However, taking into account that there is much evidence for the efficacy of Internet-based treatments, it is too early to draw firm conclusions about the effectiveness of these treatments in outpatient clinics as a whole. Trial Registration: Netherlands Trial Register NTR2824; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2824 (Archived by WebCite at http://www.webcitation/ 6g3WEuiqH) %M 27032449 %R 10.2196/jmir.4861 %U http://www.jmir.org/2016/3/e80/ %U https://doi.org/10.2196/jmir.4861 %U http://www.ncbi.nlm.nih.gov/pubmed/27032449 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e72 %T Mobile Phone-Based Unobtrusive Ecological Momentary Assessment of Day-to-Day Mood: An Explorative Study %A Asselbergs,Joost %A Ruwaard,Jeroen %A Ejdys,Michal %A Schrader,Niels %A Sijbrandij,Marit %A Riper,Heleen %+ Faculty of Behavioural and Movement Sciences, Section Clinical Psychology, Vrije Universiteit Amsterdam, Van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 20 59 88774, j.a.g.j.asselbergs@vu.nl %K affect %K data mining %K ecological momentary assessment %K experience sampling %K mobile phone sensing %D 2016 %7 29.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Ecological momentary assessment (EMA) is a useful method to tap the dynamics of psychological and behavioral phenomena in real-world contexts. However, the response burden of (self-report) EMA limits its clinical utility. Objective: The aim was to explore mobile phone-based unobtrusive EMA, in which mobile phone usage logs are considered as proxy measures of clinically relevant user states and contexts. Methods: This was an uncontrolled explorative pilot study. Our study consisted of 6 weeks of EMA/unobtrusive EMA data collection in a Dutch student population (N=33), followed by a regression modeling analysis. Participants self-monitored their mood on their mobile phone (EMA) with a one-dimensional mood measure (1 to 10) and a two-dimensional circumplex measure (arousal/valence, –2 to 2). Meanwhile, with participants’ consent, a mobile phone app unobtrusively collected (meta) data from six smartphone sensor logs (unobtrusive EMA: calls/short message service (SMS) text messages, screen time, application usage, accelerometer, and phone camera events). Through forward stepwise regression (FSR), we built personalized regression models from the unobtrusive EMA variables to predict day-to-day variation in EMA mood ratings. The predictive performance of these models (ie, cross-validated mean squared error and percentage of correct predictions) was compared to naive benchmark regression models (the mean model and a lag-2 history model). Results: A total of 27 participants (81%) provided a mean 35.5 days (SD 3.8) of valid EMA/unobtrusive EMA data. The FSR models accurately predicted 55% to 76% of EMA mood scores. However, the predictive performance of these models was significantly inferior to that of naive benchmark models. Conclusions: Mobile phone-based unobtrusive EMA is a technically feasible and potentially powerful EMA variant. The method is young and positive findings may not replicate. At present, we do not recommend the application of FSR-based mood prediction in real-world clinical settings. Further psychometric studies and more advanced data mining techniques are needed to unlock unobtrusive EMA’s true potential. %M 27025287 %R 10.2196/jmir.5505 %U http://www.jmir.org/2016/3/e72/ %U https://doi.org/10.2196/jmir.5505 %U http://www.ncbi.nlm.nih.gov/pubmed/27025287 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e71 %T An Online Intervention for Co-Occurring Depression and Problematic Alcohol Use in Young People: Primary Outcomes From a Randomized Controlled Trial %A Deady,Mark %A Mills,Katherine L %A Teesson,Maree %A Kay-Lambkin,Frances %+ National Health and Medical Research Council Centre for Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, Kensington, 2052, Australia, 61 293850320, m.deady@unsw.edu.au %K depression %K alcohol use, alcohol abuse, problem drinking %K young people at risk populations %K Internet %K intervention online therapy, eHealth %K comorbidity %D 2016 %7 23.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression and problematic alcohol use represent two of the major causes of disease burden in young adults. These conditions frequently co-occur and this is associated with increased harm and poorer outcomes than either disorder in isolation. Integrated treatments have been shown to be effective; however, there remains a significant gap between those in need of treatment and those receiving it. The increased availability of eHealth programs presents a unique opportunity to treat these conditions. Objective: This study aimed to evaluate the feasibility and preliminary efficacy of an automated Web-based self-help intervention (DEAL Project) in treating co-occurring depressive symptoms and problematic alcohol use in young people. Methods: Young people (aged 18 to 25 years) with moderate depression symptoms and drinking at hazardous levels (recruited largely via social media) were randomly allocated to the DEAL Project (n=60) or a Web-based attention-control condition (HealthWatch; n=44). The trial consisted of a 4-week intervention phase with follow-up assessment at posttreatment and at 3 and 6 months postbaseline. The primary outcomes were change in depression severity according to the Patient Health Questionnaire-9 as well as quantity and frequency of alcohol use (TOT-AL). Results: The DEAL Project was associated with statistically significant improvement in depression symptom severity (d=0.71) and reductions in alcohol use quantity (d=0.99) and frequency (d=0.76) in the short term compared to the control group. At 6-month follow-up, the improvements in the intervention group were maintained; however, the differences between the intervention and control groups were no longer statistically significant, such that between-group effects were in the small to moderate range at 6 months (depression symptoms: d=0.39; alcohol quantity: d=–0.09; alcohol frequency: d=0.24). Conclusions: Overall, the DEAL Project was associated with more rapid improvement in both depression symptoms and alcohol use outcomes in young people with these co-occurring conditions relative to an attention-control condition. However, long-term outcomes are less clear. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000033741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363461 (Archived by WebCite at http://www.webcitation.org/6fpsLEGOy) %M 27009465 %R 10.2196/jmir.5178 %U http://www.jmir.org/2016/3/e71/ %U https://doi.org/10.2196/jmir.5178 %U http://www.ncbi.nlm.nih.gov/pubmed/27009465 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e11 %T Adjusting an Available Online Peer Support Platform in a Program to Supplement the Treatment of Perinatal Depression and Anxiety %A Baumel,Amit %A Schueller,Stephen M %+ The Feinstein Institute for Medical Research, 350 Community Dr, Manhasset, NY, 11030, United States, 1 7184708267, abaumel@northwell.edu %K online %K peer %K support %K perinatal %K postpartum %K depression %K anxiety %D 2016 %7 21.03.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Perinatal depression and anxiety are common and debilitating conditions. Novel, cost effective services could improve the uptake and the impact of mental health resources among women who suffer from these conditions. E-mental health products are one example of such services. Many publically available e-mental health products exist, but these products lack validation and are not designed to be integrated into existing health care settings. Objective: The objective of the study was to present a program to use 7 Cups of Tea (7Cups), an available technological platform that provides online peer (ie, listener) based emotional support, to supplement treatment for women experiencing perinatal depression or anxiety and to summarize patient’s feedback on the resultant program. Methods: This study consisted of two stages. First, five clinicians specializing in the treatment of perinatal mood disorders received an overview of 7Cups. They provided feedback on the 7Cups platform and ways it could complement the existing treatment efforts to inform further adjustments. In the second stage, nine women with perinatal depression or anxiety used the platform for a single session and provided feedback. Results: In response to clinicians’ feedback, guidelines for referring patients to use 7Cups as a supplement for treatment were created, and a training program for listeners was developed. Patients found the platform usable and useful and their attitudes toward the trained listeners were positive. Overall, patients noted a need for support outside the scheduled therapy time and believed that freely available online emotional support could help meet this need. Most patients were interested in receiving support from first time mothers and those who suffered in the past from perinatal mood disorders. Conclusions: The study results highlight the use of 7Cups as a tool to introduce accessible and available support into existing treatment for women who suffer from perinatal mood disorders. Further research should focus on the benefits accrued from such a service. However, this article highlights how a publicly available eHealth product can be leveraged to create new services in a health care setting. %M 27001373 %R 10.2196/mental.5335 %U http://mental.jmir.org/2016/1/e11/ %U https://doi.org/10.2196/mental.5335 %U http://www.ncbi.nlm.nih.gov/pubmed/27001373 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e65 %T Acceptability of Mental Health Apps for Aboriginal and Torres Strait Islander Australians: A Qualitative Study %A Povey,Josie %A Mills,Patj Patj Janama Robert %A Dingwall,Kylie Maree %A Lowell,Anne %A Singer,Judy %A Rotumah,Darlene %A Bennett-Levy,James %A Nagel,Tricia %+ Menzies School of Health Research, Institute of Advanced Studies, Charles Darwin University, PO Box 41096, Casuarina, 0811, Australia, 61 407399919, josie_povey@hotmail.com %K mobile apps %K mental health %K indigenous populations %K therapeutics %K cognitive behavioral therapy %K acceptance and commitment therapy %K culturally competent care %D 2016 %7 11.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Aboriginal and Torres Strait Islander Australians experience high rates of mental illness and psychological distress compared to their non-Indigenous counterparts. E-mental health tools offer an opportunity for accessible, effective, and acceptable treatment. The AIMhi Stay Strong app and the ibobbly suicide prevention app are treatment tools designed to combat the disproportionately high levels of mental illness and stress experienced within the Aboriginal and Torres Strait Islander community. Objective: This study aimed to explore Aboriginal and Torres Strait Islander community members’ experiences of using two culturally responsive e-mental health apps and identify factors that influence the acceptability of these approaches. Methods: Using qualitative methods aligned with a phenomenological approach, we explored the acceptability of two culturally responsive e-mental health apps through a series of three 3-hour focus groups with nine Aboriginal and Torres Strait Islander community members. Thematic analysis was conducted and coresearcher and member checking were used to verify findings. Results: Findings suggest strong support for the concept of e-mental health apps and optimism for their potential. Factors that influenced acceptability related to three key themes: personal factors (eg, motivation, severity and awareness of illness, technological competence, and literacy and language differences), environmental factors (eg, community awareness, stigma, and availability of support), and app characteristics (eg, ease of use, content, graphics, access, and security and information sharing). Specific adaptations, such as local production, culturally relevant content and graphics, a purposeful journey, clear navigation, meaningful language, options to assist people with language differences, offline use, and password protection may aid uptake. Conclusions: When designed to meet the needs of Aboriginal and Torres Strait Islander Australians, e-mental health tools add an important element to public health approaches for improving the well-being of Aboriginal and Torres Strait Islander people. %M 26969043 %R 10.2196/jmir.5314 %U http://www.jmir.org/2016/3/e65/ %U https://doi.org/10.2196/jmir.5314 %U http://www.ncbi.nlm.nih.gov/pubmed/26969043 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e52 %T Motivation and Treatment Credibility Predicts Dropout, Treatment Adherence, and Clinical Outcomes in an Internet-Based Cognitive Behavioral Relaxation Program: A Randomized Controlled Trial %A Alfonsson,Sven %A Olsson,Erik %A Hursti,Timo %+ Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Husargatan/Dag Hammarskjölds väg, BMC ingång A11, Uppsala, 751 22, Sweden, 46 18 471 00 00, sven.alfonsson@pubcare.uu.se %K Internet %K adherence %K psychotherapy %K motivation %K patient compliance %D 2016 %7 08.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: In previous research, variables such as age, education, treatment credibility, and therapeutic alliance have shown to affect patients’ treatment adherence and outcome in Internet-based psychotherapy. A more detailed understanding of how such variables are associated with different measures of adherence and clinical outcomes may help in designing more effective online therapy. Objective: The aims of this study were to investigate demographical, psychological, and treatment-specific variables that could predict dropout, treatment adherence, and treatment outcomes in a study of online relaxation for mild to moderate stress symptoms. Methods: Participant dropout and attrition as well as data from self-report instruments completed before, during, and after the online relaxation program were analyzed. Multiple linear and logistical regression analyses were conducted to predict early dropout, overall attrition, online treatment progress, number of registered relaxation exercises, posttreatment symptom levels, and reliable improvement. Results: Dropout was significantly predicted by treatment credibility, whereas overall attrition was associated with reporting a focus on immediate consequences and experiencing a low level of intrinsic motivation for the treatment. Treatment progress was predicted by education level and treatment credibility, whereas number of registered relaxation exercises was associated with experiencing intrinsic motivation for the treatment. Posttreatment stress symptoms were positively predicted by feeling external pressure to participate in the treatment and negatively predicted by treatment credibility. Reporting reliable symptom improvement after treatment was predicted by treatment credibility and therapeutic bond. Conclusions: This study confirmed that treatment credibility and a good working alliance are factors associated with successful Internet-based psychotherapy. Further, the study showed that measuring adherence in different ways provides somewhat different results, which underscore the importance of carefully defining treatment adherence in psychotherapy research. Lastly, the results suggest that finding the treatment interesting and engaging may help patients carry through with the intervention and complete prescribed assignments, a result that may help guide the design of future interventions. Trial Registration: Clinicaltrials.gov NCT02535598; http://clinicaltrials.gov/ct2/show/NCT02535598 (Archived by WebCite at http://www.webcitation.org/6fl38ms7y). %M 26957354 %R 10.2196/jmir.5352 %U http://www.jmir.org/2016/3/e52/ %U https://doi.org/10.2196/jmir.5352 %U http://www.ncbi.nlm.nih.gov/pubmed/26957354 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 3 %P e54 %T Internet Cognitive Behavioral Therapy for Women With Postnatal Depression: A Randomized Controlled Trial of MumMoodBooster %A Milgrom,Jeannette %A Danaher,Brian G %A Gemmill,Alan W %A Holt,Charlene %A Holt,Christopher J %A Seeley,John R %A Tyler,Milagra S %A Ross,Jessica %A Ericksen,Jennifer %+ Parent-Infant Research Institute, Department of Clinical & Health Psychology, Heidelberg Repatriation Hospital Austin Health 330 Waterdale Road Heidelberg Heights, Melbourne, 3081, Australia, 61 03 9496 ext 4468, alan.gemmill@austin.org.au %K postnatal depression %K postpartum depression %K cognitive behavioral therapy %K Internet-based intervention %K randomized controlled trial %D 2016 %7 07.03.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: There are few published controlled trials examining the efficacy of Internet-based treatment for postnatal depression (PND) and none that assess diagnostic status (clinical remission) as the primary outcome. This is despite the need to improve treatment uptake and accessibility because fewer than 50% of postnatally depressed women seek help, even when identified as depressed. Objective: In a randomized controlled trial (RCT), we aimed to test the efficacy of a 6-session Internet intervention (the MumMoodBooster program, previously evaluated in a feasibility trial) in a sample of postnatal women with a clinical diagnosis of depression. The MumMoodBooster program is a cognitive behavioral therapy (CBT) intervention, is highly interactive, includes a partner website, and was supported by low-intensity telephone coaching. Methods: This was a parallel 2-group RCT (N=43) comparing the Internet CBT treatment (n=21) to treatment as usual (n=22). At baseline and at 12 weeks after enrollment, women’s diagnostic status was assessed by telephone with the Standardized Clinical Interview for DSM-IV (SCID-IV) and symptom severity with the Beck Depression Inventory (BDI-II). Depression symptoms were measured repeatedly throughout the study period with the Patient Health Questionnaire (PHQ-9). Results: At the end of the study, 79% (15/19) of women who received the Internet CBT treatment no longer met diagnostic criteria for depression on the SCID-IV (these outcome data were missing for 2 intervention participants). This contrasted with only 18% (4/22) remission in the treatment as usual condition. Depression scores on the BDI-II showed a large effect favoring the intervention group (d=.83, 95% CI 0.20-1.45). Small to medium effects were found on the PHQ-9 and on measures of anxiety and stress. Adherence to the program was very good with 86% (18/21) of users completing all sessions; satisfaction with the program was rated 3.1 out of 4 on average. Conclusions: Our results suggest that our Internet CBT program, MumMoodBooster, is an effective treatment option for women clinically diagnosed with PND. This is one of only two controlled evaluations of specialized online psychological treatment among women clinically diagnosed with PND. MumMoodBooster appears to be a feasible, effective treatment option, which is potentially accessible to large numbers of women in metropolitan, rural, and remote areas. Future work might be focused profitably on establishing comparability with face-to-face treatments and purely self-guided delivery. We have commenced a larger RCT comparing MumMoodBooster with face-to-face CBT. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12613000113752; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363561 (Archived by WebCite® at http://www.webcitation.org/6f64kuyLf). %M 26952645 %R 10.2196/jmir.4993 %U http://www.jmir.org/2016/3/e54/ %U https://doi.org/10.2196/jmir.4993 %U http://www.ncbi.nlm.nih.gov/pubmed/26952645 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e7 %T Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments %A Bakker,David %A Kazantzis,Nikolaos %A Rickwood,Debra %A Rickard,Nikki %+ School of Psychology and Monash Institute of Cognitive and Clinical Neurosciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, 18 Innovation Walk, Wellington Road, Clayton, 3800, Australia, 61 3 9905 4301, david.bakker@monash.edu %K mobile phones %K mental health %K smartphones %K apps %K mobile apps %K depression %K anxiety %K cognitive behavior therapy %K cognitive behavioral therapy %K clinical psychology %D 2016 %7 01.03.2016 %9 Review %J JMIR Mental Health %G English %X Background: The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available. Objective: To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps. Methods: A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design. Results: Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp. Conclusions: Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems. %M 26932350 %R 10.2196/mental.4984 %U http://mental.jmir.org/2016/1/e7/ %U https://doi.org/10.2196/mental.4984 %U http://www.ncbi.nlm.nih.gov/pubmed/26932350 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e10 %T Therapeutic Alliance With a Fully Automated Mobile Phone and Web-Based Intervention: Secondary Analysis of a Randomized Controlled Trial %A Clarke,Janine %A Proudfoot,Judith %A Whitton,Alexis %A Birch,Mary-Rose %A Boyd,Megan %A Parker,Gordon %A Manicavasagar,Vijaya %A Hadzi-Pavlovic,Dusan %A Fogarty,Andrea %+ Black Dog Institute, UNSW Australia, Hospital Road, Randwick NSW 2031, Australia, 61 2 9382 3767, Janine.clarke@unsw.edu.au %K therapeutic alliance %K e-therapy %K Internet interventions %K depression %K computerized cognitive behavior therapy %D 2016 %7 25.02.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Studies of Internet-delivered psychotherapies suggest that clients report development of a therapeutic alliance in the Internet environment. Because a majority of the interventions studied to date have been therapist-assisted to some degree, it remains unclear whether a therapeutic alliance can develop within the context of an Internet-delivered self-guided intervention with no therapist support, and whether this has consequences for program outcomes. Objective: This study reports findings of a secondary analysis of data from 90 participants with mild-to-moderate depression, anxiety, and/or stress who used a fully automated mobile phone and Web-based cognitive behavior therapy (CBT) intervention called “myCompass” in a recent randomized controlled trial (RCT). Methods: Symptoms, functioning, and positive well-being were assessed at baseline and post-intervention using the Depression, Anxiety and Stress Scale (DASS), the Work and Social Adjustment Scale (WSAS), and the Mental Health Continuum-Short Form (MHC-SF). Therapeutic alliance was measured at post-intervention using the Agnew Relationship Measure (ARM), and this was supplemented with qualitative data obtained from 16 participant interviews. Extent of participant engagement with the program was also assessed. Results: Mean ratings on the ARM subscales were above the neutral midpoints, and the interviewees provided rich detail of a meaningful and collaborative therapeutic relationship with the myCompass program. Whereas scores on the ARM subscales did not correlate with treatment outcomes, participants’ ratings of the quality of their emotional connection with the program correlated significantly and positively with program logins, frequency of self-monitoring, and number of treatment modules completed (r values between .32-.38, P≤.002). The alliance (ARM) subscales measuring perceived empowerment (r=.26, P=.02) and perceived freedom to self-disclose (r=.25, P=.04) also correlated significantly in a positive direction with self-monitoring frequency. Conclusions: Quantitative and qualitative findings from this analysis showed that a positive therapeutic alliance can develop in the Internet environment in the absence of therapist support, and that components of the alliance may have implications for program usage. Further investigation of alliance features in the Internet environment and the consequences of these for treatment outcomes and user engagement is warranted. Trial Registration: Australian New Zealand Clinical Trials Registry Number (ACTRN): 12610000625077; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=335772&isReview=true (Archived by WebCite at http://www.webcitation.org/6efAc5xj4). %M 26917096 %R 10.2196/mental.4656 %U http://mental.jmir.org/2016/1/e10/ %U https://doi.org/10.2196/mental.4656 %U http://www.ncbi.nlm.nih.gov/pubmed/26917096 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 2 %P e36 %T The Efficacy of Three Modalities of Internet-Based Psychotherapy for Non–Treatment-Seeking Online Problem Gamblers: A Randomized Controlled Trial %A Luquiens,Amandine %A Tanguy,Marie-Laure %A Lagadec,Marthylle %A Benyamina,Amine %A Aubin,Henri-Jean %A Reynaud,Michel %+ Paul Brousse Hospital, APHP, Villejuif - University Paris-Sud - Inserm U1178 - CESP, Department of Addiction, 12 avenue Paul Vaillant-Couturier, Villejuif cedex, 94804, France, 33 145594018, amandineluquiens@yahoo.fr %K internet-based cognitive behavioral therapy %K brief intervention %K internet-based randomized controlled trial %K problem gambling %K non-help seeking %K poker %K guidance %D 2016 %7 15.02.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based interventions targeted at the most at-risk gamblers could reduce the treatment gap for addictive disorders. Currently, no clinical trial has included non–treatment-seeking patients who have been recruited directly in their gambling environment. This study was the first exclusively Internet-based randomized controlled trial among non–help-seeking problem gamblers with naturalistic recruitment in their gambling environment. Objective: The aim of this study was to assess the efficacy of three modalities of Internet-based psychotherapies with or without guidance, compared to a control condition, among problem gamblers who play online poker. Methods: All active poker gamblers on the Winamax website were systematically offered screening. All problem poker gamblers identified with a Problem Gambling Severity Index (PGSI) score of ≥5 were eligible to be included in the trial. Problem gamblers were randomized into four groups: (1) waiting list (control group), (2) personalized normalized feedback on their gambling status by email, (3) an email containing a self-help book to be downloaded with a Cognitive Behavioral Therapy (CBT) program without guidance, and (4) the same CBT program emailed weekly by a trained psychologist with personalized guidance. Efficacy was assessed based on the change in PGSI between baseline and 6 weeks (end of treatment) or 12 weeks (maintenance) and supported by player account-based gambling data automatically collected at the three time points. Results: All groups met high attrition rates (83%), but the group with guidance had a significantly higher dropout rate than the other three groups, including the control group. Although all groups showed some improvement, with a mean decrease of 1.35 on the PGSI, no significant difference in efficacy between the groups was observed. One-third of the problem gamblers fell below the problem gambling threshold at 6 weeks. Conclusions: Guidance could have aversively affected problem gamblers who had not sought help. Despite the lack of significant difference in efficacy between groups, this naturalistic trial provides a basis for the development of future Internet-based trials in individuals with gambling disorders. Comorbidities, natural course of illness, and intrinsic motivation seem to be critical issues to consider in future designs. Trial Registration: ANSM 2013-A00794-41 %M 26878894 %R 10.2196/jmir.4752 %U http://www.jmir.org/2016/2/e36/ %U https://doi.org/10.2196/jmir.4752 %U http://www.ncbi.nlm.nih.gov/pubmed/26878894 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e10 %T Establishing and Governing e-Mental Health Care in Australia: A Systematic Review of Challenges and A Call For Policy-Focussed Research %A Meurk,Carla %A Leung,Janni %A Hall,Wayne %A Head,Brian W %A Whiteford,Harvey %+ School of Public Health, Faculty of Medicine and Biomedical Sciences, The University of Queensland, Level 2, Public Health Building, Herston, 4006, Australia, 61 733655345, c.meurk@uq.edu.au %K telemedicine %K e-health %K e-mental health %K e-therapy %K Internet %K online %K cognitive behavioural therapy %K anxiety %K anxiety disorders %K depression %K depressive disorder %K Australia %K research translation %K evidence-informed policy %K implementation %D 2016 %7 13.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Growing evidence attests to the efficacy of e-mental health services. There is less evidence on how to facilitate the safe, effective, and sustainable implementation of these services. Objective: We conducted a systematic review on e-mental health service use for depressive and anxiety disorders to inform policy development and identify policy-relevant gaps in the evidence base. Methods: Following the PRISMA protocol, we identified research (1) conducted in Australia, (2) on e-mental health services, (3) for depressive or anxiety disorders, and (4) on e-mental health usage, such as barriers and facilitators to use. Databases searched included Cochrane, PubMed, PsycINFO, CINAHL, Embase, ProQuest Social Science, and Google Scholar. Sources were assessed according to area and level of policy relevance. Results: The search yielded 1081 studies; 30 studies were included for analysis. Most reported on self-selected samples and samples of online help-seekers. Studies indicate that e-mental health services are predominantly used by females, and those who are more educated and socioeconomically advantaged. Ethnicity was infrequently reported on. Studies examining consumer preferences found a preference for face-to-face therapy over e-therapies, but not an aversion to e-therapy. Content relevant to governance was predominantly related to the organizational dimensions of e-mental health services, followed by implications for community education. Financing and payment for e-services and governance of the information communication technology were least commonly discussed. Conclusions: Little research focuses explicitly on policy development and implementation planning; most research provides an e-services perspective. Research is needed to provide community and policy-maker perspectives. General population studies of prospective treatment seekers that include ethnicity and socioeconomic status and quantify relative preferences for all treatment modalities are necessary. %M 26764181 %R 10.2196/jmir.4827 %U http://www.jmir.org/2016/1/e10/ %U https://doi.org/10.2196/jmir.4827 %U http://www.ncbi.nlm.nih.gov/pubmed/26764181 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e5 %T Heuristic Evaluation of Ehealth Interventions: Establishing Standards That Relate to the Therapeutic Process Perspective %A Baumel,Amit %A Muench,Fred %+ The Feinstein Institute for Medical Research, Department of Psychiatry, North Shore–LIJ Health System, 75-59 263rd St, Glen Oaks, NY, 11004, United States, 1 7184708267, amitbaumel@gmail.com %K eHealth %K mHealth %K digital health %K mobile health %K heuristics %K evaluation %K principles %K therapeutic process %D 2016 %7 13.01.2016 %9 Viewpoint %J JMIR Mental Health %G English %X In recent years, the number of available eHealth interventions aimed at treating behavioral and mental health challenges has been growing. From the perspective of health care providers, there is a need for eHealth interventions to be evaluated prior to clinical trials and for the limited resources allocated to empirical research to be invested in the most promising products. Following a literature review, a gap was found in the availability of eHealth interventions evaluation principles related to the patient experience of the therapeutic process. This paper introduces principles and concepts for the evaluation of eHealth interventions developed as a first step in a process to outline general evaluation guidelines that relate to the clinical context from health care providers’ perspective. Our approach was to conduct a review of literature that relates to the examination of eHealth interventions. We identified the literature that was most relevant to our study and used it to define guidelines that relate to the clinical context. We then compiled a list of heuristics we found to be useful for the evaluation of eHealth intervention products’ suitability for empirical examination. Four heuristics were identified with respect to the therapeutic process: (1) the product’s ease of use (ie, usability), (2) the eHealth intervention’s compatibility with the clinical setting, (3) the presence of tools that make it easier for the user to engage in therapeutic activities, and (4) the provision of a feasible therapeutic pathway to growth. We then used this set of heuristics to conduct a detailed examination of MyFitnessPal. This line of work could help to set the bar higher for product developers and to inform health care providers about preferred eHealth intervention designs. %M 26764209 %R 10.2196/mental.4563 %U http://mental.jmir.org/2016/1/e5/ %U https://doi.org/10.2196/mental.4563 %U http://www.ncbi.nlm.nih.gov/pubmed/26764209 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e4 %T Reducing Depression Through an Online Intervention: Benefits From a User Perspective %A Crisp,Dimity A %A Griffiths,Kathleen M %+ Centre for Applied Psychology, Faculty of Health, University of Canberra, Canberra, 2601, Australia, 61 62012069, Dimity.Crisp@canberra.edu.au %K Internet interventions %K depression %D 2016 %7 08.01.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Internet interventions are increasingly being recognized as effective in the treatment and prevention of mental health conditions; however, the usefulness of such programs from the perspective of the participants is often not reported. Objective: This study explores the experiences of participants of a 12-week randomized controlled trial of an automated self-help training program (e-couch), with and without an Internet support group, targeting depression. Methods: The study comprised a community sample of 298 participants who completed an online survey both prior to and on completion of an intervention for preventing or reducing depressive symptoms. Results: Overall, participants reported a high level of confidence in the ability of an online intervention to improve a person’s understanding of depression. However, confidence that a website could help people learn skills for preventing depression was lower. Benefits reported by participants engaged in the intervention included increased knowledge regarding depression and its treatment, reduced depressive symptoms, increased work productivity, and improved ability to cope with everyday stress. A minority of participants reported concerns or problems resulting from participation in the interventions. Conclusions: The findings provide consumer support for the effectiveness of this online intervention. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 65657330;http://www.isrctn.com/ISRCTN65657330 (Archived by WebCite at http://www.webcitation.org/6cwH8xwF0) %M 26747378 %R 10.2196/mental.4356 %U http://mental.jmir.org/2016/1/e4/ %U https://doi.org/10.2196/mental.4356 %U http://www.ncbi.nlm.nih.gov/pubmed/26747378 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 3 %N 1 %P e2 %T Using Smartphones to Monitor Bipolar Disorder Symptoms: A Pilot Study %A Beiwinkel,Till %A Kindermann,Sally %A Maier,Andreas %A Kerl,Christopher %A Moock,Jörn %A Barbian,Guido %A Rössler,Wulf %+ Innovation Incubator, Competence Tandem Integrated Care, Leuphana University of Lüneburg, Scharnhorststr. 1, Lüneburg, 21335, Germany, 49 4131677 ext 7826, till.beiwinkel@leuphana.de %K smartphone %K sensor technology %K bipolar disorder %K monitoring %K phase transitions %K communication patterns %K activity patterns %D 2016 %7 06.01.2016 %9 Original Paper %J JMIR Mental Health %G English %X Background: Relapse prevention in bipolar disorder can be improved by monitoring symptoms in patients' daily life. Smartphone apps are easy-to-use, low-cost tools that can be used to assess this information. To date, few studies have examined the usefulness of smartphone data for monitoring symptoms in bipolar disorder. Objective: We present results from a pilot test of a smartphone-based monitoring system, Social Information Monitoring for Patients with Bipolar Affective Disorder (SIMBA), that tracked daily mood, physical activity, and social communication in 13 patients. The objective of this study was to investigate whether smartphone measurements predicted clinical symptoms levels and clinical symptom change. The hypotheses that smartphone measurements are (1) negatively related to clinical depressive symptoms and (2) positively related to clinical manic symptoms were tested. Methods: Clinical rating scales were administered to assess clinical depressive and manic symptoms. Patients used a smartphone with the monitoring app for up to 12 months. Random-coefficient multilevel models were computed to analyze the relationship between smartphone data and externally rated manic and depressive symptoms. Overall clinical symptom levels and clinical symptom changes were predicted by separating between-patient and within-patient effects. Using established clinical thresholds from the literature, marginal effect plots displayed clinical relevance of smartphone data. Results: Overall symptom levels and change in clinical symptoms were related to smartphone measures. Higher overall levels of clinical depressive symptoms were predicted by lower self-reported mood measured by the smartphone (beta=-.56, P<.001). An increase in clinical depressive symptoms was predicted by a decline in social communication (ie, outgoing text messages: beta=-.28, P<.001) and a decline in physical activity as measured by the smartphone (ie, cell tower movements: beta=-.11, P=.03). Higher overall levels of clinical manic symptoms were predicted by lower physical activity on the smartphone (ie, distance travelled: beta=-.37, P<.001), and higher social communication (beta=.48, P=.03). An increase in clinical manic symptoms was predicted by a decrease in physical activity on the smartphone (beta=-.17, P<.001). Conclusions: Clinical symptoms were related to some objective and subjective smartphone measurements, but not all smartphone measures predicted the occurrence of bipolar symptoms above clinical thresholds. Thus, smartphones have the potential to monitor bipolar disorder symptoms in patients’ daily life. Further validation of monitoring tools in a larger sample is needed. Conclusions are limited by the low prevalence of manic and depressive symptoms in the study sample. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 05663421; http://www.controlled-trials.com/ISRCTN05663421 (Archived by WebCite at http://www.webcitation.org/6d9wsibJB) %M 26740354 %R 10.2196/mental.4560 %U http://mental.jmir.org/2016/1/e2/ %U https://doi.org/10.2196/mental.4560 %U http://www.ncbi.nlm.nih.gov/pubmed/26740354 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 18 %N 1 %P e3 %T Do Therapists Google Their Patients? A Survey Among Psychotherapists %A Eichenberg,Christiane %A Herzberg,Philipp Y %+ Department of Psychology, Sigmund Freud University, Freudplatz 1, Vienna, 1020, Austria, 43 6601599154, christiane@rz-online.de %K patient-targeted googling (PTG) %K Internet %K patient-therapist relationship %K professional-patient relationship, professional guidelines %K educational curriculum %D 2016 %7 05.01.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing use of the Internet and its array of social networks brings new ways for psychotherapists to find out information about their patients, often referred to as patient-targeted googling (PTG). However, this topic has been subject to little empirical research; there has been hardly any attention given to it in Germany and the rest of Europe and it has not been included in ethical guidelines for psychotherapy despite the complex ethical issues it raises. Objective: This study explored German psychotherapists’ behavior and experiences related to PTG, investigated how these vary with sociodemographic factors and therapeutic background, and explored the circumstances in which psychotherapists considered PTG to be appropriate or not. Methods: A total of 207 psychotherapists responded to a newly developed questionnaire that assessed their experience of and views on PTG. The study sample was a nonrepresentative convenience sample recruited online via several German-speaking professional therapy platforms. Results: Most therapists (84.5%, 174/207) stated that they had not actively considered the topic of PTG. However, 39.6% (82/207) said that they had already looked for patient information online (eg, when they suspected a patient may have been lying) and 39.3% (81/207) knew colleagues or supervisors who had done so. Only 2.4% (5/207) of therapists had come across PTG during their education and training. Conclusions: It is essential to provide PTG as a part of therapists’ education and training. Furthermore, the complex problems concerning PTG should be introduced into codes of ethics to provide explicit guidance for psychotherapists in practice. This report provides initial suggestions to open up debate on this topic. %M 26733210 %R 10.2196/jmir.4306 %U http://www.jmir.org/2016/1/e3/ %U https://doi.org/10.2196/jmir.4306 %U http://www.ncbi.nlm.nih.gov/pubmed/26733210 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 12 %P e274 %T An Online Health Prevention Intervention for Youth with Addicted or Mentally Ill Parents: Experiences and Perspectives of Participants and Providers from a Randomized Controlled Trial %A Woolderink,Marla %A Bindels,Jill APM %A Evers,Silvia MAA %A Paulus,Aggie TG %A van Asselt,Antoinette DI %A van Schayck,Onno CP %+ Clinical Epidemiology and Technology Assessment, Maastricht University Medical Center, Oxfordlaan 10, Maastricht, PO BOX 5800, 6202 AZ, Netherlands, 31 0031 043 3875, m.woolderink@maastrichtuniversity.nl %K online-delivered course %K process assessment %K qualitative research %K mental health %K prevention %K adolescents %D 2015 %7 02.12.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental illnesses affect many people around the world, either directly or indirectly. Families of persons suffering from mental illness or addiction suffer too, especially their children. In the Netherlands, 864,000 parents meet the diagnostic criteria for a mental illness or addiction. Evidence shows that offspring of mentally ill or addicted parents are at risk for developing mental disorders or illnesses themselves. The Kopstoring course is an online 8-week group course with supervision by 2 trained psychologists or social workers, aimed to prevent behavioral and psychological problems for children (aged 16 to 25 years) of parents with mental health problems or addictions. The course addresses themes such as roles in the family and mastery skills. An online randomized controlled trial (RCT) was conducted to assess the effectiveness of the Kopstoring course. Objective: The aim was to gain knowledge about expectations, experiences, and perspectives of participants and providers of the online Kopstoring course. Methods: A process evaluation was performed to evaluate the online delivery of Kopstoring and the experiences and perspectives of participants and providers of Kopstoring. Interviews were performed with members from both groups. Participants were drawn from a sample from the Kopstoring RCT. Results: Thirteen participants and 4 providers were interviewed. Five main themes emerged from these interviews: background, the requirements for the intervention, experience with the intervention, technical aspects, and research aspects. Overall, participants and providers found the intervention to be valuable because it was online; therefore, protecting their anonymity was considered a key component. Most barriers existed in the technical sphere. Additional barriers existed with conducting the RCT, namely gathering informed consent and gathering parental consent in the case of minors. Conclusions: This study provides valuable insight into participants’ and providers’ experiences and expectations with the online preventive intervention Kopstoring. It also sheds light on the process of the online provision of Kopstoring and the accompanying RCT. The findings of this study may partly explain dropout rates when delivering online interventions. The change in the (financial) structure of the youth mental health care system in the Netherlands has financial implications for the delivery of prevention programs for youth. Lastly, there are few RCTs that assess the effectiveness and cost-effectiveness of online prevention programs in the field of (youth) mental health care and not many process evaluations of these programs exist. This hampers a good comparison between online interventions and the expectations and experiences of the participants and providers. Trial Registration: Nederlands Trial Register: NTR1982; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1982 (Archived by WebCite® at http://www.webcitation.org/6d8xYDQbB) %M 26633244 %R 10.2196/jmir.4817 %U http://www.jmir.org/2015/12/e274/ %U https://doi.org/10.2196/jmir.4817 %U http://www.ncbi.nlm.nih.gov/pubmed/26633244 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e218 %T The Diagnostic Validity and Reliability of an Internet-Based Clinical Assessment Program for Mental Disorders %A Nguyen,David Phong %A Klein,Britt %A Meyer,Denny %A Austin,David William %A Abbott,Jo-Anne M %+ National eTherapy Centre, Swinburne University of Technology, Burwood Road, Hawthorn, VIC, 3122, Australia, 61 402497855, dpnguyen@outlook.com %K Internet %K online %K mental health %K validity %K reliability %K assessment %K diagnosis %K screening %K anxiety %K depression %D 2015 %7 21.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based assessment has the potential to assist with the diagnosis of mental health disorders and overcome the barriers associated with traditional services (eg, cost, stigma, distance). Further to existing online screening programs available, there is an opportunity to deliver more comprehensive and accurate diagnostic tools to supplement the assessment and treatment of mental health disorders. Objective: The aim was to evaluate the diagnostic criterion validity and test-retest reliability of the electronic Psychological Assessment System (e-PASS), an online, self-report, multidisorder, clinical assessment and referral system. Methods: Participants were 616 adults residing in Australia, recruited online, and representing prospective e-PASS users. Following e-PASS completion, 158 participants underwent a telephone-administered structured clinical interview and 39 participants repeated the e-PASS within 25 days of initial completion. Results: With structured clinical interview results serving as the gold standard, diagnostic agreement with the e-PASS varied considerably from fair (eg, generalized anxiety disorder: κ=.37) to strong (eg, panic disorder: κ=.62). Although the e-PASS’ sensitivity also varied (0.43-0.86) the specificity was generally high (0.68-1.00). The e-PASS sensitivity generally improved when reducing the e-PASS threshold to a subclinical result. Test-retest reliability ranged from moderate (eg, specific phobia: κ=.54) to substantial (eg, bulimia nervosa: κ=.87). Conclusions: The e-PASS produces reliable diagnostic results and performs generally well in excluding mental disorders, although at the expense of sensitivity. For screening purposes, the e-PASS subclinical result generally appears better than a clinical result as a diagnostic indicator. Further development and evaluation is needed to support the use of online diagnostic assessment programs for mental disorders. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). %M 26392066 %R 10.2196/jmir.4195 %U http://www.jmir.org/2015/9/e218/ %U https://doi.org/10.2196/jmir.4195 %U http://www.ncbi.nlm.nih.gov/pubmed/26392066 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e214 %T Adherence to Technology-Mediated Insomnia Treatment: A Meta-Analysis, Interviews, and Focus Groups %A Horsch,Corine %A Lancee,Jaap %A Beun,Robbert Jan %A Neerincx,Mark A %A Brinkman,Willem-Paul %+ Interactive Intelligence, Delft University of Technology, EWI HB, 12th Floor, Mekelweg 4, Delft, 2628 CD, Netherlands, 31 152784145, c.h.g.horsch@tudelft.nl %K sleep initiation and maintenance disorders %K patient compliance %K meta-analysis %K interview %K focus groups %K mobile apps %K user-computer interface %D 2015 %7 04.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Several technologies have been proposed to support the reduction of insomnia complaints. A user-centered assessment of these technologies could provide insight into underlying factors related to treatment adherence. Objective: Gaining insight into adherence to technology-mediated insomnia treatment as a solid base for improving those adherence rates by applying adherence-enhancing strategies. Methods: Adherence to technology-mediated sleep products was studied in three ways. First, a meta-analysis was performed to investigate adherence rates in technology-mediated insomnia therapy. Several databases were queried for technology-mediated insomnia treatments. After inclusion and exclusion steps, data from 18 studies were retrieved and aggregated to find an average adherence rate. Next, 15 semistructured interviews about sleep-support technologies were conducted to investigate perceived adherence. Lastly, several scenarios were written about the usage of a virtual sleep coach that could support adherence rates. The scenarios were discussed in six different focus groups consisting of potential users (n=15), sleep experts (n=7), and coaches (n=9). Results: From the meta-analysis, average treatment adherence appeared to be approximately 52% (95% CI 43%-61%) for technology-mediated insomnia treatments. This means that, on average, half of the treatment exercises were not executed, suggesting there is a substantial need for adherence and room for improvement in this area. However, the users in the interviews believed they adhered quite well to their sleep products. Users mentioned relying on personal commitment (ie, willpower) for therapy adherence. Participants of the focus groups reconfirmed their belief in the effectiveness of personal commitment, which they regarded as more effective than adherence-enhancing strategies. Conclusions: Although adherence rates for insomnia interventions indicate extensive room for improvement, users might not consider adherence to be a problem; they believe willpower to be an effective adherence strategy. A virtual coach should be able to cope with this “adherence bias” and persuade users to accept adherence-enhancing strategies, such as reminders, compliments, and community building. %M 26341671 %R 10.2196/jmir.4115 %U http://www.jmir.org/2015/9/e214/ %U https://doi.org/10.2196/jmir.4115 %U http://www.ncbi.nlm.nih.gov/pubmed/26341671 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 9 %P e197 %T Predictors of Response to Web-Based Cognitive Behavioral Therapy With High-Intensity Face-to-Face Therapist Guidance for Depression: A Bayesian Analysis %A Høifødt,Ragnhild Sørensen %A Mittner,Matthias %A Lillevoll,Kjersti %A Katla,Susanne Kvam %A Kolstrup,Nils %A Eisemann,Martin %A Friborg,Oddgeir %A Waterloo,Knut %+ Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037 Tromsø, Tromsø, 9037, Norway, 47 776 49230, ragnhild.s.hoifodt@uit.no %K treatment outcome %K computer-assisted therapy %K cognitive behavior therapy %K depression %K primary health care %K Bayesian analysis %D 2015 %7 02.09.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Several studies have demonstrated the effect of guided Internet-based cognitive behavioral therapy (ICBT) for depression. However, ICBT is not suitable for all depressed patients and there is a considerable level of nonresponse. Research on predictors and moderators of outcome in ICBT is inconclusive. Objective: This paper explored predictors of response to an intervention combining the Web-based program MoodGYM and face-to-face therapist guidance in a sample of primary care patients with mild to moderate depressive symptoms. Methods: Participants (N=106) aged between 18 and 65 years were recruited from primary care and randomly allocated to a treatment condition or to a delayed treatment condition. The intervention included the Norwegian version of the MoodGYM program, face-to-face guidance from a psychologist, and reminder emails. In this paper, data from the treatment phase of the 2 groups was merged to increase the sample size (n=82). Outcome was improvement in depressive symptoms during treatment as assessed with the Beck Depression Inventory-II (BDI-II). Predictors included demographic variables, severity variables (eg, number of depressive episodes and pretreatment depression and anxiety severity), cognitive variables (eg, dysfunctional thinking), module completion, and treatment expectancy and motivation. Using Bayesian analysis, predictors of response were explored with a latent-class approach and by analyzing whether predictors affected the slope of response. Results: A 2-class model distinguished well between responders (74%, 61/82) and nonresponders (26%, 21/82). Our results indicate that having had more depressive episodes, being married or cohabiting, and scoring higher on a measure of life satisfaction had high odds for positively affecting the probability of response. Higher levels of dysfunctional thinking had high odds for a negative effect on the probability of responding. Prediction of the slope of response yielded largely similar results. Bayes factors indicated substantial evidence that being married or cohabiting predicted a more positive treatment response. The effects of life satisfaction and number of depressive episodes were more uncertain. There was substantial evidence that several variables were unrelated to treatment response, including gender, age, and pretreatment symptoms of depression and anxiety. Conclusions: Treatment response to ICBT with face-to-face guidance may be comparable across varying levels of depressive severity and irrespective of the presence and severity of comorbid anxiety. Being married or cohabiting, reporting higher life satisfaction, and having had more depressive episodes may predict a more favorable response, whereas higher levels of dysfunctional thinking may be a predictor of poorer response. More studies exploring predictors and moderators of Internet-based treatments are needed to inform for whom this treatment is most effective. Trial Registration: Australian New Zealand Clinical Trials Registry number: ACTRN12610000257066; https://www.anzctr.org.au/trial_view.aspx?id=335255 (Archived by WebCite at http://www.webcitation.org/6GR48iZH4). %M 26333818 %R 10.2196/jmir.4351 %U http://www.jmir.org/2015/9/e197/ %U https://doi.org/10.2196/jmir.4351 %U http://www.ncbi.nlm.nih.gov/pubmed/26333818 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e105 %T Efficacy of a Multicomponent Positive Psychology Self-Help Intervention: Study Protocol of a Randomized Controlled Trial %A Schotanus-Dijkstra,Marijke %A Drossaert,Constance HC %A Pieterse,Marcel E %A Walburg,Jan A %A Bohlmeijer,Ernst T %+ Trimbos Institute, Netherlands Institute of Mental Health and Addiction, PO Box 725, Utrecht, 3500 AS, Netherlands, 31 302959383, m.schotanus@utwente.nl %K well-being %K flourishing %K mental-health promotion %K positive psychology %K self-help %K email support %D 2015 %7 20.08.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Positive psychology interventions have been found to enhance well-being and decrease clinical symptomatology. However, it is still unknown how flourishing can also be increased. Although multicomponent interventions seem to be necessary for this purpose, different formats can be used. A cost-effective approach could be a positive psychology-based self-help book with tailored email support to reach large target groups and to prevent dropout. Objective: This study will evaluate the efficacy of a comprehensive multicomponent self-help intervention with or without email support on well-being and flourishing, and will seek to determine the working mechanisms underlying the intervention. Methods: In this 3-armed, parallel, randomized controlled trial, 396 participants with low or moderate levels of well-being and without clinical symptomatology will be randomly assigned to (1) a self-help book condition with weekly email support, (2) a self-help book condition without email support but with a weekly information email, or (3) a waiting list control condition. Online measurements will be assessed at baseline, at post-test (3 months after baseline), and at 6 and 12 months after baseline. Results: The primary outcomes are well-being and flourishing (ie, high levels of well-being). Secondary outcomes are the well-being components included in the intervention: positive emotion, use of strengths, optimism, self-compassion, resilience, and positive relations. Other measures include depressive and anxiety symptoms, personality traits, direct medical and non-medical costs, life-events, and client satisfaction. Conclusions: This study will add knowledge to the efficacy and cost-effectiveness of a multicomponent positive psychology intervention. We will also explore who can benefit most from this intervention. If the intervention is found to be effective, our results will be especially relevant for public mental health services, governments, and primary care. Trial Registration: The Netherlands Trial Register NTR4297; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4297 (Archived by WebCite at http://webcitation.org/6Uwb5SUUM). %M 26293678 %R 10.2196/resprot.4162 %U http://www.researchprotocols.org/2015/3/e105/ %U https://doi.org/10.2196/resprot.4162 %U http://www.ncbi.nlm.nih.gov/pubmed/26293678 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e82 %T Review and Evaluation of Mindfulness-Based iPhone Apps %A Mani,Madhavan %A Kavanagh,David J %A Hides,Leanne %A Stoyanov,Stoyan R %+ Institute of Health & Biomedical Innovation, School of Psychology and Counselling, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, 4059, Australia, 61 434190971, m.mani@qut.edu.au %K mindfulness %K mindfulness-based mobile apps %K mobile health (mHealth) %K mental health %D 2015 %7 19.08.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: There is growing evidence for the positive impact of mindfulness on wellbeing. Mindfulness-based mobile apps may have potential as an alternative delivery medium for training. While there are hundreds of such apps, there is little information on their quality. Objective: This study aimed to conduct a systematic review of mindfulness-based iPhone mobile apps and to evaluate their quality using a recently-developed expert rating scale, the Mobile Application Rating Scale (MARS). It also aimed to describe features of selected high-quality mindfulness apps. Methods: A search for “mindfulness” was conducted in iTunes and Google Apps Marketplace. Apps that provided mindfulness training and education were included. Those containing only reminders, timers or guided meditation tracks were excluded. An expert rater reviewed and rated app quality using the MARS engagement, functionality, visual aesthetics, information quality and subjective quality subscales. A second rater provided MARS ratings on 30% of the apps for inter-rater reliability purposes. Results: The “mindfulness” search identified 700 apps. However, 94 were duplicates, 6 were not accessible and 40 were not in English. Of the remaining 560, 23 apps met inclusion criteria and were reviewed. The median MARS score was 3.2 (out of 5.0), which exceeded the minimum acceptable score (3.0). The Headspace app had the highest average score (4.0), followed by Smiling Mind (3.7), iMindfulness (3.5) and Mindfulness Daily (3.5). There was a high level of inter-rater reliability between the two MARS raters. Conclusions: Though many apps claim to be mindfulness-related, most were guided meditation apps, timers, or reminders. Very few had high ratings on the MARS subscales of visual aesthetics, engagement, functionality or information quality. Little evidence is available on the efficacy of the apps in developing mindfulness. %M 26290327 %R 10.2196/mhealth.4328 %U http://mhealth.jmir.org/2015/3/e82/ %U https://doi.org/10.2196/mhealth.4328 %U http://www.ncbi.nlm.nih.gov/pubmed/26290327 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e198 %T Mobile Apps for Bipolar Disorder: A Systematic Review of Features and Content Quality %A Nicholas,Jennifer %A Larsen,Mark Erik %A Proudfoot,Judith %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, 2031, Australia, 61 293829260, j.nicholas@blackdog.org.au %K mobile applications %K bipolar disorder %K review %K telemedicine %D 2015 %7 17.08.2015 %9 Review %J J Med Internet Res %G English %X Background: With continued increases in smartphone ownership, researchers and clinicians are investigating the use of this technology to enhance the management of chronic illnesses such as bipolar disorder (BD). Smartphones can be used to deliver interventions and psychoeducation, supplement treatment, and enhance therapeutic reach in BD, as apps are cost-effective, accessible, anonymous, and convenient. While the evidence-based development of BD apps is in its infancy, there has been an explosion of publicly available apps. However, the opportunity for mHealth to assist in the self-management of BD is only feasible if apps are of appropriate quality. Objective: Our aim was to identify the types of apps currently available for BD in the Google Play and iOS stores and to assess their features and the quality of their content. Methods: A systematic review framework was applied to the search, screening, and assessment of apps. We searched the Australian Google Play and iOS stores for English-language apps developed for people with BD. The comprehensiveness and quality of information was assessed against core psychoeducation principles and current BD treatment guidelines. Management tools were evaluated with reference to the best-practice resources for the specific area. General app features, and privacy and security were also assessed. Results: Of the 571 apps identified, 82 were included in the review. Of these, 32 apps provided information and the remaining 50 were management tools including screening and assessment (n=10), symptom monitoring (n=35), community support (n=4), and treatment (n=1). Not even a quarter of apps (18/82, 22%) addressed privacy and security by providing a privacy policy. Overall, apps providing information covered a third (4/11, 36%) of the core psychoeducation principles and even fewer (2/13, 15%) best-practice guidelines. Only a third (10/32, 31%) cited their information source. Neither comprehensiveness of psychoeducation information (r=-.11, P=.80) nor adherence to best-practice guidelines (r=-.02, P=.96) were significantly correlated with average user ratings. Symptom monitoring apps generally failed to monitor critical information such as medication (20/35, 57%) and sleep (18/35, 51%), and the majority of self-assessment apps did not use validated screening measures (6/10, 60%). Conclusions: In general, the content of currently available apps for BD is not in line with practice guidelines or established self-management principles. Apps also fail to provide important information to help users assess their quality, with most lacking source citation and a privacy policy. Therefore, both consumers and clinicians should exercise caution with app selection. While mHealth offers great opportunities for the development of quality evidence-based mobile interventions, new frameworks for mobile mental health research are needed to ensure the timely availability of evidence-based apps to the public. %M 26283290 %R 10.2196/jmir.4581 %U http://www.jmir.org/2015/8/e198/ %U https://doi.org/10.2196/jmir.4581 %U http://www.ncbi.nlm.nih.gov/pubmed/26283290 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e99 %T Depression Awareness and Self-Management Through the Internet: Protocol for an Internationally Standardized Approach %A Arensman,Ella %A Koburger,Nicole %A Larkin,Celine %A Karwig,Gillian %A Coffey,Claire %A Maxwell,Margaret %A Harris,Fiona %A Rummel-Kluge,Christine %A van Audenhove,Chantal %A Sisask,Merike %A Alexandrova-Karamanova,Anna %A Perez,Victor %A Purebl,György %A Cebria,Annabel %A Palao,Diego %A Costa,Susana %A Mark,Lauraliisa %A Tóth,Mónika Ditta %A Gecheva,Marieta %A Ibelshäuser,Angela %A Gusmão,Ricardo %A Hegerl,Ulrich %+ National Suicide Research Foundation, University College Cork, 4.28 Western Gateway Building, Cork, , Ireland, 353 (0)21 4205541, EArensman@ucc.ie %K cognitive behavioral therapy %K computerized %K depression %K Internet-based %K primary care %K self-management %D 2015 %7 06.08.2015 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression incurs significant morbidity and confers increased risk of suicide. Many individuals experiencing depression remain untreated due to systemic and personal barriers to care. Guided Internet-based psychotherapeutic programs represent a promising means of overcoming such barriers and increasing the capacity for self-management of depression. However, existing programs tend to be available only in English and can be expensive to access. Furthermore, despite evidence of the effectiveness of a number of Internet-based programs, there is limited evidence regarding both the acceptability of such programs and feasibility of their use, for users and health care professionals. Objective: This paper will present the protocol for the development, implementation, and evaluation of the iFightDepression tool, an Internet-based self-management tool. This is a cost-free, multilingual, guided, self-management program for mild to moderate depression cases. Methods: The Preventing Depression and Improving Awareness through Networking in the European Union consortium undertook a comprehensive systematic review of the available evidence regarding computerized cognitive behavior therapy in addition to a consensus process involving mental health experts and service users to inform the development of the iFightDepression tool. The tool was implemented and evaluated for acceptability and feasibility of its use in a pilot phase in 5 European regions, with recruitment of users occurring through general practitioners and health care professionals who participated in a standardized training program. Results: Targeting mild to moderate depression, the iFightDepression tool is based on cognitive behavioral therapy and addresses behavioral activation (monitoring and planning daily activities), cognitive restructuring (identifying and challenging unhelpful thoughts), sleep regulation, mood monitoring, and healthy lifestyle habits. There is also a tailored version of the tool for young people, incorporating less formal language and additional age-appropriate modules on relationships and social anxiety. The tool is accompanied by a 3-hour training intervention for health care professionals. Conclusions: It is intended that the iFightDepression tool and associated training for health care professionals will represent a valuable resource for the management of depression that will complement existing resources for health care professionals. It is also intended that the iFightDepression tool and training will represent an additional resource within a multifaceted approach to improving the care of depression and preventing suicidal behavior in Europe. %M 26251104 %R 10.2196/resprot.4358 %U http://www.researchprotocols.org/2015/3/e99/ %U https://doi.org/10.2196/resprot.4358 %U http://www.ncbi.nlm.nih.gov/pubmed/26251104 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 7 %P e187 %T A Web-Based Adolescent Positive Psychology Program in Schools: Randomized Controlled Trial %A Burckhardt,Rowan %A Manicavasagar,Vijaya %A Batterham,Philip J %A Miller,Leonie M %A Talbot,Elizabeth %A Lum,Alistair %+ University of NSW and the Black Dog Institute, Black Dog Institute, Hospital Rd, Randwick, 2031, Australia, 61 293824530, r.burckhardt@unsw.edu.au %K adolescent %K Internet %K early medical intervention %K randomized controlled trial %D 2015 %7 28.07.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Adolescent mental health is characterized by relatively high rates of psychiatric disorders and low levels of help-seeking behaviors. Existing mental health programs aimed at addressing these issues in adolescents have repeated inconsistent results. Such programs have generally been based on techniques derived from cognitive behavioral therapy, which may not be ideally suited to early intervention among adolescent samples. Positive psychology, which seeks to improve well-being rather than alleviate psychological symptoms, offers an alternative approach. A previous community study of adolescents found that informal engagement in an online positive psychology program for up to 6 weeks yielded significant improvements in both well-being and depression symptoms. However, this approach had not been trialed among adolescents in a structured format and within a school setting. Objective: This study examines the feasibility of an online school-based positive psychology program delivered in a structured format over a 6-week period utilizing a workbook to guide students through website content and interactive exercises. Methods: Students from four high schools were randomly allocated by classroom to either the positive psychology condition, "Bite Back", or the control condition. The Bite Back condition consisted of positive psychology exercises and information, while the control condition used a series of non-psychology entertainment websites. Both interventions were delivered online for 6 hours over a period of 4-6 weeks during class time. Symptom measures and measures of well-being/flourishing and life satisfaction were administered at baseline and post intervention. Results: Data were analyzed using multilevel linear modeling. Both conditions demonstrated reductions in depression, stress, and total symptom scores without any significant differences between the two conditions. Both the Bite Back and control conditions also demonstrated significant improvements in life satisfaction scores post intervention. However, only the control condition demonstrated significant increases in flourishing scores post intervention. Conclusions: Results suggest that a structured online positive psychology program administered within the school curriculum was not effective when compared to the control condition. The limitations of online program delivery in school settings including logistic considerations are also relevant to the contradictory findings of this study. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN1261200057831; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362489 (Archived by Webcite at http://www.webcitation.org/6NXmjwfAy). %M 26220564 %R 10.2196/jmir.4329 %U http://www.jmir.org/2015/7/e187/ %U https://doi.org/10.2196/jmir.4329 %U http://www.ncbi.nlm.nih.gov/pubmed/26220564 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 6 %P e152 %T Web-Based Cognitive Behavioral Therapy for Female Patients With Eating Disorders: Randomized Controlled Trial %A ter Huurne,Elke D %A de Haan,Hein A %A Postel,Marloes G %A van der Palen,Job %A VanDerNagel,Joanne EL %A DeJong,Cornelis AJ %+ Tactus Addiction Treatment, Raiffeisenstraat 75, Enschede, 7514 AM, Netherlands, 31 883822887, e.terhuurne@tactus.nl %K eating disorders %K bulimia nervosa %K binge-eating disorder %K eating disorders not otherwise specified %K randomized controlled trial %K eHealth %K Web-based treatment %K asynchronous therapeutic support %K treatment effectiveness %K cognitive behavioral therapy %D 2015 %7 18.06.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Many patients with eating disorders do not receive help for their symptoms, even though these disorders have severe morbidity. The Internet may offer alternative low-threshold treatment interventions. Objective: This study evaluated the effects of a Web-based cognitive behavioral therapy (CBT) intervention using intensive asynchronous therapeutic support to improve eating disorder psychopathology, and to reduce body dissatisfaction and related health problems among patients with eating disorders. Methods: A two-arm open randomized controlled trial comparing a Web-based CBT intervention to a waiting list control condition (WL) was carried out among female patients with bulimia nervosa (BN), binge eating disorder (BED), and eating disorders not otherwise specified (EDNOS). The eating disorder diagnosis was in accordance with the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, and was established based on participants’ self-report. Participants were recruited from an open-access website, and the intervention consisted of a structured two-part program within a secure Web-based application. The aim of the first part was to analyze participant’s eating attitudes and behaviors, while the second part focused on behavioral change. Participants had asynchronous contact with a personal therapist twice a week, solely via the Internet. Self-report measures of eating disorder psychopathology (primary outcome), body dissatisfaction, physical health, mental health, self-esteem, quality of life, and social functioning were completed at baseline and posttest. Results: A total of 214 participants were randomized to either the Web-based CBT group (n=108) or to the WL group (n=106) stratified by type of eating disorder (BN: n=44; BED: n=85; EDNOS: n=85). Study attrition was low with 94% of the participants completing the posttest assignment. Overall, Web-based CBT showed a significant improvement over time for eating disorder psychopathology (F97=63.07, P<.001, d=.82) and all secondary outcome measures (effect sizes between d=.34 to d=.49), except for Body Mass Index. WL participants also improved on most outcomes; however, effects were smaller in this group with significant between-group effects for eating disorder psychopathology (F201=9.42, P=.002, d=.44), body dissatisfaction (F201=13.16, P<.001, d=.42), physical health (F200=12.55, P<.001, d=.28), mental health (F203=4.88, P=.028, d=.24), self-esteem (F202=5.06, P=.026, d=.20), and social functioning (F205=7.93, P=.005, d=.29). Analyses for the individual subgroups BN, BED, and EDNOS showed that eating disorder psychopathology improved significantly over time among Web-based CBT participants in all three subgroups; however, the between-group effect was significant only for participants with BED (F78=4.25, P=.043, d=.61). Conclusions: Web-based CBT proved to be effective in improving eating disorder psychopathology and related health among female patients with eating disorders. Trial Registration: Nederlands Trial Register (NTR): NTR2415; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2415 (Archived by WebCite at http://www.webcitation.org/6T2io3DnJ). %M 26088580 %R 10.2196/jmir.3946 %U http://www.jmir.org/2015/6/e152/ %U https://doi.org/10.2196/jmir.3946 %U http://www.ncbi.nlm.nih.gov/pubmed/26088580 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 6 %P e147 %T ClickDiary: Online Tracking of Health Behaviors and Mood %A Chan,Ta-Chien %A Yen,Tso-Jung %A Fu,Yang-Chih %A Hwang,Jing-Shiang %+ Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Taipei City, 115, Taiwan, 886 2 6614 5677, hwang@sinica.edu.tw %K health behaviors %K mood %K diet %K physical exercise %K quality of sleep %K personality %D 2015 %7 15.06.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Traditional studies of health behaviors are typically conducted using one-shot, cross-sectional surveys. Thus, participants’ recall bias may undermine the reliability and validity of the data. To capture mood changes and health behaviors in everyday life, we designed an online survey platform, ClickDiary, which helped collect more complete information for comprehensive data analyses. Objective: We aim to understand whether daily mood changes are related to one’s personal characteristics, demographic factors, and daily health behaviors. Methods: The ClickDiary program uses a Web-based platform to collect data on participants’ health behaviors and their social-contact networks. The name ClickDiary comes from the platform’s interface, which is designed to allow the users to respond to most of the survey questions simply by clicking on the options provided. Participants were recruited from the general population and came from various backgrounds. To keep the participants motivated and interested, the ClickDiary program included a random drawing for rewards. We used descriptive statistics and the multilevel proportional-odds mixed model for our analysis. Results: We selected 130 participants who had completed at least 30 days of ClickDiary entries from May 1 to October 31, 2014 as our sample for the study. According to the results of the multilevel proportional-odds mixed model, a person tended to be in a better mood on a given day if he or she ate more fruits and vegetables, took in more sugary drinks, ate more fried foods, showed no cold symptoms, slept better, exercised longer, and traveled farther away from home. In addition, participants were generally in a better mood during the weekend than on weekdays. Conclusions: Sleeping well, eating more fruits and vegetables, and exercising longer each day all appear to put one in a better mood. With the online ClickDiary survey, which reduces the recall biases that are common in traditional one-shot surveys, we were able to collect and analyze the daily variations of each subject’s health behaviors and mood status. %M 26076583 %R 10.2196/jmir.4315 %U http://www.jmir.org/2015/6/e147/ %U https://doi.org/10.2196/jmir.4315 %U http://www.ncbi.nlm.nih.gov/pubmed/26076583 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 6 %P e139 %T Computerized Cognitive Behavior Therapy for Anxiety and Depression in Rural Areas: A Systematic Review %A Vallury,Kari Dee %A Jones,Martin %A Oosterbroek,Chloe %+ Department of Rural Health (DRH), Division of Health Sciences, University of South Australia, Department of Rural Health, 111 Nicolson Avenue, Whyalla Norrie, 5608, Australia, 61 0433773061, kari.vallury@unisa.edu.au %K eHealth %K mHealth %K depression %K anxiety %K cognitive therapy %K rural health %K mental health %D 2015 %7 05.06.2015 %9 Review %J J Med Internet Res %G English %X Background: People living in rural and remote communities have greater difficulty accessing mental health services and evidence-based therapies, such as cognitive behavior therapy (CBT), than their urban counterparts. Computerized CBT (CCBT) can be used to effectively treat depression and anxiety and may be particularly useful in rural settings where there are a lack of suitably trained practitioners. Objective: To systematically review the global evidence regarding the clinical effectiveness and acceptability of CCBT interventions for anxiety and/or depression for people living in rural and remote locations. Methods: We searched seven online databases: Medline, Embase Classic and Embase, PsycINFO, CINAHL, Web of Science, Scopus, and the Cochrane Library. We also hand searched reference lists, Internet search engines, and trial protocols. Two stages of selection were undertaken. In the first, the three authors screened citations. Studies were retained if they reported the efficacy, effectiveness or acceptability of CCBT for depression and/or anxiety disorders, were peer reviewed, and written in English. The qualitative data analysis software, NVivo 10, was then used to run automated text searches for the word “rural,” its synonyms, and stemmed words. All studies identified were read in full and were included in the study if they measured or meaningfully discussed the efficacy or acceptability of CCBT among rural participants. Results: A total of 2594 studies were identified, of which 11 met the selection criteria and were included in the review. The studies that disaggregated efficacy data by location of participant reported that CCBT was equally effective for rural and urban participants. Rural location was found to both positively and negatively predict adherence across studies. CCBT may be more acceptable among rural than urban participants—studies to date showed that rural participants were less likely to want more face-to-face contact with a practitioner and found that computerized delivery addressed confidentiality concerns. Conclusions: CCBT can be effective for addressing depression and anxiety and is acceptable among rural participants. Further work is required to confirm these results across a wider range of countries, and to determine the most feasible model of CCBT delivery, in partnership with people who live and work in rural and remote communities. %M 26048193 %R 10.2196/jmir.4145 %U http://www.jmir.org/2015/6/e139/ %U https://doi.org/10.2196/jmir.4145 %U http://www.ncbi.nlm.nih.gov/pubmed/26048193 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 2 %P e18 %T Preferences of Young Adults With First-Episode Psychosis for Receiving Specialized Mental Health Services Using Technology: A Survey Study %A Lal,Shalini %A Dell'Elce,Jennifer %A Tucci,Natasha %A Fuhrer,Rebecca %A Tamblyn,Robyn %A Malla,Ashok %+ School of Rehabilitation, University of Montreal, CP 6128, succursale Centre-ville, Montreal, QC, H3C 3J7, Canada, 1 514 761 6131 ext 2426, shalini.lal@umontreal.ca %K eHealth %K health services accessibility %K medical informatics %K mHealth %K patient engagement %K telemedicine %D 2015 %7 20.05.2015 %9 Short Paper %J JMIR Mental Health %G English %X Background: Despite the potential and interest of using technology for delivering specialized psychiatric services to young adults, surprisingly limited attention has been paid to systematically assess their perspectives in this regard. For example, limited knowledge exists on the extent to which young people receiving specialized services for a first-episode psychosis (FEP) are receptive to using new technologies as part of mental health care, and to which types of technology-enabled mental health interventions they are amenable to. Objective: The purpose of this study is to assess the interest of young adults with FEP in using technology to receive mental health information, services, and supports. Methods: This study uses a cross-sectional, descriptive survey design. A convenience sample of 67 participants between the ages of 18 and 35 were recruited from two specialized early intervention programs for psychosis. Interviewer-administered surveys were conducted between December 2013 and October 2014. Descriptive statistics are reported. Results: Among the 67 respondents who completed the survey, the majority (85%, 57/67) agreed or strongly agreed with YouTube as a platform for mental health-related services and supports. The top five technology-enabled services that participants were amenable to were (1) information on medication (96%, 64/67); (2) information on education, career, and employment (93%, 62/67); (3) decision-making tools pertaining to treatment and recovery (93%, 62/67); (4) reminders for appointments via text messaging (93%, 62/67); and (5) information about mental health, psychosis, and recovery in general (91%, 61/67). The top self-reported barriers to seeking mental health information online were lack of knowledge on how to perform an Internet search (31%, 21/67) and the way information is presented online (27%, 18/67). Two thirds (67%; 45/67) reported being comfortable in online settings, and almost half (48%; 32/67) reported a preference for mixed formats when viewing mental health information online (eg, text, video, visual graphics). Conclusions: Young people diagnosed with FEP express interest in using the Internet, social media, and mobile technologies for receiving mental health-related services. Increasing the awareness of young people in relation to various forms of technology-enabled mental health care warrants further attention. A consideration for future research is to obtain more in-depth knowledge on young people’s perspectives, which can help improve the design, development, and implementation of integrated technological health innovations within the delivery of specialized mental health care. %M 26543922 %R 10.2196/mental.4400 %U http://mental.jmir.org/2015/2/e18/ %U https://doi.org/10.2196/mental.4400 %U http://www.ncbi.nlm.nih.gov/pubmed/26543922 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e123 %T E-Mental Health Care Among Young Adults and Help-Seeking Behaviors: A Transversal Study in a Community Sample %A Younes,Nadia %A Chollet,Aude %A Menard,Estelle %A Melchior,Maria %+ Centre Hospitalier de Versailles, 177, rue de Versailles, Le Chesnay, 78150, France, 33 0139639380, nyounes@ch-versailles.fr %K Internet %K mental health services %K young adult %K epidemiology %K health care disparities %D 2015 %7 15.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is widely used by young people and could serve to improve insufficient access to mental health care. Previous information on this topic comes from selected samples (students or self-selected individuals) and is incomplete. Objective: In a community sample of young adults, we aimed to describe frequency of e-mental health care study-associated factors and to determine if e-mental health care was associated with the use of conventional services for mental health care. Methods: Using data from the 2011 wave of the TEMPO cohort study of French young adults (N=1214, aged 18-37 years), we examined e-mental health care and associated factors following Andersen’s behavioral model: predisposing factors (age, sex, educational attainment, professional activity, living with a partner, children, childhood negative events, chronic somatic disease, parental history of depression), enabling factors (social support, financial difficulties, parents’ income), and needs-related factors (lifetime major depression or anxiety disorders, suicidal ideation, ADHD, cannabis use). We compared traditional service use (seeking help from a general practitioner, a psychiatrist, a psychologist; antidepressant or anxiolytics/hypnotics use) between participants who used e-mental health care versus those who did not. Results: Overall, 8.65% (105/1214) of participants reported seeking e-mental health care in case of psychological difficulties in the preceding 12 months and 15.7% (104/664) reported psychological difficulties. Controlling for all covariates, the likelihood of e-mental health care was positively associated with 2 needs-related factors, lifetime major depression or anxiety disorder (OR 2.36, 95% CI 1.36-4.09) and lifetime suicidal ideation (OR 1.91, 95% CI 1.40-2.60), and negatively associated with a predisposing factor: childhood life events (OR 0.60, 95% CI 0.38-0.93). E-mental health care did not hinder traditional care, but was associated with face-to-face psychotherapy (66.2%, 51/77 vs 52.4%, 186/355, P=.03). Conclusions: E-mental health care represents an important form of help-seeking behavior for young adults. Professionals and policy makers should take note of this and aim to improve the quality of online information on mental health care and to use this fact in clinical care. %M 25979680 %R 10.2196/jmir.4254 %U http://www.jmir.org/2015/5/e123/ %U https://doi.org/10.2196/jmir.4254 %U http://www.ncbi.nlm.nih.gov/pubmed/25979680 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e116 %T Effectiveness of a Blended Web-Based Intervention on Return to Work for Sick-Listed Employees With Common Mental Disorders: Results of a Cluster Randomized Controlled Trial %A Volker,Daniëlle %A Zijlstra-Vlasveld,Moniek C %A Anema,Johannes R %A Beekman,Aartjan TF %A Brouwers,Evelien PM %A Emons,Wilco HM %A van Lomwel,A Gijsbert C %A van der Feltz-Cornelis,Christina M %+ Trimbos Institute, Netherlands institute of mental health and addiction, Da Costakade 45, Utrecht, 3500 AS, Netherlands, 31 30 2959287, dvolker@trimbos.nl %K occupational health %K randomized controlled trial %K mental health %K depression %K anxiety %K sick leave %D 2015 %7 13.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Common mental disorders are strongly associated with long-term sickness absence, which has negative consequences for the individual employee’s quality of life and leads to substantial costs for society. It is important to focus on return to work (RTW) during treatment of sick-listed employees with common mental disorders. Factors such as self-efficacy and the intention to resume work despite having symptoms are important in the RTW process. We developed “E-health module embedded in Collaborative Occupational health care” (ECO) as a blended Web-based intervention with 2 parts: an eHealth module (Return@Work) for the employee aimed at changing cognitions of the employee regarding RTW and a decision aid via email supporting the occupational physician with advice regarding treatment and referral options based on monitoring the employee’s progress during treatment. Objective: This study evaluated the effect of a blended eHealth intervention (ECO) versus care as usual on time to RTW of sick-listed employees with common mental disorders. Methods: The study was a 2-armed cluster randomized controlled trial. Employees sick-listed between 4 and 26 weeks with common mental disorder symptoms were recruited by their occupational health service or employer. The employees were followed up to 12 months. The primary outcome measures were time to first RTW (partial or full) and time to full RTW. Secondary outcomes were response and remission of the common mental disorder symptoms (self-assessed). Results: A total of 220 employees were included: 131 participants were randomized to the ECO intervention and 89 to care as usual (CAU). The duration until first RTW differed significantly between the groups. The median duration was 77.0 (IQR 29.0-152.3) days in the CAU group and 50.0 (IQR 20.8-99.0) days in the ECO group (hazard ratio [HR] 1.390, 95% CI 1.034-1.870, P=.03). No significant difference was found for duration until full RTW. Treatment response of common mental disorder symptoms did not differ significantly between the groups, but at 9 months after baseline significantly more participants in the ECO group achieved remission than in the CAU group (OR 2.228, 95% CI 1.115-4.453, P=.02). Conclusions: The results of this study showed that in a group of sick-listed employees with common mental disorders, applying the blended eHealth ECO intervention led to faster first RTW and more remission of common mental disorder symptoms than CAU. Trial Registration: Netherlands Trial Register NTR2108; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2108. (Archived by WebCite at http://www.webcitation.org/6YBSnNx3P). %M 25972279 %R 10.2196/jmir.4097 %U http://www.jmir.org/2015/5/e116/ %U https://doi.org/10.2196/jmir.4097 %U http://www.ncbi.nlm.nih.gov/pubmed/25972279 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 5 %P e117 %T A Web-Based Psychoeducational Program for Informal Caregivers of Patients With Alzheimer’s Disease: A Pilot Randomized Controlled Trial %A Cristancho-Lacroix,Victoria %A Wrobel,Jérémy %A Cantegreil-Kallen,Inge %A Dub,Timothée %A Rouquette,Alexandra %A Rigaud,Anne-Sophie %+ Assistance Publique - Hôpitaux de Paris, Department of Gerontology, Hôpital Broca, 54-56 rue Pascal, Paris, 75013, France, 33 33144083351, victoria.cristancho@gmail.com %K family caregivers %K psychological education %K eHealth %K Alzheimer disease %K emotional stress %K qualitative research %K Internet %K randomized controlled trials %D 2015 %7 12.05.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Although several face-to-face programs are dedicated to informal caregivers of persons with dementia, they are not always accessible to overburdened or isolated caregivers. Based on a face-to-face intervention program, we adapted and designed a Web-based fully automated psychoeducational program (called Diapason) inspired by a cognitive approach. Objective: This study aimed to evaluate through a pilot unblinded randomized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer’s disease (PWAD) based on a mixed methods research design. Methods: We recruited and randomized offline 49 informal caregivers of a PWAD in a day care center in Paris, France. They either received the Web-based intervention and usual care for 3 months (experimental group, n=25) or only usual care (control group, n=24). Caregivers’ perceived stress (PSS-14, primary outcome), self-efficacy, burden, perceived health status, and depression (secondary outcomes) were measured during 3 face-to-face on-site visits: at baseline, at the end of the program (month 3), and after follow-up (month 6). Additionally, semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis. Results: Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups (P=.98). The experimental group significantly improved their knowledge of the illness (d=.79, P=.008) from baseline to month 3. Of the 25 participants allocated to the experimental group, 17 (71%) finished the protocol and entirely viewed at least 10 of 12 online sessions. On average, participants used the website 19.72 times (SD 12.88) and were connected for 262.20 minutes (SD 270.74). The results of the satisfaction questionnaire showed that most participants considered the program to be useful (95%, 19/20), clear (100%, 20/20), and comprehensive (85%, 17/20). Significant correlations were found between relationship and caregivers’ program opinion (P=.01). Thus, positive opinions were provided by husbands and sons (3/3), whereas qualified opinions were primarily reported by daughters (8/11). Female spouses expressed negative (2/3) or neutral opinions (1/3). Caregivers expected more dynamic content and further interaction with staff and peers. Conclusions: In this study, quantitative results were inconclusive owing to small sample size. Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers. Caregivers did not rule out their interest in this kind of intervention provided that it met their needs. More dynamic, personalized, and social interventions are desirable. Our recruitment issues pointed out the necessity of in-depth studies about caregivers’ help-seeking behaviors and readiness factors. Trial Registration: Clinicaltrials.gov NCT01430286; http://clinicaltrials.gov/ct2/show/NCT01430286 (Archived by WebCite at http://www.webcitation/6KxHaRspL). %M 25967983 %R 10.2196/jmir.3717 %U http://www.jmir.org/2015/5/e117/ %U https://doi.org/10.2196/jmir.3717 %U http://www.ncbi.nlm.nih.gov/pubmed/25967983 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e105 %T Six-Month Outcomes of a Web-Based Intervention for Users of Amphetamine-Type Stimulants: Randomized Controlled Trial %A Tait,Robert J %A McKetin,Rebecca %A Kay-Lambkin,Frances %A Carron-Arthur,Bradley %A Bennett,Anthony %A Bennett,Kylie %A Christensen,Helen %A Griffiths,Kathleen M %+ National Drug Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, 6845, Australia, 61 8 92661610, robert.tait@curtin.edu.au %K amphetamine-related disorders %K Internet %K randomized controlled trial %K intervention studies %K cognitive therapy %D 2015 %7 29.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of amphetamine-type stimulants (ATS) places a large burden on health services. Objective: The aim was to evaluate the effectiveness of a self-guided Web-based intervention (“breakingtheice”) for ATS users over 6 months via a free-to-access site. Methods: We conducted a randomized trial comparing a waitlist control with a fully automated intervention containing 3 modules derived from cognitive behavioral therapy and motivation enhancement. The main outcome was self-reported ATS use in the past 3 months assessed at 3- and 6-month follow-ups using the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST). Secondary outcomes were help-seeking intentions (general help-seeking questionnaire), actual help seeking (actual help-seeking questionnaire), psychological distress (Kessler 10), polydrug use (ASSIST), quality of life (European Health Interview Survey), days out of role, and readiness to change. Follow-up data were evaluated using an intention-to-treat (ITT) analysis with a group by time interaction. Results: We randomized 160 people (intervention: n=81; control: n=79). At 6 months, 38 of 81 (47%) intervention and 41 of 79 (52%) control participants provided data. ATS scores significantly declined for both groups, but the interaction effect was not significant. There were significant ITT time by group interactions for actual help seeking (rate ratio [RR] 2.16; d=0.45) and help-seeking intentions (RR 1.17; d=0.32), with help seeking increasing for the intervention group and declining for the control group. There were also significant interactions for days completely (RR 0.50) and partially (RR 0.74) out of role favoring the intervention group. However, 37% (30/81) of the intervention group did not complete even 1 module. Conclusions: This self-guided Web-based intervention encouraged help seeking associated with ATS use and reduced days out of role, but it did not reduce ATS use. Thus, this program provides a means of engaging with some sections of a difficult-to-reach group to encourage treatment, but a substantial minority remained disengaged. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343307 (Archived by WebCite at http://www.webcitation.org/6Y0PGGp8q). %M 25925801 %R 10.2196/jmir.3778 %U http://www.jmir.org/2015/4/e105/ %U https://doi.org/10.2196/jmir.3778 %U http://www.ncbi.nlm.nih.gov/pubmed/25925801 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 2 %P e13 %T Effectiveness of Computer-Assisted Therapy for Substance Dependence Using Breaking Free Online: Subgroup Analyses of a Heterogeneous Sample of Service Users %A Elison,Sarah %A Davies,Glyn %A Ward,Jonathan %+ Breaking Free Online, 274 Deansgate, Manchester, M3 4JB, United Kingdom, 44 0161 834 ext 4647, selison@breakingfreegroup.com %K substance misuse %K computer-assisted therapy %K treatment %K psychosocial interventions %D 2015 %7 23.04.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: Substance misuse services within the United Kingdom have traditionally been oriented to opiate and crack users, and attended predominantly by male service users. Groups who do not fit this demographic, such as women or those whose primary drug of choice is neither heroin nor crack, have tended to be underrepresented in services. In addition, there can be stigma associated with traditional opiate and crack-centric services. Therefore, the computerized treatment and recovery program, Breaking Free Online (BFO), was developed to enable service users to access confidential support for dependence on a wide range of substances. BFO is delivered as computer-assisted therapy (CAT), or, where appropriate, used as self-help. Objective: The aim of this study was to report psychometric outcomes data from 393 service users accessing online support for substance misuse via BFO. Methods: Following initial referral to substance misuse services, all participants were supported in setting up a BFO login by a practitioner or peer mentor, and, where required, assisted as they completed an online baseline assessment battery contained within the BFO program. Following a period of engagement with BFO, all participants completed the same battery of assessments, and changes in the scores on these assessments were examined. Results: Significant improvements were found across the 393 service users in several areas of psychosocial functioning, including quality of life, severity of alcohol and drug dependence, depression, and anxiety (P=<.001 across all aspects of functioning). Additionally, significant improvements were found within specific subgroups of participants, including females (P=.001-<.001), males (P=.004-<.001), service users reporting alcohol dependence (P=.002-<.001), opiate and crack dependence (P=.014-<.001), and those seeking support for other substances that may be less well represented in the substance misuse sector (P=.001-<.001). Conclusions: Data from this study indicates that BFO is an effective clinical treatment for a wide range of individuals requiring support for substance misuse. Further work is currently underway to examine more closely the clinical effectiveness of the program. %M 26543918 %R 10.2196/mental.4355 %U http://mental.jmir.org/2015/2/e13/ %U https://doi.org/10.2196/mental.4355 %U http://www.ncbi.nlm.nih.gov/pubmed/26543918 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e44 %T Internet-Based Cognitive Behavioral Therapy for Residual Symptoms in Bipolar Disorder Type II: A Single-Subject Design Pilot Study %A Holländare,Fredrik %A Eriksson,Annsofi %A Lövgren,Lisa %A Humble,Mats B %A Boersma,Katja %+ Psychiatric Research Centre, School of Health and Medical Science, Örebro University, S House, Södra Grev Rosengatan, Örebro, 70116, Sweden, 46 196025890, fredrik.hollandare@orebroll.se %K bipolar disorder %K Internet %K cognitive therapy %K behavioral therapy %K pilot projects %D 2015 %7 23.04.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Bipolar disorder is a chronic condition with recurring episodes that often lead to suffering, decreased functioning, and sick leave. Pharmacotherapy in the form of mood stabilizers is widely available, but does not eliminate the risk of a new depressive or (hypo)manic episode. One way to reduce the risk of future episodes is to combine pharmacological treatment with individual or group psychological interventions. However, access to such interventions is often limited due to a shortage of trained therapists. In unipolar depression there is now robust evidence of the effectiveness of Internet-based psychological interventions, usually comprising psychoeducation and cognitive behavioral therapy (CBT). Internet-based interventions for persons suffering from bipolar disorder could increase access to psychological treatment. Objective: The aim of this study was to investigate the feasibility of an Internet-based intervention, as well as its effect on residual depressive symptoms in persons diagnosed with bipolar disorder type II (BP-II). The most important outcomes were depressive symptoms, treatment adherence, and whether the patient perceived the intervention as helpful. Methods: A total of 7 patients diagnosed with bipolar disorder type II at a Swedish psychiatric outpatient clinic were offered the opportunity to participate. Of the 7 patients, 3 (43%) dropped out before treatment began, and 4 (57%) were treated by means of an online, Internet-based intervention based on CBT (iCBT). The intervention was primarily aimed at psychoeducation, treatment of residual depressive symptoms, emotion regulation, and improved sleep. All patients had ongoing pharmacological treatment at recruitment and established contact with a psychiatrist. The duration of BP-II among the treated patients was between 6 and 31 years. A single-subject design was used and the results of the 4 participating patients were presented individually. Results: Initiating treatment was perceived as too demanding under current life circumstances for 3 patients who consequently dropped out during baseline assessment. Self-ratings using the Montgomery-Åsberg Depression Rating Scale—Self-rated (MADRS-S) showed symptom reduction in 3 (75%) of the 4 treated cases during iCBT. In the evaluation of the treatment, 2 patients reported that they perceived that the treatment had reduced symptoms a little, 1 that it had reduced symptoms very much, and 1 not at all. Treatment adherence (ie, module completion) was fairly high in 3 cases. In general, the modules were perceived as fairly helpful or very helpful by the patients. In one case, there was a reliable change—according to the Reliable Change Index—in self-rated symptoms of depression and perseverative thinking. Conclusions: The treatment seemed to have acceptable feasibility. The iCBT intervention could be an effective way to treat residual symptoms in some patients with bipolar disorder type II. This should be investigated in a larger study. Trial Registration: ClinicalTrials.gov NCT01742351; https://clinicaltrials.gov/ct2/show/NCT01742351 (Archived by WebCite at http://www.webcitation.org/6XnVpv4C3). %M 25908235 %R 10.2196/resprot.3910 %U http://www.researchprotocols.org/2015/2/e44/ %U https://doi.org/10.2196/resprot.3910 %U http://www.ncbi.nlm.nih.gov/pubmed/25908235 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 4 %P e88 %T The Mediating Effect of Gaming Motivation Between Psychiatric Symptoms and Problematic Online Gaming: An Online Survey %A Király,Orsolya %A Urbán,Róbert %A Griffiths,Mark D %A Ágoston,Csilla %A Nagygyörgy,Katalin %A Kökönyei,Gyöngyi %A Demetrovics,Zsolt %+ Institute of Psychology, Eötvös Loránd University, 1st Fl., 46 Izabella St, Budapest, 1064, Hungary, 36 30 976 1097, demetrovics@t-online.hu %K video games %K Internet %K motivation %K behavior, addictive %K psychopathology %K coping behavior %D 2015 %7 07.04.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid expansion of online video gaming as a leisure time activity has led to the appearance of problematic online gaming (POG). According to the literature, POG is associated with different psychiatric symptoms (eg, depression, anxiety) and with specific gaming motives (ie, escape, achievement). Based on studies of alcohol use that suggest a mediator role of drinking motives between distal influences (eg, trauma symptoms) and drinking problems, this study examined the assumption that there is an indirect link between psychiatric distress and POG via the mediation of gaming motives. Furthermore, it was also assumed that there was a moderator effect of gender and game type preference based on the important role gender plays in POG and the structural differences between different game types. Objective: This study had two aims. The first aim was to test the mediating role of online gaming motives between psychiatric symptoms and problematic use of online games. The second aim was to test the moderator effect of gender and game type preference in this mediation model. Methods: An online survey was conducted on a sample of online gamers (N=3186; age: mean 21.1, SD 5.9 years; male: 2859/3186, 89.74%). The Brief Symptom Inventory (BSI), the Motives for Online Gaming Questionnaire (MOGQ), and the Problematic Online Gaming Questionnaire (POGQ) were administered to assess general psychiatric distress, online gaming motives, and problematic online game use, respectively. Structural regression analyses within structural equation modeling were used to test the proposed mediation models and multigroup analyses were used to test gender and game type differences to determine possible moderating effects. Results: The mediation models fitted the data adequately. The Global Severity Index (GSI) of the BSI indicated that the level of psychiatric distress had a significant positive direct effect (standardized effect=.35, P<.001) and a significant indirect (mediating) effect on POG (standardized effect=.194, P<.001) via 2 gaming motives: escape (standardized effect=.139, P<.001) and competition (standardized effect=.046, P<.001). The comparison of the 2 main gamer types showed no significant differences in the model. However, when comparing male and female players it was found that women had (1) slightly higher escape scores (on a 5-point Likert scale: mean 2.28, SD 1.14) than men (mean 1.87, SD 0.97) and (2) a stronger association between the escape motive and problematic online gaming (standardized effect size=.64, P<.001) than men (standardized effect size=.20, P=.001). Conclusions: The results suggest that psychiatric distress is both directly and indirectly (via escape and competition motives) negatively associated with POG. Therefore, the exploration of psychiatric symptoms and gaming motives of POG can be helpful in the preparation of prevention and treatment programs. %M 25855558 %R 10.2196/jmir.3515 %U http://www.jmir.org/2015/4/e88/ %U https://doi.org/10.2196/jmir.3515 %U http://www.ncbi.nlm.nih.gov/pubmed/25855558 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e9 %T Privacy Issues in the Development of a Virtual Mental Health Clinic for University Students: A Qualitative Study %A Gulliver,Amelia %A Bennett,Kylie %A Bennett,Anthony %A Farrer,Louise M %A Reynolds,Julia %A Griffiths,Kathleen M %+ National Institute for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton, ACT, Canberra, , Australia, 61 02 6125 9472, amelia.gulliver@anu.edu.au %K university %K student %K mental health %K internet %K virtual clinic %K qualitative %D 2015 %7 31.03.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: There is a growing need to develop online services for university students with the capacity to complement existing services and efficiently address student mental health problems. Previous research examining the development and acceptability of online interventions has revealed that issues such as privacy critically impact user willingness to engage with these services. Objective: To explore university student perspectives on privacy issues related to using an online mental health service within the context of the development of an online, university-based virtual mental health clinic. Methods: There were two stages of data collection. The first stage consisted of four 1.5-hour focus groups conducted with university students (n=19; 10 female, 9 male, mean age = 21.6 years) to determine their ideas about the virtual clinic including privacy issues. The second stage comprised three 1-hour prototype testing sessions conducted with university students (n=6; 3 male, 3 female, mean age = 21.2 years) using participatory design methods to develop and refine a service model for the virtual clinic and determine student views on privacy within this context. Results: The students raised a number of issues related to privacy in relation to the development of the university virtual clinic. Major topics included the types of personal information they would be willing to provide (minimal information and optional mental health data), concern about potential access to their personal data by the university, the perceived stigma associated with registering for the service, and privacy and anonymity concerns related to online forums contained within the virtual clinic. Conclusions: Students would be more comfortable providing personal information and engaging with the virtual clinic if they trust the privacy and security of the service. Implications of this study include building the clinic in a flexible way to accommodate user preferences. %M 26543915 %R 10.2196/mental.4294 %U http://mental.jmir.org/2015/1/e9/ %U https://doi.org/10.2196/mental.4294 %U http://www.ncbi.nlm.nih.gov/pubmed/26543915 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e85 %T The Potential of Technology-Based Psychological Interventions for Anorexia and Bulimia Nervosa: A Systematic Review and Recommendations for Future Research %A Schlegl,Sandra %A Bürger,Carolina %A Schmidt,Luise %A Herbst,Nirmal %A Voderholzer,Ulrich %+ Department of Psychiatry and Psychotherapy, University of Munich, Nussbaumstraße 7, München, 80336, Germany, 49 89440053369, sandra.schlegl@med.uni-muenchen.de %K anorexia nervosa %K bulimia nervosa %K computers %K Internet %K mobile phone %K cognitive behavioral therapy %D 2015 %7 31.03.2015 %9 Review %J J Med Internet Res %G English %X Background: Previous studies have shown an unmet need in the treatment of eating disorders. In the last decade, interest in technology-based interventions (TBIs) (including computer- and Internet-based interventions [CBIs] or mobile interventions) for providing evidence-based therapies to individuals with different mental disorders has increased. Objective: The aim of this review was to systematically evaluate the potential of TBIs in the field of eating disorders, namely for anorexia nervosa (AN) and bulimia nervosa (BN), for both prevention and treatment, and also for carers of eating disorder patients. Methods: A systematic literature search was conducted using Medline and PsycINFO. Bibliographies of retrieved articles were also reviewed without date or study type restrictions. Results: Forty studies resulting in 45 publications reporting outcomes fulfilled the inclusion criteria: 22 randomized controlled trials, 2 controlled studies, and 16 uncontrolled studies. In total, 3646 patients were included. Overall, the studies provided evidence for the efficacy of guided CBIs, especially for BN patients and for compliant patients. Furthermore, videoconferencing also appeared to be a promising approach. Evaluation results of Internet-based prevention of eating disorders and Internet-based programs for carers of eating disorder patients were also encouraging. Finally, there was preliminary evidence for the efficacy of mobile interventions. Conclusions: TBIs may be an additional way of delivering evidence-based treatments to eating disorder patients and their use is likely to increase in the near future. TBIs may also be considered for the prevention of eating disorders and to support carers of eating disorder patients. Areas of future research and important issues such as guidance, therapeutic alliance, and dissemination are discussed. %M 25840591 %R 10.2196/jmir.3554 %U http://www.jmir.org/2015/3/e85/ %U https://doi.org/10.2196/jmir.3554 %U http://www.ncbi.nlm.nih.gov/pubmed/25840591 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e72 %T Efficacy of a Web-Based, Crowdsourced Peer-To-Peer Cognitive Reappraisal Platform for Depression: Randomized Controlled Trial %A Morris,Robert R %A Schueller,Stephen M %A Picard,Rosalind W %+ MIT Media Lab, Massachusetts Institute of Technology, E14-348A, 75 Amherst St, Cambridge, MA, 02139, United States, 1 6172530611, rmorris@media.mit.edu %K Web-based intervention %K crowdsourcing %K randomized controlled trial %K depression %K cognitive behavioral therapy %K mental health %K social networks %D 2015 %7 30.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Self-guided, Web-based interventions for depression show promising results but suffer from high attrition and low user engagement. Online peer support networks can be highly engaging, but they show mixed results and lack evidence-based content. Objective: Our aim was to introduce and evaluate a novel Web-based, peer-to-peer cognitive reappraisal platform designed to promote evidence-based techniques, with the hypotheses that (1) repeated use of the platform increases reappraisal and reduces depression and (2) that the social, crowdsourced interactions enhance engagement. Methods: Participants aged 18-35 were recruited online and were randomly assigned to the treatment group, “Panoply” (n=84), or an active control group, online expressive writing (n=82). Both are fully automated Web-based platforms. Participants were asked to use their assigned platform for a minimum of 25 minutes per week for 3 weeks. Both platforms involved posting descriptions of stressful thoughts and situations. Participants on the Panoply platform additionally received crowdsourced reappraisal support immediately after submitting a post (median response time=9 minutes). Panoply participants could also practice reappraising stressful situations submitted by other users. Online questionnaires administered at baseline and 3 weeks assessed depression symptoms, reappraisal, and perseverative thinking. Engagement was assessed through self-report measures, session data, and activity levels. Results: The Panoply platform produced significant improvements from pre to post for depression (P=.001), reappraisal (P<.001), and perseverative thinking (P<.001). The expressive writing platform yielded significant pre to post improvements for depression (P=.02) and perseverative thinking (P<.001), but not reappraisal (P=.45). The two groups did not diverge significantly at post-test on measures of depression or perseverative thinking, though Panoply users had significantly higher reappraisal scores (P=.02) than expressive writing. We also found significant group by treatment interactions. Individuals with elevated depression symptoms showed greater comparative benefit from Panoply for depression (P=.02) and perseverative thinking (P=.008). Individuals with baseline reappraisal deficits showed greater comparative benefit from Panoply for depression (P=.002) and perseverative thinking (P=.002). Changes in reappraisal mediated the effects of Panoply, but not the expressive writing platform, for both outcomes of depression (ab=-1.04, SE 0.58, 95% CI -2.67 to -.12) and perseverative thinking (ab=-1.02, SE 0.61, 95% CI -2.88 to -.20). Dropout rates were similar for the two platforms; however, Panoply yielded significantly more usage activity (P<.001) and significantly greater user experience scores (P<.001). Conclusions: Panoply engaged its users and was especially helpful for depressed individuals and for those who might ordinarily underutilize reappraisal techniques. Further investigation is needed to examine the long-term effects of such a platform and whether the benefits generalize to a more diverse population of users. Trial Registration: ClinicalTrials.gov NCT02302248; https://clinicaltrials.gov/ct2/show/NCT02302248 (Archived by WebCite at http://www.webcitation.org/6Wtkj6CXU). %M 25835472 %R 10.2196/jmir.4167 %U http://www.jmir.org/2015/3/e72/ %U https://doi.org/10.2196/jmir.4167 %U http://www.ncbi.nlm.nih.gov/pubmed/25835472 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e6 %T Clinical Practice Models for the Use of E-Mental Health Resources in Primary Health Care by Health Professionals and Peer Workers: A Conceptual Framework %A Reynolds,Julia %A Griffiths,Kathleen M %A Cunningham,John A %A Bennett,Kylie %A Bennett,Anthony %+ National Institute for Mental Health Research, Research School of Population Health, Australian National University, Building 63, Eggleston Road, Canberra, 2601, Australia, 61 2 612 ext 57275, julia.reynolds@anu.edu.au %K translational medical research %K professional practice %K primary health care %K treatment of mental disorders %K Internet %K health care technology %K health promotion %K case management %K psychotherapy %D 2015 %7 23.03.2015 %9 Viewpoint %J JMIR Mental Health %G English %X Background: Research into e-mental health technologies has developed rapidly in the last 15 years. Applications such as Internet-delivered cognitive behavioral therapy interventions have accumulated considerable evidence of efficacy and some evidence of effectiveness. These programs have achieved similar outcomes to face-to-face therapy, while requiring much less clinician time. There is now burgeoning interest in integrating e-mental health resources with the broader mental health delivery system, particularly in primary care. The Australian government has supported the development and deployment of e-mental health resources, including websites that provide information, peer-to-peer support, automated self-help, and guided interventions. An ambitious national project has been commissioned to promote key resources to clinicians, to provide training in their use, and to evaluate the impact of promotion and training upon clinical practice. Previous initiatives have trained clinicians to use a single e-mental health program or a suite of related programs. In contrast, the current initiative will support community-based service providers to access a diverse array of resources developed and provided by many different groups. Objective: The objective of this paper was to develop a conceptual framework to support the use of e-mental health resources in routine primary health care. In particular, models of clinical practice are required to guide the use of the resources by diverse service providers and to inform professional training, promotional, and evaluation activities. Methods: Information about service providers’ use of e-mental health resources was synthesized from a nonsystematic overview of published literature and the authors’ experience of training primary care service providers. Results: Five emerging clinical practice models are proposed: (1) promotion; (2) case management; (3) coaching; (4) symptom-focused treatment; and (5) comprehensive therapy. We also consider the service provider skills required for each model and the ways that e-mental health resources might be used by general practice doctors and nurses, pharmacists, psychologists, social workers, occupational therapists, counselors, and peer workers Conclusions: The models proposed in the current paper provide a conceptual framework for policy-makers, researchers and clinicians interested in integrating e-mental health resources into primary care. Research is needed to establish the safety and effectiveness of the models in routine care and the best ways to support their implementation. %M 26543912 %R 10.2196/mental.4200 %U http://mental.jmir.org/2015/1/e6/ %U https://doi.org/10.2196/mental.4200 %U http://www.ncbi.nlm.nih.gov/pubmed/26543912 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e71 %T Web-Based Psychotherapy for Posttraumatic Stress Disorder in War-Traumatized Arab Patients: Randomized Controlled Trial %A Knaevelsrud,Christine %A Brand,Janine %A Lange,Alfred %A Ruwaard,Jeroen %A Wagner,Birgit %+ Department of Clinical Psychology, Freie University, Habelschwerdter Allee 45, Berlin, 14195, Germany, 49 30 838557, christine.knaevelsrud@fu-berlin.de %K posttraumatic stress disorders %K Middle East %K war %K violence %K cognitive therapy %K mental health service %K Internet %D 2015 %7 20.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, armed conflicts in the Middle East have resulted in high rates of exposure to traumatic events. Despite the increasing demand of mental health care provision, ongoing violence limits conventional approaches of mental health care provision. Internet-based interventions for posttraumatic stress disorder (PTSD) have proved feasible and effective in Western countries, but their applicability and efficacy in war and conflict regions remains unknown. Objective: This study investigated the efficacy of a cognitive behavioral Internet-based intervention for war-traumatized Arab patients, with focus on Iraq. Methods: A total of 159 individuals with PTSD participated in a parallel group randomized trial. Participants were randomly allocated by a computer-generated sequence to a treatment group (n=79) or a waiting list control group (n=80). The treatment group received 2 weekly 45-minute cognitive behavioral interventions via Internet over a 5-week period (10 sessions in total). The primary outcome was recovery from posttraumatic stress symptoms. Results: Posttraumatic stress symptoms were significantly reduced from baseline to posttreatment (intention-to-treat analysis) in the treatment group relative to the control group (F1,157=44.29, P<.001, d=0.92). Treatment effects were sustained at 3-month follow-up. Completer analysis indicated that 29 of 47 patients (62%) in the treatment group had recovered from posttraumatic stress symptoms at posttreatment (reliable change and Posttraumatic Stress Diagnostic Scale score <20) versus 1 patient (2%) in the control group (OR 74.19, 95% CI 9.93-585.8, P<.001) indicating that the chance of recovering was 74.19 times higher in the treatment than in the control group. Conclusions: The results indicate, even in unstable and insecure settings with ongoing exposure to human rights violations through war and dictatorships, people with posttraumatic stress symptoms benefit from a cognitive behavioral treatment provided entirely through the Internet. This method of delivery could improve patients’ access to humanitarian aid in the form of e-mental health services. Trial Registration: Australian New Zealand Clinical Trial Registry, ACTRN12611001019998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347505 (Archived by WebCite at http://www.webcitation.org/6Wto4HCdH). %M 25799024 %R 10.2196/jmir.3582 %U http://www.jmir.org/2015/3/e71/ %U https://doi.org/10.2196/jmir.3582 %U http://www.ncbi.nlm.nih.gov/pubmed/25799024 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e66 %T Improving Self-Help E-Therapy for Depression and Anxiety Among Sexual Minorities: An Analysis of Focus Groups With Lesbians and Gay Men %A Rozbroj,Tomas %A Lyons,Anthony %A Pitts,Marian %A Mitchell,Anne %A Christensen,Helen %+ Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street, Melbourne, 3000, Australia, 61 9479 8700, t.rozbroj@latrobe.edu.au %K Internet therapy %K e-therapy %K cCBT %K mental health %K gay men %K lesbian %K minority stress %K depression %K anxiety %K focus groups %D 2015 %7 11.03.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: E-therapies for depression and anxiety rarely account for lesbian and gay users. This is despite lesbians and gay men being at heightened risk of mood disorders and likely to benefit from having access to tailored self-help resources. Objective: We sought to determine how e-therapies for depression and anxiety could be improved to address the therapeutic needs of lesbians and gay men. Methods: We conducted eight focus groups with lesbians and gay men aged 18 years and older. Focus groups were presented with key modules from the popular e-therapy “MoodGYM”. They were asked to evaluate the inclusiveness and relevance of these modules for lesbians and gay men and to think about ways that e-therapies in general could be modified. The focus groups were analyzed qualitatively using a thematic analysis approach to identify major themes. Results: The focus groups indicated that some but not all aspects of MoodGYM were suitable, and suggested ways of improving e-therapies for lesbian and gay users. Suggestions included avoiding language or examples that assumed or implied users were heterosexual, improving inclusiveness by representing non-heterosexual relationships, providing referrals to specialized support services and addressing stigma-related stress, such as “coming out” and experiences of discrimination and harassment. Focus group participants suggested that dedicated e-therapies for lesbians and gay men should be developed or general e-therapies be made more inclusive by using adaptive logic to deliver content appropriate for a user’s sexual identity. Conclusions: Findings from this study offer in-depth guidance for developing e-therapies that more effectively address mental health problems among lesbians and gay men. %M 25761775 %R 10.2196/jmir.4013 %U http://www.jmir.org/2015/3/e66/ %U https://doi.org/10.2196/jmir.4013 %U http://www.ncbi.nlm.nih.gov/pubmed/25761775 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 2 %N 1 %P e3 %T Breaking Open the Black Box: Isolating the Most Potent Features of a Web and Mobile Phone-Based Intervention for Depression, Anxiety, and Stress %A Whitton,Alexis E %A Proudfoot,Judith %A Clarke,Janine %A Birch,Mary-Rose %A Parker,Gordon %A Manicavasagar,Vijaya %A Hadzi-Pavlovic,Dusan %+ The Black Dog Institute, University of New South Wales, Hospital Road, Prince of Wales Hospital, Sydney, 2031, Australia, 61 2 9382 3767, alexis.e.whitton@gmail.com %K eHealth %K depression %K anxiety %K stress %K psychological stress %K self-help %K Web-based %K mental health %D 2015 %7 04.03.2015 %9 Original Paper %J JMIR Mental Health %G English %X Background: Internet-delivered mental health (eMental Health) interventions produce treatment effects similar to those observed in face-to-face treatment. However, there is a large degree of variation in treatment effects observed from program to program, and eMental Health interventions remain somewhat of a black box in terms of the mechanisms by which they exert their therapeutic benefit. Trials of eMental Health interventions typically use large sample sizes and therefore provide an ideal context within which to systematically investigate the therapeutic benefit of specific program features. Furthermore, the growth and impact of mobile phone technology within eMental Health interventions provides an opportunity to examine associations between symptom improvement and the use of program features delivered across computer and mobile phone platforms. Objective: The objective of this study was to identify the patterns of program usage associated with treatment outcome in a randomized controlled trial (RCT) of a fully automated, mobile phone- and Web-based self-help program, “myCompass”, for individuals with mild-to-moderate symptoms of depression, anxiety, and/or stress. The core features of the program include interactive psychotherapy modules, a symptom tracking feature, short motivational messages, symptom tracking reminders, and a diary, with many of these features accessible via both computer and mobile phone. Methods: Patterns of program usage were recorded for 231 participants with mild-to-moderate depression, anxiety, and/or stress, and who were randomly allocated to receive access to myCompass for seven weeks during the RCT. Depression, anxiety, stress, and functional impairment were examined at baseline and at eight weeks. Results: Log data indicated that the most commonly used components were the short motivational messages (used by 68.4%, 158/231 of participants) and the symptom tracking feature (used by 61.5%, 142/231 of participants). Further, after controlling for baseline symptom severity, increased use of these alert features was associated with significant improvements in anxiety and functional impairment. Associations between use of symptom tracking reminders and improved treatment outcome remained significant after controlling for frequency of symptom tracking. Although correlations were not statistically significant, reminders received via SMS (ie, text message) were more strongly associated with symptom reduction than were reminders received via email. Conclusions: These findings indicate that alerts may be an especially potent component of eMental Health interventions, both via their association with enhanced program usage, as well as independently. Although there was evidence of a stronger association between symptom improvement and use of alerts via the mobile phone platform, the degree of overlap between use of email and SMS alerts may have precluded identification of alert delivery modalities that were most strongly associated with symptom reduction. Future research using random assignment to computer and mobile delivery is needed to fully determine the most ideal platform for delivery of this and other features of online interventions. Trial Registration: Australian New Zealand Clinical Trials Registry (ACTRN): 12610000625077; http://www.anzctr.org.au/TrialSearch.aspx? (Archived by WebCite http://www.webcitation.org/6WPqHK0mQ). %M 26543909 %R 10.2196/mental.3573 %U http://mental.jmir.org/2015/1/e3/ %U https://doi.org/10.2196/mental.3573 %U http://www.ncbi.nlm.nih.gov/pubmed/26543909 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 3 %P e55 %T Multiple Comorbidities of 21 Psychological Disorders and Relationships With Psychosocial Variables: A Study of the Online Assessment and Diagnostic System Within a Web-Based Population %A AL-Asadi,Ali M %A Klein,Britt %A Meyer,Denny %+ Department of Arts and Education, Grande Prairie Regional College, 10726 - 106 Ave., Grande Prairie, AB, T8V 4C4, Canada, 1 780 539 2061, aalasadi@gprc.ab.ca %K comorbidity %K multiple comorbidities %K co-occurrences %K e-mental health %K online %K fully automated %K generalized anxiety disorder %K obsessive-compulsive disorder %K social anxiety disorder %K posttraumatic stress disorder %K panic disorder, major depressive episode %K insomnia, hypersomnia, dependency %K alcohol %K drug %K suicidal ideation %K social support %K quality of life %K sex %K age %D 2015 %7 26.02.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: While research in the area of e-mental health has received considerable attention over the last decade, there are still many areas that have not been addressed. One such area is the comorbidity of psychological disorders in a Web-based sample using online assessment and diagnostic tools, and the relationships between comorbidities and psychosocial variables. Objective: We aimed to identify comorbidities of psychological disorders of an online sample using an online diagnostic tool. Based on diagnoses made by an automated online assessment and diagnostic system administered to a large group of online participants, multiple comorbidities (co-occurrences) of 21 psychological disorders for males and females were identified. We examined the relationships between dyadic comorbidities of anxiety and depressive disorders and the psychosocial variables sex, age, suicidal ideation, social support, and quality of life. Methods: An online complex algorithm based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision, was used to assign primary and secondary diagnoses of 21 psychological disorders to 12,665 online participants. The frequency of co-occurrences of psychological disorders for males and females were calculated for all disorders. A series of hierarchical loglinear analyses were performed to examine the relationships between the dyadic comorbidities of depression and various anxiety disorders and the variables suicidal ideation, social support, quality of life, sex, and age. Results: A 21-by-21 frequency of co-occurrences of psychological disorders matrix revealed the presence of multiple significant dyadic comorbidities for males and females. Also, for those with some of the dyadic depression and the anxiety disorders, the odds for having suicidal ideation, reporting inadequate social support, and poorer quality of life increased for those with two-disorder comorbidity than for those with only one of the same two disorders. Conclusions: Comorbidities of several psychological disorders using an online assessment tool within a Web-based population were similar to those found in face-to-face clinics using traditional assessment tools. Results provided support for the transdiagnostic approaches and confirmed the positive relationship between comorbidity and suicidal ideation, the negative relationship between comorbidity and social support, and the negative relationship comorbidity and quality of life. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG) %M 25803420 %R 10.2196/jmir.4143 %U http://www.jmir.org/2015/3/e55/ %U https://doi.org/10.2196/jmir.4143 %U http://www.ncbi.nlm.nih.gov/pubmed/25803420 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e8 %T Enhancing Web-Based Mindfulness Training for Mental Health Promotion With the Health Action Process Approach: Randomized Controlled Trial %A Mak,Winnie WS %A Chan,Amy TY %A Cheung,Eliza YL %A Lin,Cherry LY %A Ngai,Karin CS %+ Diversity & Well-Being Laboratory, Department of Psychology, The Chinese University of Hong Kong, 3rd Floor, Sino Building, Shatin, NT, Hong Kong, 999077, China (Hong Kong), 852 39436577, wwsmak@psy.cuhk.edu.hk %K Internet-based intervention %K online intervention %K mindfulness %K Health Action Process Approach (HAPA) %K mental health promotion %D 2015 %7 19.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: With increasing evidence demonstrating the effectiveness of Web-based interventions and mindfulness-based training in improving health, delivering mindfulness training online is an attractive proposition. Objective: The aim of this study was to evaluate the efficacy of two Internet-based interventions (basic mindfulness and Health Action Process Approach enhanced mindfulness) with waitlist control. Health Action Process Approach (HAPA) principles were used to enhance participants’ efficacy and planning. Methods: Participants were recruited online and offline among local universities; 321 university students and staff were randomly assigned to three conditions. The basic and HAPA-enhanced groups completed the 8-week fully automated mindfulness training online. All participants (including control) were asked to complete an online questionnaire pre-program, post-program, and at 3-month follow-up. Results: Significant group by time interaction effect was found. The HAPA-enhanced group showed significantly higher levels of mindfulness from pre-intervention to post-intervention, and such improvement was sustained at follow-up. Both the basic and HAPA-enhanced mindfulness groups showed better mental well-being from pre-intervention to post-intervention, and improvement was sustained at 3-month follow-up. Conclusions: Online mindfulness training can improve mental health. An online platform is a viable medium to implement and disseminate evidence-based interventions and is a highly scalable approach to reach the general public. Trial Registration: Chinese Clinical Trial Registry (ChiCTR): ChiCTR-TRC-12002954; http://www.chictr.org/en/proj/show.aspx?proj=3904 (Archived by WebCite at http://www.webcitation.org/6VCdG09pA). %M 25599904 %R 10.2196/jmir.3746 %U http://www.jmir.org/2015/1/e8/ %U https://doi.org/10.2196/jmir.3746 %U http://www.ncbi.nlm.nih.gov/pubmed/25599904 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 1 %P e13 %T Characteristics and Help-Seeking Behaviors of Internet Gamblers Based on Most Problematic Mode of Gambling %A Hing,Nerilee %A Russell,Alex Myles Thomas %A Gainsbury,Sally Melissa %A Blaszczynski,Alex %+ Centre for Gambling Education and Research, Southern Cross University, PO Box 157, Lismore, 2478, Australia, 61 428115291, nerilee.hing@scu.edu.au %K gambling %K Internet %K pathological gambling %K treatment %D 2015 %7 07.01.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies of problem Internet gamblers have failed to distinguish whether their problem gambling relates to Internet or land-based gambling modes. Therefore, characteristics and help-seeking behaviors of people whose gambling problems relate specifically to Internet gambling are unknown, but could inform the optimal alignment of treatment and support services with the needs and preferences of problem gamblers. Objective: This study aimed to compare (1) characteristics of problem Internet gamblers and problem land-based gamblers and (2) uptake of different types and modes of help between problem Internet gamblers and problem land-based gamblers. Hypothesis 1 was that problem Internet gamblers are less likely to seek help. Hypothesis 2 was that problem Internet gamblers are more likely to use online modes of help. Methods: A sample of 620 respondents meeting criteria for problem gambling was drawn from an online survey of 4594 Australian gamblers. Respondents were recruited through advertisements on gambling and gambling help websites, Facebook, and Google. Measures consisted of gambling participation; proportion of gambling on the Internet; most problematic mode of gambling; help seeking from 11 different sources of formal help, informal help, and self-help for gambling problems; psychological distress (Kessler 6); problem gambling severity (Problem Gambling Severity Index, PGSI); and demographics. Results: Problem Internet gamblers were significantly more likely than problem land-based gamblers to be male (χ21=28.3, P<.001, φ=0.21), younger (t616.33=4.62, P<.001, d=0.37), have lower psychological distress (χ21=5.4, P=.02, φ=0.09), and experience problems with sports and race wagering (χ24=228.5, P<.001, φ=0.61). Uptake of help was significantly lower among problem Internet compared to problem land-based gamblers (χ21=6.9, P<.001, φ=0.11), including from face-to-face services, gambling helplines, online groups, self-exclusion from land-based venues, family or friends, and self-help strategies. Both problem Internet and problem land-based gamblers had similarly low use of online help. However, problem land-based gamblers (37.6%, 126/335) were significantly more likely to have sought land-based formal help compared to problem Internet gamblers (23.5%, 67/285; χ21=14.3, P<.001, φ=0.15). Conclusions: The findings suggest that more targeted and innovative efforts may be needed to increase use of gambling help by problem Internet gamblers. Alternatively, their lower PGSI and K6 scores suggest Internet problem gamblers may have less need for gambling-related help. This is the first known study to classify problem Internet gamblers as those whose problem gambling specifically relates to Internet gambling. Further research is needed to better understand why help-seeking rates are lower among Internet problem gamblers. %M 25567672 %R 10.2196/jmir.3781 %U http://www.jmir.org/2015/1/e13/ %U https://doi.org/10.2196/jmir.3781 %U http://www.ncbi.nlm.nih.gov/pubmed/25567672 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e293 %T eMental Health Experiences and Expectations: A Survey of Youths' Web-Based Resource Preferences in Canada %A Wetterlin,Felicia M %A Mar,Marissa Y %A Neilson,Erika K %A Werker,Gregory R %A Krausz,Michael %+ Institute of Mental Health, Department of Psychiatry, University of British Columbia, 430 - 5950 University Blvd, David Strangway Bldg, University of British Columbia, Vancouver, BC, V6T 1Z3, Canada, 1 604 362 5153, feliciawetterlin@gmail.com %K mental health services %K online systems %K adolescents %K survey %K Internet %D 2014 %7 17.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Due to the high prevalence of psychological disorders and the lack of access to care among Canadian youth, the development of accessible services is increasingly important. eMental Health is an expanding field that may help to meet this need through the provision of mental health care using technology. Objective: The primary goals of the study are to explore youth experiences with traditional and online mental health resources, and to investigate youth expectations for mental health websites. Methods: A Web-based survey containing quantitative and qualitative questions was delivered to youth aged 17-24 years. Participants were surveyed to evaluate their use of mental health resources as well as their preferences for various components of a potential mental health website. Results: A total of 521 surveys were completed. Most participants (61.6%, 321/521) indicated that they had used the Internet to seek information or help for feelings they were experiencing. If they were going through a difficult time, 82.9% (432/521) of participants were either “somewhat likely” or “very likely” to use an information-based website and 76.8% (400/521) reported that they were either “somewhat unlikely” or “very unlikely” to visit social media websites for information or help-seeking purposes during this time. Most (87.7%, 458/521) participants rated their online privacy as very important. Descriptions of interventions and treatments was the most highly rated feature to have in a mental health-related website, with 91.9% (479/521) of participants regarding it as “important” or “very important”. When presented a select list of existing Canadian mental health-related websites, most participants had not accessed any of the sites. Of the few who had, the Canadian Mental Health Association website was the most accessed website (5.8%, 30/521). Other mental health-related websites were accessed by only 10.9% of the participants (57/521). Conclusions: The findings suggest that despite interest in these tools, current eMental Health resources either do not meet the needs of or are not widely accessed by youth with mental health problems. In order to improve access to these resources for Canadian youth, Web-based platforms should provide information about mental health problems, support for these problems (peer and professional), and information about resources (self-help as well as ability to locate nearby resources), while protecting the privacy of the user. These findings will not only assist in the development of new mental health platforms but may also help improve existing ones. %M 25519847 %R 10.2196/jmir.3526 %U http://www.jmir.org/2014/12/e293/ %U https://doi.org/10.2196/jmir.3526 %U http://www.ncbi.nlm.nih.gov/pubmed/25519847 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 1 %N 1 %P e3 %T Assessing the Evidence for e-Resources for Mental Health Self-Management: A Systematic Literature Review %A Karasouli,Eleni %A Adams,Ann %+ Institute of Digital Healthcare, International Digital Laboratory, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 02476 151404, e.karasouli@warwick.ac.uk %K self-management %K mental health %K depression %K bipolar disorder %K eHealth %K e-resources %K digital technology %K systematic review %D 2014 %7 08.12.2014 %9 Review %J JMIR Mental Health %G English %X Background: In a climate which recognizes mental health as a key health improvement target, but where mental health services are increasingly over-stretched, self-management e-resources can play a potentially important role in helping to ensure people get the care and support they need. They have the potential to enable individuals to learn more about, and to exercise active involvement in, their care, and thus we see a growing interest in this area for both research and practice. However, for e-resources to become important adjuncts to clinical care, it is necessary to understand if and how they impact on patients and care outcomes. Objective: The objective of this study was to review systematically the research evidence for theory-driven and evidence-based mental health self-management e-resources; and make recommendations about strengthening the future evidence base. Methods: A comprehensive literature search in MEDLINE, EMBASE, AMED, PsycINFO, Scopus, and Cochrane Library was conducted. No limits to study design were applied. We did not restrict the types of Web-based technologies included, such as websites and mobile applications, so long as they met the study inclusion criteria. A narrative synthesis of data was performed to elaborate both the development and effectiveness of online resources. Results: In total, 2969 abstracts were identified. Of those, 8 papers met the inclusion criteria. Only one randomized controlled trial was identified. The e-resources were aimed at self-management of bipolar disorder, depression, or general mental health problems. Some of the e-resources were intended to be used as prevention aids, whereas others were recovery orientated. Conclusions: Mental health self-management e-resources have the potential to be widely effective, but our review shows it is early days in terms of development of the evidence base for them. To build robust evidence, clear guidelines are needed on the development and reporting of e-resources, so that both developers and researchers maximize the potential of a new, but rapidly evolving area. %M 26543903 %R 10.2196/mental.3708 %U http://mental.jmir.org/2014/1/e3/ %U https://doi.org/10.2196/mental.3708 %U http://www.ncbi.nlm.nih.gov/pubmed/26543903 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 11 %P e256 %T Emotional Approach Coping and the Effects of Online Peer-Led Support Group Participation Among Patients With Breast Cancer: A Longitudinal Study %A Batenburg,Anika %A Das,Enny %+ VU University Amsterdam, Department of Communication Science, De Boelelaan 1081, Amsterdam, 1081 HV, Netherlands, 31 20 598 7034, a.e.batenburg@vu.nl %K Internet %K breast neoplasms %K self-help groups %K social support %K online systems %K emotions %D 2014 %7 28.11.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous research on the effects of online peer support on psychological well-being of patients with cancer showed mixed findings. There is a need for longitudinal studies explaining if and when online peer-led support groups are beneficial. How patients cope with emotions that come along with the cancer diagnosis might influence effectiveness of online participation. Emotional approach coping is a construct encompassing the intentional use of emotional processing and emotional expression in efforts to manage adverse circumstances. Objective: In this longitudinal study, we hypothesize that mixed findings in previous research are partly caused by individual differences in coping with emotions, which may moderate the effects of online support group participation on patients’ well-being. Methods: A total of 133 Dutch patients with breast cancer filled out a baseline (T0) and a follow-up (T1, 6 months later) questionnaire assessing intensity of online participation within the online support community, emotional approach coping (ie, actively processing and expressing emotions), and psychological well-being (depression, emotional well-being, and breast cancer–related concerns). There were 109 patients who visited an online support community at both points in time. Repeated measures ANOVAs assessed change in well-being over time. Results: Results showed 3-way interactions of time, online intensity of participation, and emotional approach coping on emotional well-being (F1,89=4.232, P=.04, η2ρ=.045) and depression (F1,88=8.167, P=.005, η2ρ=.085). Online support group participation increased emotional well-being over time for patients who scored low on emotional approach coping at T0, provided that they were highly active online. Patients who were highly active online with a high score on emotional approach coping reported no change in sense of well-being, but showed the highest score on well-being overall. Participating less frequently online was only beneficial for patients who scored high on emotional approach coping, showing an increase in well-being over time. Patients participating less frequently and with a low score on emotional approach coping reported no significant change in well-being over time. Conclusions: This study extends previous findings on the effects of online peer support in two ways: by testing changes in well-being as a function of intensity of online support group participation and by examining the role of individual differences in emotional coping styles. Findings showed no negative effects of intense support group participation. Participating frequently online was especially helpful for patients who approach their emotions less actively; their emotional well-being increased over time. In contrast, frequent online users who actively approach their emotions experienced no change in well-being, reporting highest levels of well-being overall. For patients who participate less intensively within the support community, coping style seems to outweigh effects of online participation; over time, patients who actively approached emotions experienced an increase in psychological well-being, whereas patients with a low score on emotional approach coping reported no change in depression and emotional well-being. %M 25474819 %R 10.2196/jmir.3517 %U http://www.jmir.org/2014/11/e256/ %U https://doi.org/10.2196/jmir.3517 %U http://www.ncbi.nlm.nih.gov/pubmed/25474819 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 1 %N 1 %P e2 %T Implementation and Outcomes of a Collaborative Multi-Center Network Aimed at Web-Based Cognitive Training – COGWEB Network %A Tedim Cruz,Vítor %A Pais,Joana %A Ruano,Luis %A Mateus,Cátia %A Colunas,Márcio %A Alves,Ivânia %A Barreto,Rui %A Conde,Eduardo %A Sousa,Andreia %A Araújo,Isabel %A Bento,Virgílio %A Coutinho,Paula %A Rocha,Nelson %A , %+ Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Neurology Department, Rua Dr. Cândido de Pinho, Santa Maria da Feira, 4520-211, Portugal, 351 936173516, vitor.cruz@chedv.min-saude.pt %K cognitive training %K neurorehabilitation %K eHealth systems %K memory clinic %K collaborative network %K stroke %K dementia %K schizophrenia %K mental health services %D 2014 %7 27.11.2014 %9 Original Paper %J JMIR Mental Health %G English %X Background: Cognitive care for the most prevalent neurologic and psychiatric conditions will only improve through the implementation of new sustainable approaches. Innovative cognitive training methodologies and collaborative professional networks are necessary evolutions in the mental health sector. Objective: The objective of the study was to describe the implementation process and early outcomes of a nationwide multi-organizational network supported on a Web-based cognitive training system (COGWEB). Methods: The setting for network implementation was the Portuguese mental health system and the hospital-, academic-, community-based institutions and professionals providing cognitive training. The network started in August 2012, with 16 centers, and was monitored until September 2013 (inclusions were open). After onsite training, all were allowed to use COGWEB in their clinical or research activities. For supervision and maintenance were implemented newsletters, questionnaires, visits and webinars. The following outcomes were prospectively measured: (1) number, (2) type, (3) time to start, and (4) activity state of centers; age, gender, level of education, and medical diagnosis of patients enrolled. Results: The network included 68 professionals from 41 centers, (33/41) 80% clinical, (8/41) 19% nonclinical. A total of 298 patients received cognitive training; 45.3% (n=135) female, mean age 54.4 years (SD 18.7), mean educational level 9.8 years (SD 4.8). The number enrolled each month increased significantly (r=0.6; P=.031). At 12 months, 205 remained on treatment. The major causes of cognitive impairment were: (1) neurodegenerative (115/298, 38.6%), (2) structural brain lesions (63/298, 21.1%), (3) autoimmune (40/298, 13.4%), (4) schizophrenia (30/298, 10.1%), and (5) others (50/298, 16.8%). The comparison of the patient profiles, promoter versus all other clinical centers, showed significant increases in the diversity of causes and spectrums of ages and education. Conclusions: Over its first year, there was a major increase in the number of new centers and professionals, as well as of the clinical diversity of patients treated. The consolidation of such a national collaborative network represents an innovative step in mental health care evolution. Furthermore, it may contribute to translational processes in the field of cognitive training and reduce disease burden. %M 26543902 %R 10.2196/mental.3840 %U http://www.jmir.org/2014/1/e2/ %U https://doi.org/10.2196/mental.3840 %U http://www.ncbi.nlm.nih.gov/pubmed/26543902 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 4 %P e46 %T Qualitative Feedback From a Text Messaging Intervention for Depression: Benefits, Drawbacks, and Cultural Differences %A Aguilera,Adrian %A Berridge,Clara %+ University of California, Berkeley, School of Social Welfare, 120 Haviland Hall, MC7400, Berkeley, CA, 94720, United States, 1 5106428564, aguila@berkeley.edu %K mobile health %K depression %K text messaging %K culture %K digital health %K cognitive behavioral therapy %K disparities %K mental health %K behavior change %D 2014 %7 05.11.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile health interventions are often standardized and assumed to work the same for all users; however, we may be missing cultural differences in the experiences of interventions that may impact how and if an intervention is effective. Objective: The objective of the study was to assess qualitative feedback from participants to determine if there were differences between Spanish speakers and English speakers. Daily text messages were sent to patients as an adjunct to group Cognitive Behavioral Therapy (CBT) for depression. Methods: Messages inquired about mood and about specific themes (thoughts, activities, social interactions) of a manualized group CBT intervention. There were thirty-nine patients who participated in the text messaging pilot study. The average age of the participants was 53 years (SD 10.4; range of 23-72). Results: Qualitative feedback from Spanish speakers highlighted feelings of social support, whereas English speakers noted increased introspection and self-awareness of their mood state. Conclusions: These cultural differences should be explored further, as they may impact the effect of supportive mobile health interventions. Trial Registration: Trial Registration: Clinicaltrials.gov NCT01083628; http://clinicaltrials.gov/ct2/show/study/NCT01083628 (Archived by WebCite at http://www.webcitation.org/6StpbdHuq). %M 25373390 %R 10.2196/mhealth.3660 %U http://mhealth.jmir.org/2014/4/e46/ %U https://doi.org/10.2196/mhealth.3660 %U http://www.ncbi.nlm.nih.gov/pubmed/25373390 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e239 %T Tablet, Web-Based, or Paper Questionnaires for Measuring Anxiety in Patients Suspected of Breast Cancer: Patients' Preferences and Quality of Collected Data %A Barentsz,Maarten W %A Wessels,Hester %A van Diest,Paul J %A Pijnappel,Ruud M %A Haaring,Cees %A van der Pol,Carmen C %A Witkamp,Arjen J %A van den Bosch,Maurice A %A Verkooijen,Helena M %+ University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX, Netherlands, 31 887556689, m.barentsz@umcutrecht.nl %K breast cancer %K electronic questionnaires %K paper questionnaires %K quality of collected data %D 2014 %7 31.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic applications are increasingly being used in hospitals for numerous purposes. Objective: Our aim was to assess differences in the characteristics of patients who choose paper versus electronic questionnaires and to evaluate the data quality of both approaches. Methods: Between October 2012 and June 2013, 136 patients participated in a study on diagnosis-induced stress and anxiety. Patients were asked to fill out questionnaires at six different moments during the diagnostic phase. They were given the opportunity to fill out the questionnaires on paper or electronically (a combination of tablet and Web-based questionnaires). Demographic characteristics and completeness of returned data were compared between groups. Results: Nearly two-thirds of patients (88/136, 64.7%) chose to fill out the questionnaires on paper, and just over a third (48/136, 35.3%) preferred the electronic option. Patients choosing electronic questionnaires were significantly younger (mean 47.3 years vs mean 53.5 in the paper group, P=.01) and higher educated (P=.004). There was significantly more missing information (ie, at least one question not answered) in the paper group during the diagnostic day compared to the electronic group (using a tablet) (28/88 vs 1/48, P<.001). However, in the week after the diagnostic day, missing information was significantly higher in the electronic group (Web-based questionnaires) compared to the paper group (41/48 vs 38/88, P<.001). Conclusions: Younger patients and patients with a higher level of education have a preference towards filling out questionnaires electronically. In the hospital, a tablet is an excellent medium for patients to fill out questionnaires with very little missing information. However, for filling out questionnaires at home, paper questionnaires resulted in a better response than Web-based questionnaires. %M 25364951 %R 10.2196/jmir.3578 %U http://www.jmir.org/2014/10/e239/ %U https://doi.org/10.2196/jmir.3578 %U http://www.ncbi.nlm.nih.gov/pubmed/25364951 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e248 %T Comorbidity Structure of Psychological Disorders in the Online e-PASS Data as Predictors of Psychosocial Adjustment Measures: Psychological Distress, Adequate Social Support, Self-Confidence, Quality of Life, and Suicidal Ideation %A AL-Asadi,Ali M %A Klein,Britt %A Meyer,Denny %+ Department of Arts and Education, Grande Prairie Regional College, 10726 - 106 Ave.,, Grande Prairie, AB, , Canada, 1 780 539 2061, aalasadi@gprc.ab.ca %K comorbidity %K comorbidity factors, comorbidity dimensions, structure of comorbidity %K psychosocial adjustment %K disorders %K suicidal ideation %K quality of life (QoL) %K self-confidence %K distress %K social support %K online therapy %K e-mental health %K generalized anxiety disorder %K obsessive-compulsive disorder %K social anxiety disorder %K posttraumatic stress disorder %K PD %K major depressive episode %K anxiety disorders %K insomnia, hypersomnia %D 2014 %7 28.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: A relative newcomer to the field of psychology, e-mental health has been gaining momentum and has been given considerable research attention. Although several aspects of e-mental health have been studied, 1 aspect has yet to receive attention: the structure of comorbidity of psychological disorders and their relationships with measures of psychosocial adjustment including suicidal ideation in online samples. Objective: This exploratory study attempted to identify the structure of comorbidity of 21 psychological disorders assessed by an automated online electronic psychological assessment screening system (e-PASS). The resulting comorbidity factor scores were then used to assess the association between comorbidity factor scores and measures of psychosocial adjustments (ie, psychological distress, suicidal ideation, adequate social support, self-confidence in dealing with mental health issues, and quality of life). Methods: A total of 13,414 participants were assessed using a complex online algorithm that resulted in primary and secondary Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) diagnoses for 21 psychological disorders on dimensional severity scales. The scores on these severity scales were used in a principal component analysis (PCA) and the resulting comorbidity factor scores were related to 4 measures of psychosocial adjustments. Results: A PCA based on 17 of the 21 psychological disorders resulted in a 4-factor model of comorbidity: anxiety-depression consisting of all anxiety disorders, major depressive episode (MDE), and insomnia; substance abuse consisting of alcohol and drug abuse and dependency; body image–eating consisting of eating disorders, body dysmorphic disorder, and obsessive-compulsive disorders; depression–sleep problems consisting of MDE, insomnia, and hypersomnia. All comorbidity factor scores were significantly associated with psychosocial measures of adjustment (P<.001). They were positively related to psychological distress and suicidal ideation, but negatively related to adequate social support, self-confidence, and quality of life. Conclusions: This exploratory study identified 4 comorbidity factors in the e-PASS data and these factor scores significantly predicted 5 psychosocial adjustment measures. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). %M 25351885 %R 10.2196/jmir.3591 %U http://www.jmir.org/2014/10/e248/ %U https://doi.org/10.2196/jmir.3591 %U http://www.ncbi.nlm.nih.gov/pubmed/25351885 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e232 %T Posttreatment Attrition and Its Predictors, Attrition Bias, and Treatment Efficacy of the Anxiety Online Programs %A AL-Asadi,Ali M %A Klein,Britt %A Meyer,Denny %+ Department of Arts and Education, Grande Prairie Regional College, 10726 - 106 Ave, Grande Prairie, AB, T8V 4C4, Canada, 1 780 539 2061, aalasadi@gprc.ab.ca %K posttreatment attrition %K posttreatment predictors %K treatment efficacy %K online therapy %K e-mental health %K cognitive behavioral therapy %K Internet interventions %K fully automated %K self-help %K Web treatment %K generalized anxiety disorder %K obsessive compulsive disorder %D 2014 %7 14.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Although relatively new, the field of e-mental health is becoming more popular with more attention given to researching its various aspects. However, there are many areas that still need further research, especially identifying attrition predictors at various phases of assessment and treatment delivery. Objective: The present study identified the predictors of posttreatment assessment completers based on 24 pre- and posttreatment demographic and personal variables and 1 treatment variable, their impact on attrition bias, and the efficacy of the 5 fully automated self-help anxiety treatment programs for generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder with or without agoraphobia (PD/A), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD). Methods: A complex algorithm was used to diagnose participants’ mental disorders based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision; DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders were offered an online 12-week disorder-specific treatment program. A total of 3199 individuals did not formally drop out of the 12-week treatment cycle, whereas 142 individuals formally dropped out. However, only 347 participants who completed their treatment cycle also completed the posttreatment assessment measures. Based on these measures, predictors of attrition were identified and attrition bias was examined. The efficacy of the 5 treatment programs was assessed based on anxiety-specific severity scores and 5 additional treatment outcome measures. Results: On average, completers of posttreatment assessment measures were more likely to be seeking self-help online programs; have heard about the program from traditional media or from family and friends; were receiving mental health assistance; were more likely to learn best by reading, hearing and doing; had a lower pretreatment Kessler-6 total score; and were older in age. Predicted probabilities resulting from these attrition variables displayed no significant attrition bias using Heckman’s method and thus allowing for the use of completer analysis. Six treatment outcome measures (Kessler-6 total score, number of diagnosed disorders, self-confidence in managing mental health issues, quality of life, and the corresponding pre- and posttreatment severity for each program-specific anxiety disorder and for major depressive episode) were used to assess the efficacy of the 5 anxiety treatment programs. Repeated measures MANOVA revealed a significant multivariate time effect for all treatment outcome measures for each treatment program. Follow-up repeated measures ANOVAs revealed significant improvements on all 6 treatment outcome measures for GAD and PTSD, 5 treatment outcome measures were significant for SAD and PD/A, and 4 treatment outcome measures were significant for OCD. Conclusions: Results identified predictors of posttreatment assessment completers and provided further support for the efficacy of self-help online treatment programs for the 5 anxiety disorders. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). %M 25316533 %R 10.2196/jmir.3513 %U http://www.jmir.org/2014/10/e232/ %U https://doi.org/10.2196/jmir.3513 %U http://www.ncbi.nlm.nih.gov/pubmed/25316533 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e230 %T Identifying Problematic Internet Users: Development and Validation of the Internet Motive Questionnaire for Adolescents (IMQ-A) %A Bischof-Kastner,Christina %A Kuntsche,Emmanuel %A Wolstein,Jörg %+ Institute of Psychology, Faculty of Humanities, University of Bamberg, Markusstraße 8a, Bamberg, 96047, Germany, 49 951 863 2045, joerg.wolstein@uni-bamberg.de %K Internet %K adolescents %K questionnaires %K validation %K addictive behavior %K statistical factor analysis %D 2014 %7 09.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Internationally, up to 15.1% of intensive Internet use among adolescents is dysfunctional. To provide a basis for early intervention and preventive measures, understanding the motives behind intensive Internet use is important. Objective: This study aims to develop a questionnaire, the Internet Motive Questionnaire for Adolescents (IMQ-A), as a theory-based measurement for identifying the underlying motives for high-risk Internet use. More precisely, the aim was to confirm the 4-factor structure (ie, social, enhancement, coping, and conformity motives) as well as its construct and concurrent validity. Another aim was to identify the motivational differences between high-risk and low-risk Internet users. Methods: A sample of 101 German adolescents (female: 52.5%, 53/101; age: mean 15.9, SD 1.3 years) was recruited. High-risk users (n=47) and low-risk users (n=54) were identified based on a screening measure for online addiction behavior in children and adolescents (Online-Suchtverhalten-Skala, OSVK-S). Here, “high-risk” Internet use means use that exceeds the level of intensive Internet use (OSVK-S sum score ≥7). Results: The confirmatory factor analysis confirmed the IMQ-A’s 4-factor structure. A reliability analysis revealed good internal consistencies of the subscales (.71 up to .86). Moreover, regression analyses confirmed that the enhancement and coping motive groups significantly predicted high-risk Internet consumption and the OSVK-S sum score. A mixed-model ANOVA confirmed that adolescents mainly access the Internet for social motives, followed by enhancement and coping motives, and that high-risk users access the Internet more frequently for coping and enhancement motives than low-risk users. Low-risk users were primarily motivated socially. Conclusions: The IMQ-A enables the assessment of motives related to adolescent Internet use and thus the identification of populations at risk. The questionnaire enables the development of preventive measures or early intervention programs, especially dealing with internal motives of Internet consumption. %M 25299174 %R 10.2196/jmir.3398 %U http://www.jmir.org/2014/10/e230/ %U https://doi.org/10.2196/jmir.3398 %U http://www.ncbi.nlm.nih.gov/pubmed/25299174 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e219 %T A Comparison Between Phone-Based Psychotherapy With and Without Text Messaging Support In Between Sessions for Crisis Patients %A Furber,Gareth %A Jones,Gabrielle Margaret %A Healey,David %A Bidargaddi,Niranjan %+ Health Economics and Social Policy Group, School of Population Health, University of South Australia, South Australian Health & Medical Research Institute (SAHMRI), North Terrace, Adelaide, 5000, Australia, 61 80429344065, gareth.furber@unisa.edu.au %K telemedicine %K psychotherapy %K mental health services %K mobile health %K mHealth %K short message service %K eHealth %D 2014 %7 08.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Few studies have tested whether individually tailored text messaging interventions have an effect on clinical outcomes when used to supplement traditional psychotherapy. This is despite the potential to improve outcomes through symptom monitoring, prompts for between-session activities, and psychoeducation. Objective: The intent of the study was to explore the use of individually tailored between-session text messaging, or short message service (SMS), as an adjunct to telephone-based psychotherapy for consumers who present to the Emergency Department (ED) in situational and/or emotional crises. Methods: Over a 4-month period, two therapists offered 68 prospective consumers of a telephone-based psychotherapy service individually tailored between-session text messaging alongside their telephone-based psychotherapy. Attendance and clinical outcomes (depression, anxiety, functional impairment) of those receiving messages were compared against a historical control group (n=157) who received telephone psychotherapy only. Results: A total of 66% (45/68) of the consumers offered SMS accepted the intervention. A total of 432 messages were sent over the course of the trial, the majority involving some kind of psychoeducation or reminders to engage in therapy goals. There were no significant differences in clinical outcomes between consumers who received the SMS and those in the control group. There was a trend for participants in the intervention group to attend fewer sessions than those in the control group (mean 3.7, SD 1.9 vs mean 4.4, SD 2.3). Conclusions: Both groups showed significant improvement over time. Individually tailored SMS were not found to improve clinical outcomes in consumers receiving telephone-based psychotherapy, but the study was underpowered, given the effect sizes noted and the significance level chosen. Given the ease of implementation and positive feedback from therapists and clients, individually tailored text messages should be explored further in future trials with a focus on enhancing the clinical impact of the tailored text messages, and utilizing designs with additional power to test for between-group effects. %M 25295667 %R 10.2196/jmir.3096 %U http://www.jmir.org/2014/10/e219/ %U https://doi.org/10.2196/jmir.3096 %U http://www.ncbi.nlm.nih.gov/pubmed/25295667 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e226 %T Short-Term Effectiveness of Web-Based Guided Self-Help for Phobic Outpatients: Randomized Controlled Trial %A Kok,Robin N %A van Straten,Annemieke %A Beekman,Aartjan T F %A Cuijpers,Pim %+ Department of Clinical Psychology and the EMGO institute for Health and Care Research, VU University Amsterdam, van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 205983833, r.n.kok@vu.nl %K phobias %K phobic disorders %K anxiety disorders %K Web-based intervention %K Internet therapy %K randomized controlled trial %K outpatients %D 2014 %7 29.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based guided self-help has been successfully used in the general population, but it is unknown whether this method can be effectively used in outpatient clinics for patients waiting for face-to-face psychotherapy for phobias. Objective: The aim was to assess the clinical effectiveness of Phobias Under Control, an Internet-based intervention based on exposure therapy with weekly guidance. Methods: We conducted a randomized controlled trial, recruiting 212 outpatients scheduled to receive face-to-face psychotherapy for any type of phobia at an outpatient clinic. Participants suffering from at least 1 DSM-IV or ICD-10 classified phobia (social phobia, agoraphobia with or without panic disorder, and/or specific phobia as ascertained by a telephone interview at baseline) were randomly allocated to either a 5-week Internet-based guided self-help program based on exposure therapy with weekly student support followed by face-to-face psychotherapy (n=105) or a wait-list control group followed by face-to-face psychotherapy (n=107). Primary outcome was the Fear Questionnaire (FQ). Secondary outcomes were the Beck Anxiety Inventory (BAI) and Center of Epidemiological Studies-Depression scale (CES-D). Assessments took place by telephone at baseline (T0) and on the Internet at posttest (T1, self-assessment at 5 weeks after baseline). Missing data at T1 were imputed. Results: At posttest, analysis of covariance on the intention-to-treat sample showed significant but small effect sizes between intervention and control groups on the FQ (d=0.35, P=.02), CES-D (d=0.34, P=.03), and a nonsignificant effect size on the BAI (d=0.28. P=.05). Although initial acceptance was good, high nonresponse was observed, with 86 of 212 participants (40.5%) lost to follow-up at T1 and only 14 of 105 (13.3%) intervention participants finishing all 5 weeks. Conclusions: Phobias Under Control is modestly effective in lowering phobic and depressive symptoms in a relatively short period and may be clinically beneficial when implemented in routine outpatient practice. Trial Registration: Netherlands Trial Register NTR2233; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2233 (Archived by WebCite at http://www.webcitation.org/6O2ioOQSs). %M 25266929 %R 10.2196/jmir.3429 %U http://www.jmir.org/2014/9/e226/ %U https://doi.org/10.2196/jmir.3429 %U http://www.ncbi.nlm.nih.gov/pubmed/25266929 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e209 %T Web-Based Intervention Programs for Depression: A Scoping Review and Evaluation %A Renton,Tian %A Tang,Herman %A Ennis,Naomi %A Cusimano,Michael D %A Bhalerao,Shree %A Schweizer,Tom A %A Topolovec-Vranic,Jane %+ Trauma and Neurosurgery Program, St Michael's Hospital, Bond 3-012, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, 1 416 864 6060 ext 3421, topolovec-vranicj@smh.ca %K depression %K Web-based interventions %K interactive treatment %K health care access %K mental health %K technology %D 2014 %7 23.09.2014 %9 Review %J J Med Internet Res %G English %X Background: Although depression is known to affect millions of people worldwide, individuals seeking aid from qualified health care professionals are faced with a number of barriers to treatment including a lack of treatment resources, limited number of qualified service providers, stigma associated with diagnosis and treatment, prolonged wait times, cost, and barriers to accessibility such as transportation and clinic locations. The delivery of depression interventions through the Internet may provide a practical solution to addressing some of these barriers. Objective: The purpose of this scoping review was to answer the following questions: (1) What Web-delivered programs are currently available that offer an interactive treatment component for depression?, (2) What are the contents, accessibility, and usability of each identified program?, and (3) What tools, supports, and research evidence are available for each identified program? Methods: Using the popular search engines Google, Yahoo, and Bing (Canadian platforms), two reviewers independently searched for interactive Web-based interventions targeting the treatment of depression. The Beacon website, an information portal for online health applications, was also consulted. For each identified program, accessibility, usability, tools, support, and research evidence were evaluated and programs were categorized as evidence-based versus non-evidence-based if they had been the subject of at least one randomized controlled trial. Programs were scored using a 28-point rating system, and evidence- versus non-evidence-based programs were compared and contrasted. Although this review included all programs meeting exclusion and inclusion criteria found using the described search method, only English language Web-delivered depression programs were awarded an evaluation score. Results: The review identified 32 programs meeting inclusion criteria. There was a great deal of variability among the programs captured in this evaluation. Many of the programs were developed for general adolescent or adult audiences, with few (n=2) focusing on special populations (eg, military personnel, older adults). Cognitive behavioral therapy was the most common therapeutic approach used in the programs described. Program interactive components included mood assessments and supplementary homework sheets such as activity planning and goal setting. Only 12 of the programs had published evidence in support of their efficacy and treatment of depressive symptoms. Conclusions: There are a number of interactive depression interventions available through the Internet. Recommendations for future programs, or the adaptation of existing programs include offering a greater selection of alternative languages, removing registration restrictions, free trial periods for programs requiring user fees, and amending programs to meet the needs of special populations (eg, those with cognitive and/or visual impairments). Furthermore, discussion of specific and relevant topics to the target audience while also enhancing overall user control would contribute to a more accessible intervention tool. %M 25249003 %R 10.2196/jmir.3147 %U http://www.jmir.org/2014/9/e209/ %U https://doi.org/10.2196/jmir.3147 %U http://www.ncbi.nlm.nih.gov/pubmed/25249003 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e206 %T Online and Social Networking Interventions for the Treatment of Depression in Young People: A Systematic Review %A Rice,Simon M %A Goodall,Joanne %A Hetrick,Sarah E %A Parker,Alexandra G %A Gilbertson,Tamsyn %A Amminger,G. Paul %A Davey,Christopher G %A McGorry,Patrick D %A Gleeson,John %A Alvarez-Jimenez,Mario %+ Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne, 35 Poplar Rd, Parkville, Melbourne, 3052, Australia, 61 419497599, simon.rice@unimelb.edu.au %K Internet %K depression %K young adult %K adolescent %K social networking %K support groups %K review %D 2014 %7 16.09.2014 %9 Review %J J Med Internet Res %G English %X Background: Major depression accounts for the greatest burden of all diseases globally. The peak onset of depression occurs between adolescence and young adulthood, and for many individuals, depression displays a relapse-remitting and increasingly severe course. Given this, the development of cost-effective, acceptable, and population-focused interventions for depression is critical. A number of online interventions (both prevention and acute phase) have been tested in young people with promising results. As these interventions differ in content, clinician input, and modality, it is important to identify key features (or unhelpful functions) associated with treatment outcomes. Objective: A systematic review of the research literature was undertaken. The review was designed to focus on two aspects of online intervention: (1) standard approaches evaluating online intervention content in randomized controlled designs (Section 1), and (2) second-generation online interventions and services using social networking (eg, social networking sites and online support groups) in any type of research design (Section 2). Methods: Two specific literature searches were undertaken. There was no date range specified. The Section 1 search, which focused on randomized controlled trials, included only young people (12-25 years) and yielded 101 study abstracts, of which 15 met the review inclusion criteria. The Section 2 search, which included all study design types and was not restricted in terms of age, yielded 358 abstracts, of which 22 studies met the inclusion criteria. Information about the studies and their findings were extracted and tabulated for review. Results: The 15 studies identified in Section 1 described 10 trials testing eight different online interventions, all of which were based on a cognitive behavioral framework. All but one of the eight identified studies reported positive results; however, only five of the 15 studies used blinded interviewer administered outcomes with most trials using self-report data. Studies varied significantly in presentation of intervention content, treatment dose, and dropout. Only two studies included moderator or clinician input. Results for Section 2 were less consistent. None of the Section 2 studies reported controlled or randomized designs. With the exception of four studies, all included participants were younger than 25 years of age. Eight of the 16 social networking studies reported positive results for depression-related outcomes. The remaining studies were either mixed or negative. Findings for online support groups tended to be more positive; however, noteworthy risks were identified. Conclusions: Online interventions with a broad cognitive behavioral focus appear to be promising in reducing depression symptomology in young people. Further research is required into the effectiveness of online interventions delivering cognitive behavioral subcomponents, such as problem-solving therapy. Evidence for the use of social networking is less compelling, although limited by a lack of well-designed studies and social networking interventions. A range of future social networking therapeutic opportunities are highlighted. %M 25226790 %R 10.2196/jmir.3304 %U http://www.jmir.org/2014/9/e206/ %U https://doi.org/10.2196/jmir.3304 %U http://www.ncbi.nlm.nih.gov/pubmed/25226790 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e207 %T Applying Computer Adaptive Testing to Optimize Online Assessment of Suicidal Behavior: A Simulation Study %A De Beurs,Derek Paul %A de Vries,Anton LM %A de Groot,Marieke H %A de Keijser,Jos %A Kerkhof,Ad JFM %+ EMGO Institute for Health and Care Research, van der Boechorststraat 1, Amsterdam, , Netherlands, 31 205982589, dp.de.beurs@vu.nl %K suicide %K psychometrics %K computing methodologies %K Internet %K suicidal ideation %K risk assessment %D 2014 %7 11.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is used increasingly for both suicide research and prevention. To optimize online assessment of suicidal patients, there is a need for short, good-quality tools to assess elevated risk of future suicidal behavior. Computer adaptive testing (CAT) can be used to reduce response burden and improve accuracy, and make the available pencil-and-paper tools more appropriate for online administration. Objective: The aim was to test whether an item response–based computer adaptive simulation can be used to reduce the length of the Beck Scale for Suicide Ideation (BSS). Methods: The data used for our simulation was obtained from a large multicenter trial from The Netherlands: the Professionals in Training to STOP suicide (PITSTOP suicide) study. We applied a principal components analysis (PCA), confirmatory factor analysis (CFA), a graded response model (GRM), and simulated a CAT. Results: The scores of 505 patients were analyzed. Psychometric analyses showed the questionnaire to be unidimensional with good internal consistency. The computer adaptive simulation showed that for the estimation of elevation of risk of future suicidal behavior 4 items (instead of the full 19) were sufficient, on average. Conclusions: This study demonstrated that CAT can be applied successfully to reduce the length of the Dutch version of the BSS. We argue that the use of CAT can improve the accuracy and the response burden when assessing the risk of future suicidal behavior online. Because CAT can be daunting for clinicians and applied scientists, we offer a concrete example of our computer adaptive simulation of the Dutch version of the BSS at the end of the paper. %M 25213259 %R 10.2196/jmir.3511 %U http://www.jmir.org/2014/9/e207/ %U https://doi.org/10.2196/jmir.3511 %U http://www.ncbi.nlm.nih.gov/pubmed/25213259 %0 Journal Article %@ 2368-7959 %I JMIR Publications Inc. %V 1 %N 1 %P e1 %T A Web-Based Intervention for Users of Amphetamine-Type Stimulants: 3-Month Outcomes of a Randomized Controlled Trial %A Tait,Robert J %A McKetin,Rebecca %A Kay-Lambkin,Frances %A Carron-Arthur,Bradley %A Bennett,Anthony %A Bennett,Kylie %A Christensen,Helen %A Griffiths,Kathleen M %+ National Drug Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, 6845, Australia, 61 8 92661610, robert.tait@curtin.edu.au %K amphetamine related disorders %K Internet %K World Wide Web %K randomized control trial %K cognitive therapy %K online %K Web-based %K motivational enhancement %K intervention %D 2014 %7 11.09.2014 %9 Original Paper %J JMIR Mental Health %G English %X Background: Among illicit drugs, the prevalence of amphetamine-type stimulant (ATS) use is second only to cannabis. Currently, there are no approved pharmacotherapies for ATS problems, but some face-to-face psychotherapies are effective. Web-based interventions have proven to be effective for some substance use problems, but none has specifically targeted ATS users. Objective: The objective of the study was to evaluate the effectiveness of a Web-based intervention for ATS problems on a free-to-access site compared with a waitlist control group. Methods: We used a randomized controlled trial design. The primary outcome measure was self-reported ATS use in the past three months assessed using the Alcohol, Smoking, Substance Involvement Screening Test (ASSIST). Other measures included quality of life (EUROHIS score), psychological distress (K-10 score), days out of role, poly-drug use, general help-seeking intentions, actual help-seeking, and “readiness to change”. The intervention consisted of three fully automated, self-guided modules based on cognitive behavioral therapy and motivation enhancement. The analysis was an intention-to-treat analysis using generalized estimating equation models, with a group by time interaction as the critical assessment. Results: We randomized 160 people (intervention n=81, control n=79). At three months, 35/81 (43%) intervention and 45/79 (57%) control participants provided follow-up data. In the intervention group, 51/81 (63%) completed at least one module. The only significant group by time interaction was for days out of role. The pre/post change effect sizes showed small changes (range d=0.14 to 0.40) favoring the intervention group for poly-drug use, distress, actual help-seeking, and days out of role. In contrast, the control group was favored by reductions in ATS use, improvements in quality of life, and increases in help-seeking intentions (range d=0.09 to 0.16). Conclusions: This Web-based intervention for ATS use produced few significant changes in outcome measures. There were moderate, but nonsignificant reductions in poly-drug use, distress, days partially out of role, and increases in help-seeking. However, high levels of participant attrition, plus low levels of engagement with the modules, preclude firm conclusions being drawn on the efficacy of the intervention and emphasize the problems of engaging this group of clients in a fully automated program. Trial Registration: Australian and New Zealand Clinical Trials Registry: ACTRN 12611000947909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000947909 (Archived by WebCite at http://www.webcitation.org/6SHTxEnzP). %M 26543901 %R 10.2196/mental.3278 %U https://mental.jmir.org/2014/1/e1/ %U https://doi.org/10.2196/mental.3278 %U http://www.ncbi.nlm.nih.gov/pubmed/26543901 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e208 %T Norwegian General Practitioners’ Perspectives on Implementation of a Guided Web-Based Cognitive Behavioral Therapy for Depression: A Qualitative Study %A Wilhelmsen,Maja %A Høifødt,Ragnhild Sørensen %A Kolstrup,Nils %A Waterloo,Knut %A Eisemann,Martin %A Chenhall,Richard %A Risør,Mette Bech %+ Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Breivika, Tromsø, 9037, Norway, 47 99001559, maja.wilhelmsen@uit.no %K mental health %K Internet %K telemedicine %K qualitative research %K primary health care %K cognitive therapy %K depression %D 2014 %7 10.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous research suggests that Internet-based cognitive behavioral therapy (ICBT) has a positive effect on symptoms of depression. ICBT appears to be more effective with therapist support, but it is unclear what this support should comprise. General practitioners (GPs) have positive attitudes toward ICBT. However, ICBT is rarely used in regular care in general practice. More research is warranted to integrate the potential of ICBT as part of regular care. Objective: The aim of this study was to explore aspects perceived by GPs to affect the implementation of guided ICBT in daily practice. Understanding their perspectives may contribute to improving the treatment of depression in the context of general practice. Methods: A training package (3-day course) introducing a Norwegian translation of the ICBT program MoodGYM was developed and presented to GPs in Norway. Following training, GPs were asked to include guided ICBT in their regular care of patients with symptoms of depression by providing brief, face-to-face follow-up consultations between modules. We interviewed 11 GPs who had taken the course. Our interview guide comprised open questions that encouraged GPs to frame their responses using examples from their experiences when implementing ICBT. Thematic analysis was chosen to explore patterns across the data. Results: An overall belief that ICBT would benefit both the patients’ health and the GPs’ own work satisfaction prompted the GPs to take the ICBT course. ICBT motivated them to invest time and effort in improving treatment. The most important motivating aspects in MoodGYM were that a program based on cognitive behavioral therapy could add a structured agenda to their consultations and empower depressed patients. Organizational aspects, such as a lack of time and varied practice, inhibited the use of ICBT. Inadequate knowledge, recalling the program, and changing own habits were also challenging. The GPs were ambivalent about whether ICBT had a negative impact on the doctor–patient interaction in the module follow-ups. Generally, GPs made an effort to recommend MoodGYM, but the expected module follow-ups were often not provided to patients and instead the GPs returned to standard treatment. Conclusions: GPs’ feedback in the present study contribute to our understanding of the challenges of changing treatment for depression. Our findings indicated that recommending ICBT could add to the GP’s toolkit. Offering training and highlighting the following aspects may increase recommendation of ICBT by GPs: (1) ICBT is theory-based and credible, (2) ICBT increases the GPs’ work satisfaction by having a tool to offer, and (3) ICBT facilitates empowerment of patients in their own health. In addition, the present study also indicated that complex aspects must be accommodated before module follow-ups can be incorporated into GPs’ treatment of depression. %M 25208886 %R 10.2196/jmir.3556 %U http://www.jmir.org/2014/9/e208/ %U https://doi.org/10.2196/jmir.3556 %U http://www.ncbi.nlm.nih.gov/pubmed/25208886 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e199 %T Prevention of Generalized Anxiety Disorder Using a Web Intervention, iChill: Randomized Controlled Trial %A Christensen,Helen %A Batterham,Philip %A Mackinnon,Andrew %A Griffiths,Kathleen M %A Kalia Hehir,Kanupriya %A Kenardy,Justin %A Gosling,John %A Bennett,Kylie %+ Black Dog Institute, University of New South Wales, Hospital Road, Prince of Wales Hospital, Randwick, Sydney, 2031, Australia, 61 293829288, h.christensen@blackdog.org.au %K anxiety disorders %K prevention %K early intervention %K Internet %K online systems %K cognitive behavioral therapy %D 2014 %7 02.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Generalized Anxiety Disorder (GAD) is a high prevalence, chronic disorder. Web-based interventions are acceptable, engaging, and can be delivered at scale. Few randomized controlled trials evaluate the effectiveness of prevention programs for anxiety, or the factors that improve effectiveness and engagement. Objective: The intent of the study was to evaluate the effectiveness of a Web-based program in preventing GAD symptoms in young adults, and to determine the role of telephone and email reminders. Methods: A 5-arm randomized controlled trial with 558 Internet users in the community, recruited via the Australian Electoral Roll, was conducted with 6- and 12-month follow-up. Five interventions were offered over a 10-week period. Group 1 (Active website) received a combined intervention of psycho-education, Internet-delivered Cognitive Behavioral Therapy (ICBT) for anxiety, physical activity promotion, and relaxation. Group 2 (Active website with telephone) received the identical Web program plus weekly telephone reminder calls. Group 3 (Active website with email) received the identical Web program plus weekly email reminders. Group 4 (Control) received a placebo website. Group 5 (Control with telephone) received the placebo website plus telephone calls. Main outcome measures were severity of anxiety symptoms as measured by the GAD 7-item scale (GAD-7) (at post-test, 6, and 12 months). Secondary measures were GAD caseness, measured by the Mini International Neuropsychiatric Interview (MINI) at 6 months, Centre for Epidemiologic Studies-Depression scale (CES-D), Anxiety Sensitivity Index (ASI), Penn State Worry Questionnaire (PSWQ), and Days out of Role. Results: GAD-7 symptoms reduced over post-test, 6-month, and 12-month follow-up. There were no significant differences between Group 4 (Control) and Groups 1 (Active website), 2 (Active website with telephone), 3 (Active website with email), or 5 (Control with telephone) at any follow-up. A total of 16 cases of GAD were identified at 6 months, comprising 6.7% (11/165) from the Active groups (1, 2, 3) and 4.5% (5/110) from the Control groups (4, 5), a difference that was not significant. CES-D, ASI, and PSWQ scores were significantly lower for the active website with email reminders at post-test, relative to the control website condition. Conclusions: Indicated prevention of GAD was not effective in reducing anxiety levels, measured by GAD-7. There were significant secondary effects for anxiety sensitivity, worry, and depression. Challenges for indicated prevention trials are discussed. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 76298775; http://www.controlled-trials.com/ISRCTN76298775 (Archived by WebCite at http://www.webcitation.org/6S9aB5MAq). %M 25270886 %R 10.2196/jmir.3507 %U http://www.jmir.org/2014/9/e199/ %U https://doi.org/10.2196/jmir.3507 %U http://www.ncbi.nlm.nih.gov/pubmed/25270886 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e168 %T Long-Term Results of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial %A Geraedts,Anna S %A Kleiboer,Annet M %A Twisk,Jos %A Wiezer,Noortje M %A van Mechelen,Willem %A Cuijpers,Pim %+ Department of Clinical Psychology, Vrije University Amsterdam, Van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 0205987451, a.s.geraedts@vu.nl %K depression %K employees %K occupational intervention %K self-help %K prevention %K burnout %K Internet %D 2014 %7 09.07.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms via the Internet before they report sick from work could be beneficial and cost saving. Objective: In this study, we tested the effectiveness over the period of 1 year of a Web-based guided self-help intervention, called Happy@Work, for employees with depressive symptoms who were not on sick leave. Methods: A two-arm randomized controlled trial comparing a worker-directed, Web-based, guided self-help intervention to care as usual (CAU) was carried out. We recruited employees from 6 companies via the company’s Intranet and by putting up posters. The inclusion criteria were elevated depressive symptoms as measured by a score ≥16 on the Center for Epidemiologic Studies Depression scale (CES-D) and not being on sick leave. The intervention contained 6 lessons and consisted of problem-solving treatment and cognitive therapy. Participants were asked to submit weekly assignments via the website after completion of a lesson and they received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), burnout (Maslach Burnout Inventory, MBI), work performance (Health and Work Performance Questionnaire, HPQ), duration of absenteeism, and anxiety (Hospital Anxiety and Depression Scale, HADS; secondary outcomes), were completed at baseline, posttreatment, and at 6-, and 12-month follow-up. Several subgroup and per-protocol analyses were performed. Results: A total of 231 employees were randomized to either the intervention group (n=116) or to CAU (n=115). Completion of assessments varied between 54%-74%. Improvement in depressive symptoms between baseline and posttreatment was shown in all participants and these effects sustained over time. However, there were no differences between the 2 groups (adjusted regression coefficient=0.46, 95% CI –2.11 to 3.03, P=.72; Cohen’s d=0.05). Differences between groups were also not significant for the secondary outcomes. No subgroups were identified to show differences between the groups, nor did we find a between-group effect in the per-protocol analyses. Conclusions: This study showed that a worker-directed, Web-based, guided self-help intervention was not more effective than CAU in reducing depressive symptoms among employees with depressive symptoms who were not on sick leave over the period of 1 year. An intervention for this specific target group might not be necessary because the recovery in the CAU group was comparable to the intervention group and sustained over a 12-month period. Trial Registration: Nederlands Trial Register (NTR): NTR2993; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2993 (Archived by WebCite at http://www.webcitation.org/6PL9pFC0n). %M 25008127 %R 10.2196/jmir.3539 %U http://www.jmir.org/2014/7/e168/ %U https://doi.org/10.2196/jmir.3539 %U http://www.ncbi.nlm.nih.gov/pubmed/25008127 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e167 %T Experiential Virtual Scenarios With Real-Time Monitoring (Interreality) for the Management of Psychological Stress: A Block Randomized Controlled Trial %A Gaggioli,Andrea %A Pallavicini,Federica %A Morganti,Luca %A Serino,Silvia %A Scaratti,Chiara %A Briguglio,Marilena %A Crifaci,Giulia %A Vetrano,Noemi %A Giulintano,Annunziata %A Bernava,Giuseppe %A Tartarisco,Gennaro %A Pioggia,Giovanni %A Raspelli,Simona %A Cipresso,Pietro %A Vigna,Cinzia %A Grassi,Alessandra %A Baruffi,Margherita %A Wiederhold,Brenda %A Riva,Giuseppe %+ Applied Technology for Neuro-Psychology Lab, Istituto Auxologico Italiano, Via Alessandro Magnasco 2, Milan, 20149, Italy, 39 0261911 ext 2892, andrea.gaggioli@auxologico.it %K psychological stress %K Interreality %K virtual reality %K biosensors %K heart rate %K heart rate variability %K biofeedback training %K relaxation training %K physiological monitoring %K smartphones %D 2014 %7 08.07.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The recent convergence between technology and medicine is offering innovative methods and tools for behavioral health care. Among these, an emerging approach is the use of virtual reality (VR) within exposure-based protocols for anxiety disorders, and in particular posttraumatic stress disorder. However, no systematically tested VR protocols are available for the management of psychological stress. Objective: Our goal was to evaluate the efficacy of a new technological paradigm, Interreality, for the management and prevention of psychological stress. The main feature of Interreality is a twofold link between the virtual and the real world achieved through experiential virtual scenarios (fully controlled by the therapist, used to learn coping skills and improve self-efficacy) with real-time monitoring and support (identifying critical situations and assessing clinical change) using advanced technologies (virtual worlds, wearable biosensors, and smartphones). Methods: The study was designed as a block randomized controlled trial involving 121 participants recruited from two different worker populations—teachers and nurses—that are highly exposed to psychological stress. Participants were a sample of teachers recruited in Milan (Block 1: n=61) and a sample of nurses recruited in Messina, Italy (Block 2: n=60). Participants within each block were randomly assigned to the (1) Experimental Group (EG): n=40; B1=20, B2=20, which received a 5-week treatment based on the Interreality paradigm; (2) Control Group (CG): n=42; B1=22, B2=20, which received a 5-week traditional stress management training based on cognitive behavioral therapy (CBT); and (3) the Wait-List group (WL): n=39, B1=19, B2=20, which was reassessed and compared with the two other groups 5 weeks after the initial evaluation. Results: Although both treatments were able to significantly reduce perceived stress better than WL, only EG participants reported a significant reduction (EG=12% vs CG=0.5%) in chronic “trait” anxiety. A similar pattern was found for coping skills: both treatments were able to significantly increase most coping skills, but only EG participants reported a significant increase (EG=14% vs CG=0.3%) in the Emotional Support skill. Conclusions: Our findings provide initial evidence that the Interreality protocol yields better outcomes than the traditionally accepted gold standard for psychological stress treatment: CBT. Consequently, these findings constitute a sound foundation and rationale for the importance of continuing future research in technology-enhanced protocols for psychological stress management. Trial Registration: ClinicalTrials.gov: NCT01683617; http://clinicaltrials.gov/show/NCT01683617 (Archived by WebCite at http://www.webcitation.org/6QnziHv3h). %M 25004803 %R 10.2196/jmir.3235 %U http://www.jmir.org/2014/7/e167/ %U https://doi.org/10.2196/jmir.3235 %U http://www.ncbi.nlm.nih.gov/pubmed/25004803 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 7 %P e166 %T Assessing the Applicability of E-Therapies for Depression, Anxiety, and Other Mood Disorders Among Lesbians and Gay Men: Analysis of 24 Web- and Mobile Phone-Based Self-Help Interventions %A Rozbroj,Tomas %A Lyons,Anthony %A Pitts,Marian %A Mitchell,Anne %A Christensen,Helen %+ Australian Research Centre in Sex, Health and Society, Faculty of Health Sciences, La Trobe University, 215, Franklin Street, Melbourne, 3000, Australia, 61 3 9479 8765, t.rozbroj@latrobe.edu.au %K Internet therapy %K e-therapy %K cCBT %K mental health %K gay men %K lesbian %K minority stress %K depression %K anxiety %K review %D 2014 %7 03.07.2014 %9 Review %J J Med Internet Res %G English %X Background: Lesbians and gay men have disproportionately high rates of depression and anxiety, and report lower satisfaction with treatments. In part, this may be because many health care options marginalize them by assuming heterosexuality, or misunderstand and fail to respond to the challenges specifically faced by these groups. E-therapies have particular potential to respond to the mental health needs of lesbians and gay men, but there is little research to determine whether they do so, or how they might be improved. Objective: We sought to examine the applicability of existing mental health e-therapies for lesbians and gay men. Methods: We reviewed 24 Web- and mobile phone-based e-therapies and assessed their performance in eight key areas, including the use of inclusive language and content and whether they addressed mental health stressors for lesbians and gay men, such as experiences of stigma related to their sexual orientation, coming out, and relationship issues that are specific to lesbians and gay men. Results: We found that e-therapies seldom addressed these stressors. Furthermore, 58% (14/24) of therapies contained instances that assumed or suggested the user was heterosexual, with instances especially prevalent among better-evidenced programs. Conclusions: Our findings, and a detailed review protocol presented in this article, may be used as guides for the future development of mental health e-therapies to better accommodate the needs of lesbians and gay men. %M 24996000 %R 10.2196/jmir.3529 %U http://www.jmir.org/2014/7/e166/ %U https://doi.org/10.2196/jmir.3529 %U http://www.ncbi.nlm.nih.gov/pubmed/24996000 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 2 %P e30 %T Feasibility and User Perception of a Fully Automated Push-Based Multiple-Session Alcohol Intervention for University Students: Randomized Controlled Trial %A Bendtsen,Marcus %A Bendtsen,Preben %+ Medical Faculty, Department of Medical Specialist and Department of Medicine and Health, Linköping University, Motala, Linköping, 581 83, Sweden, 46 702324615, preben.bendtsen@liu.se %K alcohol intervention %K text messages %K SMS %K email %K students %K multiple-session intervention %K push-based intervention %D 2014 %7 23.06.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: In recent years, many electronic health behavior interventions have been developed in order to reach individuals with unhealthy behaviors, such as risky drinking. This is especially relevant for university students, many of whom are risky drinkers. Objective: This study explored the acceptability and feasibility in a nontreatment-seeking group of university students (including both risk and nonrisk drinkers), of a fully automated, push-based, multiple-session, alcohol intervention, comparing two modes of delivery by randomizing participants to receive the intervention either by SMS text messaging (short message service, SMS) or by email. Methods: A total of 5499 students at Luleå University in northern Sweden were invited to participate in a single-session alcohol assessment and feedback intervention; 28.04% (1542/5499) students completed this part of the study. In total, 29.44% (454/1542) of those participating in the single-session intervention accepted to participate further in the extended multiple-session intervention lasting for 4 weeks. The students were randomized to receive the intervention messages via SMS or email. A follow-up questionnaire was sent immediately after the intervention and 52.9% (240/454) responded. Results: No difference was seen regarding satisfaction with the length and frequency of the intervention, regardless of the mode of delivery. Approximately 15% in both the SMS (19/136) and email groups (15/104) would have preferred the other mode of delivery. On the other hand, more students in the SMS group (46/229, 20.1%) stopped participating in the intervention during the 4-week period compared with the email group (10/193, 5.2%). Most students in both groups expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. A striking difference was seen regarding when a message was read; 88.2% (120/136) of the SMS group read the messages within 1 hour in contrast to 45.2% (47/104) in the email group. In addition, 83.1% (113/136) in the SMS group stated that they read all or almost all the messages, compared with only 63.5% (66/104) in the email group. Conclusions: Based on the feedback from the students, an extended, multiple-session, push-based intervention seems to be a feasible option for students interested in additional support after a single-session alcohol intervention. SMS as a mode of delivery seems to have some advantages over email regarding when a message is read and the proportion of messages read. However, more students in the SMS group stopped the intervention than in the email group. Based on these promising findings, further studies comparing the effectiveness of single-session interventions with extended multiple-session interventions delivered separately or in combination are warranted. %M 25098296 %R 10.2196/mhealth.3233 %U http://mhealth.jmir.org/2014/2/e30/ %U https://doi.org/10.2196/mhealth.3233 %U http://www.ncbi.nlm.nih.gov/pubmed/25098296 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 6 %P e152 %T Pretreatment Attrition and Formal Withdrawal During Treatment and Their Predictors: An Exploratory Study of the Anxiety Online Data %A AL-Asadi,Ali M %A Klein,Britt %A Meyer,Denny %+ Department of Arts and Education, Grande Prairie Regional College, 10726 - 106 Ave, Grande Prairie, AB, T8V 4C4, Canada, 1 780 539 2061, aalasadi@gprc.ab.ca %K pretreatment attrition %K treatment withdrawal dropouts %K predictors, anxiety disorders %K eTherapy %K e-mental health %K Internet interventions %D 2014 %7 17.06.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Although in its infancy, the field of e-mental health interventions has been gaining popularity and afforded considerable research attention. However, there are many gaps in the research. One such gap is in the area of attrition predictors at various stages of assessment and treatment delivery. Objective: This exploratory study applied univariate and multivariate analysis to a large dataset provided by the Anxiety Online (now called Mental Health Online) system to identify predictors of attrition in treatment commencers and in those who formally withdrew during treatment based on 24 pretreatment demographic and personal variables and one clinical measure. Methods: Participants were assessed using a complex online algorithm that resulted in primary and secondary diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). Those who received a primary or secondary diagnosis of 1 of 5 anxiety disorders (generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, and panic disorder) were offered an online 12-week disorder-specific treatment program. Results: Of 9394 potential participants, a total of 3880 clients enrolled and 5514 did not enroll in one of the treatment programs following the completion of pretreatment assessment measures (pretreatment attrition rate: 58.70%). A total of 3199 individuals did not formally withdraw from the 12-week treatment cycle, whereas 142 individuals formally dropped out (formal withdrawal during treatment dropout rate of 4.25%). The treatment commencers differed significantly (P<.001-.03) from the noncommencers on several variables (reason for registering, mental health concerns, postsecondary education, where first heard about Anxiety Online, Kessler-6 score, stage of change, quality of life, relationship status, preferred method of learning, and smoking status). Those who formally withdrew during treatment differed significantly (P=.002-.03) from those who did not formally withdraw in that they were less likely to express concerns about anxiety, stress, and depression; to rate their quality of life as very poor, poor, or good; to report adequate level of social support; and to report readiness to make or were in the process of making changes. Conclusions: This exploratory study identified predictors of pretreatment attrition and formal withdrawal during treatment dropouts for the Anxiety Online program. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG). %M 24938311 %R 10.2196/jmir.2989 %U http://www.jmir.org/2014/6/e152/ %U https://doi.org/10.2196/jmir.2989 %U http://www.ncbi.nlm.nih.gov/pubmed/24938311 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 6 %P e140 %T Feasibility and Effectiveness of a Web-Based Positive Psychology Program for Youth Mental Health: Randomized Controlled Trial %A Manicavasagar,Vijaya %A Horswood,Deserae %A Burckhardt,Rowan %A Lum,Alistair %A Hadzi-Pavlovic,Dusan %A Parker,Gordon %+ Black Dog Institute, School of Psychiatry, UNSW Australia, Hospital Rd, Randwick, 2031, Australia, 61 2 9382 4320, v.manicavasagar@unsw.edu.au %K adolescent %K resilience %K psychological %K mental health %K Internet %K early medical intervention %D 2014 %7 04.06.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Youth mental health is a significant public health concern due to the high prevalence of mental health problems in this population and the low rate of those affected seeking help. While it is increasingly recognized that prevention is better than cure, most youth prevention programs have utilized interventions based on clinical treatments (eg, cognitive behavioral therapy) with inconsistent results. Objective: This study explores the feasibility of the online delivery of a youth positive psychology program, Bite Back, to improve the well-being and mental health outcomes of Australian youth. Further aims were to examine rates of adherence and attrition, and to investigate the program’s acceptability. Methods: Participants (N=235) aged 12-18 years were randomly assigned to either of two conditions: Bite Back (n=120) or control websites (n=115). The Bite Back website comprised interactive exercises and information across a variety of positive psychology domains; the control condition was assigned to neutral entertainment-based websites that contained no psychology information. Participants in both groups were instructed to use their allocated website for 6 consecutive weeks. Participants were assessed pre- and postintervention on the Depression Anxiety Stress Scale-Short form (DASS-21) and the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). Results: Of the 235 randomized participants, 154 (65.5%) completed baseline and post measures after 6 weeks. Completers and dropouts were equivalent in demographics, the SWEMWBS, and the depression and anxiety subscales of the DASS-21, but dropouts reported significantly higher levels of stress than completers. There were no differences between the Bite Back and control conditions at baseline on demographic variables, DASS-21, or SWEMWBS scores. Qualitative data indicated that 49 of 61 Bite Back users (79%) reported positive experiences using the website and 55 (89%) agreed they would continue to use it after study completion. Compared to the control condition, participants in the Bite Back condition with high levels of adherence (usage of the website for 30 minutes or more per week) reported significant decreases in depression and stress and improvements in well-being. Bite Back users who visited the site more frequently (≥3 times per week) reported significant decreases in depression and anxiety and improvements in well-being. No significant improvements were found among Bite Back users who demonstrated low levels of adherence or who used the website less frequently. Conclusions: Results suggest that using an online positive psychology program can decrease symptoms of psychopathology and increase well-being in young people, especially for those who use the website for 30 minutes or longer per week or more frequently (≥3 times per week). Acceptability of the Bite Back website was high. These findings are encouraging and suggest that the online delivery of positive psychology programs may be an alternate way to address mental health issues and improve youth well-being nationally. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN1261200057831; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=362489 (Archived by Webcite at http://www.webcitation.org/6NXmjwfAy). %M 24901900 %R 10.2196/jmir.3176 %U http://www.jmir.org/2014/6/e140/ %U https://doi.org/10.2196/jmir.3176 %U http://www.ncbi.nlm.nih.gov/pubmed/24901900 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 5 %P e143 %T Effectiveness of a Web-Based Tailored Intervention (E-health4Uth) and Consultation to Promote Adolescents’ Health: Randomized Controlled Trial %A Bannink,Rienke %A Broeren,Suzanne %A Joosten-van Zwanenburg,Evelien %A van As,Els %A van de Looij-Jansen,Petra %A Raat,Hein %+ Erasmus University Medical Center Rotterdam, Department of Public Health, PO Box 2040, 3000 CA, Rotterdam, , Netherlands, 31 107044634, h.raat@erasmusmc.nl %K adolescents %K youth health care %K eHealth %K Internet %K Web-based tailoring %K consultation %K randomized controlled trial %K health promotion %K prevention %D 2014 %7 30.05.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: To promote well-being and health behaviors among adolescents, 2 interventions were implemented at 12 secondary schools. Adolescents in the E-health4Uth group received Web-based tailored messages focused on their health behaviors and well-being. Adolescents in the E-health4Uth and consultation group received the same tailored messages, but were subsequently referred to a school nurse for a consultation if they were at risk of mental health problems. Objective: This study evaluated the effect of E-health4Uth and E-health4Uth and consultation on well-being (ie, mental health status and health-related quality of life) and health behaviors (ie, alcohol and drug use, smoking, safe sex). Methods: A cluster randomized controlled trial was conducted among third- and fourth-year secondary school students (mean age 15.9, SD 0.69). School classes (clusters) were randomly assigned to (1) E-health4Uth group, (2) E-health4Uth and consultation group, or (3) control group (ie, care as usual). Adolescents completed a questionnaire at baseline and at 4-month follow-up assessing alcohol consumption, smoking, drug use, condom use, mental health via the Strengths and Difficulties Questionnaire (SDQ) and the Youth Self Report (YSR; only measured at follow-up), and health-related quality of life. Multilevel logistic, ordinal, and linear regression analyses were used to reveal differences in health behavior and well-being between the intervention groups and the control group at follow-up. Subsequently, it was explored whether demographics moderated the effects. Results: Data from 1256 adolescents were analyzed. Compared to the control intervention, the E-health4Uth intervention, as a standalone intervention, showed minor positive results in health-related quality of life (B=2.79, 95% CI 0.72-4.87) and condom use during intercourse among adolescents of Dutch ethnicity (OR 3.59, 95% CI 1.71-7.55) not replicated in the E-health4Uth and consultation group. The E-health4Uth and consultation intervention showed minor positive results in the mental health status of adolescents (SDQ: B=−0.60, 95% CI −1.17 to −0.04), but a negative effect on drug use among boys (OR 0.36, 95% CI 0.13-0.96). In the subgroup of adolescents who were at risk of mental health problems at baseline (and referred for a consultation with the nurse), the E-health4Uth and consultation group showed minor to moderate positive results in mental health status (SDQ: B=−1.79, 95% CI −3.35 to −0.22; YSR: B=−9.11, 95% CI −17.52 to −0.71) and health-related quality of life (B=7.81, 95% CI 2.41-13.21) at follow-up compared to adolescents in the control group who were at risk of mental health problems at baseline. Conclusions: Findings from this study support the use of the E-health4Uth and consultation intervention in promoting the well-being of adolescents at risk of mental health problems. Future research is needed to further evaluate the effects of the consultation as a standalone intervention, and the dual approach of further tailored eHealth messages and a consultation. Trial Registration: Nederlands Trial Register: NTR 3596; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3596 (Archived by WebCite at http://www.webcitation.org/6PmgrPOuv). %M 24878521 %R 10.2196/jmir.3163 %U http://www.jmir.org/2014/5/e143/ %U https://doi.org/10.2196/jmir.3163 %U http://www.ncbi.nlm.nih.gov/pubmed/24878521 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 5 %P e141 %T Effectiveness of a Web-Based Solution-Focused Brief Chat Treatment for Depressed Adolescents and Young Adults: Randomized Controlled Trial %A Kramer,Jeannet %A Conijn,Barbara %A Oijevaar,Pien %A Riper,Heleen %+ Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Post Office Box 725, Utrecht, 3500 AS, Netherlands, 31 (0)30 2959380, jkramer@trimbos.nl %K depression %K randomized controlled trial %K Internet %K Solution Focused Brief Therapy %K young adults %D 2014 %7 29.05.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Up to 9% of young people suffer from depression. Unfortunately, many in need of help remain untreated. The Internet offers anonymous ways to help depressed youth, especially those who are reluctant to search for help because of fear of stigma. Objective: Our goal was to evaluate the effectiveness of an individual chat treatment based on Solution-Focused Brief Therapy (SFBT) to young individuals aged 12-22 years with depressive symptoms by comparing it to a waiting list control group. Methods: For this study, 263 young people with depressive symptoms were randomized to the Web-based SFBT intervention, PratenOnline, or to a waiting list control condition. The chat treatment was delivered by trained professionals. Groups were compared on depressive complaints as measured by the Center for Epidemiologic Studies Depression Scale (CES-D) after 9 weeks and 4.5 months. For the chat group only, changes in depressive symptoms at 7.5 months after baseline were explored. Results: The experimental SFBT condition (n=131) showed significantly greater improvement than the waiting list condition (n=132) in depressive symptoms at 9 weeks and 4.5 months on the CES-D, with a small between group effect size at 9 weeks (d=0.18, 95% CI -0.10 to 0.47) and a large effect size at 4.5 months (d=0.79, 95% CI 0.45-1.08). The percentage of participants showing a reliable and clinically significant change in depression was significantly larger for the SFBT intervention at 4.5 months only (28.2% vs 11.4% for the waiting list, P<.001, number needed to treat=6). At 7.5 months, the SFBT group showed further improvements. However, results have to be considered carefully because of high attrition rates. Conclusions: The Web-based SFBT chat intervention of PratenOnline was more effective than a waiting list control group in reducing depressive symptoms, and effects were larger at follow-up then at post-treatment. More studies are needed to find out if outcomes will be replicated, especially for those younger than 18 year old. Trial Registration: Netherlands Trial Register: NTR 1696; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1696 (Archived by WebCite at http://www.webcitation.org/6DspeYWrJ). %M 24874006 %R 10.2196/jmir.3261 %U http://www.jmir.org/2014/5/e141/ %U https://doi.org/10.2196/jmir.3261 %U http://www.ncbi.nlm.nih.gov/pubmed/24874006 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 5 %P e130 %T Computer-Delivered and Web-Based Interventions to Improve Depression, Anxiety, and Psychological Well-Being of University Students: A Systematic Review and Meta-Analysis %A Davies,E Bethan %A Morriss,Richard %A Glazebrook,Cris %+ Division of Psychiatry and Applied Psychology, School of Medicine, Institute of Mental Health, The University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 0115 74 84293, mcxebd@nottingham.ac.uk %K systematic review %K meta-analysis %K intervention %K universities %K students %K mental health %K depression %K anxiety %K health promotion %D 2014 %7 16.05.2014 %9 Review %J J Med Internet Res %G English %X Background: Depression and anxiety are common mental health difficulties experienced by university students and can impair academic and social functioning. Students are limited in seeking help from professionals. As university students are highly connected to digital technologies, Web-based and computer-delivered interventions could be used to improve students’ mental health. The effectiveness of these intervention types requires investigation to identify whether these are viable prevention strategies for university students. Objective: The intent of the study was to systematically review and analyze trials of Web-based and computer-delivered interventions to improve depression, anxiety, psychological distress, and stress in university students. Methods: Several databases were searched using keywords relating to higher education students, mental health, and eHealth interventions. The eligibility criteria for studies included in the review were: (1) the study aimed to improve symptoms relating to depression, anxiety, psychological distress, and stress, (2) the study involved computer-delivered or Web-based interventions accessed via computer, laptop, or tablet, (3) the study was a randomized controlled trial, and (4) the study was trialed on higher education students. Trials were reviewed and outcome data analyzed through random effects meta-analyses for each outcome and each type of trial arm comparison. Cochrane Collaboration risk of bias tool was used to assess study quality. Results: A total of 17 trials were identified, in which seven were the same three interventions on separate samples; 14 reported sufficient information for meta-analysis. The majority (n=13) were website-delivered and nine interventions were based on cognitive behavioral therapy (CBT). A total of 1795 participants were randomized and 1480 analyzed. Risk of bias was considered moderate, as many publications did not sufficiently report their methods and seven explicitly conducted completers’ analyses. In comparison to the inactive control, sensitivity meta-analyses supported intervention in improving anxiety (pooled standardized mean difference [SMD] −0.56; 95% CI −0.77 to −0.35, P<.001), depression (pooled SMD −0.43; 95% CI −0.63 to −0.22, P<.001), and stress (pooled SMD −0.73; 95% CI −1.27 to −0.19, P=.008). In comparison to active controls, sensitivity analyses did not support either condition for anxiety (pooled SMD −0.18; 95% CI −0.98 to 0.62, P=.66) or depression (pooled SMD −0.28; 95% CI −0.75 to −0.20, P=.25). In contrast to a comparison intervention, neither condition was supported in sensitivity analyses for anxiety (pooled SMD −0.10; 95% CI −0.39 to 0.18, P=.48) or depression (pooled SMD −0.33; 95% CI −0.43 to 1.09, P=.40). Conclusions: The findings suggest Web-based and computer-delivered interventions can be effective in improving students’ depression, anxiety, and stress outcomes when compared to inactive controls, but some caution is needed when compared to other trial arms and methodological issues were noticeable. Interventions need to be trialed on more heterogeneous student samples and would benefit from user evaluation. Future trials should address methodological considerations to improve reporting of trial quality and address post-intervention skewed data. %M 24836465 %R 10.2196/jmir.3142 %U http://www.jmir.org/2014/5/e130/ %U https://doi.org/10.2196/jmir.3142 %U http://www.ncbi.nlm.nih.gov/pubmed/24836465 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 5 %P e122 %T Web-Based Cognitive Training: Patient Adherence and Intensity of Treatment in an Outpatient Memory Clinic %A Tedim Cruz,Vítor %A Pais,Joana %A Alves,Ivânia %A Ruano,Luís %A Mateus,Cátia %A Barreto,Rui %A Bento,Virgílio %A Colunas,Márcio %A Rocha,Nelson %A Coutinho,Paula %+ Hospital São Sebastião, Neurology Department, Centro Hospitalar de Entre o Douro e Vouga, Rua Dr Candido de Pinho, Santa Maria da Feira, 4520-211, Portugal, 351 912582120, vitor.cruz@chedv.min-saude.pt %K cognitive training %K neurorehabilitation %K Web-based training %K eHealth systems %K training intensity %K adherence %K memory clinic %D 2014 %7 07.05.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive training has been playing an increasing role in the treatment of patients with cognitive deficits. This type of intervention, namely its intensity, can be optimized by incorporating information technology-based systems. Objective: The intent of the study was to determine the treatment intensity and patient adherence to home-based cognitive training strategies (Web-based cognitive training). Methods: A cohort of 45 patients with neurologic and psychiatric diseases attending an outpatient memory clinic (average age 50.7 years, SD 17.0; average education 7.8 years, SD 4.9) was followed over 18 months. Participants were challenged to use a Web-based cognitive training system, “COGWEB”, on a daily basis, and fulfilled at least four weeks of training supervised remotely. Additionally, 11 patients attended face-to-face sessions. Results: The average duration of continuous cognitive training was 18.8 weeks (SD 18.9). Each patient performed on average 363.5 minutes/week (SD 136.6). At 6-month follow-up, 82.8% complied with their treatment plan. The average proportion of complete weeks was 0.75 (SD 0.22). Patients with dementia trained more intensively (444.6 minutes/week), followed by patients with static brain lesion (414.5 minutes/week; P=.01). The group that held face-to-face sessions performed more training overall (481.4 vs 366.9 minutes/week), achieving a stronger expression and statistical significance in the last week of training (652.6 versus 354.9 minutes/week, P=.027). Conclusions: Overall, the weekly training intensity was high. Patients with dementia and static lesions performed more cognitive training. Face-to-face sessions were associated with higher intensities. The combination of classical methods with information technology systems seems to ensure greater training intensity. %M 24808451 %R 10.2196/jmir.3377 %U http://www.jmir.org/2014/5/e122/ %U https://doi.org/10.2196/jmir.3377 %U http://www.ncbi.nlm.nih.gov/pubmed/24808451 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 5 %P e121 %T Short-Term Effects of a Web-Based Guided Self-Help Intervention for Employees With Depressive Symptoms: Randomized Controlled Trial %A Geraedts,Anna S %A Kleiboer,Annet M %A Wiezer,Noortje M %A van Mechelen,Willem %A Cuijpers,Pim %+ VU University Amsterdam, Department of Clinical Psychology, Van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 205987451, a.s.geraedts@vu.nl %K depression, employees, occupational therapy, Internet, prevention %D 2014 %7 06.05.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Depressive disorders are highly prevalent in the working population and are associated with excessive costs. The evidence for effective worker-directed interventions for employees with depressive symptoms is limited. Treating employees with depressive symptoms before sick leave via the Internet could be beneficial and cost saving. Objective: In this study, we developed and tested the effectiveness of a Web-based guided self-help course for employees with depressive symptoms. We report on the posttreatment effectiveness of the intervention. Methods: This study is a two-arm randomized controlled trial comparing a Web-based guided self-help course to care as usual (CAU). We recruited employees from 6 different companies via the companies’ intranet and posters. The main inclusion criterion was elevated depressive symptoms as measured by a score of ≥16 on the Center for Epidemiological Studies Depression scale (CES-D). The intervention (Happy@Work) was based on problem-solving treatment and cognitive therapy and consisted of 6 weekly lessons. Participants were asked to submit their weekly assignment via the website after completion. They subsequently received feedback from a coach via the website. Self-report questionnaires on depressive symptoms (CES-D; primary outcome), anxiety measured by the Hospital Anxiety and Depression Scale (HADS), burnout measured by the Maslach Burnout Inventory (MBI), and work performance measured by the Health and Work Performance Questionnaire (HPQ; secondary outcomes) were completed at baseline and at posttreatment. Results: A total of 231 employees were randomized to either the intervention group (n=116) or CAU (n=115).The posttreatment assessment was completed by 171 (74.0%) participants. Both the intervention and the CAU group showed significant improvements in the primary outcome of depressive symptoms, but no differences between the conditions was found (d=0.16, 95% CI –0.10 to 0.41, P=.29). Significant but small effects in favor of the intervention group were found for anxiety symptoms (d=0.16, 95% CI –0.09 to 0.42, P=.04) and exhaustion (d=0.17, 95% CI –0.09 to 0.43, P=.02). Conclusions: This study showed that a Web-based guided self-help course for employees with depressive symptoms was not more effective in reducing depressive symptoms among employees than CAU. Large improvements in depressive symptoms in the CAU group were unforeseen and potential explanations are discussed. %M 24800966 %R 10.2196/jmir.3185 %U http://www.jmir.org/2014/5/e121/ %U https://doi.org/10.2196/jmir.3185 %U http://www.ncbi.nlm.nih.gov/pubmed/24800966 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 3 %N 1 %P e3 %T Employee and Family Assistance Video Counseling Program: A Post Launch Retrospective Comparison With In-Person Counseling Outcomes %A Veder,Barbara %A Pope,Stan %A Mani,Michèle %A Beaudoin,Kelly %A Ritchie,Janice %+ Shepell·fgi, 350 Sparks Street, Suite 501, Ottawa, ON, K1R 7S8, Canada, 1 613 851 1055, bveder@shepellfgi.com %K EAP %K EFAP %K counseling %K video counseling %K technology %K mental health %K online counseling %K therapy %K online therapy %D 2014 %7 24.04.2014 %9 Original Paper %J Med 2.0 %G English %X Background: Access to technologically mediated information and services under the umbrella of mental and physical health has become increasingly available to clients via Internet modalities, according to a recent study. In May 2010, video counseling was added to the counseling services offered through the Employee and Family Assistance Program at Shepell·fgi as a pilot project with a full operational launch in September 2011. Objective: The objective of this study was to conduct a retrospective post launch examination of the video counseling service through an analysis of the reported clinical outcomes of video and in-person counseling modalities. Methods: A chronological sample of 68 video counseling (VC) cases and 68 in-person (IP) cases were collected from a pool of client clinical files closed in 2012. To minimize the variables impacting the study and maintain as much clinical continuity as possible, the IP and the VC clients must have attended clinical sessions with any one of six counselors who provided both the VC and the IP services. The study compared the two counseling modalities along the following data points (see glossary of terms): (1) client demographic profiles (eg, age, gender, whether the sessions involved individuals or conjoint sessions with couples or families, etc), (2) presenting issue, (3) average session hours, (4) client rating of session helpfulness, (5) rates of goal completion, (6) client withdrawal rates, (7) no show and late cancellation rates, and (8) pre/post client self-assessment. Specific to VC, we examined client geographic location. Results: Data analysis demonstrates that the VC and the IP showed a similar representation of presenting issues with nearly identical outcomes for client ratings of session helpfulness, rates of goal completion, pre/post client self-assessment, average session duration, and client geographic location. There were no statistically significant differences in the rates of withdrawal from counseling, no shows, and late cancellations between the VC and the IP counseling. The statistical analysis of the data was done on SPSS statistical software using 2-sample and pairwise comparison t tests at a 95% level of significance. Conclusions: Based on the study, VC and IP show similar outcomes in terms of client rating of session and goal attainment. %M 25075247 %2 PMC4084764 %R 10.2196/med20.3125 %U http://www.medicine20.com/2014/1/e3/ %U https://doi.org/10.2196/med20.3125 %U http://www.ncbi.nlm.nih.gov/pubmed/25075247 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e90 %T Acceptability of Online Self-Help to People With Depression: Users’ Views of MoodGYM Versus Informational Websites %A Schneider,Justine %A Sarrami Foroushani,Pooria %A Grime,Paul %A Thornicroft,Graham %+ Institute of Mental Health & School of Sociology & Social Policy, University of Nottingham, University Park, Nottingham, NG7 2RD, United Kingdom, 44 115 8467307, Justine.Schneider@nottingham.ac.uk %K computers, cognitive therapy %K method acceptability %K depression %K workplace %K qualitative evaluation %D 2014 %7 28.03.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about the factors that influence acceptability of and adherence to online psychological interventions. Evidence is needed to guide further development of promising programs. Objective: Our goal was to investigate users’ views of two online approaches to self-help for depression: computerized cognitive behavior therapy (cCBT) and informational websites, in a workplace context. Computerized CBT offers an inexpensive and accessible alternative to face-to-face therapy, and employers have an interest in reducing the working time lost to depression or stress. Yet little is known about how employees, who have actual experience of using online approaches, judge the intervention as a process. Methods: The qualitative data reported here were collected within an online randomized controlled trial whose participants had diagnosable depression. The experimental intervention was a 5-week cCBT program called MoodGYM, and the control condition was five informational websites about mental health. Data were collected via online questionnaires. There was no evidence of the superiority of either in terms of treatment outcomes. In parallel, using brief rating scales and open-ended questions designed for this purpose, we examined the relative acceptability of each approach over time, including perceptions of cCBT compared to seeing a health care professional. Results: At least 60% of participants held online therapy to be at least as acceptable as seeing a professional about mental health issues, and they were more likely to retain this opinion over time if they used the interactive program, MoodGYM, rather than informational websites alone. Barriers to cCBT use fell into four categories: intrinsic, intrapersonal problems; extrinsic technical problems; generic issues mostly pertaining to perceptions of cCBT; and specific issues about the intervention or control condition. These indicate strategies for improving engagement. Conclusions: As first-aid for mild to moderate mental health problems, evidence-based computerized approaches have broad acceptability. This could be increased by attending to the barriers noted here and by proactively managing users’ expectations at individual and organizational levels. The findings have implications for occupational health providers and others addressing the needs of working-age adults with depression. They also raise methodological issues for online research. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 24529487; http://www.controlled-trials.com/ISRCTN24529487 (Archived by Webcite at http://www.webcitation.org/6O8cCL4mh). %M 24681717 %R 10.2196/jmir.2871 %U http://www.jmir.org/2014/3/e90/ %U https://doi.org/10.2196/jmir.2871 %U http://www.ncbi.nlm.nih.gov/pubmed/24681717 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e88 %T Internet-Based Cognitive Behavioral Therapy for Patients With Chronic Somatic Conditions: A Meta-Analytic Review %A van Beugen,Sylvia %A Ferwerda,Maaike %A Hoeve,Dane %A Rovers,Maroeska M %A Spillekom-van Koulil,Saskia %A van Middendorp,Henriët %A Evers,Andrea WM %+ Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, PO Box 9555, Leiden, 2300 RB, Netherlands, 31 71 527 4047, S.van.beugen@fsw.leidenuniv.nl %K eHealth %K internet %K intervention %K self-management %K cognitive behavior therapy %K meta-analysis %D 2014 %7 27.03.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with chronic somatic conditions face unique challenges accessing mental health care outside of their homes due to symptoms and physical limitations. Internet-based cognitive behavioral therapy (ICBT) has shown to be effective for various psychological conditions. The increasing number of recent trials need to be systematically evaluated and quantitatively analyzed to determine whether ICBT is also effective for chronic somatic conditions and to gain insight into the types of problems that could be targeted. Objective: Our goal was to describe and evaluate the effectiveness of guided ICBT interventions for chronic somatic conditions on general psychological outcomes, disease-related physical outcomes, and disease-related impact on daily life outcomes. The role of treatment length was also examined. Methods: PubMed, PsycINFO, and Embase were searched from inception until February 2012, by combining search terms indicative of effect studies, Internet, and cognitive behavioral therapy. Studies were included if they fulfilled the following six criteria: (1) randomized controlled trial, (2) Internet-based interventions, (3) based on cognitive behavioral therapy, (4) therapist-guided, (5) adult (≥18 years old) patients with an existing chronic somatic condition, and (6) published in English. 23 randomized controlled trials of guided ICBT were selected by 2 independent raters after reviewing 4848 abstracts. Demographic, clinical, and methodological variables were extracted. Standardized mean differences were calculated between intervention and control conditions for each outcome and pooled using random effects models when appropriate. Results: Guided ICBT was shown to improve all outcome categories with small effect sizes for generic psychological outcomes (effect size range 0.17-0.21) and occasionally larger effects for disease-specific physical outcomes (effect size range 0.07 to 1.19) and disease-related impact outcomes (effect size range 0.17-1.11). Interventions with a longer treatment duration (>6 weeks) led to more consistent effects on depression. Conclusions: Guided ICBT appears to be a promising and effective treatment for chronic somatic conditions to improve psychological and physical functioning and disease-related impact. The most consistent improvements were found for disease-specific outcomes, which supports the possible relevance of tailoring interventions to specific patient groups. Explorative analyses revealed that longer treatment length holds the promise of larger treatment effects for the specific outcome of depression. While the current meta-analysis focused on several chronic somatic conditions, future meta-analyses for separate chronic somatic conditions can further consolidate these results, also in terms of cost-effectiveness. %M 24675372 %R 10.2196/jmir.2777 %U http://www.jmir.org/2014/3/e88/ %U https://doi.org/10.2196/jmir.2777 %U http://www.ncbi.nlm.nih.gov/pubmed/24675372 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e87 %T Web-Based Intervention in Mindfulness Meditation for Reducing Residual Depressive Symptoms and Relapse Prophylaxis: A Qualitative Study %A Boggs,Jennifer M %A Beck,Arne %A Felder,Jennifer N %A Dimidjian,Sona %A Metcalf,Christina A %A Segal,Zindel V %+ Kaiser Permanente Colorado, Institute for Health Research, 10065 E Harvard Ave, Suite 300, Denver, CO, 80231, United States, 1 303 614 1368, Jennifer.m.boggs@kp.org %K mindfulness-based cognitive therapy %K online depression %K Web-based depression %K Internet-based depression %K depression relapse prevention %K residual depression symptoms %K online psychological treatment %K qualitative methods %D 2014 %7 24.03.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Mindful Mood Balance (MMB) is a Web-based intervention designed to treat residual depressive symptoms and prevent relapse. MMB was designed to deliver the core concepts of mindfulness-based cognitive therapy (MBCT), a group treatment, which, despite its strong evidence base, faces a number of dissemination challenges. Objective: The present study is a qualitative investigation of participants’ experiences with MMB. Methods: Qualitative content analysis was conducted via 38 exit interviews with MMB participants. Study inclusion required a current PHQ-9 (Patient Health Questionnaire) score ≤12 and lifetime history ≥1 major depressive episode. Feedback was obtained on specific website components, program content, and administration as well as skills learned. Results: Codes were assigned to interview responses and organized into four main themes: MBCT Web content, MBCT Web-based group process, home practice, and evidence of concept comprehension. Within these four areas, participants highlighted the advantages and obstacles of translating and delivering MBCT in a Web-based format. Adding increased support was suggested for troubleshooting session content as well as managing time challenges for completing home mindfulness practice. Participants endorsed developing affect regulation skills and identified several advantages to Web-based delivery including flexibility, reduced cost, and time commitment. Conclusions: These findings support the viability of providing MBCT online and are consistent with prior qualitative accounts derived from in-person MBCT groups. While there is certainly room for innovation in the domains of program support and engagement, the high levels of participant satisfaction indicated that MMB can significantly increase access to evidence-based psychological treatments for sub-threshold symptoms of unipolar affective disorder. %M 24662625 %R 10.2196/jmir.3129 %U http://www.jmir.org/2014/3/e87/ %U https://doi.org/10.2196/jmir.3129 %U http://www.ncbi.nlm.nih.gov/pubmed/24662625 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e66 %T Do Online Mental Health Services Improve Help-Seeking for Young People? A Systematic Review %A Kauer,Sylvia Deidre %A Mangan,Cheryl %A Sanci,Lena %+ Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, 3053, Australia, 61 390356097, sylvia.kauer@unimelb.edu.au %K adolescent %K young adult %K Internet %K medical informatics %K mental health %K mental disorders %K systematic review %K information seeking behavior %D 2014 %7 04.03.2014 %9 Review %J J Med Internet Res %G English %X Background: Young people regularly use online services to seek help and look for information about mental health problems. Yet little is known about the effects that online services have on mental health and whether these services facilitate help-seeking in young people. Objective: This systematic review investigates the effectiveness of online services in facilitating mental health help-seeking in young people. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, literature searches were conducted in PubMed, PsycINFO, and the Cochrane library. Out of 608 publications identified, 18 studies fulfilled the inclusion criteria of investigating online mental health services and help-seeking in young people aged 14-25 years. Results: Two qualitative, 12 cross-sectional, one quasi-experimental, and three randomized controlled trials (RCTs) were reviewed. There was no change in help-seeking behavior found in the RCTs, while the quasi-experimental study found a slight but significant increase in help-seeking. The cross-sectional studies reported that online services facilitated seeking help from a professional source for an average of 35% of users. The majority of the studies included small sample sizes and a high proportion of young women. Help-seeking was often a secondary outcome, with only 22% (4/18) of studies using adequate measures of help-seeking. The majority of studies identified in this review were of low quality and likely to be biased. Across all studies, young people regularly used and were generally satisfied with online mental health resources. Facilitators and barriers to help-seeking were also identified. Conclusions: Few studies examine the effects of online services on mental health help-seeking. Further research is needed to determine whether online mental health services effectively facilitate help-seeking for young people. %M 24594922 %R 10.2196/jmir.3103 %U http://www.jmir.org/2014/3/e66/ %U https://doi.org/10.2196/jmir.3103 %U http://www.ncbi.nlm.nih.gov/pubmed/24594922 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 1 %P e6 %T Evaluating a Brief, Internet-Based Intervention for Co-Occurring Depression and Problematic Alcohol Use in Young People: Protocol for a Randomized Controlled Trial %A Deady,Mark %A Teesson,Maree %A Kay-Lambkin,Frances %A Mills,Katherine L %+ National Drug and Alcohol Research Centre, University of New South Wales (UNSW), 22-32 King Street, Randwick NSW 2031, Sydney, 2052, Australia, 61 293850320, m.deady@unsw.edu.au %K depression %K alcohol %K young people %K Internet-based %K comorbidity %D 2014 %7 27.02.2014 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depression and alcohol misuse represent two of the major causes of disease burden in young adults. These conditions frequently co-occur and this co-occurrence is associated with increased risks and poorer outcomes than either disorder in isolation. Integrated treatments have been shown to be effective, however, there remains a significant gap between those in need of treatment and those receiving it, particularly in young people. The increased availability of Internet-based programs to complement health care presents a unique opportunity in the treatment of these conditions. Objective: The objective of our study was to evaluate whether a brief, Internet-based, self-help intervention (the DEAL [DEpression-ALcohol] Project) can be effective in treating co-occurring depression and problematic alcohol use in young people (18-25 years old). Methods: The evaluation will take the form of a randomized controlled trial (RCT), comparing the DEAL Project with an attention-control condition (HealthWatch). The RCT will consist of a four-week intervention phase and a 24-week follow-up. It will be entirely Internet-based and open Australia-wide to young people 18 to 25 years old. The primary outcomes will be change in depression symptoms and alcohol use at 5, 12, and 24 weeks post baseline. Secondary outcomes include change in general functioning and quality of life, anxiety/stress symptomatology, and a number of other depression/alcohol related outcomes. Process analysis will also measure engagement across the conditions. Results: This study is currently ongoing with preliminary results expected in late 2014. Conclusions: This study, to our knowledge, will be the first RCT of a Internet-based treatment for comorbid depression and problematic alcohol use in any age group. If successful, the program represents a novel and innovative approach to addressing the significant harms associated with these conditions and will be an invaluable resource to those not receiving help elsewhere. Trial Registration: Australian New Zealand Clinical Trials Registry; ACTRN12613000033741; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=363461 (Archived by WebCite at http://www.webcitation.org/6Mrg9VFX4). %M 24583824 %R 10.2196/resprot.3192 %U http://www.researchprotocols.org/2014/1/e6/ %U https://doi.org/10.2196/resprot.3192 %U http://www.ncbi.nlm.nih.gov/pubmed/24583824 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 2 %P e67 %T Routine Real-Time Cost-Effectiveness Monitoring of a Web-Based Depression Intervention: A Risk-Sharing Proposal %A Naveršnik,Klemen %A Mrhar,Aleš %+ Prototype Analytics, Sandoz Development Center, Lek Pharmaceuticals, SDC, Verovškova 57, Ljubljana, SI-1000, Slovenia, 386 1 5803459, klemen.naversnik@sandoz.com %K depression %K medical economics %K value-based purchasing %D 2014 %7 27.02.2014 %9 Viewpoint %J J Med Internet Res %G English %X Background: A new health care technology must be cost-effective in order to be adopted. If evidence regarding cost-effectiveness is uncertain, then the decision maker faces two choices: (1) adopt the technology and run the risk that it is less effective in actual practice, or (2) reject the technology and risk that potential health is forgone. A new depression eHealth service was found to be cost-effective in a previously published study. The results, however, were unreliable because it was based on a pilot clinical trial. A conservative decision maker would normally require stronger evidence for the intervention to be implemented. Objective: Our objective was to evaluate how to facilitate service implementation by shifting the burden of risk due to uncertainty to the service provider and ensure that the intervention remains cost-effective during routine use. Methods: We propose a risk-sharing scheme, where the service cost depends on the actual effectiveness of the service in real-life setting. Routine efficacy data can be used as the input to the cost-effectiveness model, which employs a mapping function to translate a depression specific score into quality-adjusted life-years. The latter is the denominator in the cost-effectiveness ratio calculation, required by the health care decision maker. The output of the model is a “value graph”, showing intervention value as a function of its observed (future) efficacy, using the €30,000 per quality-adjusted life-year (QALY) threshold. Results: We found that the eHealth service should improve the patient’s outcome by at least 11.9 points on the Beck Depression Inventory scale in order for the cost-effectiveness ratio to remain below the €30,000/QALY threshold. The value of a single point improvement was found to be between €200 and €700, depending on depression severity at treatment start. Value of the eHealth service, based on the current efficacy estimates, is €1900, which is significantly above its estimated cost (€200). Conclusions: The eHealth depression service is particularly suited to routine monitoring, since data can be gathered through the Internet within the service communication channels. This enables real-time cost-effectiveness evaluation and allows a value-based price to be established. We propose a novel pricing scheme where the price is set to a point in the interval between cost and value, which provides an economic surplus to both the payer and the provider. Such a business model will assure that a portion of the surplus is retained by the payer and not completely appropriated by the private provider. If the eHealth service were to turn out less effective than originally anticipated, then the price would be lowered in order to achieve the cost-effectiveness threshold and this risk of financial loss would be borne by the provider. %M 24583773 %R 10.2196/jmir.2592 %U http://www.jmir.org/2014/2/e67/ %U https://doi.org/10.2196/jmir.2592 %U http://www.ncbi.nlm.nih.gov/pubmed/24583773 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 2 %P e65 %T Seeking Insights About Cycling Mood Disorders via Anonymized Search Logs %A Yom-Tov,Elad %A White,Ryen W %A Horvitz,Eric %+ Microsoft Research, 13 Shenkar St, Herzeliya, 46875, Israel, 972 747111359, eladyt@yahoo.com %K information retrieval %K mood disorders %K bipolar disorder %K machine learning %D 2014 %7 25.02.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Mood disorders affect a significant portion of the general population. Cycling mood disorders are characterized by intermittent episodes (or events) of the disease. Objective: Using anonymized Web search logs, we identify a population of people with significant interest in mood stabilizing drugs (MSD) and seek evidence of mood swings in this population. Methods: We extracted queries to the Microsoft Bing search engine made by 20,046 Web searchers over six months, separately explored searcher demographics using data from a large external panel of users, and sought supporting information from people with mood disorders via a survey. We analyzed changes in information needs over time relative to searches on MSD. Results: Queries for MSD focused on side effects and their relation to the disease. We found evidence of significant changes in search behavior and interests coinciding with days that MSD queries are made. These include large increases (>100%) in the access of nutrition information, commercial information, and adult materials. A survey of patients diagnosed with mood disorders provided evidence that repeated queries on MSD may come with exacerbations of mood disorder. A classifier predicting the occurrence of such queries one day before they are observed obtains strong performance (AUC=0.78). Conclusions: Observed patterns in search behavior align with known behaviors and those highlighted by survey respondents. These observations suggest that searchers showing intensive interest in MSD may be patients who have been prescribed these drugs. Given behavioral dynamics, we surmise that the days on which MSD queries are made may coincide with commencement of mania or depression. Although we do not have data on mood changes and whether users have been diagnosed with bipolar illness, we see evidence of cycling in people who show interest in MSD and further show that we can predict impending shifts in behavior and interest. %M 24568936 %R 10.2196/jmir.2664 %U http://www.jmir.org/2014/2/e65/ %U https://doi.org/10.2196/jmir.2664 %U http://www.ncbi.nlm.nih.gov/pubmed/24568936 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 2 %P e54 %T Surviving and Thriving With Cancer Using a Web-Based Health Behavior Change Intervention: Randomized Controlled Trial %A O'Carroll Bantum,Erin %A Albright,Cheryl L %A White,Kami K %A Berenberg,Jeffrey L %A Layi,Gabriela %A Ritter,Phillip L %A Laurent,Diana %A Plant,Katy %A Lorig,Kate %+ University of Hawaii Cancer Center, Cancer Prevention & Control, 701 Ilalo St, B4, Honolulu, HI, 96813, United States, 1 808 441 3491, ebantum@cc.hawaii.edu %K cancer survivors %K online interventions %K social support %D 2014 %7 24.02.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the substantial improvements in cancer screening and cancer treatment in the United States, millions of adult cancer survivors live for years following their initial cancer diagnosis and treatment. However, latent side effects can occur and some symptoms can be alleviated or managed effectively via changes in lifestyle behaviors. Objective: The purpose of this study was to test the effectiveness of a six-week Web-based multiple health behavior change program for adult survivors. Methods: Participants (n=352) were recruited from oncology clinics, a tumor registry, as well as through online mechanisms, such as Facebook and the Association of Cancer Online Resources (ACOR). Cancer survivors were eligible if they had completed their primary cancer treatment from 4 weeks to 5 years before enrollment. Participants were randomly assigned to the Web-based program or a delayed-treatment control condition. Results: In total, 303 survivors completed the follow-up survey (six months after completion of the baseline survey) and participants in the Web-based intervention condition had significantly greater reductions in insomnia and greater increases in minutes per week of vigorous exercise and stretching compared to controls. There were no significant changes in fruit and vegetable consumption or other outcomes. Conclusions: The Web-based intervention impacted insomnia and exercise; however, a majority of the sample met or exceeded national recommendations for health behaviors and were not suffering from depression or fatigue at baseline. Thus, the survivors were very healthy and well-adjusted upon entry and their ability to make substantial health behavior changes may have been limited. Future work is discussed, with emphasis placed on ways in which Web-based interventions can be more specifically analyzed for benefit, such as in regard to social networking. Trial Registration: Clinicaltrials.gov NCT00962494; http://www.clinicaltrials.gov/ct2/show/NCT00962494 (Archived by WebCite at http://www.webcitation.org/6NIv8Dc6Q). %M 24566820 %R 10.2196/jmir.3020 %U http://www.jmir.org/2014/2/e54/ %U https://doi.org/10.2196/jmir.3020 %U http://www.ncbi.nlm.nih.gov/pubmed/24566820 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 2 %N 1 %P e3 %T Views of Young People in Rural Australia on SPARX, a Fantasy World Developed for New Zealand Youth With Depression %A Cheek,Colleen %A Bridgman,Heather %A Fleming,Theresa %A Cummings,Elizabeth %A Ellis,Leonie %A Lucassen,Mathijs FG %A Shepherd,Matthew %A Skinner,Timothy %+ Rural Clinical School, University of Tasmania, Private Bag 3513, Burnie, 7320, Australia, 61 364305922, Colleen.Cheek@utas.edu.au %K mental health %K stigma %K computer games %K youth %K rural health, computerized CBT %D 2014 %7 18.02.2014 %9 Original Paper %J JMIR Serious Games %G English %X Background: A randomized control trial demonstrated that a computerized cognitive behavioral therapy (cCBT) program (Smart, Positive, Active, Realistic, X-factor thoughts [SPARX]) was an appealing and efficacious treatment for depression for adolescents in New Zealand. Little is known about the acceptability of computerized therapy programs for rural Australians and the suitability of computerized programs developed in one cultural context when used in another country. Issues such as accents and local differences in health care access might mean adjustments to programs are required. Objective: This study sought to explore the acceptability of SPARX by youth in rural Australia and to explore whether and how young people would wish to access such a program. Methods: Focus groups and semistructured interviews were conducted with 16 young people attending two youth-focused community services in a small, rural Tasmanian town. An inductive data-driven approach was used to identify themes using the interview transcripts as the primary data source. Interpretation was supported by demographic data, observer notes, and content analysis. Results: Participants reported that young people want help for mental health issues but they have an even stronger need for controlling how they access services. In particular, they considered protecting their privacy in their small community to be paramount. Participants thought computerized therapy was a promising way to increase access to treatment for youth in rural and remote areas if offered with or without therapist support and via settings other than school. The design features of SPARX that were perceived to be useful, included the narrative structure of the program, the use of different characters, the personalization of an avatar, “socialization” with the Guide character, optional journaling, and the use of encouraging feedback. Participants did not consider (New Zealand) accents off-putting. Young people believed the SPARX program would appeal to those who play computer games generally, but may be less appealing for those who do not. Conclusions: The findings suggest that computerized therapy offered in ways that support privacy and choice can improve access to treatment for rural youth. Foreign accents and style may not be off-putting to teenage users when the program uses a playful fantasy genre, as it is consistent with their expectation of fantasy worlds, and it is in a medium with which they already have a level of competence. Rather, issues of engaging design and confidential access appeared to be more important. These findings suggest a proven tool once formally assessed at a local level can be adopted cross-nationally. %M 25659116 %R 10.2196/games.3183 %U http://games.jmir.org/2014/1/e3/ %U https://doi.org/10.2196/games.3183 %U http://www.ncbi.nlm.nih.gov/pubmed/25659116 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 3 %N 1 %P e8 %T A Web-Based Supportive Intervention for Families Living With Depression: Content Analysis and Formative Evaluation %A Stjernswärd,Sigrid %A Hansson,Lars %+ Department of Health Sciences, Lund University, Box 157, Lund, , Sweden, 46 46 2221904, sigrid.stjernsward@med.lu.se %K family caregivers %K depression %K online social networks %K social support %D 2014 %7 14.02.2014 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Relatives of people with a mental illness who live together can experience additional burdens that may require support. A Web-based tool including a psychoeducation module, a diary, and a password-protected forum was developed to support relatives of a person with depression. Objective: The objective of our study was to explore participants’ use of the Web-based tool, with focus on the forum, and to assess its potential health and psychosocial benefits. Methods: Twenty-five people participated in this explorative open trial. Self-rating instruments assessing caregiver burden, stigma, and the tool’s usability were analyzed with Carer QoL7-D, DISC-12, and a system usability scale. A summary measure of subjective burden was assessed with CarerQoL-VAS. The forum posts were studied using content analysis. Results: The majority reported fulfillment from their caregiving tasks (84%, 21/25), and had relational problems (76%, 19/25), their own mental health problems (72%, 18/25), support (72%, 18/25), and difficulties coordinating daily activities with caregiving (56%, 14/25). Most (72%, 18/25) reported having been able to use their inner strength to cope with stigma and discrimination, 64% (16/25) had concealed or hidden the person’s condition, and 40% (10/25) reported having been avoided or shunned by people who knew about the illness. Forty-eight percent (12/25) reported unfair treatment from family; 40% (10/25) in marriage or divorce and 36% (9/25) from mental health staff. Almost one-third (28%, 7/25) reported having stopped themselves from having a close personal relationship. Participants’ subjective assessment of the tool’s usability resulted in a mean of 61.5 (range, 22.5-90; possible total value 0-100; >70=good). Ten people participated in the forum; content analysis resulted in five categories describing relatives’ situations: balancing the caregiver’s role and relationship to the patient; their own lives and need for support; resources and patient advocacy; a looming shadow on leisure, social, and professional life; and interaction and social support. Conclusions: Further studies are needed to explore optimal ways of using Web-based tools to address support for relatives of a person with mental illness. Professional feedback may enhance the use and value of online communities. %M 24550185 %R 10.2196/resprot.3051 %U http://www.researchprotocols.org/2014/1/e8/ %U https://doi.org/10.2196/resprot.3051 %U http://www.ncbi.nlm.nih.gov/pubmed/24550185 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 2 %P e42 %T Designing Messaging to Engage Patients in an Online Suicide Prevention Intervention: Survey Results From Patients With Current Suicidal Ideation %A Whiteside,Ursula %A Lungu,Anita %A Richards,Julie %A Simon,Gregory E %A Clingan,Sarah %A Siler,Jaeden %A Snyder,Lorilei %A Ludman,Evette %+ Group Health Research Institute, 1730 Minor Ave Suite 1500, Seattle, WA, , United States, 1 206 287 2100, whiteside.u@ghc.org %K human centered design %K user centered design %K health 2.0 %K suicide %D 2014 %7 07.02.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Computerized, Internet-delivered interventions can be efficacious; however, uptake and maintaining sustained client engagement are still big challenges. We see the development of effective engagement strategies as the next frontier in online health interventions, an area where much creative research has begun. We also argue that for engagement strategies to accomplish their purpose with novel targeted populations, they need to be tailored to such populations (ie, content is designed with the target population in mind). User-centered design frameworks provide a theoretical foundation for increasing user engagement and uptake by including users in development. However, deciding how to implement this approach to enage users in mental health intervention development is challenging. Objective: The aim of this study was to get user input and feedback on acceptability of messaging content intended to engage suicidal individuals. Methods: In March 2013, clinic intake staff distributed flyers announcing the study, “Your Feedback Counts” to potential participants (individuals waiting to be seen for a mental health appointment) together with the Patient Health Questionnaire. The flyer explained that a score of two or three (“more than half the days” or “nearly every day” respectively) on the suicide ideation question made them eligible to provide feedback on components of a suicide prevention intervention under development. The patient could access an anonymous online survey by following a link. After providing consent online, participants completed the anonymous survey. Results: Thirty-four individuals provided data on past demographic information. Participants reported that they would be most drawn to an intervention where they knew that they were cared about, that was personalized, that others like them had found it helpful, and that included examples with real people. Participants preferred email invitations with subject lines expressing concern and availability of extra resources. Participants also provided feedback about a media prototype including a brand design and advertisement video for introducing the intervention. Conclusions: This paper provides one model (including development of an engagement survey, audience for an engagement survey, methods for presenting results of an engagement survey) for including target users in the development of uptake strategies for online mental health interventions. %R 10.2196/jmir.3173 %U http://www.jmir.org/2014/2/e42/ %U https://doi.org/10.2196/jmir.3173 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 1 %P e27 %T Understanding the Usage of Content in a Mental Health Intervention for Depression: An Analysis of Log Data %A Van Gemert-Pijnen,Julia EWC %A Kelders,Saskia M %A Bohlmeijer,Ernst T %+ University of Twente, Department of Psychology, Health and Technology, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 534896050, j.vangemert-pijnen@utwente.nl %K mental health %K depression %K Web-based intervention %K acceptance commitment therapy %D 2014 %7 31.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based interventions for the early treatment of depressive symptoms can be considered effective in reducing mental complaints. However, there is a limited understanding of which elements in an intervention contribute to effectiveness. For efficiency and effectiveness of interventions, insight is needed into the use of content and persuasive features. Objective: The aims of this study were (1) to illustrate how log data can be used to understand the uptake of the content of a Web-based intervention that is based on the acceptance and commitment therapy (ACT) and (2) to discover how log data can be of value for improving the incorporation of content in Web-based interventions. Methods: Data from 206 participants (out of the 239) who started the first nine lessons of the Web-based intervention, Living to the Full, were used for a secondary analysis of a subset of the log data of the parent study about adherence to the intervention. The log files used in this study were per lesson: login, start mindfulness, download mindfulness, view success story, view feedback message, start multimedia, turn on text-message coach, turn off text-message coach, and view text message. Differences in usage between lessons were explored with repeated measures ANOVAs (analysis of variance). Differences between groups were explored with one-way ANOVAs. To explore the possible predictive value of the login per lesson quartiles on the outcome measures, four linear regressions were used with login quartiles as predictor and with the outcome measures (Center for Epidemiologic Studies—Depression [CES-D] and the Hospital Anxiety and Depression Scale—Anxiety [HADS-A] on post-intervention and follow-up) as dependent variables. Results: A significant decrease in logins and in the use of content and persuasive features over time was observed. The usage of features varied significantly during the treatment process. The usage of persuasive features increased during the third part of the ACT (commitment to value-based living), which might indicate that at that stage motivational support was relevant. Higher logins over time (9 weeks) corresponded with a higher usage of features (in most cases significant); when predicting depressive symptoms at post-intervention, the linear regression yielded a significant model with login quartile as a significant predictor (explained variance is 2.7%). Conclusions: A better integration of content and persuasive features in the design of the intervention and a better intra-usability of features within the system are needed to identify which combination of features works best for whom. Pattern recognition can be used to tailor the intervention based on usage patterns from the earlier lessons and to support the uptake of content essential for therapy. An adaptable interface for a modular composition of therapy features supposes a dynamic approach for Web-based treatment; not a predefined path for all, but a flexible way to go through all features that have to be used. %M 24486914 %R 10.2196/jmir.2991 %U http://www.jmir.org/2014/1/e27/ %U https://doi.org/10.2196/jmir.2991 %U http://www.ncbi.nlm.nih.gov/pubmed/24486914 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e30 %T Caught in the Web: A Review of Web-Based Suicide Prevention %A Lai,Mee Huong %A Maniam,Thambu %A Chan,Lai Fong %A Ravindran,Arun V %+ Department of Psychiatry, Universiti Kebangsaan Malaysia Medical Centre, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, Kuala Lumpur, 56000, Malaysia, 60 3 91455555 ext 6143, laifchan@gmail.com %K suicide prevention %K Web-based %K Internet %D 2014 %7 28.01.2014 %9 Review %J J Med Internet Res %G English %X Background: Suicide is a serious and increasing problem worldwide. The emergence of the digital world has had a tremendous impact on people’s lives, both negative and positive, including an impact on suicidal behaviors. Objective: Our aim was to perform a review of the published literature on Web-based suicide prevention strategies, focusing on their efficacy, benefits, and challenges. Methods: The EBSCOhost (Medline, PsycINFO, CINAHL), OvidSP, the Cochrane Library, and ScienceDirect databases were searched for literature regarding Web-based suicide prevention strategies from 1997 to 2013 according to the modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The selected articles were subjected to quality rating and data extraction. Results: Good quality literature was surprisingly sparse, with only 15 fulfilling criteria for inclusion in the review, and most were rated as being medium to low quality. Internet-based cognitive behavior therapy (iCBT) reduced suicidal ideation in the general population in two randomized controlled trial (effect sizes, d=0.04-0.45) and in a clinical audit of depressed primary care patients. Descriptive studies reported improved accessibility and reduced barriers to treatment with Internet among students. Besides automated iCBT, preventive strategies were mainly interactive (email communication, online individual or supervised group support) or information-based (website postings). The benefits and potential challenges of accessibility, anonymity, and text-based communication as key components for Web-based suicide prevention strategies were emphasized. Conclusions: There is preliminary evidence that suggests the probable benefit of Web-based strategies in suicide prevention. Future larger systematic research is needed to confirm the effectiveness and risk benefit ratio of such strategies. %M 24472876 %R 10.2196/jmir.2973 %U http://www.jmir.org/2014/1/e30/ %U https://doi.org/10.2196/jmir.2973 %U http://www.ncbi.nlm.nih.gov/pubmed/24472876 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 2 %N 1 %P e2 %T Smartphone Ownership and Interest in Mobile Applications to Monitor Symptoms of Mental Health Conditions %A Torous,John %A Friedman,Rohn %A Keshavan,Matcheri %+ Harvard Longwod Psychiatry Residency Training Prorgam, 330 Brookline Ave, Boston, MA, 02215, United States, 1 617 667 4630, jtorous@bidmc.harvard.edu %K psychiatry %K mobile %K smartphone %K depression %K technology %K applications %D 2014 %7 21.01.2014 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Patient retrospective recollection is a mainstay of assessing symptoms in mental health and psychiatry. However, evidence suggests that these retrospective recollections may not be as accurate as data collection though the experience sampling method (ESM), which captures patient data in “real time” and “real life.” However, the difficulties in practical implementation of ESM data collection have limited its impact in psychiatry and mental health. Smartphones with the capability to run mobile applications may offer a novel method of collecting ESM data that may represent a practical and feasible tool for mental health and psychiatry. Objective: This paper aims to provide data on psychiatric patients’ prevalence of smartphone ownership, patterns of use, and interest in utilizing mobile applications to monitor their mental health conditions. Methods: One hundred psychiatric outpatients at a large urban teaching hospital completed a paper-and-pencil survey regarding smartphone ownership, use, and interest in utilizing mobile applications to monitor their mental health condition. Results: Ninety-seven percent of patients reported owning a phone and 72% reported that their phone was a smartphone. Patients in all age groups indicated greater than 50% interest in using a mobile application on a daily basis to monitor their mental health condition. Conclusions: Smartphone and mobile applications represent a practical opportunity to explore new modalities of monitoring, treatment, and research of psychiatric and mental health conditions. %M 25098314 %R 10.2196/mhealth.2994 %U http://mhealth.jmir.org/2014/1/e2/ %U https://doi.org/10.2196/mhealth.2994 %U http://www.ncbi.nlm.nih.gov/pubmed/25098314 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 12 %P e285 %T Exploring the Use and Effects of Deliberate Self-Harm Websites: An Internet-Based Study %A Harris,Isobel Marion %A Roberts,Lesley Martine %+ Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental Sciences, University of Birmingham, 90 Vincent Drive, Birmingham, B15 2TT, United Kingdom, 44 01214143356, l.m.roberts@bham.ac.uk %K Internet %K websites %K deliberate self-harm %K self-injury %D 2013 %7 20.12.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: In the United Kingdom, rates of deliberate self-harm (DSH) are rising. Alongside this, there has been an increase in the number of websites available with DSH content, and the Internet is known as a valuable resource for those who feel isolated by their condition(s). However, there is little and contradictory evidence available on the effects of using such websites. Further research is therefore required to examine the use and effects of DSH websites. Objective: Our objectives were to explore (1) the reasons people engage in the use of self-harm forums/websites, (2) the beliefs of users of self-harm forums regarding the role of such websites, (3) how the use of self-harm forums/websites modulates self-harm behaviors, and (4) other ways that self-harm forums affect the lives of individuals who use them. Methods: Data were collected by a questionnaire hosted on 20 websites with self-harm content. Participants were self-selected from users of these sites. Results were analyzed using descriptive statistics and simple thematic analysis. Results: In total, 329 responses were received with 91.8% (302/329) from female site users. The majority of participants (65.6%, 187/285) visited these sites at least twice per week, and most participants used the sites to find information (78.2%, 223/285) or participate in the forums (68.4%, 195/285). Positive effects of website use such as gaining help and support, isolation reduction, and a reduction in self-harm behaviors were reported by a large number of participants. However, smaller but important numbers reported negative effects including worsened self-harm, being triggered to self-harm, and additional negative physical and psychological effects. Conclusions: This is the first multisite study to explore DSH website use in depth. There are clear and important benefits to engaging in website use for many individuals; however, these are not experienced by all website users. Negative effects were experienced by moderate numbers following website use, and clinicians should consider the impact of a patient’s website use when consulting. %M 24362563 %R 10.2196/jmir.2802 %U http://www.jmir.org/2013/12/e285/ %U https://doi.org/10.2196/jmir.2802 %U http://www.ncbi.nlm.nih.gov/pubmed/24362563 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 2 %N 2 %P e59 %T A Rehabilitation Tool Designed for Intensive Web-Based Cognitive Training: Description and Usability Study %A Cruz,Vítor Tedim %A Pais,Joana %A Bento,Virgílio %A Mateus,Cátia %A Colunas,Márcio %A Alves,Ivânia %A Coutinho,Paula %A Rocha,Nelson Pacheco %+ Neurology Department, Hospital São Sebastião, Centro Hospitalar Entre Douro e Vouga, Rua Doutor Cândido de Pinho, Santa Maria da Feira, 4520-211, Portugal, 351 936 173 516, vitor.cruz@chedv.min-saude.pt %K cognitive training %K cognitive deficits %K neurorehabilitation %K Web-based applications %K eHealth systems %K usability test %D 2013 %7 13.12.2013 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cognitive deficits are among the most disabling of neurological diseases and have a serious impact on the quality of life of patients and families. Cognitive training has been proven successful in improving or compensating for neuropsychological deficits after acute brain injury, but its efficacy highly depends on the intensity of treatment over an extended period of time. Therefore, cognitive training indicates expensive human resources and renders the rehabilitation process vulnerable to physical and economic barriers for the majority of patients. Objective: The aim of this study was to develop and test a new Web-based rehabilitation tool that provides intensive cognitive training at home under clinical prescription and monitoring, at affordable costs. Methods: From a pool of 60 original exercises, designed and used over the past 10 years for cognitive training at our center, we developed 27 exercises on a computer game format, with automatic increase or decrease of difficulty levels. These exercises were assembled in a clean, user-friendly design and covered various cognitive domains such as attention (n=4), memory (n=11), language (n=3), calculus (n=3), praxis (n=2), and executive functions (n=3). A Web 2.0 platform was also designed to provide medical prescription of cognitive training sessions, performed at the patient’s home. These sessions included continuous monitoring of compliance, performance, and evolution; algorithms for automatic adjustment and long-term learning through use, and database recording of all activities. The end-user interaction test included 80 patients from our memory clinic from several groups including subjective memory complaints (n=20), traumatic brain injury (n=20), stroke and other static brain lesions (n=20), and mild Alzheimer’s disease (n=20). During a 1-hour session, patients and their relatives were taught to use the system and allowed to practice using it. At the end of the session, they were asked to complete a questionnaire. Results: A total of 48/80 patients (60%) attended the training session. The mean age of the patients was 60 years (SD 13.3, range 41-78), and the mean level of formal education was 6 years (range 4-16). Of all the participants, 32/48 patients (66%) have previously used a computer. All patients and their relatives made a positive evaluation of the cognitive training tool. Only 2/48 patients (4%) were not interested in performing the exercises at home; 19/48 patients (39%) mentioned the need for further coaching from a relative or health care professional. The patients who mentioned difficulties in performing the exercises have not used the computer earlier. Conclusions: This new Web-based system was very well accepted by patients and their relatives, who showed high levels of motivation to use it on a daily basis at home. The simplicity of its use and comfort were especially outlined. This tool will have an important effect on human resource management, in increasing the patient access to specialized health care and improving the quality and national health system costs of rehabilitation programs. %M 24334248 %R 10.2196/resprot.2899 %U http://www.researchprotocols.org/2013/2/e59/ %U https://doi.org/10.2196/resprot.2899 %U http://www.ncbi.nlm.nih.gov/pubmed/24334248 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 11 %P e258 %T Comparing In-Person to Videoconference-Based Cognitive Behavioral Therapy for Mood and Anxiety Disorders: Randomized Controlled Trial %A Stubbings,Daniel R %A Rees,Clare S %A Roberts,Lynne D %A Kane,Robert T %+ School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University of Technology, Kent Street, Bentley, Perth, , Australia, 61 8 9266 3442, C.Rees@curtin.edu.au %K telepsychology %K videoconferencing %K cognitive behavioral therapy %K anxiety %K mood disorder %D 2013 %7 19.11.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive-behavioral therapy (CBT) has demonstrated efficacy and effectiveness for treating mood and anxiety disorders. Dissemination of CBT via videoconference may help improve access to treatment. Objective: The present study aimed to compare the effectiveness of CBT administered via videoconference to in-person therapy for a mixed diagnostic cohort. Methods: A total of 26 primarily Caucasian clients (mean age 30 years, SD 11) who had a primary Diagnostic and Statistical Manual of Mental Disorders, 4th edition text revision (DSM-IV-TR) diagnosis of a mood or anxiety disorder were randomly assigned to receive 12 sessions of CBT either in-person or via videoconference. Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. Participants were recruited through a university clinic. Symptoms of depression, anxiety, stress, and quality of life were assessed using questionnaires before, after, and 6 weeks following treatment. Secondary outcomes at posttreatment included working alliance and client satisfaction. Results: Retention was similar across treatment conditions; there was one more client in the videoconferencing condition at posttreatment and at follow-up. Statistical analysis using multilevel mixed effects linear regression indicated a significant reduction in client symptoms across time for symptoms of depression (P<.001, d=1.41), anxiety (P<.001, d=1.14), stress (P<.001, d=1.81), and quality of life (P<.001, d=1.17). There were no significant differences between treatment conditions regarding symptoms of depression (P=.165, d=0.37), anxiety (P=.41, d=0.22), stress (P=.15, d=0.38), or quality of life (P=.62, d=0.13). There were no significant differences in client rating of the working alliance (P=.53, one-tailed, d=–0.26), therapist ratings of the working alliance (P=.60, one-tailed, d=0.23), or client ratings of satisfaction (P=.77, one-tailed, d=–0.12). Fisher’s Exact P was not significant regarding differences in reliable change from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.41, P=.26), anxiety (P=.60, P=.99), or quality of life (P=.65, P=.99) but was significant for symptoms of stress in favor of the videoconferencing condition (P=.03, P=.035). Difference between conditions regarding clinically significant change was also not observed from pre- to posttreatment or from pretreatment to follow-up for symptoms of depression (P=.67, P=.30), anxiety (P=.99, P=.99), stress (P=.19, P=.13), or quality of life (P=.99, P=.62). Conclusions: The findings of this controlled trial indicate that CBT was effective in significantly reducing symptoms of depression, anxiety, and stress and increasing quality of life in both in-person and videoconferencing conditions, with no significant differences being observed between the two. Trial Registration: Australian New Zealand Clinical Trials Registry ID: ACTRN12609000819224; http://www.anzctr.org.au/ACTRN12609000819224.aspx (Archived by WebCite at http://www.webcitation.org/6Kz5iBMiV). %M 24252663 %R 10.2196/jmir.2564 %U http://www.jmir.org/2013/11/e258/ %U https://doi.org/10.2196/jmir.2564 %U http://www.ncbi.nlm.nih.gov/pubmed/24252663 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 11 %P e242 %T MomMoodBooster Web-Based Intervention for Postpartum Depression: Feasibility Trial Results %A Danaher,Brian G %A Milgrom,Jeannette %A Seeley,John R %A Stuart,Scott %A Schembri,Charlene %A Tyler,Milagra S %A Ericksen,Jennifer %A Lester,Whitney %A Gemmill,Alan W %A Kosty,Derek B %A Lewinsohn,Peter %+ Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, United States, 1 541 484 2123 ext 2201, briand@ori.org %K postpartum depression %K Web-based intervention %D 2013 %7 01.11.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Postpartum depression (PPD)—the most common complication of childbirth—is a significant and prevalent public health problem that severely disrupts family interactions and can result in serious lasting consequences to the health of women and the healthy development of infants. These consequences increase in severity when left untreated; most women with PPD do not obtain help due to a range of logistical and attitudinal barriers. Objective: This pilot study was designed to test the feasibility, acceptability, and potential efficacy of an innovative and interactive guided Web-based intervention for postpartum depression, MomMoodBooster (MMB). Methods: A sample of 53 women who satisfied eligibility criteria (<9 months postpartum, ≥18 years of age, home Internet access and use of personal email, Edinburgh Postnatal Depression Survey score of 12-20 or Patient Health Questionnaire score from 10-19) were invited to use the MMB program. Assessments occurred at screening/pretest, posttest (3 months following enrollment), and at 6 months follow-up. Results: All six sessions of the program were completed by 87% (46/53) of participants. Participants were engaged with the program: visit days (mean 15.2, SD 8.7), number of visits (mean 20.1, SD 12.2), total duration of visits in hours (mean 5.1, SD 1.3), and number of sessions viewed out of six (mean 5.6, SD 1.3) all support high usage. Posttest data were collected from 89% of participants (47/53) and 6-month follow-up data were collected from 87% of participants (46/53). At pretest, 55% (29/53) of participants met PHQ-9 criteria for minor or major depression. At posttest, 90% (26/29) no longer met criteria. Conclusions: These findings support the expanded use and additional testing of the MMB program, including its implementation in a range of clinical and public health settings. Trial Registration: Clinicaltrials.gov NCT00942721; http://clinicaltrials.gov/ct2/show/NCT00942721 (Archived by WebCite at http://www.webcitation.org/6KjYDvYkQ). %M 24191345 %R 10.2196/jmir.2876 %U http://www.jmir.org/2013/11/e242/ %U https://doi.org/10.2196/jmir.2876 %U http://www.ncbi.nlm.nih.gov/pubmed/24191345 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e24 %T Mindfulness-Based Mobile Applications: Literature Review and Analysis of Current Features %A Plaza,Inmaculada %A Demarzo,Marcelo Marcos Piva %A Herrera-Mercadal,Paola %A García-Campayo,Javier %+ Instituto Aragonés de Ciencias de la Salud, Department of Psychiatry, Universidad de Zaragoza, Avda Isabel La Católica 1, Zaragoza, 50009, Spain, 34 976253621, jgarcamp@gmail.com %K mobile health %K mHealth %K mindfulness %K social networks %K personalized education %K health informatics %K evidence-based medicine %D 2013 %7 01.11.2013 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Interest in mindfulness has increased exponentially, particularly in the fields of psychology and medicine. The trait or state of mindfulness is significantly related to several indicators of psychological health, and mindfulness-based therapies are effective at preventing and treating many chronic diseases. Interest in mobile applications for health promotion and disease self-management is also growing. Despite the explosion of interest, research on both the design and potential uses of mindfulness-based mobile applications (MBMAs) is scarce. Objective: Our main objective was to study the features and functionalities of current MBMAs and compare them to current evidence-based literature in the health and clinical setting. Methods: We searched online vendor markets, scientific journal databases, and grey literature related to MBMAs. We included mobile applications that featured a mindfulness-based component related to training or daily practice of mindfulness techniques. We excluded opinion-based articles from the literature. Results: The literature search resulted in 11 eligible matches, two of which completely met our selection criteria–a pilot study designed to evaluate the feasibility of a MBMA to train the practice of “walking meditation,” and an exploratory study of an application consisting of mood reporting scales and mindfulness-based mobile therapies. The online market search eventually analyzed 50 available MBMAs. Of these, 8% (4/50) did not work, thus we only gathered information about language, downloads, or prices. The most common operating system was Android. Of the analyzed apps, 30% (15/50) have both a free and paid version. MBMAs were devoted to daily meditation practice (27/46, 59%), mindfulness training (6/46, 13%), assessments or tests (5/46, 11%), attention focus (4/46, 9%), and mixed objectives (4/46, 9%). We found 108 different resources, of which the most used were reminders, alarms, or bells (21/108, 19.4%), statistics tools (17/108, 15.7%), audio tracks (15/108, 13.9%), and educational texts (11/108, 10.2%). Daily, weekly, monthly statistics, or reports were provided by 37% (17/46) of the apps. 28% (13/46) of them permitted access to a social network. No information about sensors was available. The analyzed applications seemed not to use any external sensor. English was the only language of 78% (39/50) of the apps, and only 8% (4/50) provided information in Spanish. 20% (9/46) of the apps have interfaces that are difficult to use. No specific apps exist for professionals or, at least, for both profiles (users and professionals). We did not find any evaluations of health outcomes resulting from the use of MBMAs. Conclusions: While a wide selection of MBMAs seem to be available to interested people, this study still shows an almost complete lack of evidence supporting the usefulness of those applications. We found no randomized clinical trials evaluating the impact of these applications on mindfulness training or health indicators, and the potential for mobile mindfulness applications remains largely unexplored. %M 25099314 %R 10.2196/mhealth.2733 %U http://mhealth.jmir.org/2013/2/e24/ %U https://doi.org/10.2196/mhealth.2733 %U http://www.ncbi.nlm.nih.gov/pubmed/25099314 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e231 %T Rethinking the Dose-Response Relationship Between Usage and Outcome in an Online Intervention for Depression: Randomized Controlled Trial %A Donkin,Liesje %A Hickie,Ian B %A Christensen,Helen %A Naismith,Sharon L %A Neal,Bruce %A Cockayne,Nicole L %A Glozier,Nick %+ Brain & Mind Research Institute, The University of Sydney, 100 Mallet Street, Camperdown, NSW, New South Wales, 2050, Australia, 61 21847886, Liesje.Donkin@sydney.edu.au %K adherence %K Internet %K eHealth %K depression %K patient compliance %D 2013 %7 17.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: There is now substantial evidence that Web-based interventions can be effective at changing behavior and successfully treating psychological disorders. However, interest in the impact of usage on intervention outcomes has only been developed recently. To date, persistence with or completion of the intervention has been the most commonly reported metric of use, but this does not adequately describe user behavior online. Analysis of alternative measures of usage and their relationship to outcome may help to understand how much of the intervention users may need to obtain a clinically significant benefit from the program. Objective: The objective of this study was to determine which usage metrics, if any, are associated with outcome in an online depression treatment trial. Methods: Cardiovascular Risk E-couch Depression Outcome (CREDO) is a randomized controlled trial evaluating an unguided Web-based program (E-couch) based on cognitive behavioral therapy and interpersonal therapy for people with depression and cardiovascular disease. In all, 280 participants in the active arm of the trial commenced the program, delivered in 12 modules containing pages of text and activities. Usage data (eg, number of log-ins, modules completed, time spent online, and activities completed) were captured automatically by the program interface. We estimated the association of these and composite metrics with the outcome of a clinically significant improvement in depression score on the Patient Health Questionnaire (PHQ-9) of ≥5 points. Results: In all, 214/280 (76.4%) participants provided outcome data at the end of the 12-week period and were included in the analysis. Of these, 94 (43.9%) participants obtained clinically significant improvement. Participants logged into the program an average of 18.7 times (SD 8.3) with most (62.1%, 133/214) completing all 12 modules. Average time spent online per log-in was 17.3 minutes (SD 10.5). Participants completed an average of 9 of 18 activities available within the program. In a multivariate regression model, only the number of activities completed per log-in was associated with a clinically significant outcome (OR 2.82, 95% CI 1.05-7.59). The final model predicted 7.4% of variance in outcome. Curve estimates indicated that significant logarithmic (P=.009) and linear (P=.002) relationships existed between activities completed per log-in and clinically significant change. Conclusions: Only one objective measure of usage was independently associated with better outcome of a Web-based intervention of known effectiveness. The 4 usage metrics retained in the final step of the regression accounted for little outcome variance. Medium level users appeared to have little additional benefit compared to low users indicating that assumptions of a linear relationship between use and outcome may be too simplistic and further models and variables need to be explored to adequately understand the relationship. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000085077; http://www.anzctr.org.au/ACTRN12610000085077.aspx (Archived by WebCite at http://www.webcitation.org/6K9FQtKBn). %M 24135213 %R 10.2196/jmir.2771 %U http://www.jmir.org/2013/10/e231/ %U https://doi.org/10.2196/jmir.2771 %U http://www.ncbi.nlm.nih.gov/pubmed/24135213 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e227 %T Internet-Based, Culturally Sensitive, Problem-Solving Therapy for Turkish Migrants With Depression: Randomized Controlled Trial %A Ünlü Ince,Burçin %A Cuijpers,Pim %A van 't Hof,Edith %A van Ballegooijen,Wouter %A Christensen,Helen %A Riper,Heleen %+ Department of Clinical Psychology, Faculty of Psychology and Education, VU University Amsterdam, Van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 205983688, b.unlu@vu.nl %K depression %K randomized controlled trial %K ethnic groups %K Internet %K psychotherapy %D 2013 %7 11.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Turkish migrants living in the Netherlands have a high prevalence of depressive disorders, but experience considerable obstacles to accessing professional help. Providing easily accessible Internet treatments may help to overcome these barriers. Objective: The aim of this study was to evaluate the effectiveness of a culturally sensitive, guided, self-help, problem-solving intervention through the Internet for reducing depressive symptoms in Turkish migrants. Methods: A two-armed randomized controlled trial was conducted. The primary outcome measure was the severity of depressive symptoms; secondary outcome measures were somatic symptoms, anxiety, quality of life, and satisfaction with the treatment. Participants were assessed online at baseline, posttest (6 weeks after baseline), and 4 months after baseline. Posttest results were analyzed on the intention-to-treat sample. Missing values were estimated by means of multiple imputation. Differences in clinical outcome between groups were analyzed with a t test. Cohen’s d was used to determine the between-groups effect size at posttreatment and follow-up. Results: Turkish adults (N=96) with depressive symptoms were randomized to the experimental group (n=49) or to a waitlist control group (n=47). High attrition rates were found among the 96 participants of which 42% (40/96) did not complete the posttest (6 weeks) and 62% (59/96) participants did not complete the follow-up assessment at 4 months. No significant difference between the experimental group and the control group was found for depression at posttest. Recovery occurred significantly more often in the experimental group (33%, 16/49) than in the control group (9%, 4/47) at posttest (P=.02). Because of the high attrition rate, a completers-only analysis was conducted at follow-up. The experimental group showed significant improvement in depression compared to the control group both at posttest (P=.01) and follow-up (P=.01). Conclusions: The results of this study did not show a significant effect on the reduction of depressive symptoms. However, the effect size at posttest was high, which might be an indicator of the possible effectiveness of the intervention when assessed in a larger sample and robust trial. Future research should replicate our study with adequately powered samples. Trial Registration: Dutch Trial Register: NTR2303. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2303 (Archived by WebCite at http://www.webcitation.org/6IOxNgoDu). %M 24121307 %R 10.2196/jmir.2853 %U http://www.jmir.org/2013/10/e227/ %U https://doi.org/10.2196/jmir.2853 %U http://www.ncbi.nlm.nih.gov/pubmed/24121307 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e191 %T For Whom Does It Work? Moderators of Outcome on the Effect of a Transdiagnostic Internet-Based Maintenance Treatment After Inpatient Psychotherapy: Randomized Controlled Trial %A Ebert,David Daniel %A Gollwitzer,Mario %A Riper,Heleen %A Cuijpers,Pim %A Baumeister,Harald %A Berking,Matthias %+ Innovation Incubator, Division Health-Training.Online, Leuphana University Lueneburg, Main Building, Ground Floor, Rotenbleicherweg 67, Lüneburg, 21335, Germany, 49 17616781057, Ebert@leuphana.de %K maintenance treatment %K continuation treatment %K Internet-based intervention %K transdiagnostic treatment %K mental disorders/inpatient psychotherapy %K guided self-help %K randomized controlled trial %K relapse prevention %K predictors %K moderators %D 2013 %7 10.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Recent studies provide evidence for the effectiveness of Internet-based maintenance treatments for mental disorders. However, it is still unclear which participants might or might not profit from this particular kind of treatment delivery. Objective: The study aimed to identify moderators of treatment outcome in a transdiagnostic Internet-based maintenance treatment (TIMT) offered to patients after inpatient psychotherapy for mental disorders in routine care. Methods: Using data from a randomized controlled trial (N=400) designed to test the effectiveness of TIMT, we performed secondary analyses to identify factors moderating the effects of TIMT (intervention) when compared with those of a treatment-as-usual control condition. TIMT involved an online self-management module, asynchronous patient–therapist communication, a peer support group, and online-based progress monitoring. Participants in the control condition had unstructured access to outpatient psychotherapy, standardized outpatient face-to-face continuation treatment, and psychotropic management. Self-reports of psychopathological symptoms and potential moderators were assessed at the start of inpatient treatment (T1), at discharge from inpatient treatment/start of TIMT (T2), and at 3-month (T3) and 12-month follow-up (T4). Results: Education level, positive outcome expectations, and diagnoses significantly moderated intervention versus control differences regarding changes in outcomes between T2 and T3. Only education level moderated change differences between T2 and T4. The effectiveness of the intervention (vs control) was more pronounced among participants with a low (vs high) education level (T2-T3: B=–0.32, SE 0.16, P=.049; T2-T4: B=–0.42, SE 0.21, P=.049), participants with high (vs low) positive outcome expectations (T2-T3: B=–0.12, SE 0.05, P=.02) and participants with anxiety disorder (vs mood disorder) (T2-T3: B=–0.43, SE 0.21, P=.04). Simple slope analyses revealed that despite some subgroups benefiting less from the intervention than others, all subgroups still benefited significantly. Conclusions: This transdiagnostic Internet-based maintenance treatment might be suitable for a wide range of participants differing in various clinical, motivational, and demographic characteristics. The treatment is especially effective for participants with low education levels. These findings may generalize to other Internet-based maintenance treatments. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 28632626; http://www.controlled-trials.com/isrctn/pf/28632626 (Archived by WebCite at http://www.webcitation.org/6IqZjTLrx). %M 24113764 %R 10.2196/jmir.2511 %U http://www.jmir.org/2013/10/e191/ %U https://doi.org/10.2196/jmir.2511 %U http://www.ncbi.nlm.nih.gov/pubmed/24113764 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e225 %T Internet Addiction Test (IAT): Which is the Best Factorial Solution? %A Faraci,Palmira %A Craparo,Giuseppe %A Messina,Roberta %A Severino,Sergio %+ University of Enna "Kore", Faculty of Human and Social Sciences, Cittadella Universitaria, Enna, 94100, Italy, 39 0935536536, giuseppe.craparo@unikore.it %K IAT %K Internet %K addiction %K factorial structure %K psychometric properties %K structural validity %D 2013 %7 09.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet Addiction Test (IAT) by Kimberly Young is one of the most utilized diagnostic instruments for Internet addiction. Although many studies have documented psychometric properties of the IAT, consensus on the optimal overall structure of the instrument has yet to emerge since previous analyses yielded markedly different factor analytic results. Objective: The objective of this study was to evaluate the psychometric properties of the Italian version of the IAT, specifically testing the factor structure stability across cultures. Methods: In order to determine the dimensional structure underlying the questionnaire, both exploratory and confirmatory factor analyses were performed. The reliability of the questionnaire was computed by the Cronbach alpha coefficient. Results: Data analyses were conducted on a sample of 485 college students (32.3%, 157/485 males and 67.7%, 328/485 females) with a mean age of 24.05 years (SD 7.3, range 17-47). Results showed 176/485 (36.3%) participants with IAT score from 40 to 69, revealing excessive Internet use, and 11/485 (1.9%) participants with IAT score from 70 to 100, suggesting significant problems because of Internet use. The IAT Italian version showed good psychometric properties, in terms of internal consistency and factorial validity. Alpha values were satisfactory for both the one-factor solution (Cronbach alpha=.91), and the two-factor solution (Cronbach alpha=.88 and Cronbach alpha=.79). The one-factor solution comprised 20 items, explaining 36.18% of the variance. The two-factor solution, accounting for 42.15% of the variance, showed 11 items loading on Factor 1 (Emotional and Cognitive Preoccupation with the Internet) and 7 items on Factor 2 (Loss of Control and Interference with Daily Life). Goodness-of-fit indexes (NNFI: Non-Normed Fit Index; CFI: Comparative Fit Index; RMSEA: Root Mean Square Error of Approximation; SRMR: Standardized Root Mean Square Residual) from confirmatory factor analyses conducted on a random half subsample of participants (n=243) were satisfactory in both factorial solutions: two-factor model (χ2132= 354.17, P<.001, χ2/df=2.68, NNFI=.99, CFI=.99, RMSEA=.02 [90% CI 0.000-0.038], and SRMR=.07), and one-factor model (χ2169=483.79, P<.001, χ2/df=2.86, NNFI=.98, CFI=.99, RMSEA=.02 [90% CI 0.000-0.039], and SRMR=.07). Conclusions: Our study was aimed at determining the most parsimonious and veridical representation of the structure of Internet addiction as measured by the IAT. Based on our findings, support was provided for both single and two-factor models, with slightly strong support for the bidimensionality of the instrument. Given the inconsistency of the factor analytic literature of the IAT, researchers should exercise caution when using the instrument, dividing the scale into factors or subscales. Additional research examining the cross-cultural stability of factor solutions is still needed. %M 24184961 %R 10.2196/jmir.2935 %U http://www.jmir.org/2013/10/e225/ %U https://doi.org/10.2196/jmir.2935 %U http://www.ncbi.nlm.nih.gov/pubmed/24184961 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e216 %T A Web-Based Tool to Support Shared Decision Making for People With a Psychotic Disorder: Randomized Controlled Trial and Process Evaluation %A van der Krieke,Lian %A Emerencia,Ando C %A Boonstra,Nynke %A Wunderink,Lex %A de Jonge,Peter %A Sytema,Sjoerd %+ University of Groningen, University Medical Center, University Center for Psychiatry, Hanzeplein 1, Groningen, 9700 RB, Netherlands, 31 503612108, j.a.j.van.der.krieke@umcg.nl %K psychotic disorders, schizophrenia %K computers %K computer-assisted decision making %K shared decision making %K feasibility studies, randomized clinical trial %D 2013 %7 07.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Mental health policy makers encourage the development of electronic decision aids to increase patient participation in medical decision making. Evidence is needed to determine whether these decision aids are helpful in clinical practice and whether they lead to increased patient involvement and better outcomes. Objective: This study reports the outcome of a randomized controlled trial and process evaluation of a Web-based intervention to facilitate shared decision making for people with psychotic disorders. Methods: The study was carried out in a Dutch mental health institution. Patients were recruited from 2 outpatient teams for patients with psychosis (N=250). Patients in the intervention condition (n=124) were provided an account to access a Web-based information and decision tool aimed to support patients in acquiring an overview of their needs and appropriate treatment options provided by their mental health care organization. Patients were given the opportunity to use the Web-based tool either on their own (at their home computer or at a computer of the service) or with the support of an assistant. Patients in the control group received care as usual (n=126). Half of the patients in the sample were patients experiencing a first episode of psychosis; the other half were patients with a chronic psychosis. Primary outcome was patient-perceived involvement in medical decision making, measured with the Combined Outcome Measure for Risk Communication and Treatment Decision-making Effectiveness (COMRADE). Process evaluation consisted of questionnaire-based surveys, open interviews, and researcher observation. Results: In all, 73 patients completed the follow-up measurement and were included in the final analysis (response rate 29.2%). More than one-third (48/124, 38.7%) of the patients who were provided access to the Web-based decision aid used it, and most used its full functionality. No differences were found between the intervention and control conditions on perceived involvement in medical decision making (COMRADE satisfaction with communication: F1,68=0.422, P=.52; COMRADE confidence in decision: F1,67=0.086, P=.77). In addition, results of the process evaluation suggest that the intervention did not optimally fit in with routine practice of the participating teams. Conclusions: The development of electronic decision aids to facilitate shared medical decision making is encouraged and many people with a psychotic disorder can work with them. This holds for both first-episode patients and long-term care patients, although the latter group might need more assistance. However, results of this paper could not support the assumption that the use of electronic decision aids increases patient involvement in medical decision making. This may be because of weak implementation of the study protocol and a low response rate. Trial Registration: Dutch Trial Register (NTR) trial number: 10340; http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=10340 (Archived by WebCite at http://www.webcitation.org/6Jj5umAeS). %M 24100091 %R 10.2196/jmir.2851 %U http://www.jmir.org/2013/10/e216/ %U https://doi.org/10.2196/jmir.2851 %U http://www.ncbi.nlm.nih.gov/pubmed/24100091 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e206 %T Effects of a Web-Based Tailored Intervention to Reduce Alcohol Consumption in Adults: Randomized Controlled Trial %A Schulz,Daniela N %A Candel,Math JJM %A Kremers,Stef PJ %A Reinwand,Dominique A %A Jander,Astrid %A de Vries,Hein %+ CAPHRI School for Public Health and Primary Care, Department of Health Promotion, Maastricht University, P Debyeplein 1, Maastricht, 6229 HA, Netherlands, 31 43 3882832, dn.schulz@maastrichtuniversity.nl %K alcohol intake %K adults %K eHealth %K computer tailoring %K Web-based intervention %K tailoring methods %K effectiveness %D 2013 %7 17.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based tailored interventions provide users with information that is adapted to their individual characteristics and needs. Randomized controlled trials assessing the effects of tailored alcohol self-help programs among adults are scarce. Furthermore, it is a challenge to develop programs that can hold respondents’ attention in online interventions. Objective: To assess whether a 3-session, Web-based tailored intervention is effective in reducing alcohol intake in high-risk adult drinkers and to compare 2 computer-tailoring feedback strategies (alternating vs summative) on behavioral change, dropout, and appreciation of the program. Methods: A single-blind randomized controlled trial was conducted with an experimental group and a control group (N=448) in Germany in 2010-2011. Follow-up took place after 6 months. Drinking behavior, health status, motivational determinants, and demographics were assessed among participants recruited via an online access panel. The experimental group was divided into 2 subgroups. In the alternating condition (n=132), the tailored feedback was split into a series of messages discussing individual topics offered while the respondent was filling out the program. Participants in the summative condition (n=181) received all advice at once after having answered all questions. The actual texts were identical for both conditions. The control group (n=135) only filled in 3 questionnaires. To identify intervention effects, logistic and linear regression analyses were conducted among complete cases (n=197) and after using multiple imputation. Results: Among the complete cases (response rate: 197/448, 44.0%) who did not comply with the German national guideline for low-risk drinking at baseline, 21.1% of respondents in the experimental group complied after 6 months compared with 5.8% in the control group (effect size=0.42; OR 2.65, 95% CI 1.14-6.16, P=.02). The experimental group decreased by 3.9 drinks per week compared to 0.4 drinks per week in the control group, but this did not reach statistical significance (effect size=0.26; beta=−0.12, 95% CI −7.96 to 0.03, P=.05). Intention-to-treat analyses also indicated no statistically significant effect. Separate analyses of the 2 experimental subgroups showed no differences in intervention effects. The dropout rate during the first visit to the intervention website was significantly lower in the alternating condition than in the summative condition (OR 0.23, 95% CI 0.08-0.60, P=.003). Program appreciation was comparable for the 2 experimental groups. Conclusions: Complete case analyses revealed that Web-based tailored feedback can be an effective way to reduce alcohol intake among adults. However, this effect was not confirmed when applying multiple imputations. There was no indication that one of the tailoring strategies was more effective in lowering alcohol intake. Nevertheless, the lower attrition rates we found during the first visit suggest that the version of the intervention with alternating questions and advice may be preferred. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 91623132; http://www.controlled-trials.com/ISRCTN91623132 (Archived by WebCite at http://www.webcitation.org/6J4QdhXeG). %M 24045005 %R 10.2196/jmir.2568 %U http://www.jmir.org/2013/9/e206/ %U https://doi.org/10.2196/jmir.2568 %U http://www.ncbi.nlm.nih.gov/pubmed/24045005 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e200 %T An Internet-Based Intervention to Promote Mental Fitness for Mildly Depressed Adults: Randomized Controlled Trial %A Bolier,Linda %A Haverman,Merel %A Kramer,Jeannet %A Westerhof,Gerben J %A Riper,Heleen %A Walburg,Jan A %A Boon,Brigitte %A Bohlmeijer,Ernst %+ Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Department of Public Mental Health, Da Costakade 45, Utrecht, 3521 VS, Netherlands, 31 302971100, lbolier@trimbos.nl %K public health %K prevention %K depression %K well-being %K randomized controlled trial %K Internet %D 2013 %7 16.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is a worldwide problem warranting global solutions to tackle it. Enhancing well-being has benefits in its own right and could be a good strategy for preventing depression. Providing well-being interventions via the Internet may have synergetic effects. Objective: Psyfit (“mental fitness online”) is a fully automated self-help intervention to improve well-being based on positive psychology. This study examines the clinical effects of this intervention. Methods: We conducted a 2-armed randomized controlled trial that compared the effects of access to Psyfit for 2 months (n=143) to a waiting-list control condition (n=141). Mild to moderately depressed adults in the general population seeking self-help were recruited. Primary outcome was well-being measured by Mental Health Continuum-Short Form (MHC-SF) and WHO Well-being Index (WHO-5); secondary outcomes were depressive symptoms, anxiety, vitality, and general health measured by Center for Epidemiological Studies Depression Scale (CES-D), Hospital Anxiety and Depression Scale Anxiety subscale (HADS-A), and Medical Outcomes Study-Short Form (MOS-SF) vitality and general health subscales, respectively. Online measurements were taken at baseline, 2 months, and 6 months after baseline. Results: The dropout rate was 37.8% in the Psyfit group and 22.7% in the control group. At 2-month follow-up, Psyfit tended to be more effective in enhancing well-being (nonsignificantly for MHC-SF: Cohen’s d=0.27, P=.06; significantly for WHO-5: Cohen’s d=0.31, P=.01), compared to the waiting-list control group. For the secondary outcomes, small but significant effects were found for general health (Cohen’s d=0.14, P=.01), vitality (d=0.22, P=.02), anxiety symptoms (Cohen’s d=0.32, P=.001), and depressive symptoms (Cohen’s d=0.36, P=.02). At 6-month follow-up, there were no significant effects on well-being (MHC-SF: Cohen’s d=0.01, P=.90; WHO-5: Cohen’s d=0.26, P=.11), whereas depressive symptoms (Cohen’s d=0.35, P=.02) and anxiety symptoms (Cohen’s d=0.35, P=.001) were still significantly reduced compared to the control group. There was no clear dose–response relationship between adherence and effectiveness, although some significant differences appeared across most outcomes in favor of those completing at least 1 lesson in the intervention. Conclusions: This study shows that an online well-being intervention can effectively enhance well-being (at least in the short-term and for 1 well-being measure) and can help to reduce anxiety and depression symptoms. Further research should focus on increasing adherence and motivation, reaching and serving lower-educated people, and widening the target group to include people with different levels of depressive symptoms. Trial Registration: Netherlands Trial Register (NTR) number: NTR2126; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2126 (archived by WebCite at http://www.webcitation.org/6IIiVrLcO). %M 24041479 %R 10.2196/jmir.2603 %U http://www.jmir.org/2013/9/e200/ %U https://doi.org/10.2196/jmir.2603 %U http://www.ncbi.nlm.nih.gov/pubmed/24041479 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e193 %T Online Mental Health Resources in Rural Australia: Clinician Perceptions of Acceptability %A Sinclair,Craig %A Holloway,Kristi %A Riley,Geoffrey %A Auret,Kirsten %+ Rural Clinical School of Western Australia, University of Western Australia, M701, University of Western Australia, Hackett Dve, Crawley, WA, Perth, 6009, Australia, 61 8 9842 0829, craig.sinclair@rcswa.edu.au %K mental health %K Internet %K rural health %K qualitative research %D 2013 %7 05.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Online mental health resources have been proposed as an innovative means of overcoming barriers to accessing rural mental health services. However, clinicians tend to express lower satisfaction with online mental health resources than do clients. Objective: To understand rural clinicians’ attitudes towards the acceptability of online mental health resources as a treatment option in the rural context. Methods: In-depth interviews were conducted with 21 rural clinicians (general practitioners, psychologists, psychiatrists, and clinical social workers). Interviews were supplemented with rural-specific vignettes, which described clinical scenarios in which referral to online mental health resources might be considered. Symbolic interactionism was used as the theoretical framework for the study, and interview transcripts were thematically analyzed using a constant comparative method. Results: Clinicians were optimistic about the use of online mental health resources into the future, showing a preference for integration alongside existing services, and use as an adjunct rather than an alternative to traditional approaches. Key themes identified included perceptions of resources, clinician factors, client factors, and the rural and remote context. Clinicians favored resources that were user-friendly and could be integrated into their clinical practice. Barriers to use included a lack of time to explore resources, difficulty accessing training in the rural environment, and concerns about the lack of feedback from clients. Social pressure exerted within professional clinical networks contributed to a cautious approach to referring clients to online resources. Conclusions: Successful implementation of online mental health resources in the rural context requires attention to clinician perceptions of acceptability. Promotion of online mental health resources to rural clinicians should include information about resource effectiveness, enable integration with existing services, and provide opportunities for renegotiating the socially defined role of the clinician in the eHealth era. %M 24007949 %R 10.2196/jmir.2772 %U http://www.jmir.org/2013/9/e193/ %U https://doi.org/10.2196/jmir.2772 %U http://www.ncbi.nlm.nih.gov/pubmed/24007949 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 9 %P e196 %T A Pre-Post Study on the Appropriateness and Effectiveness of a Web- and Text Messaging-Based Intervention to Reduce Problem Drinking in Emerging Adults %A Haug,Severin %A Schaub,Michael P %A Venzin,Vigeli %A Meyer,Christian %A John,Ulrich %A Gmel,Gerhard %+ Swiss Research Institute for Public Health and Addiction at Zurich University, Konradstrasse 32, Zurich, 8031, Switzerland, 41 44 448 11 74, severin.haug@isgf.uzh.ch %K alcohol intervention %K problem drinking %K young people %K text messaging %K Internet %D 2013 %7 02.09.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Problem drinking, particularly risky single-occasion drinking (RSOD), also called “binge drinking”, is widespread among adolescents and young adults in most Western countries. Few studies have tested the effectiveness of interventions to reduce RSOD in young people with heterogeneous and particularly lower educational background. Objective: To test the appropriateness and initial effectiveness of a combined, individually tailored Web- and text messaging (SMS)–based intervention program to reduce problem drinking in vocational school students. Methods: The fully automated program provided: (1) online feedback about an individual’s drinking pattern compared to the drinking norms of an age- and gender-specific reference group, and (2) recurrent individualized SMS messages over a time period of 3 months. Generalized Estimating Equation (GEE) analyses were used to investigate the longitudinal courses of the following outcomes over the study period of 3 months: RSOD, alcohol-related problems, mean number of standard drinks per week, and maximum number of standard drinks on an occasion. Results: The program was tested in 36 school classes at 7 vocational schools in Switzerland. Regardless of their drinking behavior, 477 vocational school students who owned a mobile phone were invited to participate in the program. Of these, 364 (76.3%) participated in the program. During the intervention period, 23 out of 364 (6.3%) persons unsubscribed from participating in the program. The GEE analyses revealed decreases in the percentage of persons with RSOD from baseline (75.5%, 210/278) to follow-up assessment (67.6%, 188/278, P<.001), in the percentage of persons with alcohol-related problems (20.4%, 57/280 to 14.3%, 40/280, P=.009), and in the mean number of standard drinks per week: 13.4 (SD 15.3) to 11.3 (SD 14.0), P=.002. They also revealed a trend toward a decrease in the mean of the maximum number of drinks consumed on an occasion: 11.3 (SD 10.3) to 10.5 (SD 10.3), P=.08. Conclusions: The results show high acceptance and promising effectiveness of this interventional approach, which could be easily and economically implemented within school classes. %M 23999406 %R 10.2196/jmir.2755 %U http://www.jmir.org/2013/9/e196/ %U https://doi.org/10.2196/jmir.2755 %U http://www.ncbi.nlm.nih.gov/pubmed/23999406 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 8 %P e172 %T Participants, Usage, and Use Patterns of a Web-Based Intervention for the Prevention of Depression Within a Randomized Controlled Trial %A Kelders,Saskia M %A Bohlmeijer,Ernst T %A Van Gemert-Pijnen,Julia EWC %+ Department of Psychology, Health and Technology, University of Twente, PO Box 217, Enschede, 7500 AE, Netherlands, 31 651070689, s.m.kelders@utwente.nl %K Web-based intervention %K depression %K use patterns %K usage %K adherence %K design %K engagement %K attrition %D 2013 %7 20.08.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Although Web-based interventions have been shown to be effective, they are not widely implemented in regular care. Nonadherence (ie, participants not following the intervention protocol) is an issue. By studying the way Web-based interventions are used and whether there are differences between adherers (ie, participants that started all 9 lessons) and nonadherers, more insight can be gained into the process of adherence. Objective: The aims of this study were to (1) describe the characteristics of participants and investigate their relationship with adherence, (2) investigate the utilization of the different features of the intervention and possible differences between adherers and nonadherers, and (3) identify what use patterns emerge and whether there are differences between adherers and nonadherers. Methods: Data were used from 206 participants that used the Web-based intervention Living to the full, a Web-based intervention for the prevention of depression employing both a fully automated and human-supported format. Demographic and baseline characteristics of participants were collected by using an online survey. Log data were collected within the Web-based intervention itself. Both quantitative and qualitative analyses were performed. Results: In all, 118 participants fully adhered to the intervention (ie, started all 9 lessons). Participants with an ethnicity other than Dutch were more often adherers (χ21=5.5, P=.02), and nonadherers used the Internet more hours per day on average (F1,203=3.918, P=.049). A logistic regression showed that being female (OR 2.02, 95% CI 1.01-4.04; P=.046) and having a higher need for cognition (OR 1.02; 95% CI 1.00-1.05; P=.02) increased the odds of adhering to the intervention. Overall, participants logged in an average of 4 times per lesson, but adherers logged in significantly more times per lesson than nonadherers (F1,204=20.710; P<.001). For use patterns, we saw that early nonadherers seemed to use fewer sessions and spend less time than late nonadherers and adherers, and fewer sessions to complete the lesson than adherers. Furthermore, late nonadherers seemed to have a shorter total duration of sessions than adherers. Conclusions: By using log data combined with baseline characteristics of participants, we extracted valuable lessons for redesign of this intervention and the design of Web-based interventions in general. First, although characteristics of respondents can significantly predict adherence, their predictive value is small. Second, it is important to design Web-based interventions to foster adherence and usage of all features in an intervention. Trial Registration: Dutch Trial Register Number: NTR3007; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3007 (Archived by WebCite at http://www.webcitation.org/6ILhI3rd8). %M 23963284 %R 10.2196/jmir.2258 %U http://www.jmir.org/2013/8/e172/ %U https://doi.org/10.2196/jmir.2258 %U http://www.ncbi.nlm.nih.gov/pubmed/23963284 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 8 %P e165 %T Internet-Based Early Intervention to Prevent Posttraumatic Stress Disorder in Injury Patients: Randomized Controlled Trial %A Mouthaan,Joanne %A Sijbrandij,Marit %A de Vries,Giel-Jan %A Reitsma,Johannes B %A van de Schoot,Rens %A Goslings,J Carel %A Luitse,Jan SK %A Bakker,Fred C %A Gersons,Berthold PR %A Olff,Miranda %+ Center for Anxiety Disorders, Research Group Psychotrauma, Department of Psychiatry, Academic Medical Center, Meibergdreef 5, Amsterdam, 3356 BE, Netherlands, 31 208913552, j.mouthaan@amc.uva.nl %K early intervention %K prevention %K Internet %K posttraumatic stress disorder %K cognitive behavior therapy %D 2013 %7 13.08.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Posttraumatic stress disorder (PTSD) develops in 10-20% of injury patients. We developed a novel, self-guided Internet-based intervention (called Trauma TIPS) based on techniques from cognitive behavioral therapy (CBT) to prevent the onset of PTSD symptoms. Objective: To determine whether Trauma TIPS is effective in preventing the onset of PTSD symptoms in injury patients. Methods: Adult, level 1 trauma center patients were randomly assigned to receive the fully automated Trauma TIPS Internet intervention (n=151) or to receive no early intervention (n=149). Trauma TIPS consisted of psychoeducation, in vivo exposure, and stress management techniques. Both groups were free to use care as usual (nonprotocolized talks with hospital staff). PTSD symptom severity was assessed at 1, 3, 6, and 12 months post injury with a clinical interview (Clinician-Administered PTSD Scale) by blinded trained interviewers and self-report instrument (Impact of Event Scale—Revised). Secondary outcomes were acute anxiety and arousal (assessed online), self-reported depressive and anxiety symptoms (Hospital Anxiety and Depression Scale), and mental health care utilization. Intervention usage was documented. Results: The mean number of intervention logins was 1.7, SD 2.5, median 1, interquartile range (IQR) 1-2. Thirty-four patients in the intervention group did not log in (22.5%), 63 (41.7%) logged in once, and 54 (35.8%) logged in multiple times (mean 3.6, SD 3.5, median 3, IQR 2-4). On clinician-assessed and self-reported PTSD symptoms, both the intervention and control group showed a significant decrease over time (P<.001) without significant differences in trend. PTSD at 12 months was diagnosed in 4.7% of controls and 4.4% of intervention group patients. There were no group differences on anxiety or depressive symptoms over time. Post hoc analyses using latent growth mixture modeling showed a significant decrease in PTSD symptoms in a subgroup of patients with severe initial symptoms (n=20) (P<.001). Conclusions: Our results do not support the efficacy of the Trauma TIPS Internet-based early intervention in the prevention of PTSD symptoms for an unselected population of injury patients. Moreover, uptake was relatively low since one-fifth of individuals did not log in to the intervention. Future research should therefore focus on innovative strategies to increase intervention usage, for example, adding gameplay, embedding it in a blended care context, and targeting high-risk individuals who are more likely to benefit from the intervention. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 57754429; http://www.controlled-trials.com/ISRCTN57754429 (Archived by WebCite at http://webcitation.org/6FeJtJJyD). %M 23942480 %R 10.2196/jmir.2460 %U http://www.jmir.org/2013/8/e165/ %U https://doi.org/10.2196/jmir.2460 %U http://www.ncbi.nlm.nih.gov/pubmed/23942480 %0 Journal Article %@ 14388871 %I JMIR Publications Inc %V 15 %N 8 %P e145 %T Staging Dementia From Symptom Profiles on a Care Partner Website %A Rockwood,Kenneth %A Richard,Matthew %A Leibman,Chris %A Mucha,Lisa %A Mitnitski,Arnold %+ DGI Clinical Inc, 1344 Summer Street, Suite 208, Halifax, NS, B3H 0A8, Canada, 1 902 421 5710 ext 5, krockwood@dgiclinical.com %K dementia %K staging %K online survey %K symptoms %K Cognitive Impairment Not Dementia %K Mild Cognitive Impairment %K validation %K Artificial Neural Networks %K World Wide Web %D 2013 %7 07.08.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Wide Web allows access to patient/care partner perspectives on the lived experience of dementia. We were interested in how symptoms that care partners target for tracking relate to dementia stage, and whether dementia could be staged using only these online profiles of targeted symptoms. Objectives: To use clinical data where the dementia stage is known to develop a model that classifies an individual’s stage of dementia based on their symptom profile and to apply this model to classify dementia stages for subjects from a Web-based dataset. Methods: An Artificial Neural Network (ANN) was used to identify the relationships between the dementia stages and individualized profiles of people with dementia obtained from the 60-item SymptomGuide (SG). The clinic-based training dataset (n=320), with known dementia stages, was used to create an ANN model for classifying stages in Web-based users (n=1930). Results: The ANN model was trained in 66% of the 320 Memory Clinic patients, with the remaining 34% used to test its accuracy in classification. Training and testing staging distributions were not significantly different. In the 1930 Web-based profiles, 309 people (16%) were classified as having mild cognitive impairment, 36% as mild dementia, 29% as moderate, and 19% as severe. In both the clinical and Web-based symptom profiles, most symptoms became more common as the stage of dementia worsened (eg, mean 5.6 SD 5.9 symptoms in the MCI group versus 11.9 SD 11.3 in the severe). Overall, Web profiles recorded more symptoms (mean 7.1 SD 8.0) than did clinic ones (mean 5.5 SD 1.8). Even so, symptom profiles were relatively similar between the Web-based and clinical datasets. Conclusion: Symptoms targeted for online tracking by care partners of people with dementia can be used to stage dementia. Even so, caution is needed to assure the validity of data collected online as the current staging algorithm should be seen as an initial step. %M 23924608 %R 10.2196/jmir.2461 %U http://www.jmir.org/2013/8/e145/ %U https://doi.org/10.2196/jmir.2461 %U http://www.ncbi.nlm.nih.gov/pubmed/23924608 %0 Journal Article %@ 2291-9279 %I JMIR Publications Inc. %V 1 %N 1 %P e1 %T Ecological Validity of Virtual Reality Daily Living Activities Screening for Early Dementia: Longitudinal Study %A Tarnanas,Ioannis %A Schlee,Winfried %A Tsolaki,Magda %A Müri,René %A Mosimann,Urs %A Nef,Tobias %+ Gerontechnology and Rehabilitation Group, University of Bern, Murtenstrasse 50, Bern, 3010, Switzerland, 41 31 632 7582, ioannis.tarnanas@artorg.unibe.ch %D 2013 %7 06.08.2013 %9 Original Paper %J JMIR Serious Games %G English %X Background: Dementia is a multifaceted disorder that impairs cognitive functions, such as memory, language, and executive functions necessary to plan, organize, and prioritize tasks required for goal-directed behaviors. In most cases, individuals with dementia experience difficulties interacting with physical and social environments. The purpose of this study was to establish ecological validity and initial construct validity of a fire evacuation Virtual Reality Day-Out Task (VR-DOT) environment based on performance profiles as a screening tool for early dementia. Objective: The objectives were (1) to examine the relationships among the performances of 3 groups of participants in the VR-DOT and traditional neuropsychological tests employed to assess executive functions, and (2) to compare the performance of participants with mild Alzheimer’s-type dementia (AD) to those with amnestic single-domain mild cognitive impairment (MCI) and healthy controls in the VR-DOT and traditional neuropsychological tests used to assess executive functions. We hypothesized that the 2 cognitively impaired groups would have distinct performance profiles and show significantly impaired independent functioning in ADL compared to the healthy controls. Methods: The study population included 3 groups: 72 healthy control elderly participants, 65 amnestic MCI participants, and 68 mild AD participants. A natural user interface framework based on a fire evacuation VR-DOT environment was used for assessing physical and cognitive abilities of seniors over 3 years. VR-DOT focuses on the subtle errors and patterns in performing everyday activities and has the advantage of not depending on a subjective rating of an individual person. We further assessed functional capacity by both neuropsychological tests (including measures of attention, memory, working memory, executive functions, language, and depression). We also evaluated performance in finger tapping, grip strength, stride length, gait speed, and chair stands separately and while performing VR-DOTs in order to correlate performance in these measures with VR-DOTs because performance while navigating a virtual environment is a valid and reliable indicator of cognitive decline in elderly persons. Results: The mild AD group was more impaired than the amnestic MCI group, and both were more impaired than healthy controls. The novel VR-DOT functional index correlated strongly with standard cognitive and functional measurements, such as mini-mental state examination (MMSE; rho=0.26, P=.01) and Bristol Activities of Daily Living (ADL) scale scores (rho=0.32, P=.001). Conclusions: Functional impairment is a defining characteristic of predementia and is partly dependent on the degree of cognitive impairment. The novel virtual reality measures of functional ability seem more sensitive to functional impairment than qualitative measures in predementia, thus accurately differentiating from healthy controls. We conclude that VR-DOT is an effective tool for discriminating predementia and mild AD from controls by detecting differences in terms of errors, omissions, and perseverations while measuring ADL functional ability. %M 25658491 %R 10.2196/games.2778 %U http://games.jmir.org/2013/1/e1/ %U https://doi.org/10.2196/games.2778 %U http://www.ncbi.nlm.nih.gov/pubmed/25658491 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 8 %P e153 %T The Clinical Effectiveness of Web-Based Cognitive Behavioral Therapy With Face-to-Face Therapist Support for Depressed Primary Care Patients: Randomized Controlled Trial %A Høifødt,Ragnhild Sørensen %A Lillevoll,Kjersti R %A Griffiths,Kathleen M %A Wilsgaard,Tom %A Eisemann,Martin %A Waterloo,Knut %A Kolstrup,Nils %+ Department of Psychology, Faculty of Health Sciences, University of Tromsø, Tromsø, 9037, Norway, 47 776 49230, ragnhild.s.hoifodt@uit.no %K cognitive therapy %K therapy %K computer-assisted %K Internet %K mental health %K depression %K randomized controlled trial %K primary health care %D 2013 %7 05.08.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Most patients with mild to moderate depression receive treatment in primary care, but despite guideline recommendations, structured psychological interventions are infrequently delivered. Research supports the effectiveness of Internet-based treatment for depression; however, few trials have studied the effect of the MoodGYM program plus therapist support. The use of such interventions could improve the delivery of treatment in primary care. Objective: To evaluate the effectiveness and acceptability of a guided Web-based intervention for mild to moderate depression, which could be suitable for implementation in general practice. Methods: Participants (N=106) aged between 18 and 65 years were recruited from primary care and randomly allocated to a treatment condition comprising 6 weeks of therapist-assisted Web-based cognitive behavioral therapy (CBT), or to a 6-week delayed treatment condition. The intervention included the Norwegian version of the MoodGYM program, brief face-to-face support from a psychologist, and reminder emails. The primary outcome measure, depression symptoms, was measured by the Beck Depression Inventory-II (BDI-II). Secondary outcome measures included the Beck Anxiety Inventory (BAI), the Hospital Anxiety and Depression Scale (HADS), the Satisfaction with Life Scale (SWLS), and the EuroQol Group 5-Dimension Self-Report Questionnaire (EQ-5D). All outcomes were based on self-report and were assessed at baseline, postintervention, and at 6-month follow-up. Results: Postintervention measures were completed by 37 (71%) and 47 (87%) of the 52 participants in the intervention and 54 participants in the delayed treatment group, respectively. Linear mixed-models analyses revealed a significant difference in time trends between the groups for the BDI-II, (P=.002), for HADS depression and anxiety subscales (P<.001 and P=.001, respectively), and for the SWLS (P<.001). No differential group effects were found for the BAI and the EQ-5D. In comparison to the control group, significantly more participants in the intervention group experienced recovery from depression as measured by the BDI-II. Of the 52 participants in the treatment program, 31 (60%) adhered to the program, and overall treatment satisfaction was high. The reduction of depression and anxiety symptoms was largely maintained at 6-month follow-up, and positive gains in life satisfaction were partly maintained. Conclusions: The intervention combining MoodGYM and brief therapist support can be an effective treatment of depression in a sample of primary care patients. The intervention alleviates depressive symptoms and has a significant positive effect on anxiety symptoms and satisfaction with life. Moderate rates of nonadherence and predominately positive evaluations of the treatment also indicate the acceptability of the intervention. The intervention could potentially be used in a stepped-care approach, but remains to be tested in regular primary health care. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12610000257066; http://apps.who.int/trialsearch/trial.aspx?trialid=ACTRN12610000257066 (Archived by WebCite at http://www.webcitation.org/6Ie3YhIZa). %M 23916965 %R 10.2196/jmir.2714 %U http://www.jmir.org/2013/8/e153/ %U https://doi.org/10.2196/jmir.2714 %U http://www.ncbi.nlm.nih.gov/pubmed/23916965 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e11 %T Mobile Mental Wellness Training for Stress Management: Feasibility and Design Implications Based on a One-Month Field Study %A Ahtinen,Aino %A Mattila,Elina %A Välkkynen,Pasi %A Kaipainen,Kirsikka %A Vanhala,Toni %A Ermes,Miikka %A Sairanen,Essi %A Myllymäki,Tero %A Lappalainen,Raimo %+ VTT Technical Research Centre of Finland, Sinitaival 6, Tampere, 33720, Finland, 358 207223384, elina.m.mattila@vtt.fi %K stress %K mental health %K mobile phone %K acceptance and commitment therapy %K field studies %K user experience %K design %D 2013 %7 10.07.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prevention and management of work-related stress and related mental problems is a great challenge. Mobile applications are a promising way to integrate prevention strategies into the everyday lives of citizens. Objective: The objectives of this study was to study the usage, acceptance, and usefulness of a mobile mental wellness training application among working-age individuals, and to derive preliminary design implications for mobile apps for stress management. Methods: Oiva, a mobile app based on acceptance and commitment therapy (ACT), was designed to support active learning of skills related to mental wellness through brief ACT-based exercises in the daily life. A one-month field study with 15 working-age participants was organized to study the usage, acceptance, and usefulness of Oiva. The usage of Oiva was studied based on the usage log files of the application. Changes in wellness were measured by three validated questionnaires on stress, satisfaction with life (SWLS), and psychological flexibility (AAQ-II) at the beginning and at end of the study and by user experience questionnaires after one week’s and one month’s use. In-depth user experience interviews were conducted after one month’s use to study the acceptance and user experiences of Oiva. Results: Oiva was used actively throughout the study. The average number of usage sessions was 16.8 (SD 2.4) and the total usage time per participant was 3 hours 12 minutes (SD 99 minutes). Significant pre-post improvements were obtained in stress ratings (mean 3.1 SD 0.2 vs mean 2.5 SD 0.1, P=.003) and satisfaction with life scores (mean 23.1 SD 1.3 vs mean 25.9 SD 0.8, P=.02), but not in psychological flexibility. Oiva was perceived easy to use, acceptable, and useful by the participants. A randomized controlled trial is ongoing to evaluate the effectiveness of Oiva on working-age individuals with stress problems. Conclusions: A feasibility study of Oiva mobile mental wellness training app showed good acceptability, usefulness, and engagement among the working-age participants, and provided increased understanding on the essential features of mobile apps for stress management. Five design implications were derived based on the qualitative findings: (1) provide exercises for everyday life, (2) find proper place and time for challenging content, (3) focus on self-improvement and learning instead of external rewards, (4) guide gently but do not restrict choice, and (5) provide an easy and flexible tool for self-reflection. %M 25100683 %R 10.2196/mhealth.2596 %U http://mhealth.jmir.org/2013/2/e11/ %U https://doi.org/10.2196/mhealth.2596 %U http://www.ncbi.nlm.nih.gov/pubmed/25100683 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 7 %P e118 %T Maximizing the Value of Mobile Health Monitoring by Avoiding Redundant Patient Reports: Prediction of Depression-Related Symptoms and Adherence Problems in Automated Health Assessment Services %A Piette,John D %A Sussman,Jeremy B %A Pfeiffer,Paul N %A Silveira,Maria J %A Singh,Satinder %A Lavieri,Mariel S %+ VA Center for Clinical Management Research and Division of General Medicine, Department of Internal Medicine, University of Michigan, PO Box 130170, Ann Arbor, MI, 48113-0170, United States, 1 734 936 4787, jpiette@umich.edu %K cellular phone %K telemedicine %K depression %K self-care %D 2013 %7 05.07.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Interactive voice response (IVR) calls enhance health systems’ ability to identify health risk factors, thereby enabling targeted clinical follow-up. However, redundant assessments may increase patient dropout and represent a lost opportunity to collect more clinically useful data. Objective: We determined the extent to which previous IVR assessments predicted subsequent responses among patients with depression diagnoses, potentially obviating the need to repeatedly collect the same information. We also evaluated whether frequent (ie, weekly) IVR assessment attempts were significantly more predictive of patients’ subsequent reports than information collected biweekly or monthly. Methods: Using data from 1050 IVR assessments for 208 patients with depression diagnoses, we examined the predictability of four IVR-reported outcomes: moderate/severe depressive symptoms (score ≥10 on the PHQ-9), fair/poor general health, poor antidepressant adherence, and days in bed due to poor mental health. We used logistic models with training and test samples to predict patients’ IVR responses based on their five most recent weekly, biweekly, and monthly assessment attempts. The marginal benefit of more frequent assessments was evaluated based on Receiver Operator Characteristic (ROC) curves and statistical comparisons of the area under the curves (AUC). Results: Patients’ reports about their depressive symptoms and perceived health status were highly predictable based on prior assessment responses. For models predicting moderate/severe depression, the AUC was 0.91 (95% CI 0.89-0.93) when assuming weekly assessment attempts and only slightly less when assuming biweekly assessments (AUC: 0.89; CI 0.87-0.91) or monthly attempts (AUC: 0.89; CI 0.86-0.91). The AUC for models predicting reports of fair/poor health status was similar when weekly assessments were compared with those occurring biweekly (P value for the difference=.11) or monthly (P=.81). Reports of medication adherence problems and days in bed were somewhat less predictable but also showed small differences between assessments attempted weekly, biweekly, and monthly. Conclusions: The technical feasibility of gathering high frequency health data via IVR may in some instances exceed the clinical benefit of doing so. Predictive analytics could make data gathering more efficient with negligible loss in effectiveness. In particular, weekly or biweekly depressive symptom reports may provide little marginal information regarding how the person is doing relative to collecting that information monthly. The next generation of automated health assessment services should use data mining techniques to avoid redundant assessments and should gather data at the frequency that maximizes the value of the information collected. %M 23832021 %R 10.2196/jmir.2582 %U http://www.jmir.org/2013/7/e118/ %U https://doi.org/10.2196/jmir.2582 %U http://www.ncbi.nlm.nih.gov/pubmed/23832021 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 6 %P e121 %T A Service-Based Evaluation of a Therapist-Supported Online Cognitive Behavioral Therapy Program for Depression %A Sharry,John %A Davidson,Ruth %A McLoughlin,Orla %A Doherty,Gavin %+ School of Computer Science and Statistics, Trinity College Dublin, O'Reilly Institute, Dublin, D2, Ireland, 353 1 8963858, Gavin.Doherty@tcd.ie %K Internet %K user-computer interface %K depression %K cognitive behavioral therapy %K patient adherence %K online interventions %K guided online program %K online therapist support %K user experience %D 2013 %7 27.06.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Evidence suggests that Internet-delivered cognitive behavioral therapy (CBT) may be as effective as face-to-face delivery for depression, but attrition and engagement rates remain a challenge. Objective: This service-based study aimed to evaluate an online, therapist-supported, CBT-based program for depression. The program was specifically designed to address engagement issues, most notably by integrating online therapist support and communication within the platform. Methods: Participants were 80 adults who were registered university students. Participants used the modular online program over 8 weeks, supported by a therapist. Engagement information was gathered automatically by the online system, and analyzed for all participants. Severity of participants’ self-reported symptoms of depression were assessed preintervention and postintervention using the Beck Depression Inventory-II (BDI-II). Postintervention measures were completed by 53 participants. Results: A high level of engagement was observed compared to a previous study within the same service, along with extensive use of a range of program features. A statistically significant (P<.001) decrease in self-reported depressive symptomatology from preintervention (mean BDI-II 25.47) to postintervention (mean BDI-II 15.53) with a large effect size (d=1.17) was also observed. Conclusions: The results indicate the potential of unintrusive and easily provided online support to enhance engagement with online interventions. The system described in the paper also illustrates how such online support can be tightly integrated with interactive online programs by using a range of design strategies intended to improve the user experience. %M 23807565 %R 10.2196/jmir.2248 %U http://www.jmir.org/2013/6/e121/ %U https://doi.org/10.2196/jmir.2248 %U http://www.ncbi.nlm.nih.gov/pubmed/23807565 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 6 %P e126 %T Patients’ Experiences of Helpfulness in Guided Internet-Based Treatment for Depression: Qualitative Study of Integrated Therapeutic Dimensions %A Lillevoll,Kjersti R %A Wilhelmsen,Maja %A Kolstrup,Nils %A Høifødt,Ragnhild Sørensen %A Waterloo,Knut %A Eisemann,Martin %A Risør,Mette Bech %+ Department of Psychology, Faculty of Health Sciences, University of Tromsø, Tromsø, 9037, Norway, 47 77646774, kjersti.lillevoll@uit.no %K Internet-based cognitive behavioral therapy %K ICBT %K guided self-help %K depression %K qualitative %D 2013 %7 20.06.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Quantitative research on Internet-based cognitive behavioral therapy (ICBT) has collected substantial evidence for the effectiveness of this treatment approach on health outcomes. Less is known about how patients find ICBT to be generally meaningful and helpful for treating depression. Objective: To explore patients’ experiences of being in ICBT treatment with a focus on the treatment dimensions that they considered helpful. Methods: Choosing a phenomenological-hermeneutical approach, 14 patients were interviewed with semistructured qualitative interviews to elicit their understanding of using ICBT. The patients took part in a clinical trial using ICBT with MoodGYM, which also featured brief consultations with a clinical psychologist. The interviews were transcribed and analyzed according to the chosen methodology and organized into significant themes. Results: The phenomenological-hermeneutical analysis identified 5 themes relating overall to the meaning of this mode of treatment in terms of helpfulness. Two related to treatment in general: (1) taking action to address one’s problems and (2) the value of talking to a professional. The next two themes specifically addressed guided self-help using the MoodGYM program: (3) acquiring relevant knowledge, and (4) restructuring the new knowledge acquired through ICBT. A fifth theme concerned (5) actual changes in patients’ perceptions and interactions, related to either the self-help material or the face-to-face consultations with the therapist. Conclusions: Three important dimensions were made explicit: the active engagement of the patient, the guidance of the therapist, and the content of the treatment program. The findings pointed to (1) the role of MoodGYM as a source of new knowledge providing patients with a structured approach to work with their depression, (2) the patient’s role as the primary agent of change through adapting relevant knowledge from MoodGYM to their situation, and (3) the dialogue with the therapist as a trusting relationship in which to share thoughts and feelings, receive feedback and advice, and to assist the patient in making use of the MoodGYM content. %M 23786763 %R 10.2196/jmir.2531 %U http://www.jmir.org/2013/6/e126/ %U https://doi.org/10.2196/jmir.2531 %U http://www.ncbi.nlm.nih.gov/pubmed/23786763 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 5 %P e101 %T Technology-Based Interventions for Mental Health in Tertiary Students: Systematic Review %A Farrer,Louise %A Gulliver,Amelia %A Chan,Jade KY %A Batterham,Philip J %A Reynolds,Julia %A Calear,Alison %A Tait,Robert %A Bennett,Kylie %A Griffiths,Kathleen M %+ Centre for Mental Health Research, The Australian National University, Building 63, Eggleston Road, The Australian National University, Canberra ACT, 0200, Australia, 61 2 6125 8859, louise.farrer@anu.edu.au %K systematic review %K technology %K intervention %K universities %K students %K mental health %D 2013 %7 27.05.2013 %9 Review %J J Med Internet Res %G English %X Background: Mental disorders are responsible for a high level of disability burden in students attending university. However, many universities have limited resources available to support student mental health. Technology-based interventions may be highly relevant to university populations. Previous reviews have targeted substance use and eating disorders in tertiary students. However, the effectiveness of technology-based interventions for other mental disorders and related issues has not been reviewed. Objective: To systematically review published randomized trials of technology-based interventions evaluated in a university setting for disorders other than substance use and eating disorders. Methods: The PubMed, PsycInfo, and Cochrane Central Register of Controlled Trials databases were searched using keywords, phrases, and MeSH terms. Retrieved abstracts (n=1618) were double screened and coded. Included studies met the following criteria: (1) the study was a randomized trial or a randomized controlled trial, (2) the sample was composed of students attending a tertiary institution, (3) the intervention was delivered by or accessed using a technological device or process, (4) the age range of the sample was between 18 and 25 years, and (5) the intervention was designed to improve, reduce, or change symptoms relating to a mental disorder. Results: A total of 27 studies met inclusion criteria for the present review. Most of the studies (24/27, 89%) employed interventions targeting anxiety symptoms or disorders or stress, although almost one-third (7/24, 29%) targeted both depression and anxiety. There were a total of 51 technology-based interventions employed across the 27 studies. Overall, approximately half (24/51, 47%) were associated with at least 1 significant positive outcome compared with the control at postintervention. However, 29% (15/51) failed to find a significant effect. Effect sizes were calculated for the 18 of 51 interventions that provided sufficient data. Median effect size was 0.54 (range –0.07 to 3.04) for 8 interventions targeting depression and anxiety symptoms and 0.84 (range –0.07 to 2.66) for 10 interventions targeting anxiety symptoms and disorders. Internet-based technology (typically involving cognitive behavioral therapy) was the most commonly employed medium, being employed in 16 of 27 studies and approximately half of the 51 technology-based interventions (25/51, 49%). Distal and universal preventive interventions were the most common type of intervention. Some methodological problems were evident in the studies, with randomization methods either inadequate or inadequately described, few studies specifying a primary outcome, and most of the studies failing to undertake or report appropriate intent-to-treat analyses. Conclusions: The findings of this review indicate that although technological interventions targeting certain mental health and related problems offer promise for students in university settings, more high quality trials that fully report randomization methods, outcome data, and data analysis methods are needed. %M 23711740 %R 10.2196/jmir.2639 %U http://www.jmir.org/2013/5/e101/ %U https://doi.org/10.2196/jmir.2639 %U http://www.ncbi.nlm.nih.gov/pubmed/23711740 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 5 %P e99 %T Web-Based Counseling for Problem Gambling: Exploring Motivations and Recommendations %A Rodda,Simone %A Lubman,Dan I %A Dowling,Nicki A %A Bough,Anna %A Jackson,Alun C %+ Turning Point Alcohol and Drug Centre, 54-62 Gertrude Street, Fitzroy, 3065, Australia, 61 0384138433, simoner@turningpoint.org.au %K Internet %K motivation %K gambling %K counseling %K Web-based interventions %K health services accessibility %D 2013 %7 24.05.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: For highly stigmatized disorders, such as problem gambling, Web-based counseling has the potential to address common barriers to treatment, including issues of shame and stigma. Despite the exponential growth in the uptake of immediate synchronous Web-based counseling (ie, provided without appointment), little is known about why people choose this service over other modes of treatment. Objective: The aim of the current study was to determine motivations for choosing and recommending Web-based counseling over telephone or face-to-face services. Methods: The study involved 233 Australian participants who had completed an online counseling session for problem gambling on the Gambling Help Online website between November 2010 and February 2012. Participants were all classified as problem gamblers, with a greater proportion of males (57.4%) and 60.4% younger than 40 years of age. Participants completed open-ended questions about their reasons for choosing online counseling over other modes (ie, face-to-face and telephone), as well as reasons for recommending the service to others. Results: A content analysis revealed 4 themes related to confidentiality/anonymity (reported by 27.0%), convenience/accessibility (50.9%), service system access (34.2%), and a preference for the therapeutic medium (26.6%). Few participants reported helpful professional support as a reason for accessing counseling online, but 43.2% of participants stated that this was a reason for recommending the service. Those older than 40 years were more likely than younger people in the sample to use Web-based counseling as an entry point into the service system (P=.045), whereas those engaged in nonstrategic gambling (eg, machine gambling) were more likely to access online counseling as an entry into the service system than those engaged in strategic gambling (ie, cards, sports; P=.01). Participants older than 40 years were more likely to recommend the service because of its potential for confidentiality and anonymity (P=.04), whereas those younger than 40 years were more likely to recommend the service due to it being helpful (P=.02). Conclusions: This study provides important information about why online counseling for gambling is attractive to people with problem gambling, thereby informing the development of targeted online programs, campaigns, and promotional material. %R 10.2196/jmir.2474 %U http://www.jmir.org/2013/5/e99/ %U https://doi.org/10.2196/jmir.2474 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 5 %P e96 %T Predictors of Participant Retention in a Guided Online Self-Help Program for University Students: Prospective Cohort Study %A Wojtowicz,Magdalena %A Day,Victor %A McGrath,Patrick J %+ Department of Psychology and Neuroscience, Dalhousie University, 1355 Oxford Street, Life Sciences Centre, Halifax, NS, B3H 4J1, Canada, 1 902 473 2581, m.wojtowicz@dal.ca %K self-help %K online treatment %K Web-based %K retention %K dropouts %K theory of planned behavior %D 2013 %7 22.05.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Attrition is a persistent issue in online self-help programs, but limited research is available on reasons for attrition or successful methods for improving participant retention. One potential approach to understanding attrition and retention in such programs is to examine person-related variables (eg, beliefs and attitudes) that influence behavior. Theoretical models, such as the Theory of Planned Behavior, that describe conditions influencing human behavior may provide a useful framework for predicting participant retention in online-based program. Objective: We examined predictors of participant retention in a guided online anxiety, depression, and stress self-help program for university students using the theory of planned behavior. We also explored whether age, symptom severity, and type of coaching (ie, email vs phone) affected participant retention. Methods: 65 university students with mild to moderate depression, anxiety, and stress were enrolled in this prospective cohort study. Participants completed a questionnaire based on the theory of planned behavior prior to commencing the online-based program and the Depression Anxiety and Stress Scale (DASS) during the assessment module of the program. Participant retention was operationalized as the number of program modules completed. Results: Perceived control over completing the online program significantly predicted intention to complete the program (F3,62=6.7; P=.001; adjusted R2=.2; standardized beta=.436, P=.001). Age (standardized beta=.319, P=.03) and perceived behavioral control (standardized beta=.295, P=.05) predicted the number of program modules completed (F3,61=3.20, P=.03, adjusted R2 =.11). Initial level of distress (ie, symptom severity) did not predict participant retention (P=.55). Participants who chose phone-based coaching completed more program modules than participants who chose email-based coaching (Mann-Whitney’s U=137; P=.004). Conclusions: Participants’ age, level of perceived behavioral control, and choice of interaction (ie, phone-based or email-based coaching) were found to influence retention in this online-based program. %M 23697614 %R 10.2196/jmir.2323 %U http://www.jmir.org/2013/5/e96/ %U https://doi.org/10.2196/jmir.2323 %U http://www.ncbi.nlm.nih.gov/pubmed/23697614 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 5 %P e80 %T Evaluation of a Web-Based Social Network Electronic Game in Enhancing Mental Health Literacy for Young People %A Li,Tim MH %A Chau,Michael %A Wong,Paul WC %A Lai,Eliza SY %A Yip,Paul SF %+ School of Business, The University of Hong Kong, 8/F K K Leung Building, Pokfulam Road, Hong Kong, , China (Hong Kong), 852 39171014, mchau@business.hku.hk %K digital game-based learning %K mental health literacy %K social networking sites %K motivation %D 2013 %7 15.05.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based learning programs provide people with massive health care information and self-help guidelines on improving their health. The advent of Web 2.0 and social networks renders significant flexibility to embedding highly interactive components, such as games, to foster learning processes. The effectiveness of game-based learning on social networks has not yet been fully evaluated. Objectives: The aim of this study was to assess the effectiveness of a fully automated, Web-based, social network electronic game on enhancing mental health knowledge and problem-solving skills of young people. We investigated potential motivational constructs directly affecting the learning outcome. Gender differences in learning outcome and motivation were also examined. Methods: A pre/posttest design was used to evaluate the fully automated Web-based intervention. Participants, recruited from a closed online user group, self-assessed their mental health literacy and motivational constructs before and after completing the game within a 3-week period. The electronic game was designed according to cognitive-behavioral approaches. Completers and intent-to-treat analyses, using multiple imputation for missing data, were performed. Regression analysis with backward selection was employed when examining the relationship between knowledge enhancement and motivational constructs. Results: The sample included 73 undergraduates (42 females) for completers analysis. The gaming approach was effective in enhancing young people’s mental health literacy (d=0.65). The finding was also consistent with the intent-to-treat analysis, which included 127 undergraduates (75 females). No gender differences were found in learning outcome (P=.97). Intrinsic goal orientation was the primary factor in learning motivation, whereas test anxiety was successfully alleviated in the game setting. No gender differences were found on any learning motivation subscales (P>.10). We also found that participants’ self-efficacy for learning and performance, as well as test anxiety, significantly affected their learning outcomes, whereas other motivational subscales were statistically nonsignificant. Conclusions: Electronic games implemented through social networking sites appear to effectively enhance users’ mental health literacy. %M 23676714 %R 10.2196/jmir.2316 %U http://www.jmir.org/2013/5/e80/ %U https://doi.org/10.2196/jmir.2316 %U http://www.ncbi.nlm.nih.gov/pubmed/23676714 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 5 %P e82 %T Internet-Delivered Interpersonal Psychotherapy Versus Internet-Delivered Cognitive Behavioral Therapy for Adults With Depressive Symptoms: Randomized Controlled Noninferiority Trial %A Donker,Tara %A Bennett,Kylie %A Bennett,Anthony %A Mackinnon,Andrew %A van Straten,Annemieke %A Cuijpers,Pim %A Christensen,Helen %A Griffiths,Kathleen M %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 2 9382 4522, t.donker@unsw.edu.au %K interpersonal relations %K cognitive behavior therapy %K depressive disorder %K Internet %K randomized controlled trial %D 2013 %7 13.05.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Face-to-face cognitive behavioral therapy (CBT) and interpersonal psychotherapy (IPT) are both effective treatments for depressive disorders, but access is limited. Online CBT interventions have demonstrated efficacy in decreasing depressive symptoms and can facilitate the dissemination of therapies among the public. However, the efficacy of Internet-delivered IPT is as yet unknown. Objective: This study examines whether IPT is effective, noninferior to, and as feasible as CBT when delivered online to spontaneous visitors of an online therapy website. Methods: An automated, 3-arm, fully self-guided, online noninferiority trial compared 2 new treatments (IPT: n=620; CBT: n=610) to an active control treatment (MoodGYM: n=613) over a 4-week period in the general population. Outcomes were assessed using online self-report questionnaires, the Center for Epidemiological Studies Depression scale (CES-D) and the Client Satisfaction Questionnaire (CSQ-8) completed immediately following treatment (posttest) and at 6-month follow-up. Results: Completers analyses showed a significant reduction in depressive symptoms at posttest and follow-up for both CBT and IPT, and were noninferior to MoodGYM. Within-group effect sizes were medium to large for all groups. There were no differences in clinical significant change between the programs. Reliable change was shown at posttest and follow-up for all programs, with consistently higher rates for CBT. Participants allocated to IPT showed significantly lower treatment satisfaction compared to CBT and MoodGYM. There was a dropout rate of 1294/1843 (70%) at posttest, highest for MoodGYM. Intention-to-treat analyses confirmed these findings. Conclusions: Despite a high dropout rate and lower satisfaction scores, this study suggests that Internet-delivered self-guided IPT is effective in reducing depressive symptoms, and may be noninferior to MoodGYM. The completion rates of IPT and CBT were higher than MoodGYM, indicating some progress in refining Internet-based self-help. Internet-delivered treatment options available for people suffering from depression now include IPT. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 69603913; http://www.controlled-trials.com/ISRCTN69603913 (Archived by WebCite at http://www.webcitation.org/6FjMhmE1o) %M 23669884 %R 10.2196/jmir.2307 %U http://www.jmir.org/2013/5/e82/ %U https://doi.org/10.2196/jmir.2307 %U http://www.ncbi.nlm.nih.gov/pubmed/23669884 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e46 %T Online Cognitive Behavioral Therapy for Bulimic Type Disorders, Delivered in the Community by a Nonclinician: Qualitative Study %A McClay,Carrie-Anne %A Waters,Louise %A McHale,Ciaran %A Schmidt,Ulrike %A Williams,Christopher %+ Institute of Health and Wellbeing, Mental Health and Wellbeing, University of Glasgow, Administration Building, Gartnavel Royal Hospital, 1055 Great Western Road, Glasgow, G12 0XH, United Kingdom, 44 0044 141 211 ext 39, chris.williams@glasgow.ac.uk %K bulimia nervosa %K self-help %K cCBT %K qualitative research %K cognitive behavioral therapy %D 2013 %7 15.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Cognitive behavioral therapy is recommended in the National Institute for Clinical Excellence guidelines for the treatment of bulimia nervosa. In order to make this treatment option more accessible to patients, interactive online CBT programs have been developed that can be used in the user’s own home, in privacy, and at their convenience. Studies investigating online CBT for bulimic type eating disorders have provided promising results and indicate that, with regular support from a clinician or trained support worker, online CBT can be effective in reducing bulimic symptoms. Two main factors distinguish this study from previous research in this area. First, the current study recruited a wide range of adults with bulimic type symptoms from the community. Second, the participants in the current study had used cCBT with support from a nonclinical support worker rather than a specialist eating disorder clinician. Objective: To investigate participants’ experiences of using an online self-help cognitive behavioral therapy (CBT) package (Overcoming Bulimia Online) for bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). Methods: Eight participants with a mean age of 33.9 years took part in semi-structured interviews. Interviews were transcribed and analyzed using a 6-step thematic analysis process. Results: Saturation was achieved, and 7 themes were identified in the dataset. These were: (1) conceptualizing eating disorders, (2) help-seeking behavior, (3) aspects of the intervention, (4) motivation to use the online package, (5) privacy and secrecy with regard to their eating problems, (6) recovery and the future, and (7) participant engagement describing individuals’ thoughts on taking part in the online research study. Conclusions: Participants suggested that online CBT self-help represented a generally desirable and acceptable treatment option for those with bulimic type eating problems, despite some difficulties with motivation and implementation of some elements of the package. Trial Registration: International Standard Randomized Controlled Trial Number of the original RCT that this study is based on: ISRCTN41034162; http://www.controlled-trials.com/ISRCTN41034162 (Archived by WebCite at http://www.webcitation.org/6Ey9sBWTV) %M 23502689 %R 10.2196/jmir.2083 %U http://www.jmir.org/2013/3/e46/ %U https://doi.org/10.2196/jmir.2083 %U http://www.ncbi.nlm.nih.gov/pubmed/23502689 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 3 %P e42 %T Internal Versus External Motivation in Referral of Primary Care Patients with Depression to an Internet Support Group: Randomized Controlled Trial %A Van Voorhees,Benjamin W %A Hsiung,Robert C %A Marko-Holguin,Monika %A Houston,Thomas K %A Fogel,Joshua %A Lee,Royce %A Ford,Daniel E %+ Section of General Pediatrics Department of Pediatrics, University of Illinois at Chicago, 840 S Wood St, Suite 1437, MC 856, Chicago, IL, 60612, United States, 1 3129960023, bvanvoor@uic.edu %K depressive disorder %K Internet %K primary care %K support groups %D 2013 %7 12.03.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Depressive disorders and symptoms affect more than one-third of primary care patients, many of whom do not receive or do not complete treatment. Internet-based social support from peers could sustain depression treatment engagement and adherence. We do not know whether primary care patients will accept referral to such websites nor do we know which methods of referral would be most effective. Objective: We conducted a randomized clinical trial to determine whether (1) a simple generic referral card (control), (2) a patient-oriented brochure that provided examples of online postings and experience (internal motivation), or (3) a physician letter of recommendation (external motivation) would generate the greatest participation in a primary care Internet depression treatment support portal focused around an Internet support group (ISG). Methods: We used 3 offline methods to identify potential participants who had not used an ISG in the past 6 months. Eligibility was determined in part by a brief structured psychiatric interview based on the Patient Health Questionnaire-9 (PHQ-9). After consent and enrollment, participants were randomly assigned to 1 of 3 groups (control, internal motivation, or external motivation). We constructed a portal to connect primary care patients to both fact-based information and an established ISG (Psycho-Babble). The ISG allowed participants to view messages and then decide if they actually wished to register there. Participation in the portal and the ISG was assessed via automated activity tracking. Results: Fifty participants were assigned to the 3 groups: a motivation-neutral control group (n=18), an internal motivation group (n=19), and an external motivation group (n=13). Of these participants, 31 (62%) visited the portal; 27 (54%) visited the ISG itself. The internal motivation group showed significantly greater participation than the control group on several measures. The external motivation group spent significantly less time logged onto the portal than the control group. The internal motivation group showed significantly greater participation than the external motivation group on several measures. Conclusions: Referral of primary care patients with depressive disorders and symptoms to an ISG is feasible even if they have never previously used one. This may best be accomplished by enhancing their internal motivation. Trial Registration: Clinicaltrials.gov: NCT00886730; http://clinicaltrials.gov/show/NCT00886730 (Archived by WebCite at http://www.webcitation.org/6F4981fDN) %M 23482332 %R 10.2196/jmir.2197 %U http://www.jmir.org/2013/3/e42/ %U https://doi.org/10.2196/jmir.2197 %U http://www.ncbi.nlm.nih.gov/pubmed/23482332 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 15 %N 2 %P e39 %T Impact of Internet Use on Loneliness and Contact with Others Among Older Adults: Cross-Sectional Analysis %A Cotten,Shelia R %A Anderson,William A %A McCullough,Brandi M %+ University of Alabama at Birmingham, Department of Sociology, HHB 460N, 1720 2nd Avenue South, Birmingham, AL, 35294-1152, United States, 1 205 934 8678, cotten@uab.edu %K computers %K Internet %K loneliness %K social isolation %K social interaction %K older adults %K assisted living facilities %K independent living %D 2013 %7 28.02.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Older adults are at increased risk of experiencing loneliness and depression, particularly as they move into different types of care communities. Information and communication technology (ICT) usage may help older adults to maintain contact with social ties. However, prior research is not consistent about whether ICT use increases or decreases isolation and loneliness among older adults. Objective: The purpose of this study was to examine how Internet use affects perceived social isolation and loneliness of older adults in assisted and independent living communities. We also examined the perceptions of how Internet use affects communication and social interaction. Methods: One wave of data from an ongoing study of ICT usage among older adults in assisted and independent living communities in Alabama was used. Regression analysis was used to determine the relationship between frequency of going online and isolation and loneliness (n=205) and perceptions of the effects of Internet use on communication and social interaction (n=60). Results: After controlling for the number of friends and family, physical/emotional social limitations, age, and study arm, a 1-point increase in the frequency of going online was associated with a 0.147-point decrease in loneliness scores (P=.005). Going online was not associated with perceived social isolation (P=.14). Among the measures of perception of the social effects of the Internet, each 1-point increase in the frequency of going online was associated with an increase in agreement that using the Internet had: (1) made it easier to reach people (b=0.508, P<.001), (2) contributed to the ability to stay in touch (b=0.516, P<.001), (3) made it easier to meet new people (b=0.297, P=.01, (4) increased the quantity of communication with others (b=0.306, P=.01), (5) made the respondent feel less isolated (b=0.491, P<.001), (6) helped the respondent feel more connected to friends and family (b=0.392, P=.001), and (7) increased the quality of communication with others (b=0.289, P=.01). Conclusions: Using the Internet may be beneficial for decreasing loneliness and increasing social contact among older adults in assisted and independent living communities. %M 23448864 %R 10.2196/jmir.2306 %U http://www.jmir.org/2013/2/e39/ %U https://doi.org/10.2196/jmir.2306 %U http://www.ncbi.nlm.nih.gov/pubmed/23448864 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 6 %P e160 %T Young Men, Mental Health, and Technology: Implications for Service Design and Delivery in the Digital Age %A Ellis,Louise A %A Collin,Philippa %A Davenport,Tracey A %A Hurley,Patrick J %A Burns,Jane M %A Hickie,Ian B %+ Brain and Mind Research Institute, Faculty of Medicine, University of Sydney, 94 Mallett Street, Camperdown, Sydney, 2050, Australia, 61 293510901, louise.ellis@sydney.edu.au %K Young men %K mental health %K technology %K service design and delivery %K digital age %K Internet use %K games %D 2012 %7 22.11.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Young men are particularly vulnerable to suicide, drug, and alcohol problems and yet fail to seek appropriate help. An alternative or adjunct to face-to-face services has emerged with widespread uptake of the Internet and related communication technologies, yet very little evidence exists that examines the capacity of the Internet to engage young men and promote help seeking. Objective: To explore young people’s attitudes and behaviors in relation to mental health and technology use. The aim was to identify key gender differences to inform the development of online mental health interventions for young men. Methods: A cross-sectional online survey of 1038 young people (aged 16 to 24 years) was used. Results: Young men are more likely than young women to play computer games, access online video/music content, and visit online forums. More than half of young men and women reported that they sought help for a problem online, and the majority were satisfied with the help they received. Significant gender differences were identified in relation to how young people would respond to a friend in need, with young men being less likely than young women to confront the issue directly. Conclusions: Online interventions for young men need to be action-oriented, informed by young men’s views and everyday technology practices, and leverage the important role that peers play in the help-seeking process. %M 23171827 %R 10.2196/jmir.2291 %U http://www.jmir.org/2012/6/e160/ %U https://doi.org/10.2196/jmir.2291 %U http://www.ncbi.nlm.nih.gov/pubmed/23171827 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 5 %P e141 %T Reducing Suicidal Ideation: Cost-Effectiveness Analysis of a Randomized Controlled Trial of Unguided Web-Based Self-help %A van Spijker,Bregje A.J %A Majo,M. Cristina %A Smit,Filip %A van Straten,Annemieke %A Kerkhof,Ad J.F.M %+ Department of Clinical Psychology and the EMGO+ Institute for Health and Care Research, Faculty of Psychology and Education, VU University Amsterdam, van der Boechorststraat 1, Amsterdam, 1081 BT, Netherlands, 31 5988497, baj.van.spijker@gmail.com %K suicidal ideation %K randomized controlled trial %K cost-effectiveness %K Internet %K cognitive behavior therapy %D 2012 %7 26.10.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicidal ideation is highly prevalent, but often remains untreated. The Internet can be used to provide accessible interventions. Objective: To evaluate the cost-effectiveness of an online, unguided, self-help intervention for reducing suicidal ideation. Methods: A total of 236 adults with mild to moderate suicidal thoughts, defined as scores between 1-26 on the Beck Scale for Suicide Ideation (BSS), were recruited in the general population and randomized to the intervention (n = 116) or to a waitlist, information-only, control group (n = 120). The intervention aimed to decrease the frequency and intensity of suicidal ideation and consisted of 6 modules based on cognitive behavioral techniques. Participants in both groups had unrestricted access to care as usual. Assessments took place at baseline and 6 weeks later (post-test). All questionnaires were self-report and administered via the Internet. Treatment response was defined as a clinically significant decrease in suicidal ideation on the BSS. Total per-participant costs encompassed costs of health service uptake, participants’ out-of-pocket expenses, costs stemming from production losses, and intervention costs. These were expressed in Euros (€) for the reference year 2009. Results: At post-test, treatment response was 35.3% and 20.8% in the experimental and control conditions, respectively. The incremental effectiveness was 0.35 − 0.21 = 0.15 (SE 0.06, P = .01). The annualized incremental costs were −€5039 per participant. Therefore, the mean incremental cost-effectiveness ratio (ICER) was estimated to be −€5039/0.15 = −€34,727 after rounding (US −$41,325) for an additional treatment response, indicating annual cost savings per treatment responder. Conclusions: This is the first trial to indicate that online self-help to reduce suicidal ideation is feasible, effective, and cost saving. Limitations included reliance on self-report and a short timeframe (6 weeks). Therefore, replication with a longer follow-up period is recommended. %M 23103835 %R 10.2196/jmir.1966 %U http://www.jmir.org/2012/5/e141/ %U https://doi.org/10.2196/jmir.1966 %U http://www.ncbi.nlm.nih.gov/pubmed/23103835 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 5 %P e148 %T Disordered Eating in a Digital Age: Eating Behaviors, Health, and Quality of Life in Users of Websites With Pro-Eating Disorder Content %A Peebles,Rebecka %A Wilson,Jenny L %A Litt,Iris F %A Hardy,Kristina K %A Lock,James D %A Mann,Julia R %A Borzekowski,Dina LG %+ The Craig Dalsimer Division of Adolescent Medicine, Department of Pediatrics, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, 3401 Civic Center Blvd, 11NW Room 19, Philadelphia, PA, 19104, United States, 1 215 590 6864, peeblesr@email.chop.edu %K Eating disorder %K social network %K anorexia nervosa %K bulimia nervosa %K pro-eating disorder website %K pro-anorexia website %K pro-bulimia website %K pro-ED %K pro-ana %K pro-mia %D 2012 %7 25.10.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Much concern has been raised over pro-eating disorder (pro-ED) website communities, but little quantitative research has been conducted on these websites and their users. Objective: To examine associations between levels of pro-ED website usage, disordered eating behaviors, and quality of life. Methods: We conducted a cross-sectional, Internet-based survey of adult pro-ED website users. Main outcomes were Eating Disorder Examination Questionnaire (EDE-Q) and Eating Disorder Quality of Life (EDQOL) scores. Results: We included responses from 1291 participants; 1254 (97.13%) participants were female. Participants had an average age of 22.0 years and a mean body mass index of 22.1 kg/m2; 24.83% (296/1192) were underweight; 20.89% (249/1192) were overweight or obese. Over 70% of participants had purged, binged, or used laxatives to control their weight; only 12.91% (163/1263) were in treatment. Mean EDE-Q scores were above the 90th percentile and mean EDQOL scores were in the severely impaired range. When compared with moderate and light usage, heavy pro-ED website usage was associated with higher EDE-Q global (4.89 vs 4.56 for medium and 4.0 for light usage, P < .001) and EDQOL total scores (1.64 vs 1.45 for medium and 1.25 for light usage, P < .001), and more extreme weight loss behaviors and harmful post-website usage activities. In a multivariate model, the level of pro-ED website usage remained a significant predictor of EDE-Q scores. Conclusions: Pro-ED website visitors reported many disordered eating behaviors, although few had been treated. Heavy users reported poorer quality of life and more disordered eating behaviors. %M 23099628 %R 10.2196/jmir.2023 %U http://www.jmir.org/2012/5/e148/ %U https://doi.org/10.2196/jmir.2023 %U http://www.ncbi.nlm.nih.gov/pubmed/23099628 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 5 %P e122 %T The Representation of Suicide on the Internet: Implications for Clinicians %A Westerlund,Michael %A Hadlaczky,Gergo %A Wasserman,Danuta %+ National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP), Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Granits väg 4, Stockholm, 17177, Sweden, 46 8 524 870 26, michael.westerlund@ims.su.se %K suicide %K internet %K websites %K pro-suicide %K suicide-preventive %D 2012 %7 26.09.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is one of the major causes of death in the world, leading to approximately 1 million deaths per year. While much of what is said about suicide and its causes is still taboo in most contemporary societies and cultures, internet websites and discussion forums have become an important and controversial source of information on the subject. A great deal of ambivalence is discernible as to whether online communication about suicide primarily should be seen as an opportunity or a serious threat. Objective: To investigate how the subject of suicide is represented on the Internet, based on hits generated by the search engine Google. Methods: In an exploratory design, Google search results on the target word “suicide”, for the years 2005, 2009, and 2012 respectively, were systematically analyzed and compared. Results: The study shows that web pages of institutional origin on the subject predominate, that the content provided by these institutions concerns primarily research and prevention, and that the form of communication used by these senders is almost exclusively monological. However, besides these institutional pages there are a substantial number of private senders and pages, often anti-medical and against treatment of depression and other mental problems, characterized by dialogue, confessions and narratives, and to a higher degree, an alternative pro-suicide stance. Conclusions: To counteract the influence of anti-medical and pro-suicide information, the role of the Internet should be discussed with the patient in clinical practice. Dialogical and confessional communications provide an opportunity for the clinician to gain a deeper perspective into perceptions of patients, regarding both their afflictions and the role of medical treatment in their lives. %M 23010086 %R 10.2196/jmir.1979 %U http://www.jmir.org/2012/5/e122/ %U https://doi.org/10.2196/jmir.1979 %U http://www.ncbi.nlm.nih.gov/pubmed/23010086 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e115 %T Munchausen by Internet: Current Research and Future Directions %A Pulman,Andy %A Taylor,Jacqui %+ School of Health & Social Care, Bournemouth University, Royal London House, Christchurch Road, Bournemouth, BH1 3LT, United Kingdom, 44 1202 962749, apulman@bournemouth.ac.uk %K Munchausen by Internet %K Internet trolls %K identity deception %K malingering %K factitious disorder %K deviance %K social networking sites %K health support groups %D 2012 %7 22.08.2012 %9 Viewpoint %J J Med Internet Res %G English %X Background: The Internet has revolutionized the health world, enabling self-diagnosis and online support to take place irrespective of time or location. Alongside the positive aspects for an individual’s health from making use of the Internet, debate has intensified on how the increasing use of Web technology might have a negative impact on patients, caregivers, and practitioners. One such negative health-related behavior is Munchausen by Internet. Objective: Munchausen by Internet occurs when medically well individuals fake recognized illnesses in virtual environments, such as online support groups. This paper focuses on the aspect of Munchausen by Internet in which individuals actively seek to disrupt groups for their own satisfaction, which has not yet been associated with the wider phenomena of Internet trolls (users who post with the intention of annoying someone or disrupting an online environment). Methods: A wide-ranging review was conducted to investigate the causes and impacts of online identity deception and Munchausen by Internet drawing on academic research and case studies reported online and in the media. Results: The limited research relating to motivation, opportunity, detection, effects, and consequences of Munchausen by Internet is highlighted and it is formally linked to aspects of trolling. Case studies are used to illustrate the phenomenon. What is particularly worrying is the ease with which the deception can be carried out online, the difficulty in detection, and the damaging impact and potential danger to isolated victims. Conclusions: We suggest ways to deal with Munchausen by Internet and provide advice for health group facilitators. We also propose that Munchausen by Internet and Munchausen by Internet trolling should be formally acknowledged in a revised version of the Diagnostic and Statistical Manual DSM-5. This will assist in effectively identifying and minimizing the growth of this behavior as more people seek reassurance and support about their health in the online environment. We also suggest directions for future research. %M 22914203 %R 10.2196/jmir.2011 %U http://www.jmir.org/2012/4/e115/ %U https://doi.org/10.2196/jmir.2011 %U http://www.ncbi.nlm.nih.gov/pubmed/22914203 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 4 %P e110 %T The Therapeutic Relationship in E-Therapy for Mental Health: A Systematic Review %A Sucala,Madalina %A Schnur,Julie B %A Constantino,Michael J %A Miller,Sarah J %A Brackman,Emily H %A Montgomery,Guy H %+ Department of Oncological Sciences, Mount Sinai School of Medicine, Box 1130, 1425 Madison Avenue, New York, NY, 10029, United States, 1 212 659 5504 ext 85504, madalina.sucala@mssm.edu %K e-Therapy %K therapeutic relationship %K therapeutic alliance %K common factors in psychotherapy %D 2012 %7 02.08.2012 %9 Review %J J Med Internet Res %G English %X Background: E-therapy is defined as a licensed mental health care professional providing mental health services via e-mail, video conferencing, virtual reality technology, chat technology, or any combination of these. The use of e-therapy has been rapidly expanding in the last two decades, with growing evidence suggesting that the provision of mental health services over the Internet is both clinically efficacious and cost effective. Yet there are still unanswered concerns about e-therapy, including whether it is possible to develop a successful therapeutic relationship over the Internet in the absence of nonverbal cues. Objective: Our objective in this study was to systematically review the therapeutic relationship in e-therapy. Methods: We searched PubMed, PsycINFO, and CINAHL through August 2011. Information on study methods and results was abstracted independently by the authors using a standardized form. Results: From the 840 reviewed studies, only 11 (1.3%) investigated the therapeutic relationship. The majority of the reviewed studies were focused on the therapeutic alliance—a central element of the therapeutic relationship. Although the results do not allow firm conclusions, they indicate that e-therapy seems to be at least equivalent to face-to-face therapy in terms of therapeutic alliance, and that there is a relationship between the therapeutic alliance and e-therapy outcome. Conclusions: Overall, the current literature on the role of therapeutic relationship in e-therapy is scant, and much more research is needed to understand the therapeutic relationship in online environments. %M 22858538 %R 10.2196/jmir.2084 %U http://www.jmir.org/2012/4/e110/ %U https://doi.org/10.2196/jmir.2084 %U http://www.ncbi.nlm.nih.gov/pubmed/22858538 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 3 %P e91 %T Motivators and Motivations to Persist With Online Psychological Interventions: A Qualitative Study of Treatment Completers %A Donkin,Liesje %A Glozier,Nick %+ Brain and Mind Institute, The University of Sydney, Level 3, 94 Mallet Street, Camperdown, NSW 2050, Australia, 61 293510520, Liesje.Donkin@sydney.edu.au %K Adherence %K persistence %K eHealth %K online interventions %K motivation %K barriers %D 2012 %7 22.06.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Many users of Internet interventions do not persist with the full treatment program. As persistence may influence outcomes of such interventions, being able to maximize persistence is vital. However, while studies have begun to explore the predictors of dropout in Internet interventions, few have explored reasons why users persist with the programs, which may not just be the converse of the reasons for dropout. Objective: To answer the question of what influences persistence with online interventions. Methods: We interviewed participants in the Cardiovascular Risk E-couch Depression Outcome (CREDO), a trial evaluating the efficacy of an eHealth intervention (e-couch) in treating depressive symptoms in those with comorbid depression and cardiovascular risk factors. Interviews were semistructured in nature and were analyzed using a grounded theory approach. Interview numbers were curtailed (n = 12) after theoretical saturation. Results: All participants reported substantial barriers to completing the program including time constraints, competing priorities, anxiety about spending time on the computer, and perception of limited worth of the intervention. Participants who persisted with the trial reported intrinsic motivations such as personal values about task completion and sense of control, and recognized external motivators that aided the development of habits and identified personal benefits attributable to the program. Conclusions: Online interventions may benefit from content that enhances the intrinsic motivations such as a having sense of control and being able to identify with the program, and by increasing the relative value of the program in order to enhance persistence. Persistence within a trial setting appears modifiable through explicit messages regarding supporting others. In terms of motivators, the use of a hook to engage participants who are starting the intervention due to curiosity and the use of reminder systems to prompt participants may also improve persistence. The worth of such additions should be evaluated using adherence and outcomes metrics. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12610000085077; http://www.anzctr.org.au/ACTRN12610000085077.aspx (Archived by WebCite at http://www.webcitation.org/68MtyPO3w) %M 22743581 %R 10.2196/jmir.2100 %U http://www.jmir.org/2012/3/e91/ %U https://doi.org/10.2196/jmir.2100 %U http://www.ncbi.nlm.nih.gov/pubmed/22743581 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 3 %P e86 %T Effectiveness of an Online Group Course for Depression in Adolescents and Young Adults: A Randomized Trial %A van der Zanden,Rianne %A Kramer,Jeannet %A Gerrits,Rob %A Cuijpers,Pim %+ Centre of Mental Health of Youth and Adolescents, Trimbos Institute, Da Costakade 45, Utrecht, 3500 AS Utrecht, Netherlands, 31 030 2971100, rzanden@trimbos.nl %K eHealth, health promotion %K depressive symptoms %K anxiety %K adolescents %K Internet %K randomized controlled trial %D 2012 %7 07.06.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression is a serious mental health problem, whose first onset is usually in adolescence. Online treatment may offer a solution for the current undertreatment of depression in youth. For adults with depressive symptoms, the effectiveness of Internet-based cognitive behavioral therapy has been demonstrated. This study is one of the first randomized controlled trials to investigate the effectiveness online depression treatment for young people with depressive complaints and the first to focus on an online group course. Objective: To evaluate and discuss the effectiveness of a guided Web-based group course called Grip op Je Dip (Master Your Mood [MYM]), designed for young people aged 16 to 25 years with depressive symptoms, in comparison with a wait-listed control group. Methods: We randomly assigned 244 young people with depressive symptoms to the online MYM course or to a waiting-list control condition. The primary outcome measure was treatment outcome after 3 months on the Center for Epidemiologic Studies Depression Scale. Secondary outcomes were anxiety (measured by the Hospital Anxiety and Depression Scale) and mastery (Mastery Scale). We studied the maintenance of effects in the MYM group 6 months after baseline. Missing data were imputed. Results: The MYM group (n = 121) showed significantly greater improvement in depressive symptoms at 3 months than the control group (n = 123) (t187 = 6.62, P < .001), with a large between-group effect size of d = 0.94 (95% confidence interval [CI] 0.64–1.23). The MYM group also showed greater improvement in anxiety (t187 = 3.80, P < .001, d = 0.49, 95% CI 0.24–0.75) and mastery (t187 = 3.36, P = .001, d = 0.44, 95% CI 0.19–0.70). At 12 weeks, 56% (68/121) of the participants in the MYM group and 20% (24/123) in the control group showed reliable and clinically significant change. This between-group difference was significant (χ21 = 35.0, P < .001) and yielded a number needed to treat of 2.7. Improvements in the MYM group were maintained at 6 months. A limitation is the infeasibility of comparing the 6-month outcomes of the MYM and control groups, as the controls had access to MYM after 3 months. Conclusions: The online group course MYM was effective in reducing depressive symptoms and anxiety and in increasing mastery in young people. These effects persisted in the MYM group at 6 months. Trial Registration: Nederlands Trial Register: NTR1694; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1694 (Archived by WebCite at http://www.webcitation.org/683SBoeGV) %M 22677437 %R 10.2196/jmir.2033 %U http://www.jmir.org/2012/3/e86/ %U https://doi.org/10.2196/jmir.2033 %U http://www.ncbi.nlm.nih.gov/pubmed/22677437 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 1 %P e17 %T What Are Young Adults Saying About Mental Health? An Analysis of Internet Blogs %A Marcus,Madalyn A %A Westra,Henny A %A Eastwood,John D %A Barnes,Kirsten L %A , %+ Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 33706, madalyn@yorku.ca %K Young adult %K mental health %K mental health services %K life experiences %K blogging %K qualitative research %D 2012 %7 30.01.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the high prevalence of mental health concerns, few young adults access treatment. While much research has focused on understanding the barriers to service access, few studies have explored unbiased accounts of the experiences of young adults with mental health concerns. It is through hearing these experiences and gaining an in-depth understanding of what is being said by young adults that improvements can be made to interventions focused on increasing access to care. Objective: To move beyond past research by using an innovative qualitative research method of analyzing the blogs of young adults (18–25 years of age) with mental health concerns to understand their experiences. Methods: We used an enhanced Internet search vehicle, DEVONagent, to extract Internet blogs using primary keywords related to mental health. Blogs (N = 8) were selected based on age of authors (18–25 years), gender, relevance to mental health, and recency of the entries. Blogs excerpts were analyzed using a combination of grounded theory and consensual qualitative research methods. Results: Two core categories emerged from the qualitative analysis of the bloggers accounts: I am powerless (intrapersonal) and I am utterly alone (interpersonal). Overall, the young adult bloggers expressed significant feelings of powerlessness as a result of their mental health concerns and simultaneously felt a profound sense of loneliness, alienation, and lack of connection with others. Conclusions: The present study suggests that one reason young adults do not seek care might be that they view the mental health system negatively and feel disconnected from these services. To decrease young adults’ sense of powerlessness and isolation, efforts should focus on creating and developing resources and services that allow young adults to feel connected and empowered. Through an understanding of the experiences of young adults with mental health problems, and their experiences of and attitudes toward receiving care, we provide some recommendations for improving receptivity and knowledge of mental health care services. %M 22569642 %R 10.2196/jmir.1868 %U http://www.jmir.org/2012/1/e17/ %U https://doi.org/10.2196/jmir.1868 %U http://www.ncbi.nlm.nih.gov/pubmed/22569642 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e93 %T Changes in Depressive Symptoms, Social Support, and Loneliness Over 1 Year After a Minimum 3-Month Videoconference Program for Older Nursing Home Residents %A Tsai,Hsiu-Hsin %A Tsai,Yun-Fang %+ School of Nursing, Chang Gung University, 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, 333, Taiwan, 886 3 2118800 ext 3204, yftsai@mail.cgu.edu.tw %K Videoconference %K nursing home %K elderly %K social support %K depression %K loneliness %D 2011 %7 15.11.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: A 3-month videoconference interaction program with family members has been shown to decrease depression and loneliness in nursing home residents. However, little is known about the long-term effects on residents’ depressive symptoms, social support, and loneliness. Objective: The purpose of this longitudinal quasi-experimental study was to evaluate the long-term effectiveness of a videoconference intervention in improving nursing home residents’ social support, loneliness, and depressive status over 1 year. Methods: We purposively sampled 16 nursing homes in various areas of Taiwan. Elderly residents (N = 90) of these nursing homes meeting our inclusion criteria were divided into an experimental (n = 40) and a comparison (n = 50) group. The experimental group received at least 5 minutes/week for 3 months of videoconference interaction with their family members in addition to usual family visits, and the comparison group received regular family visits only. Data were collected in face-to face interviews on social support, loneliness, and depressive status using the Social Support Behaviors Scale, University of California Los Angeles Loneliness Scale, and Geriatric Depression Scale, respectively, at four times (baseline, 3 months, 6 months, and 12 months after baseline). Data were analyzed using the generalized estimating equation approach. Results: After the videoconferencing program, participants in the experimental group had significantly lower mean change in instrumental social support scores at 6 months (–0.42, P = .03) and 12 months (–0.41, P = .03), and higher mean change in emotional social support at 3 (0.74, P < .001) and 12 months (0.61, P = .02), and in appraisal support at 3 months (0.74, P = .001) after adjusting for confounding variables. Participants in the experimental group also had significantly lower mean loneliness and depressive status scores at 3 months (–5.40, P < .001; –2.64, P < .001, respectively), 6 months (–6.47, P < .001; –4.33, P < .001), and 12 months (–6.27, P = .001; –4.40, P < .001) compared with baseline than those in the comparison group. Conclusion: Our videoconference program had a long-term effect in alleviating depressive symptoms and loneliness for elderly residents in nursing homes. This intervention also improved long-term emotional social support and short-term appraisal support, and decreased residents’ instrumental social support. However, this intervention had no effect on informational social support. %M 22086660 %R 10.2196/jmir.1678 %U http://www.jmir.org/2011/4/e93/ %U https://doi.org/10.2196/jmir.1678 %U http://www.ncbi.nlm.nih.gov/pubmed/22086660 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e89 %T Anxiety Online—A Virtual Clinic: Preliminary Outcomes Following Completion of Five Fully Automated Treatment Programs for Anxiety Disorders and Symptoms %A Klein,Britt %A Meyer,Denny %A Austin,David William %A Kyrios,Michael %+ National eTherapy Centre, Faculty of Life and Social Sciences, Swinburne University, Mail H99, PO Box 218, Hawthorn, Melbourne, 3122, Australia, 61 392148851, bklein@swin.edu.au %K eTherapy %K Internet interventions %K e-mental health %K cognitive behavior therapy %K generalized anxiety disorder %K panic disorder %K obsessive compulsive disorder %K social anxiety disorder %K posttraumatic stress disorder %K self-help %K fully automated %K Web treatment %D 2011 %7 04.11.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: The development of e-mental health interventions to treat or prevent mental illness and to enhance wellbeing has risen rapidly over the past decade. This development assists the public in sidestepping some of the obstacles that are often encountered when trying to access traditional face-to-face mental health care services. Objective: The objective of our study was to investigate the posttreatment effectiveness of five fully automated self-help cognitive behavior e-therapy programs for generalized anxiety disorder (GAD), panic disorder with or without agoraphobia (PD/A), obsessive–compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social anxiety disorder (SAD) offered to the international public via Anxiety Online, an open-access full-service virtual psychology clinic for anxiety disorders. Methods: We used a naturalistic participant choice, quasi-experimental design to evaluate each of the five Anxiety Online fully automated self-help e-therapy programs. Participants were required to have at least subclinical levels of one of the anxiety disorders to be offered the associated disorder-specific fully automated self-help e-therapy program. These programs are offered free of charge via Anxiety Online. Results: A total of 225 people self-selected one of the five e-therapy programs (GAD, n = 88; SAD, n = 50; PD/A, n = 40; PTSD, n = 30; OCD, n = 17) and completed their 12-week posttreatment assessment. Significant improvements were found on 21/25 measures across the five fully automated self-help programs. At postassessment we observed significant reductions on all five anxiety disorder clinical disorder severity ratings (Cohen d range 0.72–1.22), increased confidence in managing one’s own mental health care (Cohen d range 0.70–1.17), and decreases in the total number of clinical diagnoses (except for the PD/A program, where a positive trend was found) (Cohen d range 0.45–1.08). In addition, we found significant improvements in quality of life for the GAD, OCD, PTSD, and SAD e-therapy programs (Cohen d range 0.11–0.96) and significant reductions relating to general psychological distress levels for the GAD, PD/A, and PTSD e-therapy programs (Cohen d range 0.23–1.16). Overall, treatment satisfaction was good across all five e-therapy programs, and posttreatment assessment completers reported using their e-therapy program an average of 395.60 (SD 272.2) minutes over the 12-week treatment period. Conclusions: Overall, all five fully automated self-help e-therapy programs appear to be delivering promising high-quality outcomes; however, the results require replication. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG) %M 22057287 %R 10.2196/jmir.1918 %U http://www.jmir.org/2011/4/e89/ %U https://doi.org/10.2196/jmir.1918 %U http://www.ncbi.nlm.nih.gov/pubmed/22057287 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 2 %P e39 %T A 5-Year Follow-up of Internet-Based Cognitive Behavior Therapy for Social Anxiety Disorder %A Hedman,Erik %A Furmark,Tomas %A Carlbring,Per %A Ljótsson,Brjánn %A Rück,Christian %A Lindefors,Nils %A Andersson,Gerhard %+ Department of Clinical Neuroscience, Karolinska Institutet, Internet Psychiatry M46, Karolinska University Hospital Huddinge, Stockholm, 141 86, Sweden, 46 8 585 857 91, erik.hedman.2@ki.se %K Internet %K cognitive behavior therapy %K anxiety disorders %K social anxiety disorder %K 5-year follow-up %D 2011 %7 15.06.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based cognitive behavior therapy (CBT) has been shown to be a promising method to disseminate cognitive behavior therapy for social anxiety disorder (SAD). Several trials have demonstrated that Internet-based CBT can be effective for SAD in the shorter term. However, the long-term effects of Internet-based CBT for SAD are less well known. Objective: Our objective was to investigate the effect of Internet-based CBT for SAD 5 years after completed treatment. Method: We conducted a 5-year follow-up study of 80 persons with SAD who had undergone Internet-based CBT. The assessment comprised a diagnostic interview and self-report questionnaires. The main outcome measure was the Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR). Additional measures of social anxiety were the Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS). Attrition rates were low: 89% (71/80) of the participants completed the diagnostic interview and 80% (64/80) responded to the questionnaires. Results: Mixed-effect models analysis showed a significant effect of time on the three social anxiety measures, LSAS-SR, SIAS, and SPS (F3,98-102 = 16.05 - 29.20, P < .001) indicating improvement. From baseline to 5-year follow-up, participants’ mean scores on the LSAS-SR were reduced from 71.3 (95% confidence interval [CI] 66.1-76.5) to 40.3 (95% CI 35.2 - 45.3). The effect sizes of the LSAS-SR were large (Cohen’s d range 1.30 - 1.40, 95% CI 0.77 - 1.90). Improvements gained at the 1-year follow-up were sustained 5 years after completed treatment. Conclusions: Internet-based CBT for SAD is a treatment that can result in large and enduring effects. Trial registration: Clinicaltrials.gov NCT01145690; http://clinicaltrials.gov/ct2/show/NCT01145690 (Archived by WebCite at http://www.webcitation.org/5ygRxDLfK) %M 21676694 %R 10.2196/jmir.1776 %U http://www.jmir.org/2011/2/e39/ %U https://doi.org/10.2196/jmir.1776 %U http://www.ncbi.nlm.nih.gov/pubmed/21676694 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 1 %P e11 %T Acceptability of a Clinician-Assisted Computerized Psychological Intervention for Comorbid Mental Health and Substance Use Problems: Treatment Adherence Data from a Randomized Controlled Trial %A Kay-Lambkin,Frances %A Baker,Amanda %A Lewin,Terry %A Carr,Vaughan %+ National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, NSW, 2032, Australia, 61 240335690, frances.kaylambkin@newcastle.edu.au %K computerized cognitive behavior therapy %K brief intervention %K comorbidity %K depression %K alcohol use problems %D 2011 %7 27.01.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Computer-delivered psychological treatments have great potential, particularly for individuals who cannot access traditional approaches. Little is known about the acceptability of computer-delivered treatment, especially among those with comorbid mental health and substance use problems. Objective: The objective of our study was to assess the acceptability of a clinician-assisted computer-based (CAC) psychological treatment (delivered on DVD in a clinic-setting) for comorbid depression and alcohol or cannabis use problems relative to a therapist-delivered equivalent and a brief intervention control. Methods: We compared treatment acceptability, in terms of treatment dropout/participation and therapeutic alliance, of therapist-delivered versus CAC psychological treatment. We randomly assigned 97 participants with current depression and problematic alcohol/cannabis use to three conditions: brief intervention (BI, one individual session delivered face to face), therapist-delivered (one initial face-to-face session plus 9 individual sessions delivered by a therapist), and CAC interventions (one initial face-to-face session plus 9 individual CAC sessions). Randomization occurred following baseline and provision of the initial session, and therapeutic alliance ratings were obtained from participants following completion of the initial session, and at sessions 5 and 10 among the therapist-delivered and CAC conditions. Results: Treatment retention and attendance rates were equal between therapist-delivered and CAC conditions, with 51% (34/67) completing all 10 treatment sessions. No significant differences existed between participants in therapist-delivered and CAC conditions at any point in therapy on the majority of therapeutic alliance subscales. However, relative to therapist-delivered treatment, the subscale of Client Initiative was rated significantly higher among participants allocated to the BI (F2,54 = 4.86, P = .01) and CAC participants after session 5 (F1,29 = 9.24, P = .005), and this domain was related to better alcohol outcomes. Linear regression modeled therapeutic alliance over all sessions, with treatment allocation, retention, other demographic factors, and baseline symptoms exhibiting no predictive value. Conclusions: Participants in a trial of CAC versus therapist-delivered treatment were equally able to engage, bond, and commit to treatment, despite comorbidity typically being associated with increased treatment dropout, problematic engagement, and complexities in treatment planning. The extent to which a client feels that they are directing therapy (Client initiative) may be an important component of change in BI and CAC intervention, especially for hazardous alcohol use. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12607000437460; http://www.anzctr.org.au/trial_view.aspx?ID=82228 (Archived by WebCite at http://www.webcitation.org/5ubuRsULu) %M 21273184 %R 10.2196/jmir.1522 %U http://www.jmir.org/2011/1/e11/ %U https://doi.org/10.2196/jmir.1522 %U http://www.ncbi.nlm.nih.gov/pubmed/21273184